Permit (37) CITY OF TIGARDIIII FIRE PROTECTION SYSTEM PERMIT
Is'' COMMUNITY DEVELOPMENT Permit#: FPS201600155
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9312 SW WASHINGTON SQUARE RD WO1
Project: Kay Jewelers Subdivision: None Lot: None
Project Description: Fire alarm-adding(4)notification devices.
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 09/08/2016 $123.72
12%State Surcharge-Building 09/08/2016 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 09/08/2016 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 09/08/2016 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 09/08/2016 $180.00
Hourly Building 12%State Surcharge 09/08/2016 $21.60
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 $391.66
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,198.00
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 Ntotiifida-fi6rr Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00'0. You may obtain a c•py of the rules
o irect questions to OUN (ling 503.232.1987 or 1.800.332.2344.
Issued By: ( '�C y' �' , Permittee Signature: f /�
Call 503.639.4175 by 7:00 a.m.for the next available inspect•n 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 2Q16 Received - I
IN r �? Date/13 `6 � ' PermitNo.: /j�C(p-66/
_ 13125 SW Hall Blvd.,Tigard,OR 972 w Plan Review 4.1111,:9.016
/ �,�,y.s���
Phone: 503.718.2439 Fax: 503.598..1K? PD Other Permit: ^� (�-C.,x:b
1 i.(,,,i DateB
Inspection Line: 503.639.4175 e1�1IS1 y y; H See Page 2 for
TIGARD ee � Date Read B
Juris
www.tigard-or.gov (,3401 U1 Notified Method: Supplemental Information
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❑New construction Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to
=" VIthe ne
aedareanst ddtholelarp)rooff taflo
r theequipment,materials,labor,ove ,®Addition/alteration/replacement ❑Other ,,,,,„1,111,1,„„„,,,,,„, III a
work indicated on this appli
cation.ils ° 1°11"' n PrmCy ,�t haiyrt " :.: � ae , a ,., f � Valuation:
$1-and 2-family dwelling ®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
Irah h ISIS "^`Vl dll"Ir µ111 .�,#u u���r..., h - trop.--".-:' o XIII
0 9 ts �ryil l, ���. ;t� "" :,;110, ,,..,.,,,,,,, Total number of floors: A
Job site address:9312 SW Washington Square Rd WI(9585 SW Wash Sq) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:Wl I Project name:WSQ Kay Jewelers W1 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: , suare feet
WilV 1" t �il�l; i I WI1" y}ll "Fr".MImJ9
Wi
Subdivision: I 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
;: �m 1 �z, 1> e�l o IIS �" f work indicated on this application.
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Tenant Improvement on Fire System at Washington Sq Mall store,Kay Jewelers. Valuation: $$4,198.10
Existing building area: square feet
New building area: square feet
p,f:. S ISI w N ^"d1411
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'' 1 lE"+<, 4� da w� 'k, ., II ',.....„„t.,„=,=" R vwrllglNumber of stories:
Name:Roger Ott Type of construction:
Address:9585 SW Washington Square Rd Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
h Fax:( )
Phone:(503)352-8862 rrl New:
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All ucontractors and subcontractors are required to be 11 6
"i Glll„1” a..l" iVl ua1IIVVk Va ;�;�” gW�ll1 xIm F",
Business name:Siemens
Contact name:Moses Frangopoulos licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:15201 NW Greenbrier Parkway,Suite A4 jurisdiction in which work is being performed.If the
City/State/ZIP:97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)207-1834 I Fax::(503)207-1834
E-mail:moses.frangopoulos@siemens.com
� ,. � '„ ,t,',1144
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Business name:Siemens tl' m 1)' y , is hr, (±*.�
Permit fee:
Address:Moses Frangopoulos
State surcharge(12%of permit fee):
City/State/ZIP:15201 NW Greenbrier Parkway,Suite A4
FLS plan review(40%of permit fee):
Phone:(503)207-1834 Fax:(503)207-1834 (Due upon application submittal.)
CCB lie.:133041 Total permit fees:
Authorized signature: Amount received: 1
This permit application expires if a permit is not obtained
Print name:Moses F i gopoulos Date:9/8/16 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
440-4613T(11/02/COM/wEB)
1:\Building\Permits\FPS-PermitApp_031016.doc
REC
City of Tigard Permit No.: 05ao/!o-co/SS-
,
III
a 13125 SW Hall Blvd.,Tigard,OR 972 Q2.p16
Phone: 503.718.2439 Fax: 503.598.1.1:'!t' Date Received: !C�l��0
Inspection Line: 503.639.4175 ,��
paRD
TIC RD Internet: www.tigard-or.gov Ct�l v1 l e 7 By: ce.--fru—a Lf
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ Kay Jewelers W1 Occupancy:
Job Address: 9312 SW Washington Square Rd W1 (9585 SW Wash Sq) Suite: W1
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $4,198.10
Type of System: (check one) ['Required ❑Non-required
(check one) ['Automatic ['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) /To be Relocated(max 5)
Number 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) 4 /To be Relocated(max 5)
I, Moses Frangopoulos Oregon Construction Contractors Board No. 133041
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.
Signature: Date: 9/8/16
Print Name: Moses Frangopoulos
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1
City of Tigard: Fire Protection Permit Checklist
pp Page 2-yySupplemental Information
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1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: Number of alarm devices: 4
® Addition or ❑ 1-10 heads: Affidavit required and
q ® 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
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Information: 71111111 ❑ Yes ❑ Nozard Grou.nsisi• AreaFactor • • , • • - • • $
11,^III*• Y � �'� n °" a4u ry m lau15� II lw ,h Ilmml'� I m I lu gIPN r h l. hr,, '�,Il• ,,, ! ! • d ! ! ! ! o-a !1 y tl1,11 dll v II*I4,, lI;I�� dl Iu 1,1,1 - T1hr, ICIYu r@I 11 �.. e .� u a rima "hud% 10llilll' " I�1 I, _ ,I r f .,,lI .a �ulul Ila .: 1 . at>d,,,,If. ,ar :Yia '�"dHood Pro Sect Valuation: $
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include: ividual Com onent YesP ❑t SheetsFire Alarm Pro'ect Valuation: $
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Permit Fee: IIII -
al
0 to 2,000 4 x,61,iv
11 Ille:
$198.754',11=,..
0
o-hl 1 II,61rr I nlr I n %Ill P 9d'
Z0012 001 to 3,600 $246.45 1I SII VIII ��
IIIYI11
i'I° II'i ° 11116IP V ,III"14, ^tilrlY
3,601 to 7,200 $310.05 IIII ll;lfi I , .:I:
7,201 and eater $404.39 kiluha �Tr ,�1� ,,I SMI
,.:a .1,-0111/6.n 11 a;I111 J CII>' IFI .,--4..,p a md I11= .,
Sprinkler Project Square Footage: sq. ft.
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Pro'ect valuation subtotals A,B &Cab s, .I`;$ '111 ;rr
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ove
Permit fee based on •ro'ect valuation see fee schedule : $
Permit fee based on s•uare foota•e see D above : $
State Surchar s e 12% of set= fee : $
FLS Plan Review 40% of ser 't fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mods\WSQ\5200497890 WSQ Kay Jewelers\PM\Permits\FPS_PermitApp.doc
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9312 SW WASHINGTON SQUARE RD W01,
TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00155
Jeff Grove
Violation Summary:
Inspector Contractor