Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
- 2 COMMUNITY DEVELOPMENT Permit #: FPS2012 -00009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/24/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9636 SW WASHINGTON SQUARE RD G10
Project: Buckle Subdivision: Lot:
Project Description: TI
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY BY THOMSON PROPERTY TAX SERVICES
SUITE A4 ATTN HILARY RAYMOND
BEAVERTON, OR 97006 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 234 -9995 PHONE:
FAX: 503 - 234 -8030
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/24/2012 $112.96
12% State Surcharge - Building 01/24/2012 $13.56
Type of Use: COM Info Process /Archiving - Lg $2.00 (over 01/24/2012 $4.00
Class of Work: ALT Type of Const: 11x17)
Occupancy Grp: Height: ft Info Process /Archiving - Sm $0.50 (up to 01/24/2012 $5.00
Stories: 11x17)
Plan Review - Fire Life Safety - COM 01/24/2012 $45.18
Houlry Building Rate 01/24/2012 $180.00
Commercial Sprinkler System: Hourly Building 12% State Surcharge 01/24/2012 $21.60
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:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $382.30
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,933.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,933.00
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- 00904"Yo �f ay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344. '.,1116.
Issued By: - • - •• • • - Signature:
Call 503. - .y 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 V9
9
Fire Protection System ��
stem
Y FOR OFFICE USE ONLY
'
City of Tigard �j V �� ,L ��L 0141/4<c„01. O ved A f) T
17
Permit No.: _ / _ ,.
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13125 SW Hall Blvd.,
e Tigard, R 97223 Oar Plan Review �t
Phone: 503.718.2439 Fax: 503.598.196 * */ Date/B : �� Other Permit /
TIGARD )
Inspection Line: 503.639 4175 �y0 t� Date Ready .. El See Page 2 for
Internet: www.tigard- or.gov _`C4 Notified/Method: I , (. ���M Supplemental Information
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
® Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
^' ! _.,' I->° >i rt N' ° ,: f0 : _��; work indicated on this a lication.
,.�: _,� y���:':" GA' fEGORY .OF.`>,CONS'I'RUCTI(1NFr:, =t, ,�� „�
_. '; •� ,.',..�.�...;�� ..<_.,.. ,.__,.... x,.. ,... >. =.xs�� �,.....'rz� Valuation. S
❑ 1- and 2- family dwelling ® Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
�. ,;; , '; ; -. ;:a ;) . .:YZ s: i ;;'-� - ;y:: Total number of floors:
r r_ L__9W 1N AND,: C , IOr ;. y •;_,._„» ,: ` ' o be o
Job site address: t W WASHINGTON SQUARE ROAD New dwelling area: square feet
•
City/State/ZIP: TIGARD, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: STE 610 Project name: The Buckle Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
WASHINGTON SQUARE MALL Other structure area: square feet
'.REQUtRED;DATA'::GO MERCIM 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
T, «;;, -, == ; ::, - ,. �., ,,:- , x s „ ; °E..- and the p
equipment, materials, labor, overhead, a e ofit for the
r
z:', - ``t? work indicated on this application.
°; DESCRIPTIO O,, WORK,, V ” 1' . 5' i =- ., , PP
^ar -
ADDITION OF SMOKE DETECTION IN RETAIL SPACE Valuation: 553,933.00
Existing building area: square feet
New building area: square feet
� " r :E:,Az°:«.� Number of stories:
® . . :'
., ,, „, OWNER`. > ` '• ❑ T ENrCNT '''' i
Name: ROGER OTT Type of construction:
Address: 9585 SW WASHINGTON SQUARE ROAD Occupancy groups:
City /State /ZIP: TIGARD, OR Existing:
Phone: (503)639 -8860 Fax:( ) New
P.Pli1��.AT =' 'CON, A '�T "PE SO
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Business name: SIEMENS INDUSTRY, INC. All contractors and subcontractors are required to be
Contact name: CHARLES HUGHES licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15201 GREENBRIER PARKWAY 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: (503) 207 -1839 Fax: : (503) 207-1901
E -mail: charles.hughes @siemens.com
4
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C C w 4 �SlltLDING PERNIIT4EEES ' "_
Business name: SIEMENS INDUSTRY, INC. -. :i,-(P,(ericeic;:j ;'to j0Ciiedttii� -a „, -„ =aPg
Permit fee:
Address: 15201 GREENBRIER PARKWAY
City /State /ZIP: BEAVERTON, OR 97006 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 207 -1839 Fax: (503) 207 -1901 (Due upon application.)
