Permit •4 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
`'�! a COMMUNITY DEVELOPMENT Permit#: FPS2015-00088
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2015
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9585 SW WASHINGTON SQUARE RD
Project: Washington Square Elevator Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Alarm addition for elevator
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 06/04/2015 $112.96
12%State Surcharge-Building 06/04/2015 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 06/04/2015 $45.18
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 06/04/2015 $6.00
Occupancy Grp: M Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 06/04/2015 $12.50
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: Yes
Battery Calcs Provided: No Cut Sheets Required: Yes
Total $190.20
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,057.00
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 952-001-009. ou may obtain a copy of the rules
or direct questions t• •UNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: 41 ,. Permittee Signature:
Tliri/ 1L
— —111111111111111. ---
Call 503.639.4175 by 7:00 a.m.for the next available inspection •- .
This permit card shall be kept in a conspicuous place on the job site unti ••mpletio •f the project.
Approved plans are required on the job site at the time • each inspe on.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
Received G
City of Tigard 2015 Date/f3 . � •CAI Permit N. sa is,%Q tT.P
.1111 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 21 I Plan Revie.. �� ,�� �Perm�eao
Phone: 503.718.2439 Fax: 503.598.1960 Date B : /-<.1%1,/
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready :y: / turis: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 1P 1 /jam✓ /,j Supplemental Information
®lzry-.lh. /'��ad
TYPE OF WORK 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.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: S
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9585 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:Elevator Upgrade Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
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 devices to bring elevators to code Valuation: 53057.00
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:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Siemens Industry,Inc. All contractors and subcontractors are required to be
Contact name:CJ Volesky licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:15201 Greenbrier Parkway,A4 jurisdiction in which work is being performed.If the
City/State/ZIP:Beaverton,OR 97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)896-9387 Fax::(866)254-0669
E-mail:cj.volesky@siemens.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Siemens Industry,Inc. (Please refer ro fee schedule
Permit fee: 112.96
Address:15201 Greenbrier Parkway,A4
State surcharge(12%of permit fee): 13.56
City/State/ZIP:Beaverton,OR 97006 FLS plan review(40%of permit fee):
Phone:(503)207-1900 Fax:(503)207-1901 (Due upon application submittal.) 45.18
CCB lie.:133041 Total permit fees: 171.70
Amount received:
Authorized signature: .
This permit application expires if a permit is not obtained
Print name:CJ Volesky Date:5/20/15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_0 ..a 440.4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to be done: J _
1.) "1'ypc of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 10
® Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3)copies of sketch showing area (3)copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+heads: Plan review required and ® 6+ devices: Plan review required and
(3) sets of plans. (3)sets of plans.
Additional description of work:
Type of System(Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 3057.00
Residential Sprinkler tared Svi
term)
1 Square Footage: f 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 1 $404.39
Sprinkler Project Square Footage: sq. ft.
Fife Protection Petmit)lam
Project valuation subtotal(see A,B&C above): $ 3057.00
Permit fee based on project valuation (see fee schedule): $ 112.96
Permit fee based on square footage (see D above): $
State Surcharge (12%ofpermit fee): $ 13.56
FLS Plan Review(40% of permit fee): $ 45.18
TOTAL: $ 171.70
D:\Users\voleskyc\Jobs\44op--Copy\Permits\Tigard-Elev Upgrade PermitApp.doc 2