Permit 11 v CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00044
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Addition of smoke detector.
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY BY THOMSON PROPERTY TAX SERVICES
SUITE A4 ATTN HILARY RAYMOND
BEAVERTON, OR 97006 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 -234 -9995 PHONE:
FAX: 503 - 234 -8030
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/27/2012 $112.96
12% State Surcharge - Building 03/27/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 03/27/2012 $45.18
Class of Work: ALT Type of Const: Info Process /Archiving - Lg $2.00 (over 03/27/2012 $4.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process /Archiving - Sm $0.50 (up to 03/27/2012 $5.50
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $181.20
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,673.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
appli - • aw. - work will be done in accordance with approved plans. This permit will expire if wor not started within 180 days of
issu, ce, or if work is uspended for more the 180 days. ATTENTION: Oregon law requires you to folk - ules adopted by the Oregon
Ut' ty Notification Center. • •se r• les are set forth in OAR 952 - 001 - 0010 through OAR 952 ' 'ou Y/, •btain a copy of the rules
or direct questions to OUN callin• 5 '32.1987 or 1.800.332.2344. / I-
Is ued By:
iL ......., 1 Permittee Signature:
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 RECEIVED FOR OFFICE USE ONLY
City of Tigard Received Permit No.: 1 J/. II
° 13125 SW Hall Blvd., Tigard, OR 971 D 2 +' 2 012 Plan Review -
- � .
Phone: 503.718.2439 Fax: 503.598. Date/By: di ` 4f 1 Other Permit: `, 4:9 ,04,1••• DO— ' 7
TIGARD Inspection Line: 503.639.4175 Date Rea.. : y: 3uris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
R11ILD1NG DIVISION
TYPE OF WORK 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
® 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 ® CommerciaUindustrial Valuation: $
['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: 9459 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State /ZIP: TIGARD, OR Garage/carport area: square feet
Suite/bldg. /apt. no.: STE A14 Project name: Foot Locker Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
WASHINGTON SQUARE MALL Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
ADDITION OF SMOKE DETECTION IN RETAIL SPACE Valuation: $53673.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: ROGER OTT Type of construction:
Address: 9585 SW WASHINGTON SQUARE ROAD Occupancy groups:
City /State /ZIP: TIGARD, OR Existing:
Phone: (503)639 -8860 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: SIEMENS INDUSTRY, INC. All contractors and subcontractors are required to be
Contact name: CHARLES HUGHES licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15201 GREENBRIER PARKWAY jurisdiction in which work is being performed. If the
City /State /ZIP: BEAVERTON, OR 97006 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 207 -1839 Fax: : (503) 207-1901
E -mail: charles.hughes @siemens.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: SIEMENS INDUSTRY, INC. (Please refer ro fee schedule)
Permit fee:
Address: 15201 GREENBRIER PARKWAY
City /State /ZIP: BEAVERTON, OR 97006 State surcharge (12 % of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 207 -1839 Fax: (503) 207 -1901 (Due upon application.)
CCB lic.: 133041 Total permit fees:
Authorized signature: 4/1 'A Amount received:
This permit application expires if a permit is not obtained
Print name: CHARLES HUGH Date: 03/27/2012 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri -County Building Industry
Service Board.
I.\ Building\Permits .FPS- PermitApp.doc 02/01/11 440- 4613T(I1 /02/COM/WFB)
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.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ 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 ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3558.00
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 2 sets of plans at submittal. Plan review fees are required at submittal.
C: \Projects \WA SQ \FoorLocker FPS- PermitApp.doc 02/01/11 2
'PI a Building Division
Over- The - Counter (OTC) Building Permit
T I G n R D Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: -k Occupancy Group: 1J` Type of Construction:
*Type of Use: dortk Occupancy Load: Oregon Specialty Code: 2Q (0
SPECIFICS
Number of Stories: ( Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access. Parking Spaces:
REQUIRED ITEMS q
Fire Sprinklers: A > ,� Fire Alarms: Y( Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 3(.773 FEES DUE
$ DC Prov Rvw, COM TI — Ping
$ DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ I ra.ftc Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ i 3 , 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ "' Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ • , it Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $256.00 $38.00 $ i j,' i) Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ 1S(, Z0 TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \Building \Forms \OTC - BUP.docx 01/13/2011
FrS cy
Certificate of Completion
Name of Protected Property: WASINGTON SQUARE MALL
Address: 9459 SW WASHINGTON SQUARE DRIVE — Suite A14 Foot Locker — House of Hoops
TIGARD, OR
Rep. of Protected Prop. (name /phone):ROGER OTT (bldg engineer) 503 - 639 -8860
Authority Having Jurisdiction:CITY OF TIGARD — FIRE AND RESCUE
Address: 13125 SW HALL BLVD
TIGARD, OR 97223
Phone Number:503- 718 -2439
1. Type(s) of System or Service:
X NFPA 72, Chapter 3 - Local
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: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
NFPA 72, Chapter 4 - Auxiliary
Indicate type of connection:
Local energy, Shunt, Parallel telephone
Location and telephone number for receipt of signals:
NFPA 72, Chapter 4 - Remote Station
Alarm:
Supervisory:
NFPA 72, Chapter 4 - Proprietary
If alarms are retransmitted to public fire service communications center or others, indicate
location and telephone number of the organization receiving alarm:
•
•
Indicate how alarm is retransmitted:
Updated: 3/28/2012 Page 1
•
X NFPA 72, Chapter 4 - Central Station
The Prime Contractor:SIEMENS INDUSTRY, INC.
