Permit y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' '! it COMMUNITY DEVELOPMENT Permit #: FPS2013 00062
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2013
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9618 SW WASHINGTON SQUARE RD G -5
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Modification of fire alarm for TI
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 05/21/2013 $123.72
12% State Surcharge - Building 05/21/2013 $14.85
Type of Use: COM Plan Review - Fire Life Safety - COM 05/21/2013 $49.49
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 05/21/2013 $4.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 05/21/2013 $3.50
11x17)
Houlry Building Rate 05/21/2013 $180.00
Commercial Sprinkler System: Hourly Building 12% State Surcharge 05/21/2013 $21.60
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: No Cut Sheets Required:
Total $397.16
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,480.00
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 • ation e er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di ct questions to OUNC by - in. 503.232.1987 or 1.800.332.2344.
Iss ed By: / / Permittee Signatur SA-4
Call 503.639.4175 by 7:00 a.m. for the next available insp- on 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 atfillifilif FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
`J g 1(��1 Date/13y: �oc/ 3 / p✓ 6 -000d 2..... 13125 SW Hall Blvd., Tigard, OR 97223: ,211 -0 13 Plan Review r /�
a Phone: 503.718.2439 Fax: 503.598.1960 t Date/By: 0122- ( Other Permit: ,k.( /�GQD/5 Gdd l/
Inspection Line: 503.639 (I , ( , ' Date Ready y: �>, i ® See Page 2 for
T I G A R I
Internet: www.tigard -or.gov BM t, "I j 'I Notified/Method�o�v // ' Supplemental Information
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 ® Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
111 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9618 SW WASHINGTON SQUARE ROAD New dwelling area: square feet
City/State/ZIP: TIGARD, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: STE G4/5 Project name: HELZBERG DIAMONDS 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: I 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
> ESCRII'TION OF WORK work indicated on this application.
ADDITION OF SMOKE DETECTION IN RETAIL SPACE Valuation: $$4,480.00
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:
El APPLICANT t PERSON
NOTICE 4,1 ,&&
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 I Fax: : (503) 207 -1901
E -mail: charles.hughes@siemens.com
C ONTRACTOR BUILDING PERMIT FEES*
Business name: SIEMENS INDUSTRY, INC. (Please referto 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 I Fax: (503) 207 -1901 (Due upon application.)
CCB lic.: 133041 / Total permit fees:
Authorized signature:
Amount received: 4:397,/0
/ I ' This permit application expires if a permit is not obtained
Print name: CHARLES ' ' -t'• I I' S Date: 05/20/2013 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board., s— " ,, "" „„ �J" ( / �`�,,`�_
I:\Building\Permits \FPS- PermitApp.doc 02/01/11 440- 4613T(1I/02/COM/WEB)
1
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
® Addition El 1 -10 heads: No plan review required.
❑ 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 ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 4480.00
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: \PM \Fire Permit Applications \COMPLETED FORMS \Helzberg FPS- PermitApp.do2 02/01/11