Permit (72) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I '- COMMUNITY DEVELOPMENT Permit#: FPS2017-00128
T1CC3ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9504 SW WASHINGTON SQUARE RD J02
Project: Tumi Subdivision: None Lot: None
Project Description: Fire alarm-Adding(3)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 08/14/2017 $123.72
12%State Surcharge-Building 08/14/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 08/14/2017 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 08/14/2017 $6.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/14/2017 $5.00
11x17)
Hourly Building Rate 08/14/2017 $180.00
Commercial Sprinkler System: Hourly Building 12%State Surcharge 08/14/2017 $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: Yes Cut Sheets Required: Yes
Total $400.66
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,512.00
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 qu • ns to •. C b calling 503.232.1987 or 1.800.332.2344.
Issued y: l / � Permittee Signature: i I
Call 503.639.4175 by 7:00 a.m.for the next available inspe ion date.
This permit card shall be kept in a conspicuous place on the job site unt completion of project.
Approved plans are required on the job site at the time of each I •• ion.
1s41ildin2 Permit Application
Fire Protection SystemFOR OFFICE USE ONLY
City of Tigard 1 Received (y 09,01, �Q/pZ g
OR 97223 ''....4. DateB :
13125 SW Hall Blvd.,Tigard, �' Permit No.:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ^tiG 1 4 2017
Date/B : Other Permit: 0 I ." �
h�
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for II }Internet www.tigard-or.gov � IpNotified/Method: Supplemental Information
BUILD(N �AHL)
1BVk7::*;'..''.'� "111O �1OI I Oki 4 4 d h°4 ( ...a {�»o R .Q lsl A 1..... ;k.»i."tV CirI
t h
.'.v1.. ",k . . ,. ., , ry1xa , a^ r... ? '' ).,..,A';:':,.,:. :i 177,7....., 1 J'N .I =n,as»N. _ .,1iF
;.
❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the
t.. i .ACO0i� �t . �TG �� 4 �� t' � ""twork indicated on this application.
❑ 1-and 2-family dwelling Valuation: $
®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ElOther: Number of bathrooms:
YiiIi, MITE MDLOCATIOe
Total number of floors:
? ,» « v
Job site addressW Wash Square Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:WSQ Tumi Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
IREb IMA M
OJ Raw -U KLIS1
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,materials,labor,overhead,and the profit for the
! r11 ul+ 1 r14 1 1 1 upi1lll:0�' ,
�i+ VOW�ht ` ,SII `f � � � '.dl'i 41,11, III � I,�� r.` work indicated on this application.
..� .x,<'' s, .."i0;,E�' � �n�gi ," r �^'I ,i`. . +V"1V411 I�:;. .. ... ."+ 14 ,
Tenant Improvement on Fire System at Washington Sq Mall store,Tumi. Valuation: $4,512.00
Existing building area: square feet
New building area: square feet
^"11 �� I I 1 � 1�, •.I,,q1�,
I p; T�f S M R ,III N"A :` Number of stories:
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:
,� r`r".,I I ,iI. rr IVw� II r ' ('+. . . IIIA ". ,� 1 If1 4 V'p`�I� 111'1'4.4
, Ill��� .�t�1��' , .. � 11 :r.�. TPERSQZ^M�111 6 1�11,1 1 i � 1 � I
M � rP �..��. . 1 v ;.. »»� 14�111'1V h {� ,� �, r Il 4u i, «�
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 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 Fax: :(503)207-1900
E-mail:moses.frangopoulos@siemens.com
' , § ::7'rte r « «'tQNT CR€ o 1 ' . svtiMI PERMITIEEE
1
! .:, " . o »:tl .3- ».. ",u +,5r I :ti' "a > 1 . � p" . CfusetdeecectrCe
t
Business name:Siemens
Permit fee:
Address:Moses Frangopoulos
State surcharge(12%of permit fee):
City/State/ZIP: 15201 NW Greenbrier Parkway,Suite A4 0
FLS plan review(40%of permit fee):
Phone:(503)207-1834 Fax:(503)207-1900 (Due upon application submittal.)
CCB lie.:133041 Total permit fees:
/ Amount received: er•
46
Authorized signature:
7 This permit application expires if a permit is not obtained
Date:8/14/17 within 180 days after it has been accepted as complete.
Print name:Moses Frangopoulos * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
ir t
' City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
� ,' �` �s -F� III �.
D sCri�3 'f3 o be( Ole
• 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: 3
® 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
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
•
Po'.I4JiV�' ';{P+'"o�i ,$„"r mrfr�1l ♦ VMI 1.'I'. ?,giiy�dl f,�'n 3+ll�ll yl - y lull��rlNy ,,;9, d�O: yy,�l1� ' v'er i 8P"r[gm1 F I:I ,
II IIN 4Tv,�•. .u" ' ,,, �t.r �.....--'::,',--4,..---4:,,,,:r:::.--,
. r! :.,,<. 0 l ) VIII Iq r '.,r N✓'I !k; II '4I:'�4 "' fI Nl+r,,,.., i �mN ',4,, ""t
_ ,fir@;1g r � I;Nb';i`�u� p 11 I�p,. qT = h,r-, ly ul IJ I dN 1'", '4 u. '-4y
pill .k,`s l,1!11. 1�,I L',1 I1 I+�'1:r- 0 .:'✓:'; N"�r'y+ ,{d; y ,' NPI, IIIIII "',`+II IyCPII II ,. IIICII{III to fi=x K=
is ,g3.I .,µ�qaa� „.....:i:,:,.40101..-1:--.�--- rl J Ily� II ghy ..•h r 1,-;,'l7� ':'� „,,,.7-,--..-1,:r•-•:, •---b j„ 10'11llllll III 0.01..1..'"!' E a-J I >;
” IyA •rY��' ".�u,:,!lll,y� q u„ .: Ily o t 4,a .§ *
oae e® r 500114. le III�YIo` ' 1111 s
�`—' ,II,Ip�. +N"„ {;,:E..dIIVPIJ ty,, .Nlltlu IIVry'�. '.!%:,;!..011!1111111,1!!!!1,',.,:',...1 ....4..,..-.,-.4';...- o IIJII ,� ,� 1 ,, 'I Fri , f"�`1;" 'v
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes CI No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
I� I� •� II„I I �_
yl� �5 r � �,. II��,, ` ''` "_IIdp1 ;"'4' _c......,#,..,..4-:,:,-..,”
IIr I• — I�d� II��--. NI Jd,'�-� b, nr,` •,:,,,::x."7::...,:•:",::::::::::,,,-:
b Sw " JI ..
Hood Project Valuation: $
{fI IG14e'�4 � .,�•� � � J1 .,oz I, s -
•
M
Id1VI = ,ra '"y 'Il ; , III , I _& II ,„11 ' ,n i }P ,i,-,J,::011,1,:,!:!,:::::,:-@ t * _ IIIIIII Iy11 1f e I II
6I�ir;` k <= hJtIII Irr y„ r �- IIII1: , 1111IIN :01 I ,' •i"I :�III IIII hN aI ' IrIrh:AF', I , P' I _ 11 ;401F�re . . 1 4IN9V , °d :: I14r _ ❑ Yes CalculationsSubmittal shall
include: Individual Component
Yes
Cut Sheets
VIdm ' lyil
1 ,` u �d I„
Ilm
4II
r
,Fire Alarm Project Valuation: $
p I -- 'Iy, Ir (I §111 .:•::-.....::,::::,:1,,1111,4::::-.:--:-.,:::::!:,::o ::,
gll Ifo :-- #r; V:. -I ""VIulII - M�Ikc - l - JN 4 d 61 f� ill I I ._-I1II hy3 .4 0G -yJ � l � � ' ` t . I' �, h 4U«h r, P" % V4 d VS p ', y 91 ` ' /.
' + I-Ris -'*!:•17:,..:-..:.--'7- 40"","0'. ..-
N Permit Fee: pV ':'! o I � u^Square Footage: $198.75 I `I, , n ^0 to 2,000 $246.45 # f 1111IuIl — „' r ,iilylif2>001 to 3,600 $310.05 -1,11,111,1,1110,,'.-.:' 4101ll ! vd i�l �r 1s . 1 +3,601 to 7,200 $404.39 , "'1I11 ' , „
17,201 and greater
Sprinkler Project Square Footage: sq. ft.
T¢� w Mss, 1'INIIWIry y t� -' MIDI 4 Ilu'Ipl f I , -' I:a i, . jl :-:::::'':::111;11i,1::....-,
y rt„s iIIM;�� µ'��tll I�'..' vt li rAJit x .
` ,` Ily l;, :,-101f(„Ja`• IN.4' _;,Iij11 i'�� gj„_ - '''' '- 'P4 11111 $ 1 ti 4�n 1 „
Project valuation subtotal (see A,B &C above): $
Permit fee based on project valuation (see fee schedule): $
State Surcharge (12% of permiPermit fee based on square footage (see D abtovefee)): $: $
FLS Plan Review(40% of permit fee): $
TOTAL: $
Projects(Charles Hughes)
ll:\syncplicity\frangopoulosm\FSS Sery \Open Projects\_Moses\5200561918 WSQ Tumi\PM\Permits\FPS_PermitApp.doc
City of Tigard
ECEIVED Permit No.: /P5020/ 7 DD 41$
q 13125 SW Hall Blvd.,Tigar , B
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 0 /9/I?
Inspection Line: 503.639.4175 AUG 1 4 20 17
0WARP. Internet: www.tigard-or.gov By:
CITY OF 11(6AIL
FIRE AIIARIDIWAYkkkFFIDAVITAl FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Projec Nam : WSQ Tumi Occupancy:
resi H
Job Ad $6.85-SW Washington Square Rd Suite:
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $4,512.00
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) /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) 3 /To be Relocated(max 5)
I, Moses Frangopoulos 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.
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 oft,is document with a o,py of the sketch attached shall be available for all inspections.
`
Signature: ../11111&11"../11111&11" Date: 8/14/17
Print Name: M eNzumpor gopoulos
1:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9504 SW WASHINGTON SQUARE RD J02,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00128
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor