Permit (61) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
° COMMUNITY DEVELOPMENT Permit#: FPS2018-00068
T f GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2018
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9512 SW WASHINGTON SQUARE RD H02
Project: Resveralife Subdivision: None Lot: None
Project Description: Fire Alarm Permit:Adding(3)fire 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 06/18/2018 $112.96
12%State Surcharge-Building 06/18/2018 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 06/18/2018 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 06/18/2018 $8.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 06/18/2018 $180.00
Hourly Building 12%State Surcharge 06/18/2018 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Gales Provided: Cut Sheets Required:
Total $381.30
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,974.00
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 QAR 952-001-0010 through OAR 952-001-009', You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.19y.800.332.23 .
Issued By: Permittee Signature:
al 03.639.4175 by 7:00 a.m.for the next available inspection '.te.
This permit card shall be kept in a conspicuous place on the job site until completion o 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
eceived - , Permit No.: 1
City of Tigard PECE1VE> f`.ateB : rl� t w , - ,;
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit: / - 1
IN _' Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 10111 n
,„;404,11 _ �-
T I GARD Inspection Line: 503.639.4175 JUN 1 8 2U18 Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov Notified Method: Supplemental Information
.. aa� `l '0:`".':..!.. :4'',7,,i0 !:'.',10'.:::1140,:,.6 IS 'I I� of,' { 1
tl tta 'a`''''''''''''1:''''::‘‘
+s,� ,w Yr , P. A .W� .
I ,1rh1 1 YII, ,� �;1 ! , f,�, ' �l. .I'I�Z , ...,. ' E ri.. ,5'n", > -: Ii?: .., x...
Permit fees*are based on the value of the work performed.
❑New construction �i" Perri()rtion Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the 1 all ',.....!!!.1,11111W-.,....1411!111:..,-;:,.' work indicated on this application.
w `», ,w „Ill Ill��p >, .. !� .„r.�: M�.r.I tlt, u. ' , Valuation. $
[] 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms: ;0;
Accessory building El Multi-family
Master builder 1:=1 Other Number of bathrooms:
a �Im 4,«Y 1 1
r � � � � �I IIVL �� r. Total number of floors: -�
t .l ' gym <; , a rdo �nl -.. Lt ” ' v_ h
Jqb site address:9512 SW Washington Square Rd (9585 SW Wash Sq) New dwelling area: square feet
l
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:H02 I Project name:Resveralife 1102 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
`I 4I 1=F,fi� IT
Subdivision: I Lot no.: 7.Permit fees*are 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 fi
�� ...,:: ,...40!......:.411M. work indicated on this application.
I�IIY . ,� ^ . till : �. M II ,.IwilIII �V:. ,.,
.I ; hhl �,�' �IdlNa Valuation: $3974
Tenant Improvement on Fire Alarm System at Washington Sq Mall store"Resveralife
In connection with ELC2018-00244/BUP2018-00075 Existing building area: square feet
New building area: square feet
''-',,,,.:v1.111§.: li ii. Number of stories:' Ilu `0 Idllii. Il1 s ' II rII, t* � ........
Name:Roger Ott Type of construction:
Address:9585 SW Washington Square Rd Occupancy groups:
City/State/ZIP:Tigard OR 97223 Existing:
Fax:( ) New:
,„�-�Phone:(503)352-8862 ) i t -',.,-...,,,-1-,,,,..a''''-:'''.:.l ,"1 dA A,,,,,'...„- a� ` t. - , ,I '' -' . aO.
Business name:Siemens
licensed with the 0 All contractors and subcontractors are required to be
re on Construction Contractors Board
g
Contact name:Moses Frangopoulos 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
applicant is exempt from licensing,the following reasons
City/State/ZIP:97006 apply:
Phone:(503)207-1834 Fax: :(503)207-1834
E-mail:inoses Frangopoulos@siemens coin
M l ,,. ` 1 1,8 t,l 1N PI ,e,sch FEES**,
t` Ill t��. SII 4... ,, �, VIII .vN.,€,� -=:=1 is 7 .
s i Pteus4 refer trr fed schedlte# ...
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: _
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
26r
Date:6/15/18 within 180 days after it has been accepted as complete.
Print name:Moses Fran os * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
•
4
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
L� ;„,-,,,--,--,7-1 ,:L.----.777. 17--..7.77:: - ..:,'.p ..— I,I III !1 I ",
Dscnbelnwor 170, + nv. I; III rl;l { v' III , '
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: 4
® Addition or ❑ 1-10 heads: Affidavit required and ® 1 5 devices: Affidavit requnired d
Alteration (3) copies of sketch showing area (3) esketch shoig area
to existing of work within building structure of work wsithinof ke
building structure
system
❑ 11+ heads: Plan review required and El 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
rNdlru {'�r�.. -' r ,r fin. I'�',;'I I14 I:1 n :'?I IPI IIhI d"� '' r 4.1! 1} 1;L ...,,,,, ! _ s
1< +-3 i r l,, 6 N i 1 1 It1p rl,: r +y, t p 11111 IhQ,VII1l ,°r ,NII If:°-7'"'hI r' NI n r > , r '==
s," T4 ( - Tete t),1 p�;Q D•,.....4401--
ryl.0 a �J 2l��:t'):rN:1 IN q. v h SII n ' 1 rl ''.�I Plfl :,r X.-�. ate �.
