Permit (61) 114111
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00182
T'[+CaAR_D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9321 SW WASHINGTON SQUARE RD T05
Project: Tesla Subdivision: None Lot: None
Project Description: Fire alarm for TI. Add(3)strobes,(4)speaker strobes and(1)detector.
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: Hourly Building Rate 12/12/2017 $180.00
Hourly Building 12%State Surcharge 12/12/2017 $21.60
Type of Use: COM Permit Fee-COM 12/12/2017 $145.24
Class of Work: ALT Type of Const: IIIB 12%State Surcharge-Building 12/12/2017 $17.43
Occupancy Grp: B Height: ft Plan Review-Fire Life Safety-COM 12/12/2017 $58.10
Stories: 1 Info Process/Archiving-Lg$2.00(over 12/12/2017 $8.00
11x17)
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: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $430.37
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,050.55
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 OUNC by calling 50 .232.1987 or 1.800.332.2344.
Issued By: �/0„/,‘ r Permittee Signature:
Call 503.639A175 by 7:00 a.m.for the next available in`section date.,.-"
This permit card shall be kept in a conspicuous place on the job site unci mplet'- of • :ject.
Approved plans are required on the job site at the time of each insp 'cti
Building Permit Application
Fire Protection System7RECEIVED FOR OFFICE USE ONLY
City of Tigard 2 Received//Z..
t/ �� /
III . - 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 1 2017 Date By: / 7 �� 'tN /����/y,�,
Plan Review � � 9
Phone: 503.718.2439 Fax: 503.598.1960 �y
Date/By i— a.9- j7✓) OtherPern ��
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGNRD
�n ReiM ��� / Iuris S See Page l for
Internet: www.tigard-or.govNotified Method: Supplemental information
BUILDING DIVISION � ,�
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
CATEGORY OF CONS'RUCTION work indicated on this application.
El1-and 2-family dwelling ®Corntnercial/industrial Valuation: $
ElAccessory building 1:1 Multi-family Number of bedrooms:
ElMaster builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9321SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.nos7::T05.. Project name:WSQ Tesla T05 Covered porch area: square feet
Cross street/directions to'job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CIIECHId,ST
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
DESCRIPTION OF WORK work indicated on this application.
Tenant Improvement on Fire Alarm System at Washington Sq Mall store,Tesla Valuation: $6,050.55
/itJfh� S , -1y�dhrs aAc 1.-/ Sig - ?- 55,( Existing building area: square feet
a to �/yte- e- jy' �Y New building area: square feet
® PROPERTY OWNER 0 TENANT 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:
El APPLICANT 0 CONTACT PERSON
NOTICE
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)705-1831 Fax::( )
E-mail:moses.frangopoulos@siemens.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Siemens (Please refer twee schedule)
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):
Phone:(503)207-1900 Fax:(503)207-1901 (Due upon application submittal)
CCB lic.:133041 �,.. Total permit fees:
Authorized signature:�R ------gr-7Amount received:
This permit application expires if a permit is not obtained
Print name:Moses F t i , Date:11/20/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service.Board.
l uitding\Permits\FPS-PermitApp_031016_doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist.
Page 2- Supplemental Information
Describe work to be done:
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: 8
® 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:
Type of.System (Complete A,B,C D applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I.- Hood Fire Suppression System
Hood Project Valuation: $
C) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 6,050.55
D.) Residential Sprinkler(Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal(see A,B &C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mods\228329 WSQ-Tesla\PM\Permits\FPS_PemutApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9321 SW WASHINGTON SQUARE RD T05,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00182
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor