Permit 1 M CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 COMMUNITY DEVELOPMENT Permit #: FPS2011 -00002
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2011
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9524 SW WASHINGTON SQUARE RD H08
Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Fire alarm
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY 2235 FARADAY AVE STE #0
SUITE A4 CARLSBAD, CA 92008
BEAVERTON, OR 97006
PHONE: 503 - 234 -9995 PHONE:
FAX: 503 - 234 -8030
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/13/2011 $123.72
12% State Surcharge - Building 01/13/2011 $14.85
Type of Use: COM Plan Review - Fire Life Safety - COM 01/07/2011 $49.49
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg Sheet (over 01/13/2011 $4.00
Occupancy Grp: M Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm Sheet (up to 01/13/2011 $9.50
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: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $201.56
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,100.00
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 i work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N 'cation Cen - Thos- ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUNC • ailing 51 -. 32.1987 or 1.800.332.2344. (./ Issu d By: k � / � i!/ ,[�1� / f ` / Permittee Signature: � /\ /lam /
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 6/GfiI
Fire Protection System
� FO R OFFICE USE ONLY ECrn i N a � Received /_ f
City of Tigard
a te Date /B : ' / (0 � ` J Permit No.: /%? �t /f — 0
° 13125 SW Hall Blvd., Tigard, OR e 97223 p ^I `e 20 1 1 Plan Review _ ®� n O/ c
Phone: 503.639.4171 Fax: 503.598.196 ® Date/B : i i . Other Permit: Y� d �J
l.1 fi It Inspection Line: 503.639.4175 Date Ready/By: y Juris: 121 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: /7/ Al 'Ili ( Supplemental Information
RIIII DING DIVISION Viti , /c, S.giy
. TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
E l Addition/alteration/replacement El Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling El Commercial/industrial Valuation: $
❑ Accessory building CI Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 752 t/ Sit/ 4 /FuJ.4. fl x.1 j (? }z:D New dwelling area: square feet
City /State /ZIP: 1 (rArt.Y) Cvt-- f72. . 7 Garage /carport area: square feet
1. ldg. /apt. no.: I"C 0 3 ) Project name: - )ti { Covered porch area: square feet
Cross street/directions to job site: lI 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.
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 WORK work indicated on this application. ^�
1 dLG. Art -4A- A \)e 51 64 , ter\ N „,./ 1 Ea/r~/f) fi T I P.) Valuation: $ � r f l.� P C
o L l`) � - £ iz v4 _,, - �_ /F 1/1. A`k �� Existing building area: square feet
tiQ ' —.p ) . -i luct b New building area: square feet
1=1 PROPERTY OWNER 1 ❑ TENANT Number of stories:
Name: W 45 N 1 Q et t-` Type of construction:
Address: TS 2 cf S\-- ,/' - i.`11N 6..r.),../ K yLN) Occupancy groups:
City /State /ZIP: 11. Gkti5) fl ,2 -. Existing:
Phone: ( 6rcA 6 , 1 \-- Fax: ( ) New:
' APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: M C, � � `t licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP:
apply:
Phone: (S rj t{ ` j❑ j - 7 Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
. N (Please refer to fee schedule)
Business name:
S a /IA tv 5 I Dv � C - Permit fee:
Address: ( 5 ( Nkj G , EtJ `aPl&\- P t C'a'r 51
t L- L{
State surcharge (12% of permit fee):
City/State /ZIP: e «s r,,t_.TtlAJ ; 0„,t___ ' _ ?oO 1 FLS plan review (40% of permit fee):
Phone: ( 5O) 24y7 1 C f c o Fax: ( ) ZQ 7 / qU j (Due upon application.) .
CCB lic.: 13 ( j1.0 . Total permit fees: i�! . Y r
Amount received: '
-\ Authorized signature:
1 This permit applic expires if a permit is not obtained •
Print name: �� 4, t � 4 I / Date: / / 6/ / / * within 180 days after it has been accepted as complete.
r Fee methodology set by Tri -County Building Industry
.s., Service Board.
I :\Building\Permits\FPS- PermitApp.doc 10/01/09 440- 4613T(l 1/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
El Addition El 1 -1 0 heads: No plan review required.
El Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: 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 s
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $ W ,, j&, OD
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
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