Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1114 R . COMMUNITY DEVELOPMENT Permit#: FP52014-00138
Date Issued: 02/18/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9424 SW WASHINGTON SQUARE RD K05
Project: Hot Topic Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(4)fire alarm notification appliances in public access space only. Affidavit provided.
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 08/27/2014 $134.48
12%State Surcharge-Building 08/27/2014 $16.14
Type of Use: COM Plan Review-Fire Life Safety-COM 08/27/2014 $53.79
Class of Work: ALT Type of Const: Hourly Building Rate 08/27/2014 $180.00
Occupancy Grp: Height: ft I Hourly Building 12%State Surcharge 08/27/2014 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: No Cut Sheets Required:
Total $406.01
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $5,124.00
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 • follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-01 -0091. You may obtain a copy of the rules
or direct q OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: (ca 1e 1.. f; Permittee Signature: i
111111 �J�G
Call 503.639.4175 by 7:00 a.m.for the next available insp •n ate.
This permit card shall be kept in a conspicuous place on the job sit- •ntil c• pletion of the project.
Approved plans are required on the job site at the ' e of ea inspection.
114 City of Tigard Permit No.: FPS 0261`i-Oo/3E'
. - • 13125 SW Hall Blvd.,Tigard,OR 97223
_
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 75/ 014/
TIGARD Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: arex•,ideV
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Mall-HOT TOPICS Occupancy: B
Job Address: 9424 SW Washington Square Road Suite: K05
Contractor: Siemens Industry,Inc. Phone: 503-803-7125
Valuation of work: $5124.00
Type of System: (check one) Required ❑Non-required
(check one) ❑Automatic [1 Manual ZBoth
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(max 5) /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) 4 /To be Relocated(msx 5)
I, Charles Hughes 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 p showing ermit showin the area of work within the
building's structure,
• A copy of this document shall be available for the authority having jurisdiction, and
• Electrical p
1
Signature: Date: 08/26/2014
Print Name: Charles Hughes
I:\Building\Fonns\FireAlannAffidavit_022514.docx Page 1 of 1
Building Permit Application
Fire Protection System CEI�E� FOR OFFICE USE ONLI
City of Tigard 1� 11 Received ` �1. Permit No.: •
l� Plaids : >
1,1 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q Q Date/B : other Permit: £` r ; • I — �� e •
I i t `F,t� Inspection Line: 503.639.4175 AUC� 0 U 2014 Date Ready/By: Page 2 for
Internet: www.tigard-or.gov n���_ ^^ Notified/Method: Supplemental Information
TYPE 0. �y 4� (�`+A`{yf,_)
. 1 DIVISION REQUIRED DATA:1-AND 2-FAMILY D1! G'
❑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: S0.00
❑Accessory building 1:1 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATIOKAND LOCATION Total number of floors:
Job site address:9424 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldg./apt.no.:STE K05 I Project name:Hot Topic 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
DESCRU'T4ON OF WORK . work indicated on this application.
ADDITION OF NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $55,124.00
ONLY) Existing building area: square feet
New building area: square feet
IR 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:
❑ 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: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
1 E-mail:charles.hughes@siemens.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee sckeduk
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 lie.:133041 Total permit fees: I/46.0i
'/0 Amount received: 11II
Authorized signature: C,/� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:CHARLES HUGHES Date:08/26/2014 • Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Peimits\FPS-PemitApp.doc 02/01/11 440-4613T(11/02/COM/WEB)