Permit (134) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2018-00155
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/25/2018
T[ A:R•O Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9650 SW WASHINGTON SQUARE RD G15
Project: Oakley Subdivision: None Lot: None
Project Description: Fire alarm permit:(2)speaker/strobes and(1)strobe. Affidavit submitted.
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 10/25/2018 $123.72
12%State Surcharge-Building 10/25/2018 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 10/25/2018 $49.49
Class of Work: ALT Type of Const: Hourly Building Rate 10/25/2018 $180.00
Occupancy Grp: Height: ft Hourly Building 12%State Surcharge 10/25/2018 $21.60
Stories: Info Process/Archiving-Lg$2.00(over 10/25/2018 $6.00
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $395.66
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,591.00
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 952-001-00*C You may obt.•- - opy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1 6. ..294h. , --,.....000—
Issued
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Issued By: ermi ee ure: f'
.0.d...42:zoizer__
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all IT3. .4175 by 7:00 a.m.for the next available ins.-ction date. '
This permit card shall be kept in a conspicuous place on the job site u,til completi.• • t • .lett.
Approved plans are required on the job site at the time of eac spection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
R` y' ,..,iVEID Received
City of Tigard " DateB �: ,' Permit No.:`s a' I {S
lig _ . 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 I,)r 4++ 4 Lu t u Date/8 : Other Permit:AL, i31� -
T 1 G A RD Inspection Line: 503.639.4175 a`"+ Date Ready/By: s See Page for
t �IDo
Internet: www.tigard-or.gov C,--`111 Y• OF` y - ''r 4ii... Notified/Method: Supplemental Information
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❑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
"'° ddr ,t ru I'w 1I 1'I�y � 1 ° ,,y 1 work indicated on this application.
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0 1-and 2-family dwelling ®Commercial/industrial
Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: i%k
;, 1�1 II y:V�ul!ol nr a Ir O �w plip JIRF I1t9111� . ., . .,. ... , Total numberof
i!V WGI *n t ''''''..'&1066.1,111d,P I+t g ota floors:
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Tqb site address:9650 SW Washington Square Rd(9585 SW Wash Sq Rd) New dwelling area: square feet
Ctty/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:G15 I Project name:WSQ Oakley Covered porch area: square feet
-Coss street/directions to job site: Deck area: square feet
Other structure area:
square'feet'
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
m u equipment,materials,labor,overhead,and the profit for the
,sh: .,, r 'r t' ; i , h lin II II" !7 II �� �I! 9 1111 n1"'
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Tenant Improvement on Fire Alarm System at Washington Sq Mall store Oakley Valuation: $$4,591.00
Existing building area: square feet
Addition of 2 Speaker/Strobe&1 Strobe.
Electric Permit#:ELR2018-00179 New building area: square feet
tt a M + r 911 k "79Pt,'.,a•
�, _
r t 1 ' ii .c �,S !t;, I 1 Number of stories:
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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:
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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 performedIf the
City/State/ZIP:97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)207-1834 Fax: :(503)207-1834
E-mail:moses.frangopoulos@siemens.com
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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/o of permit fee):
Phone:(503)207-1834 Fax:(503)207-1834 (Due upon application submittal.)
CCB lic.:133041 Total permit fees:
f./•-- -,� Amount received:
Authorized signature: fii --....-,
This permit application expires if a permit is not obtained
Print name:Moses Frangop i is Date: 10/25/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
'I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T01/02/COM/WEB) :
City of Tigard permit No.: u �) s
a 13125 SW Hall Blvd.,Tigard,OR 97223 III.`7• d� L iV 15f
3 Phone: 503.718.2439 Fax 503.598.1960" !+ 0 4(1' Date Received: P,S/O/ /
T1C;ARi7 Inspection Line: 503.639.4175 .9,...
/l
Internet: www.tigard-or.gov '� � )d(7D By, %.
. r G DIVISIor ,
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Oakley Occupancy:
P Y:
Job Address: 9650 SW Washington Square Rd Suite: G15 (WSQ Mall: 9585 SW Wash Sq)
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $4,591 .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 of this document with a cos of the sketch attached shall be available for all inspections.
`►
Signature: i """. Date: 10/25/18
Print Name: MO - - angopoulos
I:\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:
9650 SW WASHINGTON SQUARE RD G15,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00155
Inspection Type: Inspector:
998 Alarm Final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor