Permit III E
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
: COMMUNITY DEVELOPMENT Permit#: FPS2016-00163
T f( .RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/20/2016
Parcel: 1 S 136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: Oregon PERS Subdivision: None Lot: None
Project Description: Replacing existing fire alarm devices.
Contractor: SIEMENS INDUSTRY INC Owner: OREGON, STATE OF PUBLIC
15201 NW GREENBRIER PKWY EMPLOYEES' RETIREMENT FUND
SUITE A4 11410 SW 68TH PKWY
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503-207-1839 PHONE:
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/17/2016 $328.16
12%State Surcharge-Building 10/17/2016 $39.38
Type of Use: COM Plan Review-Fire Life Safety-COM 10/17/2016 $131.26
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 10/17/2016 $14.00
Occupancy Grp: B Height: ft 11x17)
Stories: 3
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: No Cut Sheets Required: No
Total $512.80
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $23,228.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. .0 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until col.. eti n of the project.
Approved plans are required on the job site at the time of e- ins; tion.
Building Permit Application
?ire Protection System " FOR OFFICE USE ONLY
City of Tigard Received
14 V.
Date/By.:...... Permit No.: ,
13125 SW Hall Blvd.,Tigard,OR 97223 016 v` 71.: �/ a�[7Gr�---l147j
C� � � � Plan Rei ; 1.
Phone: 503.718.2439 Fax: 503.598.19601 Date/By:f r Other Permit:
TI GARD Inspection Line: 503.639.4175 1,'(':-4.1..\1-11.d. Date Rea. ? `'�\
t •Y. Iuris: See Page 2 for
Internet: www.ti and-or. ov ',...)$;,415.014g
g g � i e � �� �t�i �' Supplemental Information
' �
❑New construction46' ❑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
4 kr+ ,y' al ` 4 — -+ work indicated on this application.
1-and 2-family dwelling ®Commercial/industrial Valuation: $
El
11:1Accessory building I=1 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
4` j * � mF �7 °' ` : Total number of floors:
Job site address:11410 SW 68th Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Oregon PERS replacement Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
aii '1 1 t nl P .''mi
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
equipment,' rmaterials,labor,
overhead,and the profit for the
'6 1!B c oN* t work indicated this application.
Replacing fire alarm,device for device. Valuation: $$23,228.00
Existing building area: square feet
New building area:
square feet
� 1 ,cf 'I , , r- ,- - Number of stories:
Name:State of Oregon Type of construction:
Address:11410 SW 68th Parkway Occupancy groups:
City/State/ZIP:Tigard,OR 97223
Existing:
Phone:(503)603-7615 Fax ( )
New:
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
LJ� :� i' I� ;7(cj.volesky@siemens.com
, t , , ' �, 1 r"F-
p 'r ' ti r 1 --'4� - -' '- Jai : ` le- EU Lpi r m ._ i r.
° K-i ° iib �- ,'-:-.7F-''''';,1'---'
� �^
Business name:Siemens ° r �e/er` e' �c ,ii
Address:15201 NW Greenbrier Pkwy,A4 Permit fee:
City/State/ZIP:Beaverton,OR 97006 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)207-1900 Fax:( ) (Due upon application submittal)
CCB lic.:133041 Total permit fees:
{ Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:CJ Volesky Date:9/15/2016 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitA.•_° 4 doc 440-4613T(11/02/COM/WEB)
• City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
f Wflak ,. = -f ,b-
1.) Typeo2.) Addtan/alter�"ation only to�sprinkler
heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices:
Addition or El 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.
A) r R �r � r
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation: $
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 23,228.00
=� +,-
1- esidoti`1 `tpr1 1
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45 ` �� 'ti `�
310.05
3,601 to 7,200 $ � '
r
7,201 and greater $404.39 '11j -
Sprinkler Project Square Footage: sq. ft.
i�i l iw` 1w
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\44op-197719 PERS\Permits\FPS_PermitApp.doc 2
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
11410 SW 68TH PKWY, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
October 31, 2016 at 5:54:59
PM
FPS2016-00163
Mark VanDomelen
Violation Summary:
Inspector Contractor