Permit (40) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 I ' COMMUNITY DEVELOPMENT Permit#: FPS2016-00115
TfC.A.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Lululemon Subdivision: None Lot: None
Project Description: Fire alarm-Add(5)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: $2,740.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: w 1 –4/IAA—kJ
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ee Signature: � –t_j
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System` FOR OFFICE USE ONLY
City of Tigard Received I a !6--Vail c
Date/By: 7 ft f6, PermitNo.:��5
q 13125 SW Hall Blvd.,Tigard,OR'' 7223 Plan Review
Phone: 503.718.2439 Fax; 5.03.59$.1960 Date/By: Other Permit:4 AV/4,_Op/3/
T I G A R D Inspection Line: 503.639.4175 , , Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.goy r Notified/Method: Supplemental Information
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❑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
�� ( df r �` `� tt work indicated on this application.
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CI1-and 2-family dwellingCommerctal/industrial
Valuation: $
111Accessory building 0 Multi-family Number of bedrooms:
CI Master builder CI Other:
Number of bathrooms:
N,r,,, JOB*$ITR I IaORMAT1O`�l r ;IJd ATJON Total number of floors:
Job site address: 93ss'- / )44 . S 1,Q/ New dwelling area: square feet
City/State/ZIP: �_1 ce .f� fjv( L — Garage/carport area: square feet
Suite/bldg./apt.no.: /
1_1
Project name: hi.LCi1 ')0„ ,t, r Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Anil 4On�x+ 7NT, oI1� 'IST'
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 t� equipment,materials,labor,overhead,and the profit for the
r g / �,- -.:61- t;fl - ' Q)EZ ' work indicated on this application.
1 jn Cf,// ..p g/4, `elot .c Valuation $ ?Xe
Existing building area: square feet
New building area: square feet
( J'ROP Y4iY O'1 N1 I2 kANT ' Number of stories:
Name: s Lb,K/e p,� r Type of construction:
Address: •
•v St...) W 9/ , ,24 Occupancy groups:
, '
City/State/ZIP: 7. e r d j D e Existing:
Phone:( ) Fax:( )
New:
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Business name: �� z
S:e.", e it All contractors and subcontractors are required to be
Contact name: f' \J VQ/r licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /�a0/ 4 jw G'e�h B — A jurisdiction in which work is being performed.If the
City/State/ZIP: Q applicant is exempt from licensing,the following reasons
tel/er 4/3 �� apply:
Phone:( j) 39G'/3 3J// Fax::( )
E-mail:
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:s (Ffrasere,(eitajc„sckedute,...t ,} -;
Business name: S, e•--)e.t.S'
/�� �/j' Permit fee:
Address: /57/ �UGJ ('/e eA J/i« /94. y
n ,/ / State surcharge(12%of permit fee):
City/State/ZIP: fatteut,2,,./ ZYZ
FLS plan review(40%of permit fee):
Phone:(5-03) $996 93x7 Fax:( ) (Due upon application submittal.)
CB lic.: /339y/ Total permit fees:
Authorized signature: i
Amount received:
This permit application expires if a permit is not obtained
Print name: C+rt do/c f4 Date: 7�(_/6 within 180 days after it has been accepted as complete.
V * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\PermitsWPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
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City of Tigard /
Permit No.: ✓i0s,g0/(? '"Ue) 115----
411
s 5 Bd., , 97223:
Phone:1312503.718.2439SWHalllv
Fax:
Tigard503.598.1OR960 Date Received: 7/i////„
TIGARD Inspection Line: 503.639.4175 7`
Internet: www.tigard-or.gov By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: (,JSQ• ii,dt.eico..on Occupancy: Al
Job Address: 9355. 5c4) CJ 1fes,, . id Suite: 77 9
Contractor: Sj e,,,e••.f Phone:
Valuation of work: $ 02 2 VB
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) 01
• 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) S" /To be Relocated(max 5) 46
1, Ci Vall 3 G..tet) Oregon Construction Contractors Board No. � 3 y7
certify the followin 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 thi cument with a copy of the sketch attached shall be available for all inspections.
illSignature: Date: 7-//-/Z,,
Print Name: e's (4l7
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