Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
U COMMUNITY DEVELOPMENT Permit#: FPS2017-00165
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2017
c;;�l.ng Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9493 SW WASHINGTON SQUARE RD A03
Project: Play Live Nation Subdivision: None Lot: None
Project Description: TI on fire alarm system(4)strobes.
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 10/26/2017 $123.72
12%State Surcharge-Building 10/26/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 10/26/2017 $49.49
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 10/26/2017 $6.00
Occupancy Grp: A-3 Height: ft 11x17)
Stories:
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $194.06
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,889.82
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 questions to OUl.y calling 503.i.1987 or 1 00.33 344.
Issued By: A Permittee nature:Si� g
Call 503.639.4175 by 7:00 a.m.for the next available in pection •a-
This permit card shall be kept in a conspicuous place on the job site ,•• on of ,e proj
Approved plans are required on the job site at the time of each insp. •
B►aild n2 Permit Application
Fire Protection System NoIsla). oNia-nn FOR OFFICE.USE ONLY
CI of Tigard ������ �� ���� Received
t. - g DateBy: l o('G11? 4 Permit No.: j��6)rS/T_rv\1/_,C'-
13125 SW Hall Blvd.,Tigard,OR 97223 1l OZ 9 6 1 J n / / !'V (�lJ v 7
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: /.0/; r7�Jcpti�l
T I GARD Inspection Line: 503.639.4175 "'� r*c Date Ready By: auris: •® See Page 2 for 7
Internet: www.tigard-or.gov �Ii , Notified/Method: I Supplemental Information
uhlll. III^'::, Ikl 1. '� <IW�I�,., Vit/f01;01,"`���JJJ..�l lttµ"sl llllVllr .,..NE r,^ -, Mu��IIIIppI c IIu �p��
, a PI ✓ ... L.„✓1 ,Bill Nlul lul "l( ,''i yl III pll Gl ; a a ” l+14' " .;° ry w,„�,:.. Ili 4^. `,.t
r1N', a "I I °%., .. l 1 ,- r «
,.. .�.:. .,�. II I ,,,,,,y1,1',,; «
,'' •, , .4,' „ . »*rk.:e;. �;1',� bd) � 'rx�l'.I
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
=
Indicate the value(rounded to the nearest
earest dollar)of all®Addition/alteration/replacement 0 Other: n equipment,materials,labor,overhead,and the profit for
r the
Ilt.044;40,000,.41,44.0-4,A,04Ii.10441141.44,404404,.1!440,4- Iryv . rrr� work indicated on this application.d411n r »4au4yl lIi�4dl �*t s E � n: .-4)�� �S m uu �� �jI", �l
0 1-and 2-family dwelling ®Commercial/industrial Valuation: $
AccessorybuildingNumber of bedrooms:
0 Multi-family
0 Master builder ❑Other: Number of bathrooms: ,
{' '�^'i w ��` t a ,, r`.a tli�II Ch" t °""'4",l1)1101101141'1•011'
11 1444'1,1444;',4,,,11111
"ir i9l11111,11'111111t4
^F
fMII t �," 6_l ,,1 1I .'• i;�,a, I -00,1k.,I . :NII)IBI1�I I+ �,��7,i� Total number of floors:
Job site addre5i; �Washington Square Rd W ) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:A03 Project name:WSQ Play Live A03 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
iliNl»I' '. 'Jr"" ";.r p 111 .ry
1,IM u�sl 1. ..,-. PIu4 VS df'k'I
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Fax map/parcel no.:
)II, 10 it III , w,
equipment,materials,labor,overhead,and the profit for the
t„ I s `) r" ''qf I�n " 4�Il�i work indicated on this application.
Tenant Improvement on Fire System at Washington Sq Mall store,Play Live Valuation: $4,889.92
e-A2/''f ( yJ ..S4T72.4c"4 E-- Existing building area: square feet
/
New building area: square feet
I ,.'44•;;;0:4'1 ' IIS r
I�,I •. I}I re a n f� p rule t lrlll, I¥ Number of stories:
t I
«o$ .,",t J. —4 w i ..(6N „+.) Bim, l',4:��,�Illa :�" ^ir�l III. Bt��lltl"
1
Name:Roger Ott Type of construction: /° it
Address:9585 SW Washington Square Rd Occupancy groups: 4 -3
1
City/State/ZIP:Tigard OR 97223
Existing:
POne (503)352-8862 •'. FaX ( �N � � II
m
�hlNew9:
«;. ,,,v,
.„..^n � �ll 44 't. 29 '4 � d , +� lwy � I1 �ur „» 7 1l” . I „ � t„ s11d ,. � , � p l. : , , l l,° arerequired to be
Business name:Siemens All contractors andsuponttors
Contact name:Moses Frangopoulos oulos licensed with the Oregon Construction Contractors Board
g
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
.. : 'ur x - ”",W II9IV '
r ��II dn ^. _,,,,j,
ItI . 1 `-W � 4.#4444
r
1 �74Mt . 441011,0%,,,',•,:041'140',440,,,,4".1
r0 ) II +1e . ?.•4041.0440044004 ,, N,fltI: t, ntt,, +qlo eu « krrBusiness name:Siemens
iir
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 lie.:133041 Total permit fees:
Authorized signature: Amount received:
. �� This permit application expires if a permit is not obtained
Print name:Moses Fr go s : --ter Date: 10/26/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry •
Service Board.
