Permit (94) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00089
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9569 SW WASHINGTON SQUARE RD B04
Project: Godiva Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(3)and relocating(3)fire alarm 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 05/04/2016 $102.20
12%State Surcharge-Building 05/04/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 05/04/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/04/2016 $0.50
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 05/04/2016 $180.00
Hourly Building 12%State Surcharge 05/04/2016 $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 $357.44
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,969.00
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 • ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-•190. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800. 44.
Issued By: - Permittee Signature:
Cal ',"k!•39.4175 by 7:00 a.m.for the next available inspection d.
This permit card shall be kept in a conspicuous place on the job site un ' • ple on of the project.
Approved plans are required on the job site at the time of>ach ins•ection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard
01\11k41)
Date/Bed5 L/ �0err)._ Permit No.: r�� �// y�GC/
. .4 13125 SW Hall Blvd.,Tigard,OR 9722 y l�v� dJ0 f
g an R /5 76,
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit:
T I G A RD �A
Inspection Line: 503.639.4175 v 0 r)l\\ Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 1 L Notified/Method: �'-CO Supplemental Information
�
# T y; �� : QUIRfi r ' l $ LUNG
m7�d,a
❑New construction ( 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
work indicated on this application.
N 1,1 4"'y d
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
� B S 1 • - T O AND LOA O A Total number of floors:
Job site address:9585 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:B04 Project name:Godiva Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED 1" ,. . I ; u ST
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
sOF 1;41554::- ..:=42,±P.:,:: work indicated on this application.
Installation of fire alarm to code. Valuation: $2969.00
Existing building area: square feet
New building area: square feet
❑" ROPER a „� �, i s 14 r tz T'_ = Number of stories:
Name:Godiva Chocolatiers Type of construction:
Address:9585 SW Washington Square Rd. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
ea *�1A1 p , ON
44 =t .- �� & saw. ti r -:00 04, - ,. ii;..,"',. .. a r,
Business name:Siemens All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Co o es
ntact name:CJ V 1 k
Y
under ORS 701 and may be required uired to be licensed in the
q
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
'°14'.4 �44214'44'44
4'44"4
Business name:Siemens
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: /55
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name:CJ Volesky Date:5/04/2016 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_071514.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to Abe done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
ElNew system Number of sprinkler heads: Number of alarm devices: 8
® 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 ❑ 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.
Type of System (Complete A,° Cor D.as applicable); f i 4s
tib '� li
A) Commerc al.Sprinider
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I H ao I Fire Su ression Systemi,
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 2969.00
D.)' Residentia1Sprinkler(Staa�ct Alone System)
i `.. , ,,,,--740,1%.:p
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 , `,_
tri
7,201 and greater $404.39 u , �� ,q7
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit-Fees _ _
Project valuation subtotal (see A,B &C above): $ 2720.00
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:A Users\voleskyc\Jobs\WSQ\52000477284 WSQ-Godiva\FPS_permitApp.doc 2
RECEIV
City of Tigard MAY 04 2016 Permit No.: t'/ . /(0 %J0(f t
13125 SW Hall Blvd.,Tigard,OR 9722 ii a
Phone: 503.718.2439 Fax: 503.598.l69I ) i Date Received: 5/�
Inspection Line: 503.639.4175
TIGARD SUIL�f GDi I>Iq+By: e(h
�/�/�
JInternet: www.tigard-or.gov
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ-Godiva Occupancy: B
Job Address: 9585 SW Washington Square Rd. Suite: B04
Contractor: Siemens Phone: 503-896-9387
Valuation of work: $2969.00
Type of System: (check one) nRequired nNon-required
(check one) ■❑Automatic nManual [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) 3
I CJ Volesky 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: 05/04/2016
Print Name: C ' • esk
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1