Permit (42) 1114CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2019 00031
T IGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2019
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9339 SW WASHINGTON SQUARE RD T11
Project: Amerisleep Subdivision: None Lot: None
Project Description: Fire alarm. Adding(6)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:
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/21/2019 $145.24
12%State Surcharge-Building 03/21/2019 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 03/21/2019 $58.10
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 03/21/2019 $6.00
Occupancy Grp: M Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 03/21/2019 $9.50
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $236.27
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,913.00
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 questions to OUNC by calling 503.232. •87 or 1.800.3 . 44.
Issued By: i•nature:
iI _tea.., - /fi -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System r /�2
Received g 3 /C eieR,, o/ a9VJ/
City of Tigard DateBy: ! l P I (J.
S
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C — Other Permit:
Phone: 503 439 Fax: 503.598.19 RECEIVE Date/By: 3—�) J 9-
T I G A RD Inspection Line: 503.639.4175 Date ReadyBy: Juris: I VI See Page 2 for
Internet: www.tigard-or.gov MAR 13 2019 Notified/Method:3 -a 1 (4 . ,� Supplemental Information
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O New construction ❑aiiiitliaNG • v a 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 , i-,`° work indicated on this application.
• 1-and 2-family dwelling ®Commercial/industrial Valuation: $
Accessory building El Number of bedrooms: ;,.
g
Master builder El Other: Number of bathrooms:
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',"4,•-1, •" h:„;..1788,h.„ t• I h ;u will a Total number of floors: _.
Job site address:9339 SW Washington Square Rd(9585 SW Washington) New dwelling area: square feet ---
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:T11 I Project name:WSQ Amerisleep Covered porch area: square feet
•Ctoss street/directions to job site: Deck area: square felt
i •
ii Other structure area: square feet;.
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Sybdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tex map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the .
f
; ,11,,hiG 1 < , , 1 work indicated on this application.
Tenant Improvement on Fire Alarm System at Washington Sq Mall store Amerisleep. Valuation: $$6,913.00
Addition of 6 notification devices Existing building area: square feet
Electrical Permit# ELR 2019-00020 New building area: square feet
8 i ':„:•,019,.:r -N'pv 414',1111;"1ti, ':.11,'i i8' r r i, 1 x'. i e e 't Number of stories: _.
Name:Roger Ott Type of construction:
I
Address:9585 SW Washington Square Rd Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing: .
Phone:(503)352-8862 Fax:( ) New: w"
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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 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
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Business name:Siemens N 1 ,. tr � i i . �r;,1 " ,l
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)207-1834 (Due upon application submittal.)
CCB lic.:133041 Total permit fees:
Amount received:
Authorized signature: moi'
���-� This permit application expires if a permit is not obtained
�� within 180 days after it has been accepted as complete.
Print name:Moses Fran / ' Date:3/12/19
Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuildingTermits\FPS-PermitApp_031016.doc 440-46131(11/02/COM/WEB)
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City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
s;
1.) Type of Work: 2.) Addition/alteration onlyto sprinkler heads: 3.) Addition alteration onlyto alarm devices:
Yh P � /
❑ New system Number of sprinkler heads: Number of alarm devices: 6
® 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:
S.rinklerTpe ❑ Wet ❑ D
Additional Stand.i.es
Information: .. ❑ Yes ❑ No
Hazard Grou.
Densi ?
Desi Area
K. Factor
S• •'- t $
. is , hYriVltfi;i .11l4 l djfiuljfilufi 41a .. . fr .dttl � ;;.;, ...4., .1
Hood Pro'ect Valuation: $
Submittal shall Batte Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Pro'ect Valuation: $ 6,913.00
4"""1 11'1 w a iii i 1 . .u'I,i
S•uare Foota_•e 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 treater $404.39
Sprinkler Project Square Footage: sq. ft.
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 •ermit fee : $
FLS Plan Review 40% of•ermit fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mos\258317 WSQ Amerisleep\PM\Permits\WSQ Amerisleep Permit.doc