Permit y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
, � COMMUNITY DEVELOPMENT Permit #: FPS2013 -00030
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/04/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9759 SW WASHINGTON SQUARE RD D05
Project: The Art of Shaving Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Fire alarm for new TI
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY PO BOX 847
SUITE A4 CARLSBAD, CA 92018
BEAVERTON, OR 97006
PHONE: 503 - 207 -1839 PHONE:
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FAX: 503 - 207 -1901
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FEES
Description Date Amount
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Specifics: Permit Fee - COM 03/04/2013 $134.48
12% State Surcharge - Building 03/04/2013 $16.14
Type of Use: COM Plan Review - Fire Life Safety - COM 03/04/2013 $53.79 •
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 03/04/2013 $4.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 03/04/2013 $3.50
11x17)
Info Process /Archiving - Lg $2.00 (over 03/04/2013 $4.00
Commercial Sprinkler System: 11x17)
Sprinkler Required: Sprinkler Type: Info Process /Archiving - Sm $0.50 (up to 03/04/2013 $3.50
11x17)
Standpipe Required. Hazard: Houlry Building Rate 03/04/2013 $180.00
Density: 0 Design Area. 0 Hourly Building 12% State Surcharge 03/04/2013 $21.60
K Factor: 0
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Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes . Smoke Detectors Req: Yes
Battery Calcs Provided: No Cut Sheets Required: Yes
Total $421.01
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $5,004.20
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. .w the rules adopted by the Oregon
Utili otification nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -009 ay obtain a copy of the rules
or rest questions to O NC b Ilin 503.232.1987 or 1.800.332.2344. 1 4
Iss ed By: Permittee Signature: 4ga.
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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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
Fire Protection System RECEIVED Received QQ 2
Y. FOR OFFICE USE ONLY
City of Tigard DateB p) / %
Permit No.: /...95 /...95
q 13125 SW Hall Blvd., Tigard, OR wpR 4 2013 Plan Review ,(� ^n � _ -
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: , i Other Permit. t7tl/� Jo
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris El See Page 2 for
Internet: www.tigard- or.gov 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.
dwelling Valuation:
❑ I- and 2-family 5
y g ®C ommercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9759 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City /State /ZIP: TIGARD, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: STE D05 Project name: The Art of Shaving 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.
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.
ADDITION OF SMOKE DETECTION IN RETAIL SPACE Valuation: $55,004.20
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*
(Please refer to fee schedule)
Business name: SIEMENS INDUSTRY, INC.
Permit fee:
Address: 15201 GREENBRIER PARKWAY
State surcharge (12% of permit fee):
City /State /ZIP: BEAVERTON, OR 97006
FLS plan review (40% of permit fee): x`53 .71
Phone: (503) 207 -1839 Fax (503) 207 -1901 (Due upon application.) �J
CCB lie.: 13304 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: CHARLES HUGHES Date: 03/03/2013 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1 :\Building\Permits\FPS- PermitApp.doc 02/01/11 440- 4613T(I1 /02 /COM/WEB) •7/
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
® Addition ❑ 1 -10 heads: No plan review required.
❑ 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 ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 5004.20
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.
C: \PM \Fire Permit Applications \COMPLETED FORMS \TAGS FPS - PermitApp.doc 02 /01/11
• / E3c
Certificate of Completion C CU �" �`� ���
Name of Protected Property: WASINGTON SQUARE MALL
Address: 9759 SW WASHINGTON SQUARE RD — Suite D05 The Art of Shaving
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: 3/4/2013 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 Sam Correll on 03/05/2013 , includes the devices
listed below and has been in service since 03/05/2013
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: 03/05/2013
Organization: Siemens Industry, Inc.
Updated: 3/4/2013 Page 2
3. Certification of System Operation
All operational features and functions of this partial system were tested by SAM CORRELL
on 03/05/2013 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
Other (specify):
Signed: Date: 3/05/13
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) 2 Smoke Detectors: Ion 2 Photo
b) Duct Detectors: Ion 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: 3/4/2013 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: 3/4/2013 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) 3/05/13 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 2 smoke
detector in the retail area of the space.
PROJECT MANAGER 03/05/2013
(signed) for Alarm Service 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
#00
PROJECT MANAER 03/05/2013
(signed) for Alarm Service Company (title) (date)
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority
having jurisdiction:
03/06/2013
(signed) representative of the authority having jurisdiction (title) (date)
Updated: 3/4/2013 Page 5