Permit (100) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
R B . COMMUNITY DEVELOPMENT Permit#: FPS2017-00096
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2017
f �� 9 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9538 SW WASHINGTON SQUARE RD H14
Project: Nespresso Subdivision: None Lot: None
Project Description: Fire alarm-Modification of(11)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 07/24/2017 $145.24
12%State Surcharge-Building 07/24/2017 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 07/24/2017 $58.10
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 07/24/2017 $6.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/24/2017 $15.00
11x17)
Hourly Building Rate 07/24/2017 $90.00
Commercial Sprinkler System: Hourly Building 12%State Surcharge 07/24/2017 $10.80
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: Smoke Detectors Req:
Battery Gales Provided: Yes Cut Sheets Required: Yes
Total $342.57
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,956.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No. = Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir= questions to I.UNC b -fling 503.232.1987 or 1.800.332.2344.
Issued By: ^ # _1 -L_-6L.i(.,,
/ Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspectio •a e
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System ;rte (-1C' ,t •: FOR OFFICE USE ONLY
F�•,` r :, , i , Received
III . City of Tigard (� 47 /7 1 Permit No.:f/ `{>/7��Q6
q Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196Q,: Date/By: '� Other Permit: ��17�Ot/OJ
T I GARD Inspection Line: 503.639.4175 Date Ready/By: /+ Juris: See Page 2 for
Internet: www.tigard-or.gov •rifled Method: 7 /17 // Supplemental Information
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❑New construction 0 DemolitionIndicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Other: , - labor,overhead, • profit
~ a'" s NII fi'` "�I�gl,t r ' '' , a 'ti u'i�hilu'IP���91i a` 'tu Ip fhi4 • • -, • application.
+,. t'.4.4'$:•'.'••, HN ,hot 4 f® s 4 . `` w �tilf'PII�9�w* t�,,
❑ 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
0 Accessory building 0 Multi-family
❑Master builder ❑Other: • ' '
..-.. oe N,_: i v I .le ptnlyl'J,t. t .9 ►. mi}�ke II+t^+ re l.oliN1I^iV1plltt� I,Ilii „x Total number
Job site address:9. 6 SW Wash Square Road • ' _ ' feet
City/State/ZIP:Tigard,OR 97223 • po ' feet
Suite/bldg./apt.no.:H13&H14 Project name:WSQ NespressoCovered porch area: square feet
Cross street/directions to job site: square
Other structure area: square feet
Eiriiiintrit . hfp 'I' w
w
t 'tt tliatti
Subdivision: Lot no.: 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
k" 'I �I�v�tl aid"t"o, i ai 1 C � p ' , • indicated• ••,
Tenant Improvement on Fire System at Washington Sq Mall store,Nespresso. valuation: r '
Existing building area: square feet
New building area: square feet
3. k-" + 4 +t ', Illi ¢ , P s
' 1IIPR{ Q° ,I , ,,,, 1,rc. a ,t' A
Name:Roger OttType of construction:
Address:9585 SW Washington Square Rd Occupancy
City/State/ZIP:Tigard OR 97223
Phone:(503)352-8862 Fax:( )
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,.,11 7 'd ` Itl +' r'' `Mtrp y 1 f ,f m 1 Iii `
._ '. , - •NT . ,f4, 4,q kl.i Ff'4 VI i @� IW II`V7.i�l�l 1+ _'rr w•i �lil' $1 I.. ,„, . r ,
Business name:Siemens , , , subcontractors are re
ub , , , , to be
Board
Contact name:Moses Frangopoulos ' vvith the Ore=' ' ' '
ntractors
under ORS 701 and may be required to be licensed in the
Address: 15201 NW Greenbrier Parkway,Suite dijuns
ction in which work is being perfonned..If the
City/State/ZIP:97006 applicant is exempt from licensing, following the
reasons
Phone:(503)207-1834 I Fax::(503)207-1900
E-mail:moses.frangopoulos@siemens.com
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' t0, 4ww�7,u w "£ K. =cr s t. ' 1"t'''1","" ,4k rp , $at � ,cI x 347t.� Or ,y
. .404,66; ,4 ' NoJ061 N,.ww1h 4/4t6 , _ ,;66 ... . r, .. "---'""4664Vy." q.r*. wC4 e?to ?. iw . ..�. )'..'''.
Business name:Siemens
Permit fee:
Address:Moses Frangopoulos
State surcharge(12%of permit fee):
City/State/ZIP: 15201 NW Greenbrier Parkway,Suite A4 0
FLS plan review(40%of permit fee):
Phone:(503)207-1834 Fax:(503)207-1900 (Due upon application submittal.)
CCB lic.:133041 ` Total permit fees:
,,,.. V� Amount received:
Authorized signature: / -
This permit application expires if a permit is not obtained
�.-�/ Date:6/22/17 within 180 days after it has been accepted as complete.
