Permit (41) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1114 COMMUNITY DEVELOPMENT Permit#: FPS2016-00114
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued; 07/13/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9609 SW WASHINGTON SQUARE RD LO2B
Project: Shoe Mill Subdivision: None Lot: None
Project Description: Fire alarm-Add(4)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: $2,522.00
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 Notifica •. 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 q -stions to • NC b calling 503.232.1987 or 1.800.332.2344.
Issued :y: Permittee Signature:
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 !.-4.,4, 1 a ,, FOR OFFICE USE ONLY
City of Tigard Received ns !�
114 - Date/By: Permit No.: N [l
13125 SW Hall Blvd.,Tigard,OR 972�4 l 7 �� �� X17
S ;( Plan Review' /j /1��4�0
Phone: 503.718.2439 Fax: 503.598 X5 0 1 Other Permit:6,44
Date/By:
T I GARD Inspection Line: 503.639.4175 Date Ready/By: furls: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
'"' - Z;- 'i i 't - , ! t ikd.. i P; r'r :r ri fir. **t" io : �7 _
❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
��.. t� t work indicated on this application.� G � R s o O
0 1-and 2-family dwelling ,0Commercial/industrial Valuation: $
❑Accessory building /❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
�F _ Ti * i3 1 C ie-N Total number of floors:
Job site address: 9 /24? 5-1--) /)� - Q/ New dwelling area: square feet
City/State/ZIP: -7-1-2c,_,--d_lb[� �' 1C� Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: C X10 e // Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other strryucture area: square feet
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
<<„ t rte ,, �a equipment,materials,labor,overhead,and the profit for the
410 : ,i� 114 i, ` p i " "'" work indicated on this application.
, -4.sr�l1 /e /7/4s.1 J, c_al -c Valuation: $ P2
Existing building area: square feet
' New building area: square feet
' ',T � T
Number of stories:
Name:
r .46,c- 47 y/ Type of construction:
Address:
4i,g sl..„ ,/�pL. Occupancy groups:
City/State/ZIP: A r,t' / Z.31,1 Existing:
Phone:( ) , , Fax:( )
m 4 � `. - P `'.' 9 li�+'i i„�"t,'^^ New: j ,y
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Business name: 4�.�— :. - _ c
:e..., est All contractors and subcontractors are required to be
Contact name: (`� licensed with the Oregon Construction Contractors Board
)/may
Address: /._.5 ,20 under ORS 701 and may be required to be licensed in the
4t� terse /4�q,,v- ,04� jurisdiction in which work is being performed.If the
City/State/ZIP: �� applicant is exempt from licensing,the following reasons
AUG"
/ apply:
Phone: 3) 239C-5'9 3,, Fax: :( )
E-mail:
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Business name: t4 �` ' � 4
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Permit
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Address: � Permit fee:
/S62 ) / � [ ce re is « iek.3. State surcharge(12%of permit fee):
City/State/ZIP: 'eauti LO�
Z FLS plan review(40%of permit fee):
Phone:(5-o ) 896_ 993 2s7 Fax:( ) (Due upon application submittal.)
CB lic.: j 3 3 y/ Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: Cr tvi ,c/r�� Date: T�1_l G within 180 days after it has been accepted as complete.
V * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doe 440-4613T(11/02/COM/WEB)
City of Tigard Permit No.: P6,7/-0/ —00//1/
—(x//41
11 * 13125 SW Hall Blvd.,Tigard,OR 97220, ,
X Phone: 503.718.2439 Fax 503 598 1960- Date Received: 1//4! Leo
Inspection Line: . .
TIGARD Internet: www.tigard-or.go503639v4175 By: ( ,
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: C.JSQ — C D r ;- "; I i Occupancy:
Job Address: 9e,e)1 ,,2 G„~;.s '> S .k Suite: L 0,R./
Contractor: ; Phone:
Valuation of work: $ a,s22 06
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) a /To be Relocated(max 5) 0
• Number of Proposed Manual Alarm Stations: To be Added(max 5) (15 /To be Relocated(max 5) cif
Number of Proposed Notification Appliances: To be Added(max 5) 11 /To be Relocated(max 5) 0
,I (.��(j.,/ . Oregon Construction Contractors Board No. /3309/certify the following is true and define he 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 cument with a copy of the sketch attached shall be available for all inspections.
40 Signature: Date: 7'" //-/
Print Name:
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