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Permit CITY OF TI GARD BUILDING PERMIT PERMIT #: BUP2005 -00524 � DEVELOPMENT SERVICES DATE ISSUED: 10/13/2005 • 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300 SITE ADDRESS: 09339 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: TI, fire alarm. REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: FPS FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 2N : sf N: S: E: W: OCCUPANCY GRP: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 74 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 6,962.00 Owner: Contractor: WASHINGTON SQUARE LLC OREGON ELECTRIC GROUP BY THE MACERICH COMPANY 1010 SE 11TH AVE 9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97214 'none: 0- 503 g 78865 Phone: 234 -1001 234 -9900 FEES Reg #: LIC 203 Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 10/5/2005 $110.50 [TAX] 8% State Surcharq 10/5/2005 $8.84 . [FLS] FLS Pln Rv 10/5/2005 $44.20 Total $163.54 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 than 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 95 ; i -ii • through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by c., ling 503 -246 •.99 or 1-81e- 32 -2344. Is. ued By. __ � � ' , ,Ak _�' Permittee Signet r� resLa.... Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 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. Fire Prote I tem WaCh i SS � Building Permit A '„t I s® �� FOR OFFICE USE ONLY � 1V/�' Received Qty of Tigard 5 Date/B - / 'M6� ' Permit No.: � 5 - 005 13125 SW Hall Blvd., Tigard, OR 97223 � 10 Plan Revue �' / OS Phone: 503.639.4171 Fax: 503.55®0 ARrr b Date/13 Other Permit: Inspection Line: 503.639.4175 �® � � Date Re''"�: ® See Page 2 for Internet: www.ci.tigard.or.us '(1GA Notified/Method Supplemental Information gU O NG D N1S,o • TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction 0 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 CATEGO RY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: $ El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address'9339 5W Washington Square Rd New dwelling area: square feet City /State/ZIP: Tigard, OR 97223 Garage/carport area: square feet Suite/bldg. /apt. no.: TI1 I Project name: Janeville 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. Install fire alarm in new mall T.I. Valuation: $. 4, ���'� Existing building area: 2 square feet New building area: - x;829' - ' — square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: 1 Name: Washington Square LLC Type of construction: ,2 B Address: 9585 SW Washington Square Rd Occupancy groups: rn 7y City /State/ZIP: Tigard, OR 97223 Existing: Phone: (503)234-9900 Fax. (503)535 -2620 New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Oregon Electric Group, Inc. All contractors and subcontractors are required to be Contact name: Loni Martin licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1010 SE 11 Ave. jurisdiction in which work is being performed. If the City/State/ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons apply: Phone: (503) 234-9900 I Fax: : (503) 535 -620 E -mail : loni @oregon- electric.com -_____ CONTRACTOR Business name: Oregon Electric Group, Inc. BUILDING PERMIT FEES* Address: 1010 SE 11 Ave. Please refer to fee schedule. City / State/ZIP: Portland, OR 97214 Fees due upon application Phone: (503) 234-9900 Fax: (503) 535 -2620 Amount received CCB lic.: 203 _ Date received: Authorized signatur=a� j C,....__ This permit application expires if a permit is not obtained C '7 within 180 days after it has been accepted as complete. Print name: Loni Martin Date: 9/30/05 * Fee methodology set by Tri- County Building Industry Service Board. 1\B utldinglPernutsN.EPS- Pernut App dm 12513 440.4613T( I I/02/COM/WEB) CITY OF TIGARD BUILDING DIVISION PERMIT #: BUP2005 00524 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 Aori' , �,, � A Inspection Requests (24 Hrs.): (503) 639 -4175 'II� INSPECTION WORKSHEET FOR DATE: 11/7/2005 TIME: 7:05AM PAGE: 39 SITE ADDRESS: 09339 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: JANEVILLE DESCRIPTION: TI, fire alarm. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639 -8865 CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 234 -1001 Inspection Request Scheduled For: Date: 11/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 998 Alarm final 020468 -02 503-793 -7177 N Corrections /Comments /Instructions: k ielfrird C. (4.. C L(Jvv-N 0 4 06 G2-C. 5 ,• - a . ( • th-pAss... . ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: `'' Date: i / Phone #: (503) 718- • CITY, OF TIGARD • BUILDING DIVISION PERMIT #: BUP2005 -00524 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 atilt Inspection Requests (24 Hrs.): (503) 639 -4175 �� __.. • INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 10 SITE ADDRESS: 09339 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: JANEVILLE DESCRIPTION: TI, the alarm. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639 -8865 CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 234 -1001 Inspection Request Scheduled For: Date: 11/4/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 998 Alarm final 020412 -02 503 - 793-7177 N Corrections /Comments /Instructions: • (+56220 41 iU517,tkr5g.4(/.06- C� n PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL • CALL FOR INSPECTION ❑ ADDITI f ( Phone AL FEES ASSESSED Inspector: ,fr '' Date: ` #: (503) 718- . 