Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 • COMMUNITY DEVELOPMENT Permit#: FP52021-00084
Date Issued: 8/25/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9640 SW WASHINGTON SQUARE RD Gil
Project: Warby Parker Subdivision: None Lot: None
Project Description: (6)new alarm devices,(3)ceiling mount strobes, (3)multi-candela ceiling mount speaker/strobes
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY BY MACERICH RET
SUITE A4 PO BOX 4085
BEAVERTON, OR 97006 SANTA MONICA, CA 90411
PHONE: 503-207-1839 PHONE:
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/25/2021 $102.20
12%State Surcharge-Building 08/25/2021 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 08/25/2021 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/25/2021 $18.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/25/2021 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $179.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,689.54
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: / Permittee Signature:
fi
L- , �/ f/14 iE.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Applicatio ECEIVED .'7 , Zl
Fire Protection System [p9 s�`1]'° FOR OFFICE USE ONLY-
JUl, 2 6 2i!.
Rece ved
City of Tigard DaeB 7 2cAz` iw
N Perm No.:f\-. 207,1_ 141
Illiri 13125 SW Hall Blvd.,Tigard,OR 9722p OF TIGARLi Plan Review
Phone: 503.718.2439 Fax: 503.598.19 DateB : /AI other Permit TI c„s I,D Inspection Line: 503.639.4175 BUILDING DIVISION Date ReadyBy: �� ® See Page 2 for
Internet: www.tigard-or.gov n ified/Methoy"// Amin Supplemental Information
TYPE ON WORK REQUIRE4ATA: I-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fits*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
l4 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ElI-and 2-family dwelling NI Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE JNl'ORMA ION AND LOCATION Total number of floors:
Job site address: 9640 SW Washington Square Road New dwelling area: square feet
City/State/ZIP:Tigard, Oregon 97223 Garage/carport area: square feet
Suite/bldg/apt.no.: G-1 1 Project name:440P-314306 WSQ Warby Parker Covered porch area: square feet
Cross street/directions to job site: Near SE Mall Entrance between the Deck area: square feet
85C Bakery Cafe and UNTUCKit clothing store Other structure area: square feet
e,v itt as s, :a3 I RCIAL-LSEC°t'
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
Addition of(6) notification devices to accommodate tenant improvement Valuation: $2,689.54
for new store moving into retail space G-11. Adding (3)8cd ceiling mount Existing building area: square feet
strobes and (3) multi-candela ceiling mount speaker/strobes New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories: 1
Name: Maria Halstead Typeofconstruction:Type 1
Address: 9585 SW Washington Square Road Occupancy groups:Group M
City/State/ZIP:Tigard, Oregon 97223 Existing:
Phone:(503) 693.8865 Fax( ) New: - -
Izi APPLICANT ❑ CON TACT' PERSON NOTICE
Business name:Siemens All contractors and subcontractors are required to be
Contact name: Ashley Smallwood licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:15201 NW Greenbrier Parkway Suite A4 jurisdiction in which work is being performed.If the
City/State/ZIP: Beaverton, Oregon 97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(971)998.4551 Fax::(503)207-1901
E-mail' ashley.smallwood@siemens.com
CONTRACTOR BUILDING PERMIT FEES*- ' `
Business name: Siemens (Please refer to fee schedulet
Permit fee: $102.20
Address:15201 NW Greenbrier Parkway Suite A4 State surcharge(12%of permit fee): $12.26
City/State/ZIP: Beaverton, Oregon 97006 FLS plan review(40%of permit fee):
Phone:(971)998.4551 Fax:(503)207-1901 (Due upon application submittal.) $40.88
CCB tic.: 133041 Total permit fees: $155.34
Smallwood bwor 9,nJCYLmBMmo° eYs.°am._^amaw-Po^ink.. Amount received:
Authorized signature: °a;,_n er ama, ova �m
Ash ley o�le.lo oi.n oais -or 'This permit application expires if a permit is not obtained
Print name: Ashley Smallwood Date: July 11 th' 2021 within 180 days after it has been accepted as complete.
" Fee methodology set by'Tri-County Building Industry
Service Board.
I:\Building\Permils\FPS-PermitApp_031016.doc 440-4613T(I I/02/COMIWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
.
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 6
® Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ® 6+ devices: Plan review required and
(3)sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line _ ❑ Yes El No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component l Yes
Cut Sheets
Fire Alarm Project Valuation: $2,689.54
D.) Residential.Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 5246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees '
Project valuation subtotal (see A, B&C above): $2,689.54
Permit fee based on project valuation (see fee schedule): $102.20
Permit fee based on square footage (see D above):$
State Surcharge (12%of permit fee): $12.26
FLS Plan Review(40%of permit fee): $40.88
TOTAL: $2,844.88
I:\Building\Permits\FPS_PermitApp_031016.doc 2