Permit IIq CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1. COMMUNITY DEVELOPMENT Permit#: FPS2014-00155
T t G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2014
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9589 SW WASHINGTON SQUARE RD B09
Project: Apple Store Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire alarm,addition of notification in retail space.
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 10/03/2014 $112.96
12%State Surcharge-Building 10/03/2014 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 10/03/2014 $45.18
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 10/03/2014 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 10/03/2014 $5.00
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $178.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,715.00
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 Notif C-enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091 '.0 may obtain a copy of the rules
or dir questions to OUNC b == ling 503.232.1987 or 1.800.332.2344.
Is ued By: /
_ 011 / Permittee Signature:
�iia�rt
Call 503.639.4175 by 7:00 a.m.for the next available ins. ion dat=
This permit card shall be kept in a conspicuous place on the job site u it com• •tion of the project.
Approved plans are required on the job site at the time of eac inspection.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONL1
City of Tigard "� 9�iy Pern it No.:/ 4 -e0/5-s-
-
13125 SW Hall Blvd.,Tigard,OR��zz223 plan Revie n q frd!4_ Other Permit.Phone: 503718.2439 Fax: 503.�$$R9r�5 2014 DaeBy •� ! v�l� /be
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Jura ® See Page 2 for
Internet: www.tigard-or.gov t;ITYOFTIGARD Notified/Method: 1O/i l
ItL'� Supplemental Information
O,N :' DtED DATA: AND 2-FAMILY DWELLING
Permit fees*are based on the value of the work performed.
❑New construction ❑Demolition 1�
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 coNsntue noti work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial
Valuation: S
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
SITE INFORMATION AIID LOCATION Total number of floors:
Job site addres W WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldg./apt.no.:STE B09 I Project name:Apple TI 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 NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $3,715.00
ONLY)
Existing building area: square feet
New building area: square feet
R.PROPERTY OWNER ` 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
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:cj.volesky@siemens.com
CONTRACTOR BUILDING PERMIT FEES* 4
(Please refer to fee.schehite)
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)207-1900 Fax:(503)207-1901
(Due upon application.)
CCB lie.:133041 Total permit fees:
• Amount received:
Authorized signature: �— - This permit application expires if a permit is not obtained
Print name:CJ Volesk Date:09/252014 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\FPS-PetmitApp.doc 02/01/11 440-46131(11/02/COM/WEB)
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 description of work:
Type of System (Complete A, B, C or D as a•plicable):
A.) Commercial Sprinkler
❑ Wet ❑ l)ry
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: $ 3715.00
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
D:\Users\voleskyc\jobs\Tigard-Apple TI PermitApp.doc 02/01/11 2
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
9589 SW WASHINGTON SQUARE RD B09,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2014-00155
Jeff Grove
Nfpa72 received
Violation Summary:
Inspector Contractor