Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114 �_ COMMUNITY DEVELOPMENT Permit#: FPS2013 00167
T ARE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2013
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Washington Square Mall Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(3)sprinkler heads for remodel of existing food court restroom and corridor leading to restroom.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD,CA 92018
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/13/2013 $56.47
12%State Surcharge-Building 11/13/2013 $6.78
Type of Use:
Class of Work: Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $63.25 1
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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 by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 FOR OFFICE USE ONLY
y RECENE.10
R eceived
City of Tigard 3 2p13 — Permit No.:
jig
`I 1 Date/B . ��/ ..r, a i 3_a oIG
° 13125 SW Hall Blvd.,Tigard,OR 9722301 a Plan Review
Phone: 503.718.2439 Fax: 503.598.19660,, T (�O Date/By. Other Permit: /, a 3— 3
T I G/�R D Inspection Line: 503.639.4175 (� I'�+ Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov CM f±DWIS'o� Notified/Method: Supplemental Information
BOLVIA
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.
Valuation: $❑ 1-and 2-family dwellin g ®Commercial/industrial
❑ 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:9585 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 Garage/carport area: square feet
Suite/bldg-/apt.no.: - - - Project name:Washington Sq.Restroom 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.
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 3 heads for remodel to restroom Valuation: $5675.00
Existing building area: square feet
New building area: 0 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 2
Name:Washington Square Mall Type of construction:
Address:Above Occupancy groups:
City/State/ZIP: Existing: Light
Phone:( ) Fax:( )
New: Light
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Payne licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.lithe
City/State/ZIP:Tigard,OR 97223 - applicant is exempt from licensing,the following reasons
_` apply:
Phone:(503)684-2928 Fax::( )
E-mail:a.payne @wyattfire.com
CONTRACTOR ' BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
- Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
- FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
—�
CCB lic.:64077 • Total permit fees: 3 a5---
Authorized signature: _ t Amount received:
1� This permit application expires if a permit is not obtained
Print name:Ashley Payne 0 Date:11/11/13 within 180 days after it has been accepted as complete.
" Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permiis\FPS-PermitApp.doc Rev 01/05/2012 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 Z 1-10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 3
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Z Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Light
Density 0.10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 675
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: $
•
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.
C:\Users\Ashley\Desktop\TigardApp.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9585 SW WASHINGTON SQUARE RD OFFICE,
TIGARD, OR, 97223
Commercial - Fire Protection System
999 Sprinkler Final
2013-12-09 00:00:00
FPS2013-00167
PASS - No C of O
Violation Summary:
Inspector Contractor