Permit a CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2008 -00108
COMMUNITY DEVELOPMENT DATE ISSUED: 5/15/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L04 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIC
PROJECT: POTTERY BARN
Project Description: Installing Fire alarm system.
REISSUE: `iPy FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: 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: 340 BASEMENT: sf AREA SEP. RATED:
STOR: 2 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:N
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING:
VALUE: $ 22,884.00
Owner: Contractor:
WASHINGTON SQUARE LLC FISHER DEVELOPMENT INC
BY THE MACERICH COMPANY 506 SW 6TH AVE STE 403
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97204
TIGARD, OR 97223
Phone: Contact #: PRI 503- 219 -9163
FAX 503 - 248 -9036
Reg #: LIC 64095
FEES
Description Date Amount
REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 4/9/2008 $212.65 -
[TAX] 12% State Surch 4/9/2008 $25.52
[FLS] FLS PIn Rv 4/9/2008 $85.06
Total $323.23
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 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By ermittee Signature: ���y/
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.
VOrreRY TaN443 '(AI
Fire Protection System .
• Vvifd ng Permit Applicatieli `U FOR OFFICE USE ONLY
City Tigar
1 F ! a e ce iv e d . — ���
r ��
9 �( �� )Date /B . �I p Permn `
23 a 4 Plan Revte, r /�' /
1 '2 . ° 13125 SW W Hall Blvd., Phone: 503.639.4171 Fax:.S03.598.�.9. ,�_' • 1� Date /B Mk W0 Other Permit a /�a/j7— �(o0ii
TIGARD Inspection Line: 503.639.417 \ 0" \ ;z . (� �.te Ready /By: lugs ® See " Page 2for
``'���
Internet: www tigard -or goV \., 9 N` � Q ���� -- • O fied/Method• Supplemental Information
WU a � ' „A.,0
�`�NI ®• t 1 v'aiS'tj o -
TYPE OF WO � `OM ` - 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
c stAdditio alteration placement- ® Other: fLt ......1/4.0 vE 1 equipment, materials, labor, overhead, and the profit for the
.CATEGORY OF CONSTRUCTION work indicated on this application.
-- Valuation: $
❑ I - and 2- family dwelling It Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
11 Master builder ❑ Other: Number of bathrooms:
94/ 417 ` JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: . S/AJ (rt/ I+ rn t/ c�f�,j 54 • 2 D ' New dwelling area: square feet
City/State /ZIP: 'T't ( . t _' O w `1' Garage/carport area: square feet
r
Suite/bldg. /apt. no.: Project name: 1OTreyt -`( 1 Covered porch area: square feet
Cross street/directions to job site: ii./45,4, 5 Q, M MI - l — Deck area: square feet
f * 3T s / Dc 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.
// Valuation: $ ZZ ' & 1. O 0
F^` 11ti.a A t►,,...-w� 1—€ v a a c l /Ex PfMU S, O l
Existing building area: square feet
New building area: square feet 5 *1/46
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction: Q„ p v
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
1 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: SIEN.e/.J 5 All contractors and subcontractors are required to be
Contact name: 6 Co/L f licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 30 S $'J c €-T /} E. jurisdiction in which work is being performed. If the
7 applicant is exempt from licensing, the following reasons
City/State /ZIP:
pcn.'Cv+s -M I O. ' 1 13 apply:
Phone: (50) ) Z3 r. f 9g ) Fax: : (so, ) 13 y y0 36
E -mail: 5q wt _ C it/LC C 1\ 5 C or f - cern-t
CONTRACTOR BUILDING PERMIT FEES*
Business name: 1� 1 .F Lk „ a ,, 0_,, c �' (Please refer fa fee schedule)
Permit fee: _' '- D
Address:
S� G S i 4( v3 State surcharge ($ of permit fee): ,mss 5-01,, City/State /ZIP: o G7N O,e q�,- o
/ FLS plan review (40% of permit fee).
Phone: () D I a (63 Fax: (�j3 ) �-� k ` q ( (, (Du upon application) lxD
CCB lie.: (O "/ 0 7 r Total permit fees: 32,3 r} 3
Authorized signature: /� Amount received: 3(8 r ryR
/ This permit application expires if a permit is not obt5ined
Print name: 54-x1 tE ( T, `4 L ( Date: lJ /y' /D r within 180 days after it has been accepted as complete.
Ir r * Fee methodology set by Tri- County Building Industry
Service Board.
I \Building \Permits \FPS- Perm.App doc 03/23/06 440- 4613T(1 I /02 /COM/WEB)
CITY OF TIGARD ' 1
BUILDING DIVISION PERMIT #: BUP2008- 00108
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5115/2001i
Phone: (503) 639 -4171 Ang#140
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/19/20► % TIME: 7:00AM PAGE: 43
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L04 CLASS OF WORK:
• SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN
DESCRIPTION: Installing Fire alarm system.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: FISHER DEVELOPMENT INC PHONE #: 603 - 219 - 9163
Inspection Request Scheduled For: Date: 5/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 • Final inspection 069996-01 503 - 545 -3757 N 7. 3C7
Corrections /Comments /Instructions:
•
•
11 "A V PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • CALL FOR INSPECTION , ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 41/022__ Phone #: (503) 718- t;
. � �� y �a�s�- p o
g �b
Certificate of Completion
Name of Protected Property:_ w AS R• Q. NU LL- PU71 J �
Address:
Rep. of Protected Prop. (name /phone):
Authority Having Jurisdiction: C o f Cr
Address:
Phone Number:
1. Type(s) of System or Service:
NFPA 72, Chapter 3 - Local
If alarm is transmitted to location(s) off premise, list where received:
040 G-
NFPA 72, Chapter 3 - Emerr a cy -ac farm Service
Quantity of voiceIala annels: Single: Multiple:
Quantity of ers totalled: Quantity of speaker zones:
Qu ' of telephones or telephone jacks included in system:
NFPA 72, Chapter 4�A cil a'
Indicate type of ection:
Local Stunt, Parallel telephone
'on and telephone number for receipt of signals:
NFPA 72, Chapter emote Station
Alarm:
S isory:
N A 72, Chapter 4 - Proprietary
If alarms are retransmitted topubli ire service communications center or others, indicate
location and telephone arfiber of the organization receiving alarm:
irate how alarm is retransmitted:
Updated: 6/10/2007 Page •
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NFPA 72, Chapter 4 - Centra tatioon
The Prime Contract
C entrarStation Location:
Means of transmission of signals from the protected premise to the central station:
McCuJJoh 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. 'A'-- Ac k..-c, n 15 f r1 C
System Location: IA W ►J PA hi 6 — 5t. y 0 Fri LE
Organization Name/Phone Representative Name /Phone
Installer gv G-Ae. 5 t440. 2)6 OOP
Supplier 61z. ell 1 L
S Lay t4t) 5 234 51 9 f
Service Organization 5 5 Toh. 5 C-
5 2_3V `19`%r Sol Z3y 9991
Location of Record (As- Built) Drawings:
C J 5 iTc
Location of Owners Manuals:
p..+ Sit
Location of Test Reports:
'St 6.-q. S /off - 5 IT
A contract, dated S1 for test and i s Caron in accordance with NFPA standard(s)
No.(s) _ 1 Z G I a t l,AJE s dated Sr o is In effect.
2. Certification of System Installation
(s=ill Wit. 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 SAM C,rt 1 on s -, s7o 8 , includes the devices
listed below end has been in service sine s/i 57.0 r
X NFPA 72, Chapters i `3 L 't 6 circle all that apply)
_ y NFPA 70, National Electrical Code, Article 760
Manufacturer's Instructions
-(sPecifY) : ..
Date: , CM74 ?
Organization: �i /E E k./
Updated: 6/10/2007 Page 2
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3. Certification of System Operation
All operational features and functions of this system were tested by Sh & C /l m l
on S/i S' or and found to be operating properly in accordance with the
r equirernen)s of:
NFPA 72, Chapters 1 �3 4 5 "6 7 c heck all that apply)
NFPA 70, National Electrical Code, Article 760
Manufacturer's Instructions
Other (specify):
Signed: Date: 57 /S /c 8
Organization: (54 -C 5
4. Alarm Initiating Devices and Circuits (Use blanks to indicate quantity of
deviceg,)
MANUAL
a) Manual Stations encodedActivating Transmitters Coded
b) C Waal Fire Alarm and Guard's Tour Coded Stations
AUTOMATIC
Coverage: Complete Partial
Abnb ib—�a) _ I Smoke Detectors: Ion _ 1 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): ICIP9
5. Supervisory Signal Initiating Devices and Circuits (Use blanks to indicate
quantity of devices.)
GUARD'S TOUR
a) Coded Stations
b) Noncaded S ' Activating Transmitters
c) Compu Guard Tour System Comprised of Transmitter Stations
Intermediate Stations
Note: ination devices recorded under 4(b) and 5(a).
SPRINKLER SYSTEM
a) Coded Valve S • : isory Signaling Attachments
Valve S • = isory Switches Activating Transmitters
b) B • g Temperature Points
c) ite Water Temperature Points
d Site Water Supply Level Points
Updated: 6/10/2007 Page
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Electric Fire Pum
e) fir ump Power
f) ire Pump Running
g Phase Reversal
Engine- Driven Fire P
h) Seie in Auto Position
i) gine or Control Panel Trouble
j) F ire Pump Running
Engine - Driven Generator:
k) Selector • uto Position
I) Co Panel Trouble
m) ransfer Switches
n) Engine Running
Other Supervisory Function(s) (specify):
14
6. Alarm Notification Appliances and Circuits 2- -5Tz o B E
Quantity of indicating appliance circuits e t ed to the system: I — 5 P E A K .
Types and quantities of alarm indicating appliances installed: A AUEc> i /J A - L EXTEi—nc
a) Bells Inch PR,.)Et_
Speakers
b) _ Horns
c) Chimes
d) Other.
e) VI Visual Signals Type: �• N E _L_6 UL sY►J � '5 DLO lif-
- 7 with audible 10 w/o audible
f) Local Annunciator N SPEw1c
7. Signaling Line Circuits:
Quantity and Style (See NFPA 72, Table 3 ., - .!naling line circuits connected to system:
Quantity: Style:
8. System Power Supplies
a) Primary (Main): Nominal Voltage: Curr nt-Rtit
Overcurrent Protection: Type: urrent Rating:
Location;
b) Secondary (Standby):
Storage Battery: Amp- HaurRating
Calculated ca bit to drive system, in hours: ® 24 60
Engine • n generator dedicated to fire alarm system:
on of fuel storage:
Updated: 6110/2007 Page
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•
c) Emergency or Standby System used as backup to Prim
P er Supply, instead of using a
Secondary Power Supply:
Emergency System descri FPA 70, Article 700
I pgally Require y System described in NFPA 70, Article. 7111
Option ndby System described in NFPA 70, Article 702, which also meets the
ormance requirements of Article 700 or 701
9. System Software
a) _ )C Operating System Software Revision tevei(s): C 5 Cr 4 11 0
b) 6 --1 4- Application Software Revision Level(s):
c) _ Revision Completed by: rti F.1 I S i E^"t 5
(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): A--
System deviations from the referenced NFPA standard(s) are: $1,4—
(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: 6/10/2007 Pagel
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