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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT �' } Permit#: FPS2017-00095 COMMUNITY DEVELOPMENT Date Issued: 07/13/2017 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 000300 Jurisdiction: Tigard Site address: 9710 SW WASHINGTON SQUARE RD F01 Project: Untuckit Subdivision: None Lot: None Project Description: Fire alarm-Adding(5)notification appliances. 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 07/13/2017 $123.72 12%State Surcharge-Building 07/13/2017 $14.85 Type of Use: COM Plan Review-Fire Life Safety-COM 07/13/2017 $49.49 Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 07/13/2017 $6.00 Occupancy Grp: Height: ft 11x17) Stories: Info Process/Archiving-Sm$0.50(up to 07/13/2017 $7.50 11x17) Hourly Building Rate 07/13/2017 $180.00 Commercial Sprinkler System: Hourly Building 12%State Surcharge 07/13/2017 $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: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $403.16 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $4,636.00 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.-- .• , OUNC by calling 503.232.1987 or 1.800.332.2344. Issu-d By: Permittee Signat e: j i 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. R Building Permit Applicatw ; Fire Protection System FOR OFFICE USE ONLY Cl Of Tigard 1,; i j r� 1 Received /_©��� th7/4/7 � . ✓ g l Permit No.: III ■ 13125 SW Hall Blvd.,Tigard,OR 97223 DateR Plan Review Phone: 503.718.2439 Fax: 50 X48! 6 t 1 a Other Permit: �' !U S- �_ ti 1� Date/B ,ex T I GARD Inspection Line: 503.639 4175 Date Ready By: Juris. ® See Page 2 for Internet: www.tigard-or.govp :1•/.1‘,.,:i _ $,�z- t € Notified/Method: Supplemental Information +71 1 I�� �¢ '? N':I�"� II IN w,.. � 1iµ ��N,,. Iµt,l ri M, f �r ;"wlhlV.:;',,,,II Ila Lil1l' ",i„ts sw�,zz"'w.ra ,���lil': c�"4W IV N r�x. aV"""m'P;f� ru^ ^„x wi111 d ..m.:, ” I• r4 "t IlR i lilt .'� s W a ,{ a ` ,.Ik :: x, u C fit I,r' „,:,,,,,,,,,,,q,..,,-. HkIId i�kN !i 1 I'" "`i; °11 v �, ��.w �`' � �vv,,�.: ,.„.:.:"ssu �,„"''� IHI 1a I i+>�Ifivt, .;4N.I1pr�„ ` �.Ar„. .7•1%.11,,i; � s�.�- -.�i,.8�^t���1 • <.�i�”"•"'d l t �tl"la�o'+. 0 New construction 0 Demolition Permit fees*are ased on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all El Addition/alteration/replacement 0 OMer equipment,materials,labor,overhead,and the profit for the I� » v�"' t", 1 ,�. IIN :ala a k�u4�lN #t wu91i ,,..i.414111,1, ��I, i a >� r o S s "p N ; ,lu' work indicated on this application. ,'NI• ll .+' ... 4r ,<.i dl l..... tia' '1 .a ...nv"�Ii1YM�w,a .wNa4���1��..'�_... ❑ 5';---/and';-family dwelling ®Commercial/industrial Valuation: $ 0 Accessory building ❑Multi-family Number of bedrooms: 0 Master builder ❑Other: Number of bathrooms: �Iy ''*--44111:0'8,P ,u.l hi 9W ��.! i� o ��1 Total number of floors: 'Ct,u. r>�st.> . ,����rywa.�t�4S" id � � 4L,rea ..." N" Job site address:9710 SW Wash Square Road New dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.:FOl I Project name:WSQ UNTUCKit Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet 111 lY ,.r Iy.II ay. , �S ,y =} t i ^F �� I , �:'� t��i s P II I"I7 �u i „�l,pt s �1' .. 2'�"��+'��",�I.