I:\Building\PermitsWPS-PermitApp_031016.doc 440-4613T01/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1411110,701E- �9� .— '�--'�✓- .'a"`-- r_' .IV7r�;i r ""'`�INS, ">.1 4fl 10"w.n"slid�,I
I n
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: 4
® 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:
�011p,IIr', _ #+t• y Clnymll I�l9lu,3
�o . . . . . x .r- Nillll tlI
� �wM �mlu �" s, rci . I �aV�I�tl ��j�„I�u, ��Na�r✓r'S':” Yw
1j14111�� s ,; "Illtl�-,, Y14iti Tv� 1�1Ir�b,
r II rr:+,:rc: „, : br? ..� I�I!I�, ->, �., 'rc4 Frr rl^F�.,a ky^"4T;171. ry ''qu - dP.,, J mlNl rll�rlll 1,71$77.17,
7,1
w � '' 1111,11-r-
II I,N;Iulj'I'II N14'�'�II'Ij, �„����� �IN 1IG91�i III I Irl I .��"':' ,I YJIIIIII r aS„'�I ISI"1 ,.,� iN�t IdIV.1j�'�hGlfµ
u�II,,III IIII a T�iN I P e�'�,.�r I I IIII ill',�j �,�, I II Ilrl III"nf"� �S_ `�, I I -<ss _ 'i,� III .�
11111 �:����,r�. '�.Ir �' ...,,„I�IIN11p•' IIIIjGGullll�_; h�� :75.r- Y�", I �>; ,u°Iy�l' � , P
!.r �. 11 III I II,��^: � C" 11'• Fq,�?. ��` !K_.,lil�d ,,n,„_ uhII!{ r� � ��„ '� ^. .-.��!I�,���- u.�.. �Ilijljl�IliwIIVIIIIIWIII
rF r, 9u^II^l, 1nnP ' t 4lnu,a^i^ ��IuluNll!u'''ur , _ ,,,,r: ulllrllhlllll!I6111dV"Plulq "NI
S p rinkler TA.e ❑ Wet ❑ D
Additional Stand.i.es
Information: EZEMIMEMMIEli ❑ Yes ❑ No
Hazard Group
Densi
Desi. Area
K. Factor
S.rinkler Pro'ect Valuation: $
k• r sn, 4 fir.!�' ,rail�Ny IIID 1�1r: n oulVNjl Cr NIS, r'4-a°'%BVI VIIWI hurl I u _I r�" °�+”'+t �^+u"s
w� w�u}yn 'N IInNp _fhP I� Irl -
s . jl�Ira Y . ..
;la d c__, lu 1�1 °� -s `u aa > V;'��>
W m � r e ti^ r,w,t^(Y 1 m I, uF��
Hood Pro'ect Valuation: $
717.".7:
4iXdIIIIIIIIIq.1Mu,,.:�' � YIIlk �IIII 911ptl 1 - I �INGp lr �,IIrIIIY.�II llll � ~t tis���# ,,�,. r,�I���l,l'I•'II@ rM"h""�^,'"
,1h !,11111PI s . Iyk1 Ill4a • ,IldaV1 16 uVhh�
.•,-
,.
Submittal shall Batte Calculations Yes
include: Individual Component = Yes
Cut Sheets
Fire Alarm Pro'ect Valuation:
7777
s� - ;r ll"ulurrup1”^1r+I1 rtlrcrllll7
477:-C.1117,
' .� I�IUIIII�II 19hllu„r.�l`'114 1h191h-'Ip16IIr11111 11lu11 B�-r�t,.wx`� 4 NfN1' v111 , 1„,41$04I ?wIdla1I 1,-lI^IjItlI,IIl^lII1iIru;{Ip1Inl1l ls r,.t l.s
�1p'1lI
l{
jra{P
rflIh•:4,�1 W'ti.Y�trMll4e1IQI�a�'il VIuticl,eI r�I NI I�tlh1
'I�N�AN
,i11lta ut
S.uare Foota.e: Permit Fee: - ,1 � , II
,tsrc,
l�rI, �
0 to 2,000 $198.75 1,1114,r0,,.` II
11II 4.- kry
2001 to 3,600 $246.45 41 " I
,,i.11110114 1°1' rc
3,601 to 7,200 $310.05 N
7,201 and eater $404.39 0IIV441101 1,1110,111&. 1,,1[111111,111111,1141111,,,,-- e
;,
Sprinkler Project Square Footage: sq. ft.
.`-,;-i:"%12,11” t '�s - ujG � Mu rr w- <
a ipl II ,N u • ,;—e' ' ail tl� i ��I hoilli ,rrex - y t„ .1
ruui ��� I II IuNu�g' '-••^�. - 11'� I�n�
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•e see D above : $
State Surchar•e 12% of permit fee : $
FLS Plan Review 40% of permit fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Molts\5200582467 WSQ-Play Live\PM\Permits\FPS_PermitApp.doc
f
NOISJA10 91\11011119
City of Tigard 08V911 JO ' JC
• 13125 SW Hall Blvd.,Tigard,OR 97223 7 r� l Permit No.:
11111
• 11 Phone: 503.718.2439 Fax: 503.598.1960 L 1 O G 9 U 1 J L Date Received:
T 1C;AILU Inspection Line: 503.639.4175
Internet: www.tigard-or.gov i ID y:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Play Live A03 Occupancy: Play Live
Job gessSW Washington Square Rd Suite: A03
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $4,889.92
Type of System: (check one) 111Required ❑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) 4 /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 ystem permit.
• Electrical permit.
• A copy of this docum• 1 'th a copy of the sketch attached shall be available for all inspections.
Signature: �" Date: 10/26/17
Print Name: Moses Frangopoulos
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1