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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 1111 a COMMUNITY DEVELOPMENT Permit #: FPS2011 -00009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9530 SW WASHINGTON SQUARE RD H10 Project: Apple Store Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Fire alarm for break room. Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC 15201 NW GREENBRIER PKWY 2235 FARADAY AVE STE #0 SUITE A4 CARLSBAD, CA 92008 BEAVERTON, OR 97006 PHONE: 503 - 234 -9995 PHONE: FAX: 503 - 234 -8030 FEES • Description Date Amount Specifics: Permit Fee - COM 02/03/2011 $102.20 12% State Surcharge - Building 02/03/2011 $12.26 Type of Use: COM Plan Review - Fire Life Safety - COM 02/03/2011 $40.88 Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm Sheet (up to 02/03/2011 $6.00 Occupancy Grp: M Height: ft 11x17) Stories: 2 Houlry Building Rate 02/03/2011 $180.00 Hourly Building 12% State Surcharge 02/03/2011 $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: Yes Alarm Type: Automatic Pull Station Required: Smoke Detectors Req: Yes Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $362.94 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $2,450.00 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 • calling 503.232.1987 or 1.800.33 Issued By: • : mittee Signature: Call 503. • •• • 75 by :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 �i Fire Protection System �� YO FOR OFFICE USE ONLY City of Tigard ��� \,1 Received i © j'% Pernut o.: cra,i1 °. i .r I —4 . s c� • "c' 13125 SW Hall Blvd., Tigard, OR 97223 �) Plan Review t I. Phone: 503.639.4171 Fax: 503.598.1960 NQQ Date/B : pill � �! Other Permit: L / ,dio — A L: l I I CARD Ins Line: 503.639 ��1G 0 D ate Ready .y : %'See age 2 for O N ISI Notified/Method: Internet: www.tigard- or.gov Cl `t`t � 0 �i Supplemental Information TYPE OF WO REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all IR Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: ❑ 1- and 2- family dwelling g Commercial/industrial / El Accessory building ❑ Multi - family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: w AC S 1{ 1k) &Tod 5 Q AX 9 530 kje i-f i 5 4 ) IL 9 New dwelling area: square feet City /State /ZIP: --/ f}1.1, 0, 0 /L / Garage /carport area: square feet Suite/bldg. /apt. no.: i Project name: A? ? L5 t,' LeAK elywt Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ,4 b 1- A T 1)E.T. AA. 1) �,— S CNC.E& Sf'L E Valuation: $ Z c SO • U Existing building area: square feet - Th 1..) CV.) Y3 0 YLGCAK - 1 New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: --r 1 Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ti APPLICANT ❑ CONTACT PERSON NOTICE Business name: It MCki } (,n. 0 Wri - All contractors and subcontractors are required to be Contact name: F M Ca2/LEl l licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: f 820 / Al Kd t CEN'R,t €„ f 1[4,,y S T - t .. A jurisdiction in which work is being performed. If the City /State /ZIP: E applicant is exempt from licensing, the following reasons AU €�Td• OA_ '?loo apply: Phone: ( 'SO 7 24y-i (Q 0 cl Fax:: (5c 3) 7.....,5-7 I �1 c/ E -mail: CONTRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: �E,.4. i / 4 9u3T,ty �, I Permit fee: Address: / 6 /V � i.. G rt -¢ t3tl k7` p/ (4. r 1 T-- A City/State/ZIP: / State surcharge (12% of permit fee): ity /State /ZIP: 3 EA vl=n - Tav i 0 2 97,1 (�6 FLS plan review (40% of permit fee): Phone: (51, ) ail _ ) 906 Fax: (56 3) 24 /90/ (Due upon application.) CCB lic.: / 6 7 3, L Total permit fees: /_ n Amount received: *65. 5 L l Authorized signature: This permit application expires if a permit is not obtained Print name: c5��? ��2 1 Date: 2l 3/ ( within 180 days after it has been accepted as complete. f� Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\FPS- PermitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. El Alteration ❑ 11+ heads: Plan review required. El Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I Hood Fire Suppression System Hood Project Valuation: $ C) Fire Alarm Submittal shall Battery Calculations El Yes include: Individual Component El Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: 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 greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees 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: $ Plan review requires a completed application and three (3) sets of plans at submittal. Plan review fees are required at submittal. I: \Building \Permits \FPS - PermitApp.doc 01/20/2011 2 FP Zola- cf,c, © Certificate of Completion Name•of Protected Property: ( /4rI/id, JC -rca•t/ _ � G�� �- /- ,� '� s= 2'4TK 7X'n- Address: • Rep. of Protected Prop. (name /phone): Authority Having Jurisdiction: / ✓�� ct: Address: Phone Number: 1. Type(s) of System or Service: 4 ., NFPA 72, Chapter 3 - Local /�`` ' 1":"r14)6--- If alarm is transmitted to location(s) off premise, list where received: NFPA 72, Chapter 3 - Emergency Voice /Alarm Service . Quantity of voice /alarm channels: 2_ Single: k Multiple: Quantity of speakers installed: EA/J.5710 6- Quantity of speaker zones: E / STti/ G Quantity of telephones or telephone jacks included in system: Le IA NFPA 72, Chapter 4 - Auxilia Indicate type. of conne t+e • Local energy, , /� Shunt, _ Parallel telephone Location,an5telephone number for receipt of signals: NFPA 72, Chapter 4 - Remote - Station • Alarm: • Super J y -�' NFPA 72, Chapter 4 - Proprietary If alarms are retransmitted to public fir _semi ommunications center or others, indicate location and telephone number of the org•azation receiving alarm: • Indicate h_o alarm is retransmitted: • Updated: 8/11/2010 Page 1 T: \Fire \Misc \Commissioning Forms \master cert cornp.doc NFPA 72, Chapter 4 - Central Station The Prime Contractor: Central Station Location: Means of transmission of signals from th otected premise to the central station: McCulloh Multiplex One -Way Radio Digital Alarm Commu j a or Two -Way Radio Others Means of transmis 'dn of alarms to the public fire service communications center: 1. 