Permit , CITY OF -�GAR� FIRE PROTECTION SYSTEM PERMIT
k n
` COMMUNITY DEVELOPMENT Permit#: FPS2015-00164
Date Issued: 10/15/2015
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9540 SW WASHINGTON SQUARE RD H15
Project: See's Candies Subdivision:VASHINGTON SQUARE ESTATES NO Lot: S
Project Description: Adding(3)fire alarm devices for TI Affidavit submitted.
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-MF 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 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 $2,631 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 952-001-0090 You may obtain a copy of the rules
or direct OUNC by calling 503 232 1987 or 1 800 332 2344 /
Issu d B k_. Permittee Signature: 41 A 11
•
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. /
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.
'Buii' ing Permit Application
Fire Protection System FOR OFFICE USE ONLY
Received /
City of Tigard a I� DateB �0 ��j Permit ��- _ -
13125 SW Hall Blvd,Tigard,OR 97223 . v
Tigard, � Plan Review
III Phone 503 718 2439 Fax' 503 59.WIC G� Date/By Other Peumt Picg01 _(ic,1-3-7
TIGARD Inspection Line 503 639 4175 �Q�� Date Ready/By Juns 0 See Page 2 for
Internet www tigard-or gov 00 J ) Notified/Method •�3 Supplemental Information
TYPE' OF W l� REQUIRED DATA:1-AND 2.FAMIT.Y DWELLING
❑New construction 5151diatI 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.
111 I-and 2-family dwelling ®Commercial/industrial Valuation: $
El Accessory building ❑Multi-family
Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
r' „ _ Total number of floors:
JOB SITE INFORMATION AND AND LOCATION - _
Job site address:9540 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:SEE'S CANDIES 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*ATA:COMMERCIAL-USE CHECKLIST y
Subdivision: 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: $2,631.00
ONLY)
Existing building area: square feet
New building area: square feet
Number of stories:
T,® PROPERTY-ow,NER _ El TENANT
Name:ROGER OT1' Type of construction:
Address:9585 SW WASHINGTON SQUARE ROAD Occupancy groups:
City/State/ZIP:TIGARD,OR Existing:
-
Phone•(503)639-8860 Fax:( ) New:
® APPLICANT 7❑ 'CON'I'ACI 'PERSON"a- ' =- NOTICE _ '
Business name:SIEMENS INDUSTRY,INC. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:CJ VOLESKY under ORS 701 and may be required to be licensed in the
Address:15201 GREENBRIER PARKWAY jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:BEAVERTON,OR 97006 apply:
Phone:(503)896-9387 Fax: :(503)207-1901
E-mail:ej.volesky @siemens.com
"' "$t ' '` ',CONTRACTOR,' � ` ,- _ BUILDING`PERMIT-FEES ,.,1
�, - LL _ _ ; ' (Please,refer to feesc/iedul'e)$_.,.: 1,1'
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):
)lication
upon app .
Phone:(503)207-1900 Fax:(503)207-1901 (Due up t
Total permit fees: (GI.Se(
CCB tic.:133041
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
AO within 180 days after it has been accepted as complete.
Print name:CJ Volesky Date: 10/13/15 * Fee methodology set by Tri-County Building Industry
Service Board
1 VBuilding\Permits\FPS-PermrtApp doe 02/01/11 440-4613T(I l/02/COM/WEB)
City of Tigard Permit No.:
n 13125 SW Hall Blvd.,Tigard,OR 97223
Phone. 503.718.2439 Fax: 503.598.1 Q 1\J Date Received: /Or(3/6
Inspection Line: 503.639.4175
T i G \R u' Internet www hgard-or gov By: fire-AN-0V N - -
S gGl r� -
C7 3 201
FIRE ALARM Sitjlitl ' VIT FOR ALTERATIONS
VISI
ORUMOM IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: �Q , See` - ��- Occupancy:
Job Address: 9'Syd .�(,� 62J, , ,PUG Suite:
Contractor: e Phone: 3 r g76 -Y387
Valuation of work: $ a •3 I
Type of System: (check one) ❑Required ❑Non-required
(check one) ❑Automatic ❑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) 0
I, C-3 Oregon Construction Contractors Board No. /13 b `((
certify the following is true aid-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 thi o ment with a copy of the sketch attached shall be available for all inspections.
Signature: Date: ./y/3/1_5
Print Name: J i
1:\Building\Forms\FireAlarmAffidavit 071514 docx Page 1 of 1
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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 -
111 Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
IIood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Yes
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 ProtectionTermit 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 application and 2 sets of plans at submittal. Plan review fees are required at submittal.
1)\Users\volcskyc\fobs\WSQ\5200454042 Sec's Candies VTigard-Sees TI PemutApp clgc 02/01/11