Permit (44) CITY OF TIGARD111FIRE PROTECTION SYSTEM PERMIT
: COMMUNITY DEVELOPMENT Permit#: FPS2019-00011
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2019
ng Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9567 SW WASHINGTON SQUARE RD BO3B
Project: Na Hoku Subdivision: None Lot: None
Project Description: Fire alarm. Addition of(5)notification devices for TI.
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: 503-580-3845
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/30/2019 $145.24
12%State Surcharge-Building 01/30/2019 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 01/30/2019 $58.10
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 01/30/2019 $6.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 01/30/2019 $180.00
Hourly Building 12%State Surcharge 01/30/2019 $21.60
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 $428.37
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,814.00
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-i$90 lain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '
Issued By: rmittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspect'�,t
This permit card shall be kept in a conspicuous place on the job site u-.111mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Pr itection System RECEIVED FOR OFFICE USE ONLY
City of Tigard Received �I�/ 1��� /�,� ���
Date iv
Ill _ ° 13125 SW Hall Blvd.,Tigard,OR 97223 IAN 2 3 2019 Plan Revie r ,��.
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : `'jIj ///�I��
TIGARD Inspection Line: 503.639.4175 Ut�_Y UI I I(.ARD Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
r*,;,--:.' F,,:,4„,,,* � lora �«..LJ (pp 'hd"i il x:v regi d � 4yo* u....., sem,. s «air�,�:.,
a ; TT':' "" r1 +1Ra:^'ria ,.^" f`. R• ,." "i vill �I ^4.1,1, " ;:, ,4 m r:("P` azA 1„1 t ) £* ��'t� Y I I k`.: �t«q N& i'`,
at''"k.,t,' : aA 5 Pv, ” "'ke« 4 r. a _ A'AN... wrt r4 N w �li~I"a_"_;�e.< '' .� �,� d i,�«u' r444441414-�; r rh,a 4.,.. .-'v>a.� .:«- ;�` „'�.d4 u4'V vuM»'I�`iW�9V'�I hP `�;
0 New construction 0 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 thea� 1, a IIII'd •a �m ray + k'
vele tha-.4 work indicated on this application.
I « ' 01 i 141,4'21t:1,'
41,'0 m mit'''.. "1704'4''''''' 's�1" 7•'"'"
'a , '."''''''''''4'
a "�' ;. I,1' 7
1-and 2-family dwelling ®Commercial/industrial Valuation: $
Accessory building 0 Multi-family Number of bedrooms `-,,
,r�
0
Master builder 0 Other: Number of bathrooms: ",=1.=',,-`'.
r�.. .,vh4A r,mw,(w . ": :• _ .,-... . i , .• w „
,*" s Np NL,i I 4N 114 4141r1614144411, Mr ” Total number of floors:r ",, 11 t t Vx «t0 b a0e a lIki vw ? r ?
Job site address:9567 SW Washington Square Rd(9585 SW Washingto) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:BO3B I Project name:WSQ Na Hoku Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
�Iilr iar 4 , t O� Ih�Mlh�ll+ . h 'a: ibor# r
Subdivision: 1 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
N
1 g4 i " p i��i110 �Iv� ru� r work indicated on this application.
;44,42,V7, Ilr: �� r"a . a .
Tenant Improvement on Fire Alarm System at Washington Sq Mall store Na Hoku Valuation: $6,814.00
Addition of 5 notification devices Existing building area: square feet
Electrical Permit# ELR 2018-00236 New building area: square feet
- z e. j r ', , W[I—Tx, ?, Number of stories:d? N4l � ' a ius 414114' "«r bN „ ; " s . .0 ,P.I0,ir I � gqI;:. P ,,, 'i � „fr .'.1.4^0 la = w � jW _....
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:
; g,y 2t*ur 14 w C 'ta wb W a *�:,, *m "la't, i i " aw
,,.,5,„
Nua `ry. :,4,5,5,55,...,,,„5„5„-,5,-t+ , '1j'
�` «« 5 i ` ., of `« ii�l hl I11i l t` , Y , rti 1 ,:a«.a, *s
'I-: , l rorrr1L'5" " 4x '- r r 1 uy �� '''; '»'' i ^iil lidT « f !,:4,11'Ir {� `�
+�b(w3a .iF� `r Ih uhl�ihhlli, "ael T1A-�^aas ,,. x ,o a.. .P?=''',6W,'''''".�°x
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 I Fax::(503)207-1834
E-mail:
p ,,momo;se..a>sw.frran'rg.otpoulos.r.,�@..siemr en..s.comr
:�, ,.N ,, ®.. ,1,i ,i4,, ,, *` ta'.'
w 'moll R 1 i 1 3s 4 1141i 1 r,irr r* R«I rh,«' N ry, " «, S ; x r Nt rti , ril ° ,1 "
n
,
Business name:Siemens
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 lic.:133041 Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Moses Frangopou os Date:1/23/19 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
(t
-k
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
+ 1 x p a b 3 rli + ?` ' 1
a r4a�s �ih� •r 4r'uw 1hW !k eb' :� a-i°" 1 �v}T�r �m��I �41y
r..... ... , .'. �r. _+„ ,v„a.4.s: ` .. .a”x' ,a'::w.ksu" :. '11 __ .4 un `«a6...r I a0 t,e'�040 Nb u, n— :_. �9 r ,y r.4," ,e d I a- , ss;
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
❑ 11+ heads: Plan review required and 1:1(36)+ dices: review required and
(3) sets of plans. setsevof plans.Plan
Additional description of work:
-ir-. '''.411,111,,:r1}1'
vs: -p,;.17:
g
VF' :j4'"`
''"„,,,,,m--z,,,= : w ._ ti1 xi1 � 4B977"1 11111I UF _ ` r .. � a,
,la or i1C^jo,,,,_,i.,61,7,,,,,,,,,:"r' u 1 'F94 4,5 u ; 4, „11,,
a 1r^.•
I---111`'' isei, J pIs °°'`` g g Tr , r.r1 ;111111r11 IN11111i1! p . ,4",,,”
a 1Ihlf I! ,"1/44,:`,- d3"1 �e ; tM __ # m t'lT ;n:� "lily,
1rr rP ; 1 .' ' 11 % 4 ti d ,4 . r4� 1i1+ 1a �
4.
