Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 COMMUNITY DEVELOPMENT Permit#: FPS2016-00044
T IG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9610 SW WASHINGTON SQUARE RD G01
Project: The Walking Company Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire alarm for TI. Installing(3)notification appliances. 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 03/09/2016 $102.20
12%State Surcharge-Building 03/09/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 03/09/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 03/09/2016 $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: Automatic
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: $2,676.00
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
CW4139.-4175 39.4175 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.
Building Permit Application
Fire,Protection System -V NiAl
FOR OFFICE ESE ONLI
City of Tigard N Receiv
Date/By: ,3 ,//6"/ 4•77— Permit PermilNo.: y3 /4 00021
13125 SW Hall Blvd.,Tigard, 7223
' S Phone: 503.718.2439 Fax: 503.598.1960 $ 201Fj UPI
DatePtanBRevy:iew Other Permit/41(40;e/(U'C,YJCbla
T l G A R D Inspection Line: 503.639.4175 MPR Date Ready/By: Jur See Page 2 for
Internet: www tigard-or.gov6 Notified/Method: t Supplemental Information
' 1:1 TYPE 0 0 � "= REQUIRED DATA, 1 2-F LY*DWELLING
❑New construction q 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: $ 1
❑Accessory building 111Multi-familyNumber of bedrooms:
0 Master builder 111 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9610 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:GOl Project name:The Walking Store Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DA 'A:COMMERCIAL-USE-CHECKLIST
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.
Installing fire alarm to code. Valuation: $$2,676.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER .h El TENANT '.`. ` ' - Number of stories:
Name:The Walking Store Type of construction:
Address:9610 SW Washington Square Rd. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
APPLICANT ® CONTACT PERSON NO •
TICE
Business name:Siemens 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 NW Greenbrier Pkwy,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
l''.4'` CONTRA+E TOR BUILDING PERMIT FEES*
Business name:Siemens
(Please refer to fee schedule) . .
Permit fee:
Address: 15201 NW Greenbrier Pkwy,A4
City/State/ZIP:Beaverton,OR 97006 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)207-1900 Fax:( ) (Due upon application submittal.)
CCB lie.: 133041 Total permit fees: /(pl. 3P/
• Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:CJ Volesky Date:3/8/2016 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1_\Building\Permits\FPS-Permit App_071 . oc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
` Page 2- Supplemental Information
Describe work to be done: 4
1.) Type 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: 3
® Addition or El 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 El 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type ofSystem(Complete kA, C or D as applicable):
A,) Cominetcial Sp 'milder
El Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B) TypevI-1, o 4 ire Suppi ssi'on.System, P u
Hood Project Valuation: $
m y
C.) Fire Alarm = -
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 2676.00
t �.
D, Residential.Sprinkler(Staid`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: $
1):AUsers\voleskyc\Jobs\WSQ\5200743507 WSQ-The Walking Store\FPS_PcrmitAp} loc
WIN T
City of Tigard _.,! ‘ Permit No.: 6 a/0/6—�xx�vel
4 13125 SW Hall Blvd.,Tigard, ' ,.
Phone: 503.718.2439 Fax: 5,•. •8.1960 Q �1 1v Date Received: 3/g/i6
Inspection Line: 503.639.4175 D L�
T i GA R D Internet: www.tigard-or.gov MPR +'i By: --6/.....,„0.2..., [04
FIRE ALARM , ma
r9 DAVIT FOR ALTERATIONS
,A
\NANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ - The Walking Store Occupancy: M
Job Address: 9610 SW Washington Square Rd. suite: G01
Contractor: Siemens Phone: 503-896-9387
Valuation of work: $2676.00
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) 0 /To be Relocated(max 5) 0
Number of Proposed Manual Alarm Stations: To be Added(max 5) 0 /To be Relocated(max 5) 0
Number of Proposed Notification Appliances: To be Added(max 5) 3 /To be Relocated(max 5) 0
I Siemens 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:
• 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 do ment with a copy of the sketch attached shall be available for all inspections.
Signature: _ Date: 3/08/2016
Print Name: CJ V; i,1''
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1