Permit (142) t n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11
' '! •° COMMUNITY DEVELOPMENT Permit#: FPS2016-00045
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016
Parcel: 1S 1260000300
Jurisdiction: Tigard
Site address: 9477 SW WASHINGTON SQUARE RD A07
Project: Yankee Candle Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire alarm-modification of(4)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 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: Info Process/Archiving-Sm$0.50(up to 03/09/2016 $4.00
11x17)
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $165.34
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 uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility - ication Center. e - . e set forth in OAR 952-001-0010 through OAR 952-001-009e You may obtain a copy of the rules
or dir•ct questions to OUNC by c• g 503.2 2.1987 or 1.800.332.2344.
Is ued By: /9,d/tieA
/ Permittee Si nature: 110
Call 503.639.4175 by 7:00 a.m.for the next available'• . ction 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 Applicaticua
VED
Fire Protection System roR Orrlcl: t SE()N 1.)
City of Tigard MAR 2416 Received � �
g DateB : i Permit No.: I
• 13125 SW Hall Blvd.,Tigard,OR 972235111
Plan Review
P' 61 Or ��;.i C Other Permit:
Phone: 503.718.2439 Fax: 503.5 S��l�r�?'�i. DateB
l K H Ins ction Line: 503.639.4175 j ', i 4;q Date Ready/By: Suns See Page 2 for
Internet: www.tigard-or.gov B"ILl�l1�►i, Notified Method: Supplemental Information
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 ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 1:1Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9477 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:A07 Project name:Yankee Candle Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.
Installing fire alarm to code. Valuation: $$2,676.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 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 0 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*
Business name:Siemens (Please refer tefeesrh.i t'
Permit fee:
Address: 15201 NW Greenbrier Pkwy,A4
State surcharge(12%of permit fee):
City/State/ZIP:Beaverton,OR 97006
FLS plan review(40%of permit fee):
Phone:(503)207-1900 Fax:( ) (Due upon application submittal.)
CCB lic.: 133041 Total permit fees:
��ry si9nen oY vaesrzy c,ryce
Volesky ou:�-vorcryee.o s��"s. Amount received: 1(es,
Authorized signature: emal=cj.rdesky@uoss ns.corn
Clyde Reason .0 3091e 0103!1 the
t This permit application expires if a permit is not obtained
Dat•:2016.03.09 m:o at aero r within 180 days after it has been accepted as complete.
Print name:CJ Volesky Date:3/9/2016
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pertnits\FPS-PemutApp_071514.doc 440-4613T(11/02/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:
0 New system Number of sprinkler heads: Number of alarm devices:
® Addition or ❑ 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 0 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
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 ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 2676.00
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: $
D:\Users\voleskyc\Jobs\WSQ\5200468268 WSQ-Yankee Candle\FPS_PermitApp.doc2
City of TigardC fir. Permit No.: 1/05��(I�- ds--
111 " 13125 SW Hall Blvd.,Tigard,OR 9 °'� tx*'
ffi Phone: 503.718.2439 Fax: 503.598.1960Date Received: COO
Inspection Line: 503.639.4175 MAR 92016 •
TIGARD Internet: www.tigard-or.gov By: / •1 r
CITY 0a_
FIRE ALARM ALAIMI-PitgitiVIMMIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ - Yankee Candle Occupancy: M
Job Address: 9477 SW Washington Square Rd. suite: A07
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) 4 /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 document with a copy of the sketch attached shall be available for all inspections.
VoleskyDIchtbth Clyde Wobad the-� Y 3/09/2016
Date 2 i I 09 au-vM-9.tlmnwm
Signature: ��,6-�-���:���ar Date:
Print Name: CJ Volesky
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1