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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit #: FPS2012 -00034 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2012 Parcel: 1S1260000300 Jurisdiction: Tigard Site address: 9611 SW WASHINGTON SQUARE RD L03 Project: Jos A Bank Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108 Project Description: Fire alarm 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 03/08/2012 $134.48 12% State Surcharge - Building 03/08/2012 $16.14 Type of Use: COM Plan Review - Fire Life Safety - COM 03/08/2012 $53.79 Class of Work: ALT Type of Const: Info Process/Archiving - Lg $2.00 (over 03/08/2012 $4.00 Occupancy Grp: Height: ft 11x17) Stories: Info Process/Archiving - Sm $0.50 (up to 03/08/2012 $6.50 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: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $214.91 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $5,123.00 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 f ow he rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -009 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: r — Permittee Signature: _ r – »� Call 503.6 175 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 AnnlicpiiE Fire Protection System (I CEf VED R ONLY FO OFFICE USE ONLY R ecei Datr/B ved City of Tigard '+Q�iA Permit No '520/2-6196 =.4/ pD 8 2012 • 13125 SW Hall Blvd., Tigard, O 4Y3 8 Plan Review ►1��! r Permit. ,,�,�i� II C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 01/4 �� © Other • 0 -- 605? TIGARD Inspection Line: 503.639.417CITY OF TI GA Date Ready /By: Juris: la is: See Page 2 for Internet: www.tigard or.go �DILD! t t ., D Notified/Method: Supplemental Information BUILDING DIVISION 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 ® Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2- family dwelling ® Commercial/industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 91 01 JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:2.5731W WASHINGTON SQUARE ROAD New dwelling area: square feet City /State/ZIP: TIGARD, OR Garage/carport area: square feet Suite/bldg. /apt. no.: STE L03 Project name: Joseph A Banks Covered porch area: square feet Cross street/directions to job site: Deck area: square feet WASHINGTON SQUARE MALL 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. ADDITION OF SMOKE DETECTION IN RETAIL SPACE Valuation: $$5,123.00 Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: 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: ® APPLICANT ❑ CONTACT PERSON NOTICE 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 CONTRACTOR BUILDING PERMIT FEES* Business name: SIEMENS INDUSTRY, INC. (Please refer to fee schedule) Permit fee: Address: 15201 GREENBRIER PARKWAY City/ State/ZIP: BEAVERTON, OR 97006 State surcharge (12% of permit fee): Phone: (503) 207 -1839 I Fax: 503 207 -1901 FLS plan review (40% of permit fee): ( ) ( ) (Due upon application) CCB tic.: 133041 Total permit fees: Authorized signature: Amount received: This permit application expires If a permit Is not obtained I Print name: CHARLES HUGHES I Date: 01/24/2012 within 180 days after it has been accepted as complete. • Fee methodology set by Tri-County Building Industry Service Board. I:\ Building \Pamits\FPS- PamitApp.doc 02 /01 /11 440-4613T(1 I /02/COM/W13B) FPS ZoQocc j 3 Certificate of Completion Name of Protected Property: WASINGTON SQUARE MALL 9611 Address: ,94SW WASHINGTON SQUARE DRIVE — Suite L03 Joseph A Banks TIGARD, OR Rep. of Protected Prop. (name /phone):ROGER OTT (bldg engineer) 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: 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 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: • Updated: 4/30/2012 Page 1 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 Supplier SIEMENS INDUSTRY CHARLES HUGHES 503 - 207 -1900 Service Organization SIEMENS INDUSTRY SERVICE DEPT 503 - 207 -1900 Location of Record (As- Built) Drawings: 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 X 4 X 5 X 6 X 7 X 10 X NFPA 70, National Electrical Code, Article 760 • X Manufacturer's Instructions Other (specify): • Signed: Date: Organization: Updated: 4/30/2012 Page 2 3. Certification of System Operation All operational features and functions of this partial system were tested by SAM CORRELL on April 24 2012 and found to be operating properly in accordance with the requirements of: X NFPA 72, Chapters X4 X5 X6 X7 X 10 X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions Other (specify): • 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 • AUTOMATIC Coverage: Complete NO Partial _ YES a) 5 Smoke Detectors: Ion 5 Photo b) 4 Duct Detectors: Ion 4 Photo c) Heat Detectors: FT RR FT /RR RC d) Sprinkler Water Flow Switches: Noncoded, Activating Transmitters Coded e) Other (list): 5. Supervisory Signal Initiating Devices and Circuits GUARD'S TOUR • 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 Updated: 4/30/2012 Page 3 • • Electric Fire Pump: e) 0 Fire Pump Power f) 0 Fire Pump Running g) 0 Phase Reversal Engine - Driven Fire Pump: • • h) 0 Selector in Auto Position i) 0 Engine or Control Panel Trouble • • j) 0 Fire Pump Running • 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: • • • • • Updated: 4/30/2012 Page 4 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 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 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 q smoke detector in the retail area of the space. f inals4„ g 14 O, ck at4 • PROJECT MANAGER 04/24/2012 • (signed) - ervice Company (title) (date) Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA • standard(s): System deviations from the referenced NFPA standard(s) are: None ■ (ifs sro_ PROJECT MANAER 04/24/2012 (signed)71 -Wrr Service Company (title) (date) Upon '. etion of the system(s) satisfactory test(s) witnessed (if required by the authority havin• !diction: • - 1 -7- uic_D.1 tA. - I 1■15 1 /A- t i (signed) representati `+ the authority having jurisdiction (title) (dat • • • • Updated: 4/30/2012 Page 5 •