Permit IN . CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a • COMMUNITY DEVELOPMENT Permit#: FPS2014-00078
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2014
TIGARD 9 Parcel: 1 51260000300
Jurisdiction: Tigard
Site address: 9508 SW WASHINGTON SQUARE RD J01
Project: Pandora Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire alarm for TI. Affidavit with(1)notification appliance received.
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 05/01/2014 $112.96
12%State Surcharge-Building 05/01/2014 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 05/01/2014 $45.18
Class of Work: ALT Type of Const: Hourly Building Rate 05/01/2014 $180.00
Occupancy Grp: Height: ft Hourly Building 12%State Surcharge 05/01/2014 $21.60
Stories:
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 $373.30
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,692.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: . ___. 52--- Permittee Signature: / /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
05/01/2014 09:32 FAX RI 001/002
Building Permit Application
Fire Protection System FOR OFFICE ( SL 0\1.1
City of Tigard , k
.— , i',,,---' Received
Dale/8 . ME fir= .
Permit No.: FPS,. - e
• 13125 SW Hall Blvd.,Tigard,OR 9 ' 1*..11..' t'' ' a 0
li
' . I Plan Review
11 Phone: 503.718.2439 Fax: 5 .5 &$& 4 • Date/B : Other Permit: 4 A /,,,,Al i
TIGARD Inspection Line: 503.639.4175 1,---ik -' Dole Ready/By:
Intemet: www.tigard-or.gov li ' 1 Notified/Method: rin. SuppIccni.I Inrormaiion
Ni : :- :-.41 ;, ','i';', ',•' ' .17i.ikriii.*.'■ .' .'iii. .' , r .':::1:,;; li;!,.1..'clii:1':.k!;1:; i:Ii!i: 4QtinttijikrAi4r4iiiii.,ilkii.ittliiit,ittii:i5'idi:,
0 New construction h I- • . Permit fees*are based on the value of the work performed.
A . k"- Indicate the value(rounded to the nearest dollar)of all
23 Addition/alteration/replacement 7tA •I Cr; equipment,materials,labor,overhead,and the profit for the
CATEGORY cjii!IC,ofi&iiiticiiiii4,1.-.:',y;i.:;,1;!..1..,ti.1,ii ...., ...,,ii,;7.' work indicated on this application.
Valuation: $0.00
0 1-and 2-family dwelling 0 Commercial/industrial ,
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
l4g:OX9#:1§17'•);NI:° 47PN..,ArIPl.qqATIPP', ,.. ., '! .,,,, ' Total number of floors:
Job site addrets: W WASHINGTON SQUARE ROAD - New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldgJapt.no.:STE 1,07.7011 Project Eqi. pm;4 tr)r-c), Covered porch area: square feet
Cross street/directions to job site: " '(°( ' -C-°' t" .(41),.. Deck area: square feet
WASHINGTON SQUARE MALL t
1 ' 3t,. . 1 Other structure area: square feet
,,,;.7141)1111WOMICIMMI
I.
WA IA ;:k:REQUIREDIUTA.:EONEMERCIAL-U5ECHECKLIST-' '
Subdivision: noty..111u, 9...... ,T,
Lot no.: s
----. Permit fees*are based on the value of the work performed.
Tax map/parcel no.:
V'
"if:fLl'a Indicate the value(rounded to the nearest dollar)of all
II- D 4 1 equipment,materials,labor,overhead,and the profit for the
...''I •!!:!1''''''i'•;i.:1.';'',0, ili§aidp-tioNlytiv4iiiiie,'*,!: !,'j.,!'!. IPi!.II,.,;:ii:,.;!,.! ;:!!:, work indicated on this application.