Central Station Location: Dallas Call Center 1- 866 -552 -7823
Means of transmission of signals from the protected premise to the central station:
McCulloh Multiplex One -Way Radio
X Digital Alarm Communicator Two -Way Radio Others •
Means of transmission of alarms to the public fire service communications center:
1. Telephone
2.
System Location: 9585 SW WASHINGTON SQUARE DRIVE TIGARD, OR
Organization Name /Phone Representative Name /Phone
•
Installer
Supplier SIEMENS INDUSTRY CHARLES HUGHES 503 -207 -1900
Service Organization SIEMENS INDUSTRY • SERVICE DEPT 503 - 207 -1900
Location of Record (As- Built) Drawings:
WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Owners Manuals:
WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Test Reports:
WASHINGTON SQUARE MALL FACILITIES DEPT
A contract, dated for test and inspection in accordance with NFPA standard(s) •
No.(s) dated is in effect. •
2. Certification of System Installation
This system has been installed in accordance with the NFPA standards as listed below, was
inspected by on , includes the devices
listed below and has been in service since
X NFPA 72, Chapters X 4 X 5 X 6 X 7 X 10
X NFPA 70, National Electrical Code, Article 760
X Manufacturers Instructions
_Other (specify):
Signed: Date:
Organization:
•
Updated: 3/28/2012 Page 2
3. Certification of System Operation
All operational features and functions of this partial system were tested by SAM CORRELL
on MARCH 26 2012 and found to be operating properly in accordance with the
requirements of:
X NFPA 72, Chapters X4 X5 X6 X7 X 10
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
Other (specify):
Signed: Date:
Organization:SIEMENS INDUSTRY, INC.
4. Alarm Initiating Devices and Circuits
MANUAL
a) Manual Stations Noncoded, Activating Transmitters Coded
b) Combination Manual Fire Alarm and Guard's Tour Coded Stations
AUTOMATIC
Coverage: Complete NO Partial YES
a) 3 Smoke Detectors: Ion 3 Photo
b) Duct Detectors: Ion Photo
c) 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
GUARD'S TOUR
a) 0 Coded Stations
b) 0 Noncoded Stations Activating 0 Transmitters
c) 0 Compulsory Guard Tour System Comprised of 0 Transmitter Stations
and 0 Intermediate Stations
Note: Combination devices recorded under 4(b) and 5(a).
•
SPRINKLER SYSTEM
a) . 0 Coded Valve Supervisory Signaling Attachments
Valve Supervisory Switches Activating Transmitters
b) 0 Building Temperature Points
c) 0 Site Water Temperature Points
d) 0 Site Water Supply Level Points
•
Updated: 3/28/2012 Page 3
•
•
Electric Fire Pump:
e) 0 Fire Pump Power •
•
f) 0 Fire Pump Running
g) 0 Phase Reversal
Engine- Driven Fire Pump:
h) 0 Selector in Auto Position
i) 0 Engine or Control Panel Trouble
j) 0 Fire Pump Running
Engine - Driven Generator:
k) 0 Selector in Auto Position
I) 0 Control Panel Trouble
m) 0 Transfer Switches
n) 0 Engine Running
Other Supervisory Function(s) (specify):
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system:
Types and quantities of alarm indicating appliances installed:
a) 0 Bells Inch
0 Speakers
b) Horns
c) Chimes
d) 0 Other:
e) Visual Signals Type:
with audible w/o audible
f) 0 Local Annunciator
7. Signaling Line Circuits:
Quantity and Style of signaling line circuits connected to system:
Quantity: • Style:
8. System Power Supplies
a) Primary (Main): Nominal Voltage: Current Rating:
Overcurrent Protection: Type: Current Rating:
Location:
b) Secondary (Standby):
Storage Battery: Amp -Hour Rating
Calculated capacity to drive system, in hours:
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
•
Updated: 3/28/2012 Page 4
•
•
c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a
Secondary Power Supply:
0 Emergency System described in NFPA 70, Article 700 •
0 Legally Required Standby System described in NFPA 70, Article 701
0 Optional Standby System described in NFPA 70, Article 702, which also meets the
performance requirements of Article 700 or 701
9. System Software •
a) Operating System Software Revision Level(s):
b) Application Software Revision Level(s):
c) Revision Completed by: SAM CORRELL SIEMENS
(name) (firm)
10. Comments:
This project was for the purpose of a remodel space only, it involved the addition of 3 smoke
detector in the retail area of the space.
DI •:f l +'dN -
Hughes Charles ' : . e
r., . I 3. tray PROJECT MANAGER 03/26/2012
(signed) for Alarm S- f ice Company (title) (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: None
. 4
••I I Nu• Charles •
Hughes, n .7m?7 v
N- . lN.sn.N ghe.
Charles o... i s - .Yles
Da .20 • 6 . 7 -- la:42.O7W PROJECT MANAER 03/26/2012 .
(signed) for Ala ( ervice Company (title) (date)
•
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority •
having jurisdiction: . •
. (signed) representative of the authority having jurisdiction (title) (date)
•
•
Updated: 3/28/2012 Page 5