Permit (34) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN s 11
COMMUNITY DEVELOPMENT Permit#: FPS2017-00064
Date Issued: 06/08/2017
T(GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 000300
Jurisdiction: Tigard
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: None Lot: None
Project Description: Fire alarm for TI:Adding and altering(30)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 06/08/2017 $188.28
12%State Surcharge-Building 06/08/2017 $22.59
Type of Use: COM Plan Review-Fire Life Safety-COM 06/08/2017 $75.31
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 06/08/2017 $6.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 06/08/2017 $9.00
11x17)
Hourly Building Rate 06/08/2017 $180.00
Commercial Sprinkler System: Hourly Building 12%State Surcharge 06/08/2017 $21.60
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: No Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $502.78
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $10,438.00
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 q tions to * N -Ilin• 503.232.1987 or 1.800.332.2344.
Issued y: ,I� Po A.,_, / ' Permittee Signature: `) —ii
Call 503.639.4175 by 7:00 a.m.for the next available inspectIe0ate. J
This permit card shall be kept in a conspicuous place on the job site until completio • 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
Cl of Tigard Received `
`5 g fir /7 Y►lI Permit No.: 1` 1 "
DateB
13125 SW Hall Blvd.,Tigard,OR 97223 +- -r+" Plan Rev.-.1".-_ ,
1114 _ Phone: 503.718.2439 Fax: 503.59 y Date/B : ,lit.' Ira Other Permit:iJ
TIGARD Inspection Line: 503.639.4175 �4C - Date Rea. See Page 2 forte
Internet: www.tigard-or.gov Notified/Method. �s 7 *-ii Supplemental Information
g. t" aACi\ ,
1 suHa" ,I, `i`., ' ,,.' `. '�I flb"... °ut um ..,,:- �r, zw£,%".:: Ilqur;l" I' a" .»' <Ft . ,. :^N. „4, G", ; . u'if�. ii [o 1I�i1�)r
.xuC 1 aw..... ,.1 I ..x, _yam 1f "�5` 4arl,ll 44".. d, 3: a �3,,,1, 11 1 :u KK ,� t ....41�
i! t ., i rt r oft ''"'"°"G + n �rPermit fees*are based on the value ofithe work performed. ,
❑New constructionformed.
11 - �^ ,SI
�y. Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement !I ' $ �E la i 'j equipment,materials,labor,overhead,and the profit for the
Rik
�'�Ii,�I� ,I . i,i( : w ,p i j i I1 I I f-r,II I " work indicated on this app lIca tion.
❑ 1-and 2-family dwelling Z Commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
. 1 III y `� r tl '
l Total number of floors:w ,,14,00w,'"' „4'''''' Or"m9ni tit l d r.,,,0„'7140'47'.:0 " 4'x i
Job site address:9591 SW Wash Square Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:B10 1 Project name:WSQ Victoria Secret Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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
,I , 1 equipment,materials,labor,overhead,and the profit for the
q M n „ as �`' .. .. E., qr` "�# %10,1;1N,9a I� A" IIID'.
tai& .ANit ,.� , t „ ", ,,, . I1t .. — work indicated on this application.
Tenant Improvement on Fire System at Washington Sq Mall store,Victoria Valuation: $$10,438.00
Secret. ,'y r i iot yvl
Existing building area: square feet
$� 'r {, y-f3 } !lily New building area: square feet
.� '" , t ,.,t0 ' 1,I r41a4 tidl, ll` 5 G , i'l'p �P14 a Numberofstories:
d .._„a un111.�s�� VI/ RIS 4��it I�"a1�`
Name:Roger Ott Type of construction:
Address:9585 SW Washington Square Rd Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
Phone:(503)352-8862 Fax ( )
New:
. Y. a. k ' l . I `
s
441.1., t [ 1 r, ` '13)14 � 1 0) ®mI. s. a1 s . . IIa l°J *"rid '."'" I:4" l �, 1 ,. I,t �t , r. r . . .n, ,,v ' r adaa I ' s ,x V,m _ .,,,L. a , .BnenmAll contractors and subcontractors are required to beusiem
,,.
ss ens
Contact name:Moses Frangopoulos licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:15201 NW Greenbrier Parkway,Suite A4 jurisdiction in which work is being performed.If the
City/State/ZIP:97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)207-1834 I Fax::(503)207-1834
E-mail:moses.frangopoulos@siemens.com
11,
'y '11V u V
,uG6*t, " x• + � 1 'V � ty �aJk."�r::111: S01 f16x '700k11:1"fi"a4-4:0000-40111114I1
, �`r �lhGl�` ' s ' a '44:4'0 • � � iiill+ ::
Business name:Siemens
Permit fee:
Address:Moses Frangopoulos
State surcharge(12%of permit fee):
City/State/ZIP: 15201 NW Greenbrier Parkway,Suite A4
FLS plan review(40%of permit fee):
Phone:(503)207-1834 Fax:(503)207-1834 (Due upon application submittal.)
CCB lic.:133041 A —,_ Total permit fees:
Authorized signature: /` ✓� I Amount received:
This permit application expires if a permit is not obtained
Print name:Mose rangopojos,- Date:5/15/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
440-4613T(11/02/COM/WEB)
I:\Building\Permits\FPS-PermitApp_031016.doc
ti
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
A. I4r , m1;t,, ba ?tta r ssSsyy 5,,•_w�- •W 111 tor:Ti I l e""*" _ lano alarm deviceY'"'xYds...,:1) Type ofWo�rk:11" Addition/alteration only to sprinkler heads: 3.) Addition/aionly
❑ New system Number of sprinkler heads: Number of alarm devices: j4J
® Addition or ❑ 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
0 11+ heads: Plan review required and ® 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
111 _- .: +" ' jI+' v n a>• •, z _ - - -: zv.
a ° ap k e`$?X a iii ��� �.,�i'C a u�• � d tI �i � r�. Fes`-=.-
YexrC
I� a IYI � I
i C 6 1 41' �! '� @:� e�� N r
I�. ❑ Wet ❑. D
Additional Stand.i.es
Information: . .. ❑ Yes ❑ No
Hazard Group
Densi
Desi• Area
K. Factor
S.rinkler Pro'ect Valuation: $
mJ' f ,. 9 P�
it. i�' ^ Tawe" ,N i�; -,�,:. ,Y
%1 thm .11,111 x,fir. .ww..... . ......:, 'sr'x__
tion: $
Hood Pro'ect Valua
3'^T*a. yre
ve a..�,..I
Submittal shall Batte Calculations ❑ Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Pro Sect Valuation: 7'
:.0 �wb9 . . . �'�yp 'ar 3^ 7.1 41 .£ m Iii MI', ILII "x I. 8 �i -;mac a!�?y+Y
S.uare Footage: Permit Fee: +'k �;
O to 2,000
$198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 I -;" 11
,•
7,201 and • eater $404.39 .
Sprinkler Project Square Footage: sq. ft.
�"`- r tit"'; �� ,I
Pro'ect valuation subtotal see A,B & C above : $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s•uare foota•a see D above : $
State Surchar.e 12% of .ermit fee : $
FLS Plan Review 40% of.ermit fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mods\5200545388 WSQ Victoria Secret\PM\Permits\FPS_PermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9591 SW WASHINGTON SQUARE RD B10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00064
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9591 SW WASHINGTON SQUARE RD B10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00064
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor