Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II COMMUNITY DEVELOPMENT Permit #: FPS2013 -00176
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2013
T f G A R. D Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9491 SW WASHINGTON SQUARE RD A04
Project: Zumiez Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Addition of notification in retail space (Public access space only)
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:
FAX: 503 - 207 -1901
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/05/2013 $112.96
12% State Surcharge - Building 12/05/2013 $13 56
Type of Use: COM Plan Review - Fire Life Safety - COM 12/05/2013 $45.18
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 12/05/2013 $4.00
Occupancy Grp: Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 12/05/2013 $12.50
11x17)
Houlry Building Rate 12/05/2013 $180.00
Commercial Sprinkler System: Hourly Building 12% State Surcharge 12/05/2013 $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 $389.80
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,649.00
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
iss or if vvi)rk suspended for more the 180 days. ATTENTION: Oregon law requires you to folk the rules adopted by the Oregon
ility Notification Cent, Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 - 0090. ®• a obtain a copy of the rules
or direct questions to OUNC ing '1 32.1987 or 1.800.332.2344. /
Issued By: � Permittee Signature: 4111M8
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 T iii` �j
Fire Protection System EC IVEL FOR OFFICE USE ONLY
IN Received
City of Tigard DAB _! �/ Permit No.: - ' °60/7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r�
_ Phone: 503.718.2439 Fax: 503.598.19E C 5 2 O 13 Date/B : .■, AL ...Ober Permit: 4666 J /j
TIGARD Inspection Line: 503.639.4175 Date Ready :*'.' Juris: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method Supplemental Information
CITY OF 'DC °.
TYPE 0' . 0 ` REQUIRED DATA: I- AND 2- FAMILY DWE J ! t k
❑ 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.
ID 1- and 2- family dwelling ® Commercial/indust al Valuation: $0.00
El 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: 9491 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP: TIGARD, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: STE A04 I Project name: Zumiez 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: I 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 NOTIFICATION IN RETAIL SPACE (PUBLIC ACCESS SPACE Valuation: $$3,649.00
ONLY) 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
u..
Business name: SIEMENS INDUSTRY, INC. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: CHARLES HUGHES 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
applicant is exempt from licensing, the following reasons
City/State/ZIP: BEAVERTON, OR 97006 apply:
Phone: (503) 207 -1839 Fax: : (503) 207 -1901
E -mail: charles.hughes(&siemens.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer In 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):
Phone: (503) 207 -1839 Fax: (503) 207 -1901 (Due upon application.)
CCB lic.: 133041 ' Total permit fees:
IP Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: CHARLES ' GHES Date: 12/05/2013 * Fee methodology set by Tri- County Building Industry
Service Board.
I \ Building \Permits\FPS- PennitApp. doc 02/01/11 440- 4613T(I 1 /02 /COM/WEB)
II III Building Division
Over - The - Counter (OTC) Building Permit
T l G n lz Check List
Project Description: _A U
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work *: )�� Occupancy Group: M Type of Construction: 2_13 Type of Use * *: ( .44 Occupancy Load: Oregon Specialty Code: r fcxO
SPECIFICS
Number of Stories: # 2.-- - " Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right _ Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: _ W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: terL%,, Fire Alarms: ( t ) 6, Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ , -) 6:34 £C- I FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI (effective 7/1/2013) $ ma _ Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ W 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ ' r�r" Plan Review, Structural
$5,000 - $74,999 $70.00 $10.00 $ Plan Review, Fire Life Safety
$75,000 - $149,999 $174.00 $26.00 $ • 40 Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $278.00 $41.00 $ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ . s er:
Date /Time: $ ( Fie,20 T I AL FEES DUE
*TYPE OF USE: COM = commercial; CMS = commercial mat ufactured structure.
**CLASS OF WORK ACS = accessory; ADD = addition; AD ■ = accessory dwe ' • : unit; ALT = alteration; DEM = demo; NEW = new;
OTR = other (use for fences, decks, retaining walls, signs, awnings o .
I: \Building \Forms \OTC - BUP.docx 07/01/2013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9491 SW WASHINGTON SQUARE RD A04,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
2014-01-14 (null)
FPS2013-00176
PASS - No C of O
NFPA 72 completion report received
Violation Summary:
Inspector Contractor