Permit (28) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00052
-FE Gt+ RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/08/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9522 SW WASHINGTON SQUARE RD H07
Project: Pink Victoria's Secret Subdivision: None
Project Description: Fire alarm for TI:(9)devices. Lot: None
Contractor: SIEMENS INDUSTRY INCOwner: 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
05/08/2017 $134.48
12%State Surcharge-Building 05/08/2017 $16.14
Type of Use: COM Plan Review-Fire Life SafetyCOM
Class of Work: ALT Type of Const: lig - 05/08/2017 $53.79
yp Info Process/Archiving-Lg$2.00(over 05/08/2017
Occupancy Grp: M Height: ft 11x17) $8.00
Stories: 1
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: Yes Cut Sheets Required: Yes
Total $212.41
Valuations:
Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $5,630.00
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 4 ct question + OUNC by calling 503.232.1987 or 1.800.332.2344.
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ik
Issued By: / Permittee Signature: �.
Call 503.639.4175 by 7:00 a.m.for the next available insp=ction date
This permit card shall be kept in a conspicuous place on the job site untii,comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fjre Protection System
FOR OFFICE USE ONLY
City of Tigard _ Received 4 ,
Ill a 13125 SW Hall Blvd.,Tigard,OR 97223 DateB : �� Permit No.: . J�Ly! �_ .,:F -,
Phone: 503.718.2439 Fax: 503.598.196FIECEIVEPlan 12Eviewars 1
TIGARD Inspection Line: 503.639.4175 DateB : OtherPermit:� .
Date ReadyBy. `
www tigard or gov APR 1 2017
Notified/Methor. 3 /7 ,,,,,,,;,/‘ n See Page 2 for
,� Supplemental Information
Internet: x,/
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`nim ° Its ! w; h`, y a c c.> 41//,,,,roilI�u�/ +. F," q�. /fl fi,. . .
New cons 44° ,t u ., 4.
^_ p/%;//,„ , p°a D ., �.tal11y i ,/sem. /.., ,'�.,
❑ truction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
EI Addition/alteration/replacement ° Other equipment,materials,labor,overhead,and the profit for the
r work indicated on this application.
�o-e�'. � iii.; nu <,.. ���,,,.,
0 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
El Master builder El Other: Number of bathrooms:
t
° ''. . }a, ,F .�.. r , , �, ., 4 t s s �� , Total number of floors:
Job site address. ' :5 SW Wash Square Road
New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223
Garage/carport area: square feet
Covered porch area: square feet
Suite/bldg./apt.no.:1107 I Project name:WSQ Pink Victoria Secret
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: 7./1 t 6 i i'`
ILot no.: Permit fees*are based on the value of the work performed
ax map/parcel no: Indicate the value(rounded to the nearest dollar)of all
d �� tf n.ft� " +b •.a
equipment,materials,labor,overhead,and the profit for the
,,,,,7111,4,47:
r,° work indicated on this application.
Tenant Improvement on Fire System at Washington Sq Mall store,Pink Victoria Valuation: $$5,630.00
Secret. /, 1�y,,� ✓- 7 Existingbuildingarea:
1, square feet
►r , s ;
New building area: square feet�� " P^ i Number of stories:
Name:Roger Ott
Type of construction:
Address:9585 SW Washington Square Rd
Occupancy groups:
City/State/ZIP:Tigard OR 97223
Phone:(503)352-8862Existing:
Fax:( )
r:44u P< u N l'''''' �. ° rh N"I. New
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Business name:Siemens v ° ,9 t .: Ai' , s�^'E `",
All contractors and subcontractors are required to be
Contact name:Moses Frangopoulos licensed with the Oregon Construction Contractors Board
Address:15201 NW Greenbrier Parkway,Suite A4 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP:97006 applicant is exempt from licensing,the following reasons
Phone:(503)207-1834 I Fax: :(503)207-1834 apply:
E-mail:moses.frangopoulos@siemens.com
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Business name:Siemens V� , a� u' ri < *17,1,-..,L,, � "'/''���� rr
Address:Moses Frangopoulos Permit fee:
City/State/ZIP:15201 NW Greenbrier Parkway,Suite A4 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
/ '/ (Due upon application submittal)
Phone:(503)207-1834 I Fax:(503)207-1834
CCB lic.:133041 /: ‘ /?
Total permit fees:
Authorized signature: Amount received:
a
Print name:Moses Frang �� Date:4/18/17 I withinThispermit 180 daysapplication after it has expires been if acceptedpermitis asnot coot mo
* Fee methodology set by Tri-County Building Industry
440-4613 T(1 1/02/COM/W EB)
I:1BuildingTermitsWPS-PermitApp_031016.doc Service Board.