l,j,,....,;L. . )- ;! ! :,;.. !• ,Iii,. ,..,...,,, .,1,,,,.{..•:!:.,..,':.,.,... work
ADDITION OF NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $3692.00
ONLY)
Existing building area: square feet
New building area: square feet
Number of stories:
;,1 ;':,:':■1.;P3i!,•*101TiiPil10;s7t*.k;'; ':'::: .;' '1!•,!:' .l '::iqE'',;::',111-717,04.i.', 1;'!1 ■!:I;:;I:);ii :i'4i'; Nm
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:
Y':!' ''I
II i, 14,1.n!,4J ,.IS 4'az....k.. fi.,LA l..:'.ii.. iz sc„j.il1•,lii::;,:;!:::W,, '',.: ::'•1';IIIi;;::!: ;;';:;;!:t!: l ., d .t i i,
I
Business name:SIEMENS INDUSTRY,INC. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:CJ VOLESKY 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)896-9387 Fax::(503)207-1901
E-mail:ej.volesIcy@siemens.com
eijaiiiiiV;,,±;;II;;.;.;!: 4i ;:!:;.; ;1; :!ii;I;0,.IiI;;;[:I. i .,:i;;1;::cii01:1Hiii!ilVIPM,P,ligPrrrii §r ;I : lii;i;i:i.!1!:i!i
Ht !. ::!:I'l..ii. ■:,:':i.:■1:,011:!:Ii!.;',!H;. :Fi.,,T,!!i il.,.',IL,„, ,, ,...,.., ....,:i! i.. !*:!ii':.g,%.i. !! ; ,,..;!..„i;oi;;;!.!4.,..:11,i,;(pieds,i,eiriofieitekeepil■!iii.::!!:,:,1:.:10■.,i!,,i!,,,,,
Business name:SEEM:ENS 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)207-1900 Fax:(503)207-1901 (Due upon application)
Total permit fees:
CCB lie.:133041
Amount received: 171.70
,
Authorized signature: . ----,
This permit application expires if a permit is not obtained
- within 180 days after it has been accepted as complete.
Print name:CJ Volesky I Date:05/01/2013 * Fee methodology set by Tri-County Building Industry
Service Board.
1:18ulldlog1PermiLaPS-Permi .doc 02/01/11 44046131(l 1/02/COMAVE8)
05/01/2014 09:21 FAX [ ]003/007
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only
® Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional desorption of work:
Type of System(Complete A,13, 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: $ 3692.00
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: $ 171.70
-
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
D:\Users\voleskyc\Jobs\44op-152305 WSQ Pandora\Permits\Tigard AEO FPS-Pe iii pp.doc 02/01/11
05/01/2014 08:47 FAX a002/003
RECEIVED
City of Tigard MAY 1 2014 Permit No.: F---/P5920
• 13125 SW Hall Blvd.,Tigard,OR 97223
Date Received:
Inspection Line: 503.639.4175' Phone: 503.718.2439 Fax: 503.598.19pITVOt IGAOO 5/
/l
T i n t u /
Internet: www.tigard-or.gov %UILDM(�('y f igIntf By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Mall—Pandora Suite J01 Occupancy: B
Job Address: 9767 SW Washington Square Road Suite: D07
Contractor: Siemens Industry, Inc. Phone: 503-896-9387
Valuation of work: $3692.00
Type of System: (check one) Required LiNon-required
(check one) ❑Automatic nManual Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(mex 5) /To be Relocated(msx5)
Number of Proposed Manual Alarm Stations: To be Added on.5) /To be Relocated on.s)
Number of Proposed Notification Appliances: To be Added on.5) 1 /To be Relocated on.5)
I,CJ Volesky Oregon Construction Contractors Board No. 133041
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition,I understand the following is required:
• A sketch attached to this document and the building permit showing the area of work within the
building's structure,
• A copy of this document shall be available for the authority having jurisdiction,and
• Electrical permit.
Signature: J Date: 05/01/2014
Print Name: C eskv
I:1Building\Forrns\FireAlarmAffidavit 022514.docx Page 1 of 1
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9508 SW WASHINGTON SQUARE RD J01,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
June 13, 2014 at 8:19:03 AM
FPS2014-00078
Chip Barnett
Violation Summary:
Inspector Contractor