� s,""�MwI„ 1 I NI aM : _�I 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 Spl equipment,materials,labor,overhead,and the profit for the rx px" 1k .:I I " ,a atl ft r''',Iggl a N u�I I:'',i;4„,;.' R,. i;a i „ ,R ,, ",I1 'Ib i''' „" ,'''' I qll ?IIII'tiIy work indicated on this application. w ,u•. �.��as„ . a. l'"-'''''''''Nll I., •� Il mn.,. Tenant Improvement on Fire System at Washington Sq Mall store,UNTUCKit Valuation: $4,636.00 Existing building area: square feet New building area: square feet e. }a �� 'Il” Iq °IG r 4 d a - ,,111 � . a ,_. ,.. I Number of stories: qu;," „1„,,...,,o,,,,1,11111„„1,n, , . . :'�, 'I” , ., „apt r” :: 1 ,I,a •a,: Name:Roger Ott Type of construction: Address:9585 SW Washington Square Rd Occupancy groups: City/State/ZIP:Tigard OR 97223 Existing: wPhonFax ( ) 66 66 �,. ,.. New: e e:(503)352-8862 I' ia k»w k,,,,,,‘„ ,.,,:s:', 14.: `p� *' 66,661,10/11,6,,,,,,A,.6=,;.,0 �l i0 it g..... ,•_ .,.. anw*a&"t. atm „.'MP Ii �d1a w ® „ ti £i. MlotlR..l.sa.. , .4k" ", YMg.x$.•w alai'n''''',4:1;1)1°:17:1:1:'4101-,4".4,''''''i r.,✓,} a4 " 4iz ar. V `. Business name:Siemens All contractors and subcontractors are required to be Contact name:Moses Frangopoulos licensed with the Oregon Construction Contractors Board under ORS 701 and may bei 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)207-1900 E-mail:moses.frangopoulos@siemens.com .. "d r 111 RFu• , :.s�:. 5 .,.,61,E N 9 R r+ a . ,�,,, „ t a u4 " I ,w�a '�' . „xil'�' �+?�u��tiIM �IpI iz 1 1 G � ` '�'J �” "1 � r 4�Vi h � a � li w r Business name:Siemens tl.11uVul ulwli 7th ^4 .„ r 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)207-1900 (Due upon application submittal.) CCB lic.:133041 Total permit fees: Authorized signature ) Amount received: f ia pe Date:6/22/17 This withinpermit 180 daysapplication after itexphas beenres if acceptedermitis as coot mo obtaind Print name:Moses F ngokoylos * Fee methodology set by Tri-County Building Industry Service Board. 440-4613TQ 1/02/COM/WEB) I:\Building\Permits\FPS-PermitApp_03I016.doc 1 City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information --V'' I w w{r le *:T "4:t a 5M o,o,„ ,,B , I I sY 9'1;I �?rS ill� Gdr b ',,.. a Ip„ ,r �_��:du rIOIrr . • „",.. Y 1 ti. ' .-. '.: 4';us' w ,r x•,w: l ��Ir " yJi�:,r%Mr .Il f r+: u':a:«,,I NI, ? ',,'u�d+'I�II�,, harM ,.'''6'I�Ca 1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices: ❑ New system Number of sprinkler heads: Number of alarm devices: 5 ® 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 El heads: Plan review required and ❑ 6+ devices: Plan review required and (3) sets of plans. (3) sets of plans. Additional description of work: °d R" m pN v ry a lilt q!'!n {d s 4 Y a * 4 1 I : ' 'tll 1 J, o E • Arif �, . F �rI I�yl?I 9 ud �4 - W' lea�4s 1 . iv. tt^r I _ 01,,P »� {,.,-: r k,h dc4.,IINNuLA Y w z'v.�' ,. i .'rr IL �, z t ',� , Im li I *s ' PII,a '2,':':-.:;:1774;';t1 , ',"F' ,& �I�,IIIr, h `— .f",.- Ty a ap ii Ih ti �I � ^r�� �: IV°d ��'v,,,,_ � r��'�'nM r�r E��_�4 -�' ,r e '"V,t,.. 1117 :�ck4r dao a�, S.rinklerTpe ❑ Wet ❑ D Additional Stand•i.es Information: . .. ❑ Yes El No Hazard Grou. Densi Desi• Area K. Factor S.rinkler Pro'ect Valuation: $ i • •I"aI° 6 ® Q h .w ®.. x u�}/'� i. .may , Ifi � S{G II IIII II 71.1P....71,*.',-.