9339 �, Rot Certificate of Completion Name of Protected Property: Washington Square Mall Expansion - JANEVILLE Address: 9585 SW Washington Square Road Tigard, Oregon 97223 -4450 Rep. of Protected Prop. (name /phone): Roger Ott (503) 639 -8865 Authority Having Jurisdiction: City of Tigard Address: 13125 SW Hall Blvd Tigard, Oregon 97223 Phone Number: (503) 639 -4171 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: Honeywell Central Monitoring Station X NFPA 72, Chapter 3 - Emergency Voice /Alarm Service Quantity of voice /alarm channels: 1 Single: X Multiple: Quantity of speakers installed: 2 Quantity of speaker zones: 1 Quantity of telephones or telephone jacks included in system: None 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: 11/7/2005 Page 1 T: \Fire \Misc \Commissioning Forms \master cert comp.doc l NFPA 72, Chapter 4 - Central Station The Prime Contractor: Central Station Location: Means of transmission of signals from the protected premise to the central station: McCulloh Multiplex One -Way Radio Digital Alarm Communicator Two -Way Radio Others Means of transmission of alarms to the public fire service communications center: 1. 2. System Location: Organization Name /Phone Representative Name /Phone Installer Oregon Electric Group Scott Johnson (503) 234 -9900 (503) 234 -9900 Supplier Siemens Building Technologies Ron Pulioff (503) 234 -9995 (503) 234 -9995 Service Organization Siemens Building Technologies Service Department (503) 234 -9995 (503) 234 -9995 Location of Record (As- Built) Drawings: Security Office Location of Owners Manuals: Security Office Location of Test Reports: Security Office A contract, dated 11/1/1999 for test and inspection in accordance with NFPA standard(s) No.(s) NFPA 72 dated 2002 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 Scott Johnson on 11/02/2005 , includes the devices listed below and has been in service since 11/03/2005 X NFPA 72, Chapters X 1 X 3_ 4 X 5 X 6 X 7 X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions Other (specify): Signed: „rr - Date: 1112or/[�_S” O rganization: Vi& Updated: 11/7/2005 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 Jim Bramlaqe on 11/03/2005 and found to be operating properly in accordance with the requirements of: X NFPA 72, Chapters X1 X3 _4 X5 X 6 X7 X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions Other (specify): Signed: OR8/ ,e Date: 1/29kc, Organization: Siemens Building Technologies 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 X a) 5 Smoke Detectors: Ion 5 Photo b) 1 Duct Detectors: Ion 1 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 (Use blanks to indicate quantity of devices.) GUARD'S TOUR a) _ Coded Stations b) Noncoded Stations Activating Transmitters c) Compulsory Guard Tour System Comprised of Transmitter Stations and Intermediate Stations Note: Combination devices recorded under 4(b) and 5(a). SPRINKLER SYSTEM a) Coded Valve Supervisory Signaling Attachments Valve Supervisory Switches Activating Transmitters b) Building Temperature Points c) Site Water Temperature Points d) Site Water Supply Level Points Updated: 11/7/2005 Page 3 T: \Fire \Misc \Commissioning Forms \master cert comp.doc Electric Fire Pump: e) Fire Pump Power f) Fire Pump Running g) Phase Reversal Engine- Driven Fire Pump: h) Selector in Auto Position i) Engine or Control Panel Trouble j) Fire Pump Running Engine- Driven Generator: k) Selector in Auto Position I) Control Panel Trouble m) Transfer Switches n) Engine Running Other Supervisory Function(s) (specify): 6. Alarm Notification Appliances and Circuits Quantity of indicating appliance circuits connected to the system: 1 Types and quantities of alarm indicating appliances installed: a) Bells Inch Speakers b) Horns c) Chimes d) Other: e) 3 Visual Signals Type: Speaker /strobes 2 with audible 1 w/o audible f) Local Annunciator 7. Signaling Line Circuits: Quantity and Style (See NFPA 72, Table 3 -6.1) of signaling line circuits connected to system: Quantity: 1 Style: Class B, Style 4 8. System Power Supplies a) Primary (Main): Nominal Voltage: 120/1/60 Current Rating: 5 amp Overcurrent Protection: Type: Circuit breaker Current Rating: 20 amp Location: Panel HP4, circuits 40 & 42 b) Secondary (Standby): X Storage Battery: Amp -Hour Rating 55 amp -hour Calculated capacity to drive system, in hours: X 24 60 Engine- driven generator dedicated to fire alarm system: Location of fuel storage: Updated: 11/7/2005 Page 4 T: \Fire \Misc \Commissioning Forms \master cert comp.doc c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a Secondary Power Supply: Emergency System described in NFPA 70, Article 700 Legally Required Standby System described in NFPA 70, Article 701 Optional Standby System described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701 9. System Software a) X Operating System Software Revision Level(s): CSGM 17.01 b) _ X Application Software Revision Level(s): Revision 55 c) X Revision Completed by: Jim Bramlage Siemens Building Technologies (name) (firm) 10. Comments: (signed) for Central Station or Alarm Service Company (title) (date) Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): None System deviations from the referenced NFPA standard(s) are: None (signed) for Central Station or Alarm Service 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: 11/7/2005 Page 5 T: \Fire \Misc \Commissioning Forms \master cert comp.doc A 1