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•City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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41
--t— l: .— ': -11,401,,-um . i'n �: am....,m ,
— I r o 1PN a � :L1,1 Tim :� �1 _r1 PILII a 41 '� E , ; � ,u ° m00 ,
a' �• r ,n - idxsc. �N x� a .,±, 4 ^AH' m , _ " ,4' . f'irf 1u : n ',r �1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.)Addirin/alteration
only to alarm devices:
❑ New system Number of sprinkler heads:
Number of alarm devices: 9
® Addition or ❑ 1-10 heads: Affidavit required and
Alteration ❑ 1-5 devices: Affidavit required and
(3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within buildingstructure
system of work within building structure
❑ 11+ heads: Plan review required and ® 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
' • � r j i a 1 -7440-re
,, . . . g1e n u 4444].-043144:P 'r N AIN." " ^" .. 11a :'' t" �P1 , r, ry7.40-44,a44v1,40.�Y ' 41A7 44 714 6 :^ e:qN !1 "11' , .,qr
,;. > 1,1,,„ ,�i„ NI vl 11,4 Pu.. , 11 "; 1N I 1. lluhJi P mn 'uP t1 N
Additional Stand.i.es ❑ II 4
Wet ❑ D
Information: inammignizzimm
El Yes ❑ No
Hazard Grou.
Densi
Desi. Area
K. Factor
➢1 ,rinkler Pro Sect Valuation: $
pi '' w [, a 1 1 ' � S!
a '1,4, til 0 . . 1 ? Flood Pro'ect ,. 1; ;P, 11 `I r Iw' 1 ; - .
Valuation: $
ham+, ".+^` , y v v a '4„ 1 3 FIs il� 1a 11 i law.4 10, ..r
II N� � r1 I _
44
.r.: _i "F, I C, _':`f 1 ! VII 1 P 1'44.11 iY�11 q 1 icy, '4',A.111121111111 IIP" rll NI <s 1 r ' 1 "I f lilu+ra^ NI: vN
ki(qP N '9 ® gas :' "ate V + .'4111 `� „ �e Ire ;.�:,9 1 r^W' h1,,. „on w 1 1I,114,1 1IN,.,� 1 ' �"'t:i ' 1,1�+y'd 1 1 11 ,. IIk'�l
:. ," :1"p .., (1::�: ,, Nlr �"A ,,I I h '. i :1 1r§:1 1i r *1 11 1"*',` 1�" vlr 111'4611'
lid iN� ,fder N j f,10'1, "�1"„L-14,1041,4114/4.,4```I.
Submittal shall k1. "�, 1I1 11111 u:+ a1 V41' 11
Batte Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Pro Sect Valuation: a��-�=
,c Pi�;; • ,�_`' .-1 ',p j1,1T G:' 'I'�, i! !NhGv, r 1. o°¢re m1" 1-` PN II 4 p'�i" r llldl ;.. V p. °. ' uvt,°r " 9iZ7� ' T� .;
e r,•� z ,'-A"'': .0 w1'v c- 1m., ` lX 1pi, 4440" V1 ll' 111 P441 ^,iv rPV 11
"ji 4 . J, 4 '�j1' ti' y Jil �l'"0","44,14.� .1,. . m ^ 1r: q1 1 rl � BII uta N `I' V� VV 1''' { 1,ice:
::�i. I . ,r ` v X ' 9 A 1 • .11,r va v^ ,
,.:"u+ ?.�...:'u, 1 r 5. d1 I 11 .x1':11 111 �r' h1 y4-11,441.1)„,, [Avis a ile i
VV. �IIIP 1 1 l � � ' k li , 1 j1 II 1 :19
S•uare Foota•e• 004 44
_ - ' Permit Fee: 1 X11 fit -4.0.4,44_ 11
0 to 2,000 11 , ,i
$198.75 111 111 N ", vs,,1 11
_ 2 001 to 3,600 oia, • 1 111,1 1 111
$246.45 k1 Ai;, 1m IN 1,1 1 1l.. , 1 p . 1 ,
3,601 to 7,200 $310.05 "1 1 kJ
7,201 and : eater $404.39 illi
y I 11 p IP I 1 1fi
,1 1 ,l1µ II 44'144,.4140
11!1 11 II 110101II 4i'. 1 1u V° h 1,t
Sprinkler Project Square Footage:g sq. ft.
u a
47111111
< c 1 !r ,' '°--� .r�+:':':� .- ,'- ';�� 1,, ,� so 3 a ' 1 a„ , rll '+:iPq p 1m: IB pl wx
'1,047 1 1 ".. 1 v1 r N o,::14.. w • '1 11 pv , ell;
, 1 Nat'1 Il.. A. yu 4 ly. o SIN ,,
Pro'ect valuation subtotal see A,B &C above : $ W 44,7'00-'1'
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s.uare foota•e see D above : $
State Surchar•e 12% of .ermit fee : $
FLS Plan Review 40% of.ermit fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sew Projects(Charles Hughes)\Open Projects\_Mods\5200535285 WSQ-Pink Victoria Secret\PM\Permits\FPS_PermitApp.doc