Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021 00083
Date Issued: 12/28/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9348 SW WASHINGTON SQUARE RD W14A
Project: Sunglass Hut Subdivision: None Lot: None
Project Description: Fire alarm devices for tenant improvement: adding(5)audible/visual appliances and(2)visual appliances.
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 08/12/2021 $102.20
12%State Surcharge-Building 08/12/2021 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 08/12/2021 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/12/2021 $8.00
Occupancy Grp: B Height: ft 11x17)
Stories:
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: No Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $163.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,340.00
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:
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 Application'ECEI V E
137 2
Fire Protection System JUL 15 202' Ft ll Fkfl It ha 1 i',,1.
City of Tigard CITY OF TIGAHU Date/By: 9 z3/2_, .)D Permit No.f S Zv2./—0oe12
.1,1, r 13125 SW Hall Blvd,Tigard,OR 9 . Plan Revco
.DING DIVISIC1r
Phone: 503.718.2439 Fax: 503.59 , Date/By Si), other Permit:
i 6r.1 A iz,13 Inspection Line: 503.639.4175 D to ReadyBy: ' 3uris 0 See Page 2 for
Internet: www.tigard-or.gov otified/Method Supplemental Information
TYPE OF WORK REQUIRED D. A 1-AND 2-FANELLI DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
VI Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CAT LGORY OF CONST RUCTION work indicated on this application.
❑ 1-and 2-family dwelling 23 Commercial/industrial Valuation: $
CI
Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
q eJOB SITE INFORMATION AND LOCAT ION Total number of floors:
Job site address:9586 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Portland, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.STE 1/1/14A Project name:wash,sq mall sung lass hut TI Covered porch area: square feet
Cross street/directions to job site:located inside Washington Square Mall Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-PSE CHECKLIST
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
DESCRIPTION OF 91ORK work indicated on this application.
Adding 5 audible/visual appliances and 2 visual appliances Valuation: $2,340
3 _...__..._- Existingbuildingarea: ----.._ ---..._......._
1024 square feet
New building area:1024 square feet
❑ PROPERTY OWNER 124 1ENANT Number of stories!? for space/2 for total mall
Name:Sunglass Hut Type of construction: Y _
Address:9585 sw washington sq rd. STE W14A Occupancy groups:B
City/State/ZIP:Portland OR 97223 Existing:
Phone:(503)968-8757 Fax:( ) New.
i3 APPLIICANTI CONTACT PERSON NOTICE
Business name:Siemens Industry Inc All contractors and subcontractors are required to be
Contact name:David Teal licensed with the Oregon Construction Contractors Board
under ORS 70I and may be required to be licensed in the
Address:15201 NW Greenbrier Pkwy, STE A-4 jurisdiction in which work is being performed.If the
City/State/ZIP:Beaverton Or 97006 applicant is exempt from licensing,the following reasons
apply.
Phone:(971 )762-5422 cell phone Fax::(503)207 1901
E-mail:David Teal 4'�Slerre( S.CO-n
CONTRACTOR BUILDING PERMIT FEES'
(Meese rr,O aoJ.e schedule,
Business name:Siemens Industry Inc
Address:15201 NW Greenbrier Pkwy, STE A-4 Permit fee:
City/State/ZIP:Beaverton OR 97006 State surcharge(12%ofperrnit fee): __
FLS plan review(40%of permit fee):
Phone:(503-207 1900 office Fax:(503)207 1901 (Due upon application submittal.)
CCB llc.:133041 Total permit fees:
asiNlr vonae by Taal David Amount received:
Authorized signature: Teal David CN.T.aI oa a o sMm.a,.swr..l.
8" CxrIz BERIAWUMBER•ZWG 4
�w 2021 07 1,1 14 3808-070 This permit application expires if a permit is not obtained
Print name:David Teal I Date:7.2.2021 within 1S0 days after it has been accepted as complete.
1 ` Fee methodology set by Tri-County Building Industry
Service Board.
I:1BuildingTetmitsll+PS-PemdtApp_031016.doc 440-4613T(11/07ICOM/WEB)
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:
® Addition or ❑ 1-10 heads: Affidavit required and 0 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
0 11+ heads: Plan review required and ® 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:installing 7 new devices
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 0 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 Jf Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $2340
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
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): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
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