Permit (12) IliCITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'f,. COMMUNITY DEVELOPMENT Permit#: FPS2016-00116
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9364 SW WASHINGTON SQUARE RD R01
Project: Blue Nile Subdivision: None Lot: None
Project Description: Fire alarm-Add(3)notification 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 07/13/2016 $102.20
12%State Surcharge-Building 07/13/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 07/13/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 07/13/2016 $0.50
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,666.00
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 questio OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Cit_Oet—lk—A--k—t
Permittee Signature: C\`c "
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.
Building Permit Applicati9n
:. .:
Fire Protection System ' ''--- ---- ••., FOR OFFICE USE ONLY
City of Tigard Received
/Br 7 /1 /6, (Z.,..4 Permit No.: -11179a4-Cid/(0
., ,: .
. 13125 SW Hall Blvd.,Tigard,OR 97223 - ' '-'; :.
11411 Date
Plan Review
Other Permit:.06a pe,,,/o..,...„,0 I 7,3.,
- Phone: 503.718.2439 Fax: 503.598.1960
Date/By:
, . . _
Inspection Line: 503.639.4175' :, . - - - -.,::, Date Ready/By•: Juris: 1 See Page 2 for
TIGARD f
Internet: www.tigard-or.gov.,., .. Notified/method:
Supplemental Information
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Permit fees*are based on the value of the work performed.
0 New construction 0 Demolition
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
afibioitir,.,,,o'jVt4ii4i. a .;':.V::r;'3:',.-:':.,..7'.,e..:-;:t.TOAI.:7-ni-ijigl work indicated on this application.
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Valuation: $
0 Accessory building
0 1-and 2-family dwelling ommercial/industrial
0 Multi-family
Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
0r**ko***PrA*ItLOW*:ok,cr.=,- ., Total number of floors:
Job site address: 21:r", _....1. (....k.4-
New dwelling area: square feet
v
City/State/ZIP: 72:1 et"....d, e>le , Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: /‘ -e /1..,k/e '/ Covered porch area: square feet
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Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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Subdivision: I 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
,, v equipment,materials,labor,overhead,and the profit for the
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,m0,0pplirptiRF?-Vmc,, ,.,, 1-, -,. ,,, - - , work indicated on this application.
.cyce /) 7/23, ciajoe .e Valuation .
Existing building area: square feet
New building area: square feet
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Number of stories:
Name: '.. /e Type of construction:
,
Address: 91s-75- 37.(4.? .C...s_ir..„...‹ .._. .„ / .-)-1,w, Occupancy groups:
7- 4
City/State/ZIP: -y-A A(....t / / zy,e
Existing:
Phone:( ) """ Fax:( )
New:
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Business name: lifc=7=5forty==70,fty.i SiCebt e it 1-- All contractors and subcontractors are required to be
Contact name: CVllicensed with the Oregon Construction Contractors Board
,) oes-4
under ORS 701 and may be required to be licensed in the
-.
Address: /._5o/ iji,) ,.e e.„„6,-,et --- /94 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: ,6 / ae5/'
e-,2 P Cc 0/3/ apply:
Phone:(30-...3) zr,04-50,3, i Fax::( )
E-mail: , Ci.. Lip /e_j'A-4, & ,..,. .--,emc.4.....0 • Ce...,...
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Business name: .1:f,$)e,,,s,
Permit fee:
Address: is— / vi,_, (3fee, -,..,__
Y State surcharge(12%of permit fee):
City/State/ZIP:
'au e./ilbe/ • $,IZ'
FLS plan review(40%of permit fee):
Phone:(so?) •F96- .5,3 2s7 I Fax:( )
(Due upon application submittal.)
,..- Ci0 B lic.: j..?,. „ y/
Total permit fees:
Authorized siAmount received:gnature: ( '
Print name: Date:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
7- /6
i
* Fee methodology set by Tri-County Building Industry
Service Board.
IABuildingTermits\FPS-Permit App_031016 doc 440-46131(11/02/COM/WEB)
City of Tigard "'
Permit No.: /-;05jQS c9v/ —vU //(P
*t 13125 SW Hall Blvd.,Tigard,OR 9743Phone: 503.718.2439 Fax 503.598.1960 Date Received: 7///f/
T 1 GARI7 Inspection Line: 503 639 4175
Internet: www.tigard-or.gov By:
614--
FIRE
14 --FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: /4) J 4/1.4.c_ ,�;/e Occupancy: /fl
Job Address: i Sly GJtc.lh�r �a�e - Suite: �l
Contractor: 3� 37e 41_e'r Phone:
Valuation of work: $ o�Gt e .O0
Type of System: (check one) ❑Required ❑Non-required
(check one) ,utomatic (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) pt /To be Relocated(max 5)4111/ Ji
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) f
eji 111:45)..t/ ( Si e to s j Oregon Construction Contractors Board No. /3 3o 4/
certify the following ls'frue 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.
Signature: ( - Date:
Print Name: (7i1:1 a/c,
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
9364 SW WASHINGTON SQUARE RD R01,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00116
Jeff Grove
Violation Summary:
Inspector Contractor