CCB lie.: 133041 Total permit fees: • 3r
30
Authorized signature — - - Amount received: 2�� D _
_'; This permit application expires if a permit is not obtained
Print name: CHAR HUGHES Date: 01/24/2012 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1 \Building \Permits \FPS- PermuApp doc 02/01/11 440- 4613T(I 1/02 /COM/WEB)
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91,3405k/ !/ash , 5 i22r 6io
Certificate of Completion
Name of Protected Property: WASINGTON SQUARE MALL
•
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Address: 9585 SW WASHINGTON SQUARE DRIVE — Suite G10 The Buckle •
TIGARD. OR
Rep. of Protected Prop. (name /phone):ROGER OTT (bidq enqineer) 503 - 639 -8860
Authority Having Jurisdiction:CITY OF TIGARD — FIRE AND RESCUE
Address: 13125 SW HALL BLVD
TIGARD, OR 97223
Phone Number:503- 718 -2439
1. Type(s) of System or Service:
X NFPA 72, Chapter 3 - Local
If alarm is transmitted to location(s) off premise, list where received:
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NFPA 72, Chapter 3 - Emergency Voice /Alarm Service
Quantity of voice /alarm channels: Single: Multiple:
Quantity of speakers installed: . Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system: •
NFPA 72, Chapter 4 - Auxiliary
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Indicate type of connection:
Local energy, Shunt, Parallel telephone
Location and telephone number for receipt of signals:
NFPA 72, Chapter 4 - Remote Station
Alarm:
Supervisory: •
NFPA 72, Chapter 4 - Proprietary
If alarms are retransmitted to public fire service communications center or others, indicate
location and telephone number of the organization receiving alarm:
Indicate how alarm is retransmitted:
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Updated: 3/28/2012 Page 1 .
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X NFPA 72, Chapter 4 - Central Station
The Prime Contractor:SIEMENS INDUSTRY, INC.
Central Station Location: Dallas Call Center 1- 866 - 552 -7823 •
Means of transmission of signals from the protected premise to the central station: •
McCulloh Multiplex One -Way Radio
X Digital Alarm Communicator Two -Way Radio Others
Means of transmission of alarms to the public fire service communications center:
1. Telephone
2 . •
System Location: 9585 SW WASHINGTON SQUARE DRIVE TIGARD, OR
Organization Name /Phone Representative Name /Phone
Installer Frahler ELECTRIC
Supplier SIEMENS INDUSTRY CHARLES HUGHES 503 - 207 -1900
Service Organization SIEMENS INDUSTRY SERVICE DEPT 503 - 207 -1900
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Location of Record (As- Built) Drawings:
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WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Owners Manuals:
WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Test Reports:
WASHINGTON SQUARE MALL FACILITIES DEPT
A contract, dated for test and inspection in accordance with NFPA standard(s)
No.(s) dated is in effect.
2. Certification of System Installation
This system has been installed in accordance with the NFPA standards as listed below, was
inspected by on , includes the devices
•
listed below and has been in service since •
X NFPA 72, Chapters X4 X5 X6 X7 X 10
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
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Other (specify):
Signed: Date:
Organization:
Updated: 3/28/2012 Page 2
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3. Certification of System Operation
All operational features and functions of this partial system were tested by SAM CORRELL
on MARCH 26 2012 and found to be operating properly in accordance with the
requirements of:
X NFPA 72, Chapters X 4 X 5 X 6 X 7 X 10 •
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
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Other (specify):
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Signed: Date: •
Organization:SIEMENS INDUSTRY, INC. •
4. Alarm Initiating Devices and Circuits
MANUAL
a) Manual Stations Noncoded, Activating Transmitters Coded •
b) Combination Manual Fire Alarm and Guard's Tour Coded Stations •
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AUTOMATIC
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Coverage: Complete NO Partial YES •
a) 3 Smoke Detectors: Ion 3 Photo
b) Duct Detectors: Ion Photo
c) Heat Detectors: FT RR FT /RR RC
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d) Sprinkler Water Flow Switches: Noncoded, Activating
Transmitters Coded •
e) Other (list): •
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5. Supervisory Signal Initiating Devices and Circuits
GUARD'S TOUR
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a) 0 Coded Stations
b) 0 Noncoded Stations Activating 0 Transmitters •
c) 0 Compulsory Guard Tour System Comprised of 0 Transmitter Stations •
and 0 Intermediate Stations •
Note: Combination devices recorded under 4(b) and 5(a).
SPRINKLER SYSTEM
a) 0 Coded Valve Supervisory Signaling Attachments •
Valve Supervisory Switches Activating Transmitters
b) 0 Building Temperature Points
c) 0 Site Water Temperature Points
d) 0 Site Water Supply Level Points
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Updated: 3/28/2012 Page 3
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Electric Fire Pump: . •
e) 0 Fire Pump Power
f) 0 Fire Pump Running
g) 0 Phase Reversal
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Engine- Driven Fire Pump: :
h) 0 Selector in Auto Position
i) 0 Engine or Control Panel Trouble •
j) 0 Fire Pump Running
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Engine- Driven Generator:
k) 0 Selector in Auto Position
I) 0 Control Panel Trouble
m) 0 Transfer Switches •
n) 0 Engine Running
Other Supervisory Function(s) (specify):
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system:
Types and quantities of alarm indicating appliances installed: •
a) 0 Bells Inch
0 Speakers
b) Horns
c) Chimes
d) 0 Other:
e) Visual Signals Type:
• with audible w/o audible
f) 0 Local Annunciator
7. Signaling Line Circuits:
Quantity and Style of signaling line circuits connected to system:
Quantity: Style:
8. System Power Supplies •
a) Primary (Main): Nominal Voltage: Current Rating:
Overcurrent Protection: Type: Current Rating:
Location:
b) Secondary (Standby):
Storage Battery: Amp -Hour Rating
Calculated capacity to drive system, in hours:
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
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Updated: 3/28/2012 Page 4
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c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a
Secondary Power Supply:
0 Emergency System described in NFPA 70, Article 700 •
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0 Legally Required Standby System described in NFPA 70, Article 701
0 Optional Standby System described in NFPA 70, Article 702, which also meets the •
performance requirements of Article 700 or 701
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9. System Software
a) Operating System Software Revision Level(s):
b) Application Software Revision Level(s):
c) Revision Completed by: SAM CORRELL SIEMENS
(name) (firm)
10. Comments:
This project was for the purpose of a remodel space only, it involved the addition of 3 smoke
detector in the retail area of the space.
D4 "! q^ ..n. hes `
Hughes Lha
o =Sieme cn:H
°aE20 .0328 • • :35 PROJECT MANAGER 03/26/2012
(signed) for Alarm Se '-- ompany (title) (date) •
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA •
standard(s):
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System deviations from the referenced NFPA standard(s) are: None
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Dlyi s ;. ..' H..+ /l
Hughes Charles 9-- m wy; !�
Om 20 04 17180' PROJECT MANAER 03/26/2012 •
(signed) for Alarm Service ompany (title) (date) •
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority
having jurisdiction:
(signed) representative of the authority having jurisdiction (title) (date)
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Updated: 3/28/2012 Page 5
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