Print name:Moses Frang�sou of s t..
j * Fee methodology set by Tri-County Building Industry
Service Board.
440-4613T(11/02/COM/WEB)
I:\Building\Permits\FPS-PermitApp_031016.doc
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
O New system Number of sprinkler heads: Number of alarm devices: 11
® Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies 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:
'� ... �s^fPM
mcm 11111
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$111
�111111 1 .41111141ll:G :2C10, E, 1
A.
1:1
at
IIMEMS
E. ❑ Wet ❑ D
Additional Standpipes
Information: EMEEMBERZEI 0 Yes ❑ No
Hazard Group
Densi
Desi Area
K. Factor
S. '1 , - 1•-c V. . •. m• $
•
1 1 I •'� ,,,,yr.,id h 1 I • + M14 T"' i 1W4.'
"
^ y ppm 1. 11 }4 � r ' . , ' 11tlry11u `. �yi1ryj1 pmr m $ g ® .i .di ua a : A. � :. _.:
Hood Pro'ect Valuation: $
14 ti:. .r,I III a-f �'i rlii p11R f11' `!Ii
II p tl,11b I"'V4r „`o-l1
'f, 71: '1 i..°9111 4''' 4 rx'A;1 , 11; '. ".'S;,' hlI11�1 4,44 ).,,6 ,, " ?otic, liIIIIIIIII yiP1 ItlJ II I;11�1i4[� °w"4 +1,4I�III1r t 41�r i Irv'� 111 i.;;_ "ill�torr h r III11j!'v, w Ilii li 1 �Iµul V'1 lh 11, 11Vr.�.^ ,ti',+�;1ill.l lud111„l"� a1 '41�V 4wV E
Submittal shall Batte Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Pro'ect Valuation: $
' 1 -j ,"q.' h • or ua�„'.'.b+I it„,..-:.8•2....-_, III t - Iir tl�r d'. wI mt:
',71Fill , t y I1 G., M »q1 G, 1 tl�1,yF4NI a f111' Ij11
301 tl0.`V;,?'” �q�'!.h '�111G1 M n'� .: �7:).1011
NP"I I� y :.k!,-;720111**-1'' +r� ,�,� NIII°,^� � �1 ':1Ct 1 I IN1 - a` d� ' v - y� 011 J bj1t {', Natoll ,2j �1 �� I�� � ro dr I IV, �. "u "Rei .e m . . m ,.@s 1 t ndla • 6 0.‘,... a m"'qV j �IIj1ur'r 1111 wu,, • rrw 1 u .
Twit°.>, + ” AI 1kkii I ": ''"''y'O V$r :e-!fir "''' a4I �.._ Vey11111 ,rr X11 191 a I stllgr r 1
t -
a1w h1 i 11tlm'" r 1111 1 m 4 t• 1111 iso_�,.
Square Foota.e: Permit Fee: t- 111 ti r 1 'llllMllmIlIGI� , N
4A ,“ r ,, f :.,',"'1171''- rE'M Ir1111111£ k 1111 re -
0 to 2,000 $198.75 -...;.';-:;,,,,..11100'4,,,.:0I +11111111 '. ld,
� 11 Y� 1n 19 i IS, r a u�l r,�l {�y',
2,001 to 3,600 $246.45 7 fi1 i�q
P�I�rlll�l r° --.•)r-.P, -.,K.;':--1`:'.j- IIM1111i111 r N ,4! t ,"'1411µkw
3,601 to 7,200 $310.05 ,ttr h'11111114�1�1 . 11>,1 ` 11J1
7 201 and : eater $404.394 I IIIIIh11 14,11" . phl "1hll+a "v.� . �Il, y.;
hr 11 yV111 . ,1111 , C' .aalG u" U e.:,, i"' . u
Sprinkler Project Square Footage: sq. ft.
�4z GJ I�'M'I IN tlr ",,u I .Pr0 ly' }',p11111 ,,, §- �,, ±';"�11y,1Y ., ,1 lb€,% ,,,,p,;, - i IIi4S1Au. rll',1
NIul1.<:ffm +i A'1 11 l�l�f 5", 111 ,, 1GY3,13,1 toteettork,pre �tT. pl 11 d 1W L,e, ,. k.:` '4irar : dtiu414 'Y'.. A1�11�4 �.
Y 1" „�11ek fr .�&f u.,u". � 1u R1Ckx1 AA
Pro'ect valuation subtotal see A,B &C above : $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on spuare foota•e see D above : $
State Surchar•e 12% of permit fee : $
FLS Plan Review 40% of permit fee : $
TOTAL: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Molts\5200555754 WSQ Nespresso(H13 H14)\PM\Permits\FPS_PermitApp.doc