Permit (10) t .4CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
:nu 8 .' COMMUNITY DEVELOPMENTr
Permit FPS2016-00117
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9546 SW WASHINGTON SQUARE RD H16
Project: Ann Taylor Subdivision: None
Project Description: Fire alarm-Add(5)notification devices. Lot: None
Contractor: SIEMENS INDUSTRY INCOwner: 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
07/13/2016 $102.20
12%State Surcharge-Building 07/13/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safet COM
Y- 07/13/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 07/13/2016
Occupancy Grp: Height: ft 11x17) $0.50
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 $155.84
Valuations:
Sprinkler Valuation: Required Items and Reports(Conditions)
$0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,587.00
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: L /✓"(�' Permittee Signature:
6-...e.e._ ecitp7/7- =7"-C_____,
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
City of Tigard `
Received a---
4 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: , 7 // �!� ` 'L/Jj Permit No.: �pl�p•�Yj`��7
` Phone: 503.718.2439 Fax: 503.598.1960 Plan Review /
r i, Date/By: Other Permit: ��(6_� 7V
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: loris:
Internet: www.tigard-or.gov I H See Paget 2l nr
Notified/Method: Supplemental Information
c v,*n -'*.`. � ,ga. ,°'.��`z yf v r- '�.a....�:. ,+'a' K:d?�<.4z..-r„c J.�,.
- way.
El New construction 0 Demolition Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all
�s at e� equipment,materials,labor,overhead,and the profit for the
A�_ :: ., Gt7`RY 0 e k Wt til t, .; work indicated on this application.
DI1-and 2-family dwelling cm
omercial/mdustrial Valuation: $
❑Accessory building ////❑Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
4, JO'Bry s 1'-F 1i ORMAT`101 AND}� CA,7I®1;I Total number of floors:
Job site address: 7 50 4)4.5i je, New dwelling area: square feet
City/State/ZIP: d btr Gare e/ca ort� square feet
Suite/bldg./apt.no.: t4/t Project name: ,Q g rP area:"9.22:, 217A,,- / Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: �_ 4,1" # �
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
> € � 9 equipment,materials,labor,overhead,and the profit for the
,rrie , 4. .. - ;01:: S o .? t 111,{ ,c... i h v :J =a< work indicated on this application.
( j--4,574_// -Pie. ,i4r.i- 6 cad -c Valuation $ $?_t
Existing building area: square feet
New building area: square feet
_ .. , , . u ,.e _r.:= e �: Number of stories:
Name: /9,7� ccvte„ ", a.�
L �•/ r Type of construction:
Address: ?ZS-L./ _ 4f...)&,_4_,
`' _ Occupancy groups:
City/State/ZIP: 14 a r / D/O
/ � Existing:
Phone:( ) Fax ( )
APit14GANT ] � n �CUNf. '1`�ileSbk r New
Business name:
� / s-,..,,,, e n All contractors and subcontractors are required to be
Contact name: c...,) 14/C ylicensed with the Oregon Construction Contractors Board
Address: /5020/ �� / under ORS 701 and may be required to be licensed in the
20/1
/ G,,e ti a r /21 f✓ jurisdiction in which work is being performed.If the
City/State/ZIP: Q� Tom/ �� / applicant is exempt from licensing,the following reasons
(_ apply:
Phone: �) $9�—/�8, I Fax: :( )
E-mail: G Lip/ik
jVk tV r' : .4(Fler* J ofeseddte ;Bustness name: Sipw1��f
Address: /S- V� /. / _ Permit fee:
/ a2 f ['/e rA ii:
-e.--
Q�u�/a �� y State surcharge(12%of permit fee):
r FLS plan (40% permitfee):
Phone:(so?) ,:r94..... 93�7/ I Fax:( ) review of
(Due upon application submittal)
-y CCB lic.: j 33 5/ Total permit fees:
Authorized signature: ( Amount received:
This permit application expires if a permit is not obtained
Print name: Ct r Jr/c f� I Date: ,/i_1 G I within 180 days after it has been accepted as complete.
V * Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuildinglPermits�FPS-PermitApp_031016.doc
440-4613 T(11/02/C OM/WEB)
City of Tigard i '; Permit No.: ( 45,90 I i - 00/ 17
• • 13125 SW Hall Blvd.,Tigard,OR 97223 /
Phone: 503.718.2439 Fax 503 598,1960„ Date Received: 7/« /O
Inspection Line: 503.639.41751;
TIGARL?
Internet: www.tigard-or gov. , By:
S"
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: `,)SQ - Trlor Occupancy: ,
Job Address: 2 1 Sid L4) 5- , Suite: /-f/t
Contractor: Si tool e/!J Phone:
Valuation of work: $ p2,-27. 00
Type of System: (check one) ❑Required ❑Non-required
(check one) i utomatic ❑Manual ❑Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max 5) 99C /To be Relocated(max 5)
IIINumber of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) ,5 /To be Relocated(max 5) 0
I, Uo/e4 (Si Oregon Construction Contractors Board No. /330(1/
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
1111, Signature: (-)
Date: 7--//-16
Print Name: CCJV Jr
D y
I:\Building\Forms\FireAlarmAffidavit 071514 docx Page 1 of 1