Permit _ CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
1 q
g: • COMMUNITY DEVELOPMENT Permit#: FPS2015-00163
Date Issued: 10/15/2015
TIGARI? 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Lolli&Pops Subdivision:VASHINGTON SQUARE ESTATES NO Lot: S
Project Description: Adding(4)fire alarm devices
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 10/14/2015 $102 20
12%State Surcharge-Building 10/14/2015 $12 26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/14/2015 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2 00(over 10/14/2015 $6.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required No 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 Cut Sheets Required
Total $161 34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation $0 00
Residential Square Footage 0
Fire Alarm Valuation $2,656 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 • : Ica io .-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or• ect questions to O C by t 1• 03.232 1987 or 1.800 332 2344
Issued By: Permittee Signature: /
v — —
Call 503.639.4175 by 7:00 a.m.for the next available inspection die.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
Received
City of Tigard ��® DateBv lU �KI Permit No / /S,
- ° 13125 SW Hall Blvd,Tigard,OR 97223 Plan Review
Phone- 503 718.2439 Fax• 503.598 1°�eC�N Date/By Othei Permit c'/ i s 6ba' L1
TIGARD Inspection Line 503 639.4175 O�C, Date Ready/By I ��a Juris See Page 2 for L
Internet www tieard-or gov C� 3 2 Notified/Method o� �'" / —G Supplemental Information
D Pad. D e'er
TYPE OF WOtj rt O`DGI`CJ`, . REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ (kI�,tMI` i\AG �V Permit fees*are based on the value of the work performed.
)T" 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.
Valuation: S
❑ I-and 2-family dwelling ®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
111 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9642 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. 1-011; ' Pop.; 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.
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: 52,656.00
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:C.1 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 tic.: 133041 Total permit fees:
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:C.1 Volesky Date: 10/13/15 * Fee methodology set by Tn-County Building Industry
Service Board.
I\nuddmg\Permns\FPS-PermitApp doe 02/01/11 440-4613T(1 I/02/COM/WEB)
- City of Tigard Permit No.: cPS /S-OO I Co 3
q 13125 SW Hall Blvd.,Tigard,OR 97223
Phone 503.718 2439 Fax. 503 598 ` CEIV ED Date Received: /0//3 /S
Inspection Line. 503 639.4175 !!
T G R L Internet: www.tigard-or.gov By: 11:1-90
0
OCT 132015
FIRE ALARM UTS' A, DAVIT FOR ALTERATIONS
1914144aRNINVROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: U .S 9 Lc'/ ' %,7 - Occupancy:
Job Address: PC,0 45,4 S- . /o/_ Suite:
Contractor: S-2 P.A.e4 S Phone: , 3- S',6 -2.3$ 2
Valuation of work: $ 026,.
Type of System: (check one) 'Required ❑Non-required
(check one) jgAutomatic [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(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) / /To be Relocated(max 5) b
1, )4,74 Oregon Construction Contractors Board No. /3 3 by/
certify the following is true acid 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 this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: /c5//3/
Print Name: e J (14.ik7
I.\Building\Forms\FireAlarrAffidavit_071514 docx Page 1 of 1
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
® Addition ❑ 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 Sprinkler
❑ 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: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Ycs
Cut Sheets
Fire Alarm Project Valuation: $ 3191.00
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 apphcation and 2 sets of plans at submittal. Plan review fees are required at submittal.
I)\Users\voleski c\fobs\WSQ\5200455282 WSQ 1.&PV'1'tgard-1.&I'11 PermilApp da 02/01/11