Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111'1 COMMUNITY DEVELOPMENT Permit#: FPS2018-00139
Date Issued: 10/10/2018
T f(;A RI) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9520 SW WASHINGTON SQUARE RD H06
Project: L'Occitane Subdivision: None Lot: None
Project Description: Fire alarm.Addition of(1)speaker/strobe and(1)strobe.
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 10/10/2018 $123.72
12%State Surcharge-Building 10/10/2018 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 10/10/2018 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 10/10/2018 $6.00
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 10/10/2018 $180.00
Hourly Building 12%State Surcharge 10/10/2018 $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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $395.66
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,580.00
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 ,ollow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009 . •; -•: —._ . a copy of •- rules
or direct questions to OUNC by call'• 503.232.1;87 or 1.800.332.2344.
Issued By: �� Ori ./11", Permittee Signature: (t ill.w- /'"
Call 503.639.4175 by 7:00 a.m.for the next available in4
This permit card shall be kept in a conspicuous place on the job site until1 , - .TT• e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire`PrUtection System RecFOR OFFICE USE ONLY
City of Tigard OCT10 2018 DateB :d '
. DateB / / �,I ll
lig ° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 s ` Date/B Oth:�f y
U,L %)F: 8ewry y: See Page 2for
Inspection Line: 503.639.4175 n n Date Read B loris:
TIGARD Internet: www.tigard-or.gov BUILDIN EAVl.�4 7�1 Notified/Method: Supplemental Information
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0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
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. y . r.Kli<O.:,I1: I; I+ wo.0 `'NW: work indicated on this application.' : )
.'.'..':''...''''.:!,: ::;':: :,;"'.j.«„ f t ',-0 . 0Fwvh ? 0 0 0:44.1
1-and 2-family dwelling ®Commercial/industrial
Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms: w;
LI Master builder 0 Other:
Number of bathrooms:
i ,.» f t n+^:• h'f 1” F 14 rly m P 'utweil'tl+t' r^
'9 ,' I.al, I.a a� 1 a #t4' � ON11'"�'"" I„, Total number of floors:
;.".;s „ , Iy A l: rm�i'R'Wuli ',+�uX Igt,11 1 1i, .,.....K^, 4hW. i,1.110.1006N031100*Prh yµ 11
Job site address:9520 SW Washington Square Rd(9585 SW Washingto) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet __ ,
Suite/bldg./apt.no.:H06 I Project name:WSQ L'Occitane Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
” BRAY. '... al�1N ,,P* ,
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax mno.: Indicate the value(rounded to the nearest dollar)of all
Ta t map/parcel
,I r €u �' a r, T equipment,materials,labor,overhead,and the profit for the
r r 1IiI,i t „ ,..4r, `et r < 1 r hrt,400.h.olII141I Y ,�I11Ga11III' ,
rr ,Pii�'+I t ; 6 I t»: , r s ?�, , , work indicated on this application.
u1pT',w�",�re:�«I�r. »�, ' �'.... ., :,Ms!;- .,m onF,.',.",,F-4,41 .., ,' .,r. F..,,{0.mi6��"Rt.°c.°...yPa_5«, .v,-�., :,.
Tenant Improvement on Fire Alarm System at Washington Sq Mall store L'Occitane Valuation: $4,580.00
Addition of 1 Speaker/Strobe&1 Strobe. Existing building area: square feet
New building area: square feet
a , & '''610
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r � � ►+ O' � ������j I y ?aP�iux � � r� Number of stories:
''''ifiu*"i 4tr s+.rik the .1�Go� Itl �" '.i i Y
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:
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Fry
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., .,
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
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Business name:Siemens
Permit fee:
Address:Moses Frangopoulos
State surcharge(12%of permit fee):
City/State/ZIP:15201 NW Greenbrier Parkway,Suite A4a —
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:
�`---- "'Ill”. received:
Authorized signature: -,-
�..- This permit application expires if a permit is not obtained
Print name:Moses Frangopoulos Date: 10/9/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_03 t016.doc 440-4613T(11/02/COM/WEB) --
1
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental InformationF14
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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: 2
Z 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:
i i 11;1
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4,4.444i4,44
a.,.
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
h ..., �" `. 1:::".,?„,. ,,'Y":+ rx. uti P.j ry 4'IhRl 114Yj1�l IINI 411il IYVII 6 ik,.. ryR 1"41 RI 11p7 Ilir ,x. xx Y a aY!r Ra " ,
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Hood Project Valuation:
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,�;rl {I•'rI�N�����1Yi 'h(IIII iIN�,�111111�1I11VI tll,�l.��€ r '� 'h�;'k,�.�
E! ,et .."r{ *4 h l9 r IY'hlRll N 11�N��I y�11„I��II Nr1 m161�;II{III ti„ 4 rI✓l a ' sr!,'61Vq'11�p�11111 P II F” 119
�ll�l ld{bh���1111111 I�mN M�NPI�1��141 11�1�111i 111111"6Ci"rNy, 'I. 11!11gHlililplW111WIi1Vl{i 111y^m1;,`;i
61 161M I r� c 1,1611�P,
Submittal shall Battery Calculations ® Yes
include: Individual Component /1 Yes
Cut Sheets
Fire Alarm Project Valuation: $ 4,580
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,A,111:11,110;.,!,` �M"'.ININ�lVI �,�u11111 �,NIIII II��11 I°ih1,111„1�...It 1 1 1���.6 y�>� ,�e4��< .�� _ ,•"�, n4 . I,J IINjIP�1IINNBh�•�-„ ,t. -. >�� ,V"" -
r y v r' (>"A rr !I aril r r xl
Square Footage: Permit Fee: "° +
0 to 2,000 $198.75
2 001 to 3,600
$246.45 .1I�r� ,'` ;” ° ,
hyr,,Rl I,I
3,601 to 7,200 $310.05N�
7,201 and greater $404.39 ,
Sprinkler Project Square Footage: sq. ft.
141404,, d r pw"'"r�T'ully� 1 .114r ,
,
,. :.
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: $
Di\syncplicity\frangopoulosm\FSS Sery Projects(Charles Hughes)\Open Projects\_Mods\5200642863 WSQ L'Occitane(H06)\PM\Permits\WSQ L'Occitane Permit.doc
RECEIVED
City of Tigard OCT 10 2058 Permit No.: fr5). 7 -00 l3,
111 it 13125 SW Hall Blvd.,Tigard,OR 97223
II Phone: 503.718.2439 Fax: 503.598.1960 erry ;�: �;y� Date Received: (0 (/d //
1 IOARI Inspection Line: 503.639A175 BUILDiNC �ViS lO61
Internet: www.tigard-or.gov y: G��yZ�c ^
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: WSQ L'Occcitane Occupancy:
Job Address: 9520 SW Washington Square Rd Suite: H06 (WSQ Mall: 9585 SW Wash Sq)
Contractor: Siemens Phone: 503-352-8862
Valuation of work: $4,580.00
Type of System: (check one) ❑■Required ❑Non-required
(check one) ['Automatic nManual ['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) 2 /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 per- it.
• A copy of thi. 1 • : • i opy of the sketch attached shall be available for all inspections.
Signature: — Date: 10/9/18
Print Name: Moses Frangopo os
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1