'w� +' � '"r V ,',f4r ax' .;;.' .5,-,.:4'.-t...';-
4s ^611� 1119 l7w1V , n a E . � t � Pr i t ,-111,',..-- - �� " ❑ Wet ❑ Dry- � 11 -n+ � .. .n3 ,: 1 991`" r._. sprinkler
Type
Additional Standpipes
Information: Sprinkler Supply Line El Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
1 ,��;„1VuI ylvl:�w ry1111 uvy;a_;.mr "?'=_tdv4,"4 lie,, ^, 11^ + , 111 ul,,1111 `on 4111111 I try Y 1,11'',, h.,VIf
wig : ,,^:, b:„9;PlItiVtl u1111 4.(.�r r'fi ar.� a411 i .?Vira Ili i�a.Cti�1 ”, "e.,"' ,..�. :`,c4xv 4 2 .J$1 1 ,.>„s 'n 4�I Ftl lu:,.:': �vlirk
Hood Project Valuation: $
a r '1 1 'Y '"Nw 111 it i- s 4W ro:^' 1 n' Gtll'IIHi1i111 4m r '-”- c.:,,1,4,,,,'''
� r �r k uRg `'' 7 m: 1 111' d
y ,;n i s 1 o^1 �� ' :nL. ^ 49,11 y'yV1 11`1 r -a>.= x,,11 ,_ ,r" 4 W a'4'' i,�1 °y9'p,
, m'� a ` - "�' +}.1t I1J1u1 j�1j r 0,07/ 4 M IYI 1 11,111 e.a x ` _ lr. Y4'a 114 V $ 1„
.� nr, - : L � � ws� Pla1 111,:I mr � nI,,Fr< 1 I I C i:�;t �51 1,1,1,1r V1�:yd I,,1
.._,... ,. �... -.0:10
0Jr' au°P'''
'1[11w°°'' .re. ,__ e 1 1.1,.. ,a.nu ,1 ,,,,,ii...---
,..
tl
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $..„4"4-,,,,,,*:,,
6,84.00
=3.,.-,-n-:.;y 'n _" t•r d^>I,1 ° 1 Fa+ 1 tF n„.1::,4:::;14,-;:::,..:::,:r,;'85;1
4 r r1 d1 ,i3On.:0
.14
` 1 n v ^Cr,,h r III r a, -= r „lin. $- `_" n I k�
iii '! el�rr\7,-, 1�N!' °o .„, 1 , '" N _ ;� '" _ i _.t{ f'y `
i?:! 1,1w 4;,' -,,Il , ., rd�l�lu1._N 11,14. r n t,�ll:�'. '� vrw 1 - r'd , ' ,V, II,,
I9F"�dr� n - I �4��4''1�"1�"a 1 �xwp "�
Square Footage: Permit Fee: wr gin"§ ph a
0 to 2,000 $198.75 91 4 i , R + d1 - .
2,001 to 3,600
$246.45 1'111 M 1 ` q,I I"
°4411141,'I
nill V1 s `4411 „',/4.,' 1
3,601 to 7,200 $310.05
141 1 , r, I ,' :rM '1� 8 11 1_..
7,201 and greater $404.39 �r = 11, a,llll:ul tia`
Sprinkler Project Square Footage: sq. ft.
” r.:% ,,.r ry 1;ti 1 I'; n '.,"1111'1'1
� ,. ,F.. aM i:, �: ,, h *,i "Mu w i 114 i ,,,,,:t:.,„:,;:;,1.,
x„rs&y s,
. I,. t ''''' . . 1111'1 t Cet W '' *' -t 1, 1 ., _.a ^9111
Project valuation. subtotal (see A,B &C above): $
Permit fee based on proect valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review((4120://00
40% of permit fee): $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mos\255839 WSQ Na Hoku\PM\Permits\WSQ NaHoku Permit.doc
City of Tigard Permit No.: PPS840,
`j!NI 111
13125 SW Hall Blvd.,Tigard,OR 97223
S Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /71,
3 4y
Inspection Line: 503.639.4175
TIGARI Internet: www.tigard-or.gov By:
VEP
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS '
OR TENANT IMPROVEMENTS ��N 2 2019
t;ITY C) 17112:9
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) 3UtLpi ; I�IVI,Sl
Project Name: WSQ Na Hoku Occupancy:
Job Address: 9567 SW Washington Square Rd Suite: BO3B (WSQ Mall: 9585 SW Wash Sq)
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $6,814.00
Type of System: (check one) ['Required ❑Non-required
(check one) El 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 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 copy of the sketch attached shall be available for all inspections.
Signature: Date: 1/23/19
Print Name: Moses Frangopoulos
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:
9567 SW WASHINGTON SQUARE RD B03B,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2019-00011
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor