Permit (98) CITY OF TIGARD IN FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT
Permit#: FPS2017-00173
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2017
Tf G} °C' Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9461 SW WASHINGTON SQUARE RD A13
Project: Lids Subdivision: None Lot: None
Project Description: Fire alarm permit:Adding(3)alarm devices. Affidavit submitted.
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 11/07/2017 $123.72
12%State Surcharge-Building 11/07/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/07/2017 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/07/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 11/07/2017 $180.00
Hourly Building 12%State Surcharge 11/07/2017 $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 $390.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,684.00
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 OA - 1-0010 through OAR 952-001-1+90. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8 .332.2344.
r
J
Issued By: Permittee Signature: (
!.F
Call 503.639.4175 by 7:00 a.m.for the next available inspec •n•ate.
This permit card shall be kept in a conspicuous place on the job site until •mpletio • - . oject.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System I.
3' FOR OFFICE USE ONLY
City Of Tigard �' ;eived
1 g s. .�d -"Date/By: d� 7/17 � Permit No.: S,Z1')I7_cc.i.7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960DateBy: Other Permit: � jf 7.�}�
T I GARD Inspection Line: 503.639.4175 , 7 �1 Date Ready/By: iuds: Bl SeetP�agge 2 for ?
Internet: www.tigard-or.gov Notifted/Method: Supplemental Information
gni, r 'ik 41
t ". �
TYPE OF WORK[[' TN( I I REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑De h lion F 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: $
IllAccessory building ❑Multi-family Number of bedrooms:
0 Master builder IDOther: Number of bathrooms:
JOB SI'1"I. INFORMATION AND LOCATION Total number of floors:
Job site address:9461 SW Washington Square Rd ID(9585 SW Wash Sq) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:A13 Project name:WSQ Lids A13 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.
Tenant Improvement on Fire Alarm System at Washington Sq Mall store"Lids" Valuation: $$4,684.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Roger Ott Type of construction:
Address:9585 SW Washington Square Rd Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
Phone:(503)352-8862 Fax:( ) New:
APPLICANT Q CONTACT PERSON
NOTICE
Business name:Siemens All contractors and subcontractors are required to be
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 Fax::(503)207-1834
E-mail:moses.frangopoulos@siemens.com
CONTRACTOR BUILDING PERMIT FEES*
- lP refer'10
fee schedule)Business name:Siemens -
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: #3?o it,„
Authorized signature:
�'� Amount received:
This permit application expires if a permit is not obtained
Print name:Mos• r i.. :1 o Date:11/7/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices:)k3 /�1 17
1/ Addition orq
1-10 heads: Affidavit required and ® 1-5 devices: Affidavit required and 52
❑
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:
Type of,System(Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
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: $ 4,684.00
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: $
D:\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mos\5200580464 WSQ Lids\PM\Permits\FPS_PermitApp.doc
ED
City of Tigard RF
° ,( i _ _
• Permit No.: 'del �. _' ►'7
13125 SW Hall Blvd.,Tigard,OR 97223
m Phone: 503.718.2439 Fax: 503.598.1960 i Date Received:
Inspection Line: 503.639.4175 ` €
T 1( A K U
Internet www.tigard-or.gov ( ,.
FIRE ALARM SW '' I la1T FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: �� t_ d-S Occupancy: L
Job Address: 5 W a, j (R4, Suite: /I 1�
Contractor: .S; Phone: 5-6 ?- 2 07- j 341
Valuation of work: $
Type of System: (check one) 'Required DNon-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) 3 /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) /To be Relocated(max 5)
i,
11 vS S3 jl "3,5
[^a v( •t)7 v v i�j ) Oregon Construction Contractors Board No. \ % I
certify the following idand 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: \ / 7/1
Print Name: �� �� 0
I:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9461 SW WASHINGTON SQUARE RD A13,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00173
Inspection Type: Inspector:
998 Alarm Final Chip Barnett
Result:
PASS - NoCofO
Comments:
NFPA 72 completion report received
Violation Summary:
Inspector Contractor