Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2015 00015
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2015
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9650 SW WASHINGTON SQUARE RD G15
Project: Ivivva Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Addition to fire alarm system.
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 02/04/2015 $86.06
12%State Surcharge-Building 02/04/2015 $10.33
Type of Use: COM Plan Review-Fire Life Safety-COM 02/04/2015 $34.42
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 02/04/2015 $12.50
Occupancy Grp: M Height: ft 11x17)
Stories: 1
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 $143.31
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,775.00
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 ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-0014%-0. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8• .2344.
Issued By: - I ittee Signature:
.4r ■_1011-11111111P
Call 503.69.'Albby 7:00 a.m.for the next available ins•= o .ate.
This permit card shall be kept in a conspicuous place on the job sit= ntil •mpletion of the project.
Approved plans are required on the job site at the ti of =.ch inspection.
Building Permit Application d 2c vs
Fire Protection System FOR OFFICE USE ONLY•
City of Tigard RECEIVED DateB ,,. rutitNo _
IN
-
• 13125 SW Hall Blvd.,Tigard,OR 97223 Pla R Received•ew �� '0�/S
Phone: 503.718.2439 Fax: 503.598.1960 JAN 2 6 2015 Date/B : 11021a, '� (�J Other Perm j Q
TIGARD Inspection Line: 503.639.4175 Date Ready : : Avis: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
WILDING DIVISION
TYPE OF RK 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.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
46,go���JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site addressy!ra5 gW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldg./apt.no.:STE G15 Project name:Ivivva Athletica 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 NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $$1,775.00
ONLY) Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ 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
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.voleskynsiemens.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):
Phone:(503)207-1900 Fax:(503)207-1901 (Due upon application.)
Total permit fees:
CCB lic.:133041 IA(
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:CJ Volesky Date:1/23/2015 * Fee methodology set by Tri-County Building Industry
Service Board.
I\Building\Pcmits\FPS-PermitApp oc 02/0 11 440-4613T(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:
o ❑ 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 applicable):
A.) Commercial Sprinler
❑ 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: $
ti
\C.) Fire Alarm
Su ttal 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\Forms\Job related\Permit\Tigard-PermitApp.doc 02/01/11 2
RECEIVED
City of Tigard JAN 2 6 2015 Permit No.: FPSo?OlS—r x.13 l s
13125 SW Hall Blvd.,Tigard,OR 97223
(' \!`ii Phone: 503.718.2439 Fax: 503.598.19t,�ITY OF TIGARD Date Received: ///(o/j5
Inspection Line: 503.639.4175
I BUILDING DIVISION By:
Internet: www.tigard-or.gov
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: I P/ v C/// tt-1 . Occupancy:
Job Address: 95X-C- SGs (d fa,, £/ Suite:
Contractor: /eels_P,-i f Phone:
Valuation of work: $
Type of System: (check one) 311 equired ['Non-required
(check one) ['Automatic [Manual ['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(max5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) ° /To be Relocated (max 5)
Number of Proposed Notification Appliances: To be Added(max 5) p` /To be Relocated(max 5)
I, OCie 1r/5-,-c3c n�4 f Oregon Construction Contractors Board No. I g,30q
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:
• Submit (3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• Electrical permit.
• A copy of th. document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: // /`j
Print Name: e s ply ///
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