Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• • COMMUNITY DEVELOPMENT Permit#: FPS2015-00005
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2015
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10230 SW WASHINGTON SQUARE RD
Project: Spec Space Subdivision: OAKBURG Lot: 9
Project Description: Prep for new tenant build-out.
Contractor: SIEMENS INDUSTRY INC Owner: PPR SQUARE TOO 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 01/16/2015 $145.24
12%State Surcharge-Building 01/16/2015 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 01/16/2015 $58.10
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 01/16/2015 $8.00
Occupancy Grp: A-2 Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 01/16/2015 $18.00
11x17)
Hourly Building Rate 01/16/2015 $180.00
Commercial Sprinkler System: Hourly Building 12%State Surcharge 01/16/2015 $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: Automatic
Pull Station Required: No Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $448.37
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,938.00
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 foll.w the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00•s. ou may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
11111111k6 Issued By: •ermittee Signature:
Cal 503.639.4175 by 7:00 a.m.for the next available inspection .•te.
This permit card shall be kept in a conspicuous place on the job site until c• pleti,n of the project.
Approved plans are required on the job site at the time of eac insp= tion.
Building Permit Application
Fire Protection System 4V FOR OFFICE USE ONLY
Received
City of Tigard Re ceiv a». Permit No.: — ._• 13125 SW Hall Blvd.,Tigard,O4S)Ct‘
3 S Plan R .e - -
Phone: 503.718.2439. Fax: 503.598.1960`` 1 t-- Date/B :At;/� �� (. Other Permit: c , 4 _ • ,
I I 1, \I:I> Inspection Line: 503.639.4175 PN 1� Date Re:`r"y:
Notified/Method ',� Jugs ® See Page 2 for
Internet: www.tigard-or.gov t'�,�� �� Supplemental Information
TYPE i d EQUIRED DATA:1-AND 2-FAMILY DWELLING
El New construction to \-molition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwelling ®Commercial/industrial Valuation: $
El Accessory building ❑Multi-family Number of bedrooms:
1:1 Master builder El Other:
Number of bathrooms:
.I Total number of floors:
JOB SI"I'E INFORMATION AND LOCATION
Job site address:10230 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:PANERA BREAD 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 CIIECKLIST
Subdivision: I 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
work indicated on this application.
ADDITION OF NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $6,938.00
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:
_ ® LICAN7' ❑ CON"PACT 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*
(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.)
CCB lic.:133041 Total permit fees: l 1 3
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:01/14/15 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building&.Permits\PS-Permit oc 02/01/11 440-4613T(11/02/COM/WEB)
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
10230 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2015-00005
Jeff Grove
Violation Summary:
Inspector Contractor