2. System Location: Of Organization Name /Phone Representative Name /Phone • Installer rA A -1 C Supplier /'S —.Leer 6� ,r�r �. ic-i Co /Z L L SLI 3 2. 7 / i Service Organization M r A.1 - ._. [ALi2US y -74 C° Location of Record (As- Built) Drawings: OAt / T Location of Owners Manuals: OW .1 Location of Test Reports: A contract, dated ..._.----- forFes and d pection in accordance with NFPA standard(s) dated is in effect. 2. Certification of System Installation (Fill out after installation is complete and wiring checked for opens, shorts, ground faults, and improper branching, but prior to conducting operational acceptance tests.) This system has been installed in accordance with the NFPA standards as listed below, was inspected by . 'ik.S7,A..` on Z , includes the devices listed below and has been in service since )C NFPA 72, Chapters 3 4 5 _ 6 rcle all that apply) X NFPA 70, National Electrical Code, A rticle 760 X. Manufacturer's Instructions _ Other (specify): Signed: C.� 7 Date: z 'V n I Organization: Updated: 8/11/2010 Page 2 T: \Fire \Misc \Commissioning Forms \master cert comp.doc 3. Certification of System Operation All operational features and functions of this system were tested by - 'Q ^ • 4 - 14 4 C <5 7V° on P-- If and found to be operating properly in accordance with the requirements of: �--- - X•NFPA 72, Chapters 1 3 4 5 6 77 (check all that apply) '< NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions Other (specify): Signed: ' - ___... Date: 2' d'— l/ Organization: -} /& t- c 4. Alarm Initiating Devices and Circuits (Use blanks to indicate quantity of devices.) MANUAL a) Manual Stations Noncoded, Activating Transmitters Coded b) Combination Manual Fire Alarm and Guard's Tour Coded Stations AUTOMATIC • Coverage: Complete Partial C'' � Tr p a) Smoke Detectors: Ion Photo ��C�' � b) Duct Detectors: Ion Photo c) .d Heat Detectors: FT RR ¥.- FT /RR RC d) Sprinkler Water Flow Switches: Noncoded, Activating Transmitters Coded e) Other (list): 5. Supervisory Signal Initiating Devices and Circuits (Use blanks to indicate quantity of devices.) GUARD'S TO • a) Coded Stati b) Noncoded Transmitters • c) Compulsory Guard T` r System Comprised of Transmitter Stations and Intermediate atioris Note: Combination devices recorded under 4(b) and 5(a). SPRINKLER SYSTEM �'�, / 4A a) Coded Valve Supervisory Signaling Attach nts Valve Supervisory Switches Activating T ansmitters b) Building Temperature Points c) Site Water Temperature Points d) Site Water Supply Level Points • • Updated: 8/11/2010 Page 3 T: \Fire \Misc \Commissioning Forms \master cert comp.doc Electric Fire Pump: e) Fir mp Power f) .p ire Pump Running g_) Phase Reversal Engine- Driven Fire Pub' h) Selec n Auto Position i) gine or Control Panel Trouble j) Fire Pump Running Engine- Driven Generator: k) Selector i to Position I) Cogt r'o1 Panel Trouble m) Tfnsfer Switches n) Engine Running Other Supervisory Function(s) (specify): 6. Alarm Notification Appliances and C ircuits Quantity of indicating appliance circuit con to the system: _ 5 r L7 - AIC.C& Types and quantities of alarm indicating appliances installed: s t.n • a) Bells Inch Speakers b) Horns c) Chimes d) Other: e) i Visual Signals Type: C -"Axv5 5 NL M.i. i, ri (4&. -kUk with audible dv /o audible f) Local Annunciator 7. Signaling Line Circuits: ?re" - 6-x(-5T 1.-I c Quantity and Style (See NFPA 72, Table 3 -6.1) of signaling line circuits connected to system: Quantity: Style: 8. System Power Supplies a) Primary (Main): Nominal Voltage: ) 2Q Current Rating: Overcurrent Protection: Type: P,-r Current Rating: 7.0 Location: b) Secondary (Standby): Storage Battery: Amp -Hour Ram sy Calculated capacity to drive s_tea oP1 urs: 24 _ 60 Engine- driven genera.,to&- dedicated to fire alarm system: Location of el•-stb ar ge: Updated: 8/11/2010 Page 4 T: \Fire \Miss \Commissioning Forms \master cert comp.doc c) Emergency or Standby System usedLas°b ckup to Primary Power Supply, instead of using a Secondary Power Supply: Emergency System - described in NFPA 70, Article 700 Legally fj .eclijired Standby System described in NFPA 70, Article 701 Optional Standby System described in NFPA 70, Article 702, which alto meets the "performance requirements of Article 700 or 701 - 9. System Software a) Operating System Software Revision Level(s): G & .& '7- 01 b) Application Software Revision Levels): c) ,'` Revision Completed by: (name) (firm) 10. Comments: . 2/51 (signed) for Centra9 Station or Alarm Service Company (itle) (date) Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): System deviations from the referenced NFPA standard(s) are: (signeVfor Central Station or Alarm Service Company (title) (date) Upo 1" ompletio .f the system(s) satisfactory test(s) witnessed (if required by the authority having jurf v ; fction. a Z - // w igned >.resentative of the authority having jurisdiction (title) (date) Updated: 8/11/2010 Page 5 T: \Fire \Misc \Commissioning Forms \master cert comp.doc