Permit (143) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00043
T IGARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9368 WASHINGTON SQUARE RD R03
Project: Papyrus Subdivision: None Lot: None
Project Description: Reinstalling(3)smoke/heat detectors and(3)notification appliances after construction. 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 $91.44
12%State Surcharge-Building 03/09/2016 $10.97
Type of Use: COM Plan Review-Fire Life Safety-MF 03/09/2016 $36.58
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 03/09/2016 $4.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 03/09/2016 $180.00
Hourly Building 12%State Surcharge 03/09/2016 $21.60
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 $344.59
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,950.00
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.
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Issued By: -• -e Signature:
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Call X9.4175 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 FOR OFFICE USE ONLY
City of Tigard viEctiVE DateBy: 3 V /(o ; Permit No.: i^?�-�//.�. J(3
y: / 11PP l�(.JCJ
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit: y�,
T I G A R D Inspection Line: 503.639.4175 MAR 8 £U Date ReadyBy: Juris: ee Page Z for�v��
Internet: www.tigard-or.gov RINttlNotified/Method. Supplemental Information
' + t ont , 1x FAMILY MIN ,!{ 3
T'A'P)[; O O �' R>4Q
1=1 New construction ElMalian 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 QFONSI'ItUCTION
work indicated on this application.
CI1-and 2-family dwelling ®Commercial/industrial Valuation: $
111Accessory building ❑Multi-family Number of bedrooms:
111 Master builder 111 Other:
Number of bathrooms:
JOB Sj<TE INPORMA'T'1<ON-AND LOCATION Total number of floors:
Job site address:9368 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard, Garage/carport OR 97223 Gara e/ca ort area: square feet
Y g
Suite/bldg./apt.no.:R03 Project name:Papyrus Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
t4iik i'646i4irititoi8iA10DATAC LIS
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.
Testing of fire alarm after construction. Valuation: $1950.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER` TENANT; Number of stories:
Name:Papyrus Type of construction:
Address:9368 SW Washington Square Rd. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
,®.APPLICANT ® CONTACT PERSON NOTICE
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
CONTRACTOR BUILDING PERMIT FEES* ,f
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:
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.
I:\Building\Permits\FPS-PermitApp_I 1 .oc 440-4613T(I 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
• Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El 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: Some devices were removed and reinstalled after construction. We are going to
test for proper operation.
Typeof'Systryein(Complete A,£ , 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 Su ire sion.S ste t,
Hood Project Valuation: $
C.) )Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1950.00
D Residential Sprinkler(StandiAlone System)
k
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):A Users\voleskyc\Jobs\WSQ\5200472027 WSQ-Papyrus\Permits\FPS_PermitApp.do2
vcost
City of Tigard Permit No.: FP5020 t o—ocid4,3
13125 SW Hall Blvd.,Tigard,OR 972
v Phone: 503.718.2439 Fax: 503.598.1960 % '7 tU Date Received: 3/00
Inspection Line: 503.639.4175 MAR i� / /
T I G A R D Internet: www.tigard-or.gov 1,4+`y y By : a-x.(,.�v
FIRE ALARM SO ) " IZIAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ - Papyrus, R03 Occupancy: M
Job Address: 9368 SW Washington Square Rd. Suite: R03
Contractor: Siemens Phone: 503-896-9387
Valuation of work: $ 1950.00
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) 3
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) 0 /To be Relocated(max 5) 3
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 ent with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 3/08/2016
Print Name: CJ Vo sky
I:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9368 WASHINGTON SQUARE RD R03, TIGARD,
OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00043
Jeff Grove
NFPA 72 completion form received
Violation Summary:
Inspector Contractor