s' „,.,-',;',•-,..,:',',',,-:',";;-_-,,,,,,,-Y-: ri -'r Oi; } d I w ::,Gs Ii:1i:i SII!I° r�r 1 11�',II IV - Irl d s. p,, -
?,Zu%9 ' : 4 V �l II : III : :IItl:gIl2h '; :y I°
1 r P il . a I I'a�' d '1I'I'Il Voll i 9i:4i III IIIII, : n 1�IIIV„ II I
.-'�"N '9 to r r r 1: �':, 1 111 ti .. !, :IIIIII uJ_ -.,. ''-M"'-'''' '''''.'-'41:"'''''----:':'::-'''.::::":!':'"!'":'
-¢
I�b �' :�,�R'.� {.'. 81 N'15P Ip III n I�Yq^,'' ..I III Ii Ill '"� �� � :III 1
.> I1I ili�'V' ' _, I'i' �u I'':III VI:q,114 `
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes El No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
iI " .� I°r: :- : III I :I VIII n, '61� 1j1i, :,
r '„ I: : III14 aI II:11 41 II!:�
i'1;) Z`yp T Grid i.i Sud pr+e si S d/ :i� .
11 .r l 2�l ,N ,
Hood Project Valuation: $
".. :,. :I'FI' h - , ` '1:I4ti :-> Ir + '_- -. _. 1 :1 t a:ITI n 14r �`
aEi II rd' n{ I::} ' 1 : :'l lll'I 1' : III r - 4 III z 11 N11'i
,.C1,' '1' _ ".a. Lm:0,, s _ ,.IN':14111:III11411 _, ' "N of lm v'. �' hIlG�llllill'1:1 1 "11 N 'ri .; II ., ..
fllw. -,�,-= r :rIrG1 j, 11 p Ir t:.
Submittal shall V Battery Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3%j 741 '--`'''-1
II Ix:. I r :N i ,. : ''r II IIIIII iw, z:,a• r1•r 4 I: G"INII x I Ih111j1'I'111191,Id, '. r 1" ° II 110,;�,'.0
Itis - l is rIN IN1yllk010 II Vh ,, r141i111116 r k': -: r'�II1 :, 4 :III II III..111 ;fi ni114l1� j iI IMI
r 1 .J L t rr;'z ::111:111..,111 II Ill.:p: 4: , .•
11,-;4k, esu tra I t, ler(S d Qne Syst m) YI
1, 11: 1
:11111: �I:
Square Footage: Permit Fee: q
0 to 2,000 $198.75 t 1 lid k
9,001 to 3 600 $246.45 h
a.r' r: Illul
' .::i1.;,,;'1';----,-.-7_-__
t 1 �'1 :II1 :1:1'1 1 1 :I '
3,601 to 7,200 $310.05 1 11�l 11 r 1,111�j11�1j 'IIIAIj�:' :
r IIIVI:11 IIf ,r,�i11j'i11h1'"II op 4uw1;,. -
7,201 and greater $404.39 ��:� ° ,�.,'„„mI,'4 _ �� �.
Sprinkler Project Square Footage: sq. ft.
: t _
I-_ 'Wh:.r'R : ” 1 :, :r�11ar - r _,,: ' r =ydW PY pES :,.: : u ler1i L £ F
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\_Mods\5200624307 WSQ Resveralife\PM\Permits\FPS_PermitApp.doc
RECEIVE')
City of Tigard Permit No.: / Q5 e r— '6('
1,,I .
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 � Date Received: GV/Sh I
Inspection Line: 503.639.4175 JUN 1 p 2li 18
Ti G A R D Internet: www.tigard-or.gov By: or04/1{?-✓ f p,l--
CITY OF TIGARD
FIRE ALARM MillEVONFIROAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: . Q P e.sv eflTe__ Occupancy:
Job Address: Qin a Sti/ 1A-1440 S 'RS Suite: 14 0 a
Contractor: , e% XtS Phone: S v1 - 5s-2-M2
Valuation of work: $ "q 71/
Type of System: (check one) 'Required ❑Non-required
(check one) EAutomatic ['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) ,3 /To be Relocated(max 5)
I, POS POvtR r �12. Oregon Construction Contractors Board No. ( 3j^vy
certify the follobeilig 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 1 this document with a copy of the sketch attached shall be available for all inspections.
Signature: itig _ Date: Cly e J
«i
Print Name: Illi! ' • ._A-4 , d(J
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:
9512 SW WASHINGTON SQUARE RD H02,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00068
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor