Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 ' COMMUNITY DEVELOPMENT Permit#: FPS2019-00127
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2019
T IGARD Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9595 SW WASHINGTON SQUARE RD B12
Project: Aldo Subdivision: None Lot: None
Project Description: Fire alarm. Adding(4) notification devices.
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 10/03/2019 $134.48
12%State Surcharge-Building 10/03/2019 $16.14
Type of Use: COM Plan Review-Fire Life Safety-COM 10/03/2019 $53.79
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 10/03/2019 $6.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 10/03/2019 $180.00
Hourly Building 12%State Surcharge 10/03/2019 $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: Yes Cut Sheets Required: Yes
Total $412.01
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $5,898.00
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 503.232.1987 or :C4,-3•20.22,344._,
Issued By: •ermittee Signature: �' k
Call 5^ :63•.4175 by 7:00 a.m.for the next available insp+actiu l.'r^—
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 FOR OFFICE USE ONLY
INPlCity of TigardDRa[e/Bey ` P _aoi..7
r 13125 SW Hall Blvd.,Tigard,OR 97223
an Review � , /���?' ( n_ `�
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: -r Ott /
TIGARD Inspection Line: 503.639.4175 DateReady/By: / /�/f� Juris H See Page 2 for
Internet: www.tigard-or.gov S Notifi�d/Method: ll�fr.
Supplemental Information
r � rt�e1II'h��� Fg1(o- 1 ��
<,< TYPE OF WORK RE 5)1 `'h Ir� , 1 e
�,•r., , ,.. s� L11X�ix�l6l���le x� iir,. ' ,tw $.
❑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 CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation:
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other Number of bathrooms:
° t w ` ""'t` Total number of floors:
, J®Bj.§ITE INFORMATION AND LOCATION:
Job site address: ' .W 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.: ' . J Project name:WS ery n ato Covered porch area: square feet
Cross street/directi ys .jib site: Deck area: square feet
Other structure area: square feet
IIi IVhuuhut!^ r t 1 iii.a ° i' 'l
..h` ' :.L USI CILIA KLIST
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
" 1"1 ° ,)t i1ltt'rl z1 x1Aidi;;;;.'6:#: work indicated on this application. _
Tenant Improvement on Fire Alarm System at Wash Sq Mall store Aldo(B12) Valuation: S5,898.00
Addition of 4 notification devices. Existing building area: square feet
Electrical Permit#ELR201970014 3� New building area: square feet
gi!'i"iti9H1'Ii til uli ® ElNumber of stories:
��� PROPERTY OWNERFENAN'I' —
Name:Roger Ott Type of construction:
---
Address:9585 SW Washington Sgaare Rd Occupancy groups: __
City/State/ZIP:Tigard OR 97223__ — Existing:
Phone: 31352-8862 Fax:( __ New:
_ ® APPLICANT` _�_ El (ONTAC I PERSON ,iiy {0'0,1'"� ,a 11' deo) c ,:'" --
Business name:Siemens_ - _ All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Moses Frangopoulos 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
applicant is exempt from licensing,the following reasons
City/State/ZIP:97006 apply:
Phone:(503)207-1834 Fax::(503)207-1834
Email int frau 11 lis' iemens.com
P+f q ,,r, 1� —
� �'1�'i 7.11.,...,t:' .i��,i CONTRACTOR RACTOR ,. BUILDING PERMIT FEES*
(Please refer to fee schedule) ____
Business name:Siemens - -- Permit fee:
Address:Moses Frangopoulos State surcharge(12%of permit fee):
City/State/ZIP: 15201 NW Greenbrier Parkwa .Suite A4 FLS plan review(40%of permit fee):
(Due upon application submittal.)
Phone:(503)207-1834 I Fax:(503)207-1834
CCB lic.: 133041 Total permit fees:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
/ ' within 180 days after it has been accepted as complete.
Print name:Moses Frangopoulos Date: * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
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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: 4
® Addition or 0 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:
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ai, aataSprinkler Type ❑ Wet ❑ Dry _
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
u,�r� 1+11911 si JhIPo dxt `��ul IIm N1 ar q w 1 N�d v.�
wwi �kliMkS� �,1 �1.m. i1tul�MEx
Hood Project Valuation: $
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Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $5,898.00
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III 1 Imp. t d111 :-tom ll 7 tl 1 1 x mE 1,v 'N. IY ~Mpb u
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1411 �'P�1al ..._ .xulh�11j11111)Iuvk1 aa9av1111ilulo ,�tiu111 .t; t .11,1E1111IIIIINP x1III
ululy
Square Footage: Permit Fee: I I�'Ij�hIIII�6�'Ik1 I7j,1�I�111 1
0 to 2,000 $198.75 , '110111r'
,11 'aag111111 I��I ,
* '111111
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05IINIIIIIi! 1 1111y 1 ! :
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
. .. 11 1 Flre Protection Permit Fe �..kexM .<. v t
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 Sen,Projects(Charles Hughes)\Open Projects\_Moles\262898 WSQ Hollister\PM\Permits\WSQ Hollister Permit.doc
City of Tigard Permit No.: 5 1% a)12.7a 13125 SW Hall Blvd.,Tigard,OR 97223 / J/�
Z Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /
so
Inspection Line: 503.639.4175 f[ //',/
TIGARD Internet: www.tigard-or.gov By: j .(. r Ot r`/t i'C(vAkd
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Aldo Occunancy:
Job Haaress: 1 5,5-SW Washington Square Rd SUIIC:i3 12. (WSQ Mall: 9585 SW Wash Sq)
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $5,898.00
Type of System: (check one) nRequired nNon-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) 4 /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.
fj 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,s f this document with a copy of the sketch attached shall be available for all inspections.
Signature: J�� '�- Date: :'\,/())01
Print Name: '4Ose angopoulos
1:ABuilding\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1