-a . % .. ' Vulutnn,L_ o ,x'SE n ,I" ! .. r ,i.;�,.auFo-. ,, ,xu �I,i' ...a.�w 1IaU�,�1IIJvV',il, „,.. a „,,,„,,,,A4� { .as.; .IPorI Hood ProSect Valuation: $ �f�rr Ilr� °�r n•,..!1:111111111,11,,, I q I{I } �°fisk.; C11,1'11 I u ��;��P � r1 I , o- ,7.,...''74;:A, � � 1,1„,,,.,„, h 1'I ,„-' 2° -,1�VI ;G w' I. *, '�N ll I4 v > r,": rxs eI IIIiv .. (IIII IIP�IIkx'- ``'.-44=' wl IIBrIHhp✓"'" 44A °I AAA, r.r«rirP ys RIII d f Ir4 �. ...k * �'� h d i' ". ...,d I I "P" -IN�'1,',4�m4 * . r .�: '4,,..>,I d.. .�.: „lid ,h'1,: x, l! 11 r - 'bs'{r III r�urs�.,01'��G� � d�I u,'I� �� �� III hi� „'4.,,:„;.:,.. `� u r� I �. c Submittal shall Batte Calculations ❑ Yes include: Individual Component ® Yes Cut Sheets Fire Alarm Pro'ect Valuation: $ ,laA '-+'- 41ItiIIl Ir, {4(6611,1 her {a a VhI^ I ru k{” ilk II IVI„lk 4tl�Id"47'�,P d ",TPL1 9 � ; '. uh� , _, n . i4?F= :,: W I '#"A,? � I, '',A ".A 44-,A h 4�' 4,IIII I'm!, d r �I r { 4t, Pae” pya �9 1 t 116I '`� 7f '"s- IIM� �r iI��,I h�"f� 0.II j h ';A:44— ,.':,1, II At,- i i r IC �hp r� F.1' ,15R,l rc,4di ''11"41-'--L 3 auC t 'c4 r q"11ll1.A.r l a „^ ....",„„),111,4,1",,,,, ,,' r i .' �ti .,.al. 11ilh0rl w Ila' "^p,m _+. a.:}�'•s� yr 5 Ilrl 4I �I"�f S.uare Footage• Permit Fee: � ,A4141,:1114 � �� � - � Y- F���� ,', IPIII�ihl 0 to 2,000 $198.75 I,^ ''�', r= . ;,: 2,001 to 3,600 $246.45 "Pr ylI d ,, " '14, lI tlI III Slp rIV h r '... � a yr Ij oll rilillilll II z � ; 3,601 to 7,200 $310.05 11hla VI:IuIII 7 201 and :reater $404.39 3 rIa • hII. 1u'11IIIIII(IIII IIF,^ 4 �i,adtll lwSIIIW:IIa,..rsy` Sprinkler Project Square Footage: sq. ft. 1 111 . �iaa �kfrL Ia4 Lm tiv ",w -'' ' r '�I'dMt.IU1 6y",, ' I�,rI 11.` •r �'%47,,•�,.� � ii Pew:.,,. I Ii,W=, > .Id I M:I iI�Il�p a�VM1IPi. -..- ,. "i_ 1, .f�4�Im' „. _ ati: PrO'ect valuation subtotal see A,B &C above : $ Permit fee based on aro 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\_Mos\5200554303 WSQ UNTUCKit FO1\PM\Permits\FPS_PermitApp.doc City of Tigard Permit No.: r%�j �'!�('d q� III :9 13125 SW Hall Blvd.,Tigard,OR 97223 n,I�/1 2 Phone: 503.718.2439 Fax: 503.598.1960 Date Received: M Inspection Line: 503.639.4175 „ n p 7'GARP Internet: www.tigard-or.gov By: (�{,GE��jj'I�^�'►'/ FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (MAXIMUM OF 5 DEVICES WITHOUT PLANS) Project Name: WSQ UNTUCKit Occupancy: Job Address: 9710 SW Washington Square Road Suite: F01 Contractor: Siemens Industry, Inc Phone: 503.207.1900 Valuation of work: $4,636.00 Type of System: (check one) ORequired ❑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) /To be Relocated(max 5) Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5) Number of Proposed Notification Appliances: To be Added(max 5) 5 /To be Relocated(max 5) I, Moses Frangopoulos w/ Siemens Oregon Construction Contractors Board No. 133041 certify the following 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. Batterysupplies are capable of supporting the system modifications. g) pp p pp g Y 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 sys m permit. • Electrical permit. • A copy o►t is docu nt ith a copy of the sketch attached shall be available for all inspections. Signature: ___ Date: 6/22/17 Print Name: ‘Y4•-' _ rangopoulos I:\Building\Forms\FireAlannAffidavit_071514.docx Page 1 of 1