Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
l'14-1
I COMMUNITY DEVELOPMENT Permit#: FPS2015-00126
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2015
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9422 SW WASHINGTON SQUARE RD K06
Project: The Duck Store Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire Alarm-addition of notification in retail space(public access space only)
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 08/13/2015 $112.96
12%State Surcharge-Building 08/13/2015 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 08/13/2015 $45.18
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 08/13/2015 $6.00
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 $177.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,191.00
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 t - rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. •u m iy obtain a copy of the rules
or direct questions to OUNC by calling 503.23 2.1987 or 1.800.332.2344.
Issued By: 016ll"2 .69
Permittee Signature:
Call 503.639.4175 M1
by 7:00 a.m.for the next available inspection e.
This permit card shall be kept in a conspicuous place on the job site until c pletion of th- •roject.
Approved plans are required on the job site at the time of ea inspectio•
M,ltng Permit Applica ,CEIVED
Fire Protection System tOR OI 11( I. 1 si O\1.1
City of Tigard AUG 10 2015 Deis .15SI Permit No.: P.3 ,c—o )/2 a
14 13125 SW Hall Blvd.,Tigard,O Plan Revie
Phone: 503.718.2439 Fax: 5 '''1'TIGARD Date/3 : ;OW' °ti"'r Permit: /UV 4I 5(t/g9:-
1 I c It n Inspection Line: 503.639.41 BUILDING DIVISION Date ed/Met Ready/B.57:- ��/� /� )u ® s«Page 2 for
Internet: www.tigard-or.gov Notified/Met6od: `o/ Supplemental Information
Vin W /e
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.
❑ 1-and 2-family dwelling ® m
Comercial/industrial Valuation: $
❑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:9422 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldgJapt.no.: Project name:The Ducks Store 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: CUECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
ADDITION OF NOTIFICATION IN RETAIL SPACE(PUBLIC ACCESS SPACE Valuation: $53,191.00
ONLY)
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER l ❑ 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 0 CONTACT PRISON 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 I Fax::(503)207-1901
E-mail:cj.volesky @siemens.com
CONTRACTOR BUILDING PERMIT FEES*
(Pdwsrtdur bike s heirlei
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:
Amount received: {374
Authorized signature: t 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:07/31/15 * Fee methodology set by Tri-County Building industry
Service Board.
I:1BuildingTermits\FPS-PermitApp.do+02/0 440-4613T(t 1/02/COM/WEB)