Permit (16) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN I ' ' COMMUNITY DEVELOPMENT Permit#: FPS2019-00097
t[;A R.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2019
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Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9753 SW WASHINGTON SQUARE RD D02
Project: 85C Bakery Subdivision: None Lot: None
Project Description: Fire alarm. Adding(13)notification devices,power supply,and(2)smoke detectors(DD). Electrical permit
ELR2019-00101.
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 07/31/2019 $188.28
12%State Surcharge-Building 07/31/2019 $22.59
Type of Use: COM Plan Review-Fire Life Safety-COM 07/31/2019 $75.31
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/31/2019 $6.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 07/31/2019 $10.50
11x17)
Hourly Building Rate 07/31/2019 $180.00
Commercial Sprinkler System: Hourly Building 12%State Surcharge 07/31/2019 $21.60
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 $504.28
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Firs-Alann-Vainetion:-_-- $IO,02t:06
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 952-001-0 0. •u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 0 1.800.332.2344. /
Issued By: • Permittee Signature: iIi/►��- —►
ice\
Call 603.639.4175 by 7:00 a.m.for the next available inspection date.
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This permit card shall be kept in a conspicuous place on the job site until complet'• e project.
Approved plans are required on the job site at the time of each insp- on.
Building Permit Application
System
Y FOR OFFICE USE ONLY
Fire Protection S
City of Tigard 1 U 1 1 b 2019 Received , ,� Jq
111 w 13125 SW Hall Blvd.,Tigard,OR 97223 Datey: `� 1 �, G / /)
■ t_.,. Plan Revie ) ,/I / �
Phone: 503.718.2439 Fax: 503.598.1960�✓9 � (l(,, " "•ate/By: �' J7 ��G2.yCLr 2r
l'c.✓.It , Inspection Line: 503.639.4175 t 91 i Rey i � , �`�i ���e ,-Ready/By: / ,Jur s: ® See Page 2 toff LTJ
Internet www tigard or gov t,7! ] i s ifed/Met /� �' Supplemental Information
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❑New construction ❑Demolition Permit asalet hs work f
Indicatefees*the valueareb(roundededonthe to vtheue nearestofe dollar)perof allormed.
0 Addition/alteration/replacement 0 Otherequipment,materials,labor,overhead,and the profit for the
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1171' �W N as oq ( fl „ p)01 IT l Glia work indicated on this application.
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dwelling Valuation: $
0 1-and 2-family g 0 Commercial/industrial
0 Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
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ql l�1:l4 4 I; "I,III 1,��[i,M 1 N .«.+ rN II�IIIIIII IINII II Ilk , NI+�V�h� Total number of floors:
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Job site address:9753 SW Washington Square Rd(9585 SW Wash Sq Rd) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:002 ( Project name:WSQ 85c Bakery Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet:'. `
Other structure area: square feet
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Subdivision: I 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
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equipment,materials,labor,overhead,and the profit for the
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I,, Id �I� work indicated on this application.
Tenant Improvement on Fire Alarm System at Wash Sq Mall store 85c Bakery Valuation: $10,621.00
Addition of 13 notification devices,power supply and 2 smoke detectors(DD) Existing building area: square feet
Electrical Permit#ELR2019-00101 New building area: square feet
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':.� �,"I o tY ERI' 1 , tIl, III ,I„ IVIIIII Number of stories:
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Name:Roger Ott Type of construction:
Address:9585 SW Washington Square Rd Occupancy groups:
Existing:
City/State/ZIP:Tigard OR 97223
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<;�II �V II r . yT�P° NII� «IIs At„.`yrPhone (503)352-8862 Y�. Iri {{' �I h ? „l : „, ,d.Il rhi ' , tII1 III 5a Ixs. , eatww : .[3 . ... ,, r
Business name:Siemens All contractors and subcontractors are required to be
Contact name:Moses Frangopoulos etiB
under ORSlicensedwith 701the andOrmaygon be
Construcrequiredon toContractors 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
r ' E-mail: moses.frangopoulos@siemens.com
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Business name:Siemenstie}e�,Ft+1ecerktte , ,ul
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)207-1834 Fax:(503)207-1834 (Due upon application submittal.)
CCB lic.:133041 Total permit fees:
Authorized signature: �r� Amount received:
This permit application expires if a permit is not obtained
Print name:Moses F _ I Date:7/15/19 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
440-4613101/02/COM/WEB)
is\Building\Permits\FPS-PermitApp_031016.doc