Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
✓�. COMMUNITY DEVELOPMENT Permit#: FPS2022-00163
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 12/5/2022
T[G,IRL7 g
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9610 SW WASHINGTON SQUARE RD G01
Project: Lush Subdivision: None Lot: None
Project Description: Fire alarm permit:Relocating and replacing(4)devices. Affidavit submitted.
Contractor: FRAHLER ELECTRIC COMPANY Owner: PPR WASHINGTON SQUARE LLC
11860 SW GREENBURG RD BY MACERICH RET
TIGARD, OR 97223 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 503-639-4627 PHONE:
FAX: 503-639-4673
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/02/2022 $156.00
12%State Surcharge-Building 12/02/2022 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 12/02/2022 $62.40
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 12/02/2022 $5.00
Occupancy Grp: 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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $242.12
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $7,778.00
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. Y ay obtain a copy of the rules
Issued By: Arierge.....;_.: ttee 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 oject.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
Fire Protection System RECE d FOR OFFICE USE ONLY
priiCI Of Tigard Received 7� Permit No.: ��
`J g ,� ?�� DateBy: �t/J'/G�t� /c —cJt 4� 1'"V
Phone:3125 SW Hall Blvd.,Tigard,OR 98.19 �n <3 f Plan Review
503.715.2439 Fax: 503.598.1960 -t^x,rr1 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 ClrLrOFTIG UvateReady/By orris: 0 See Page 2for
Internet: www.tigard-or.gov CiUlLUW'1G 1S 31fi7onfied/Method: �/ , Supplemental information/
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
E Addition/alteration/replacement ❑ Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ❑a Commercial/industrial Valuation: S
['Accessory building El Multi-familyNumber of bedrooms:
El builder ❑Other:
Number of bathrooms:
ri6/,. JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site addressr9581 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:GO1 Project name:WSQ Lush Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: •
Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Relocate and replace(4)fire notification devices to accomodate Valuation: 7,778.00
a tenant improvement. Existing building area: square feet
New building area: square feet
❑� PROPERTY OWNER ❑ TENANT Number of stories:
Name:PPR WASHINGTON SQUARE LLC Type of construction:
Address:PO BOX 4085 Occupancy groups:
City/State/ZIP:Santa Monica, CA 90411 Existing:
Phone:( ) Fax:( )
New:
❑� APPLICANT D CONTACT PERSON NOTICE
Business name:Siemens Industry All contractors and subcontractors are required to be
Contact name:David Hemmer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9755 SW Barnes Rd Suite 205 jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97225 applicant is exempt from licensing,the following reasons
apply:
Phone:( )971-864-4759 Fax::( )
E-mail:david.hemmer@siemens.com
CONTRACTOR BUILDING PERMIT FEES*
(Pleuse refer to fee scheduler
Business name:JRA dba Frahler Electric
Permit fee:
Address:11860 SW Greenburg Road
State surcharge(12%of permit fee):
City/State/ZIP:Tigard Oregon 97223 FLS plan review(40%of permit fee):
Phone:( )503-639-4673 Fax:( ) (Due upon application submittal.)
CCB lie.:197172 c� Total permit fees:
Authorized signature: y) Amount received:
r7Y This permit application expires if a permit is not obtained
Print name:David Hemmt--') Date:11/30/22 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I1Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/CObWJEB)
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: 4
❑■ 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 ❑ 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 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $7,778.00
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): $7,778.00
Permit fee based on project valuation (see fee schedule): $156.00
Permit fee based on square footage (see D above): $NA
State Surcharge (12% of permit fee): $18.72
FLS Plan Review (40% of permit fee): $62.40
TOTAL: $237.12
I:\Budding\Perrnits\I PS_PermitApp_031016.doc 2
RECENED
City of Tigard � , Permit No.: �
S (:F--��Ut.).
III 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.19�11�°ItY 1 IG
Date Received: I l / 42
Inspection Line: 503.639.4175 'vl LU ^ ! '
I ' "'O Internet: www.tigard-or.gov BUILDING MSId1`# By: 14. f'1AQ�t I i t)
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ - Lush Occupancy: B
Job Address: 9585 SW Washington Square Rd Suite: G01
Contractor: Siemens Industry/David Hemmer Phone: 971-864-4759
Valuation of work: $7,778.00
Type of System: (check one) *Required ❑Non-required
(check one) *Automatic ['Manual ['Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max 5) 0 /To be Relocated(max 5) 0
Number of Proposed Manual Alarm Stations: To be Added(max 5) 0 /To be Relocated(max 5) 0
Number of Proposed Notification Appliances: To be Added(max 5) 0 /To be Relocated (max 5) 4
1 Siemens Industry/David Hemmer Oregon Construction Contractors Board No. 133041
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 11/30/22
Print Name: David Hemmer
C\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of I