Permit i
FOR OFFICE USE ONLY-SITE ADDRESS:
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Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
` _'PI i Tran m s ttal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ' _ Tn_ DATE RECEIVED:
DEPT: BUILDI DIVISION RECEIVED
FROM: C2c z7 IAC—lIANe.4-- APR 2 8 2022
CITY OF TIGARU
COMPANY: 01.6, -Tk,rra 140 W\(S BUILDING DIVIS1nf
PHONE: 5-O'3— 7861 — 02- t5 By:
EMAIL: cAc15 G \a,t\C.k- c-rctiV\otnAts. rlt+-
RE: k 4M4 Ski.) Wo.lY1v- ' L.) FPS ZO72. cDcT
(Site Address) (Permit Number)
1—trn t . L o d 4
(Project name or subdivisi,ii,me and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. X Revisions: t") C8'k5 4- 4 n ?:(4?-
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: irn, - -+--i^e n o c4,1c-4 f p Ial() Ta( 7�.a V 3(-
r-i 3CS- i ` II r) `-) A -\►.-�-1 01% n�
1 --- 1 c�rA4 i o
FOR OFFICE USE ONLY
Route o Permit Technician: Dates . 2� Initials: 1 k
Fees Due: Yes ❑ No Fee Description: Amount Due:
0.-- h i pi Gv, re.v;..c%J $ yc—
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes No ❑ Done
Applicant Notified: �y Date: 5-8 yl. Initials: ,'-y,
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00052
Date Issued: 4/6/2022
T f GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S1046C10700
Jurisdiction: Tigard
Site address: 14044 SW WALNUT LN
Project: Fern Ridge, Lot 4 Subdivision: FERN STREET SUBDIVISION Lot: 4
Project Description: Adding fire sprinkler to new dwelling.
Contractor: GEO PLUMBING LLC Owner: K5 URBAN PROPERTIES& MANAGEMENT LLC
1710 NE 199TH ST PO BOX 25571
RIDGEFIELD, WA 98642 PORTLAND, OR 97239
PHONE: 360-500-0999 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Info Process/Archiving-Lg$2.00(over 04/06/2022 $2.00
11x17)
Type of Use: SF Info Process/Archiving-Sm$0.50(up to 04/06/2022 $22.50
Class of Work: NEW Type of Const: VB 11x17)
Occupancy Grp: R-3 Height: 25 ft Fire Protection System Permit-RES 04/06/2022 $246.45
Stories: 2 12%State Surcharge-Building 04/06/2022 $29.57
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0.1 Design Area: 500
K Factor: 4.4
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $300.52
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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 fort in OAR 952-001-0010 through OAR 952-001-0090. You ma ob • a copy ofthe rules
Issued By: Permittee Signature: � v \CY-)
C/
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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 g)
Fire Protection System RECEIVED FOR OFFICE USE ONLY
Received
Cityof Tigard1 /� Permit No.. 2O2i-(Y]o
1315 SW Hall lvd.,Tigard,OR 97223 MAR 2 2 2022 DateBy: �!� (. l J` L 2
g Plan Review
C �� Other Permit.
Phone: 503.718.2439 Fax: 503.598.19601 tY OF TIGARD Date/By: y " 4 Lt ow
TIGARD Inspection Line: 503.639.4175 Date Ready/By: GG1`�y ) ® See Page 2for
Internet: www.tigard-or.gov 3UILDING DIVISION Notified/Method:•1` / ]1 r Supplemental Information
�,L(<.+i yl3.
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
lifi New construction ❑ 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
A1-and 2-family dwelling ElCommercial/industrial
Valuation: S
4❑Accessory building El Multi-familyNumber of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: \4O44 .c. \AA\The,}- LiANew dwelling area: 3 r43 i0 square feet
City/State/ZIP: Ti r Ci 6?i .Garage/carport area: square feet
r
Suite/bldg./apt.no.: Project name: [ R ,.,.1 Covered porch area: 'ct square feet
Cross street/directions to job site: 1 � l rn Deck area: „_- square feet
Other structure area: r square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: R>rn ';d_ Lot no.: A 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.
ACIA t ire, yin V.It r- -{0 v6e--
Valuation: S
ir"tt1 1 _IC r � (6 r z;'lik ,ki'kiln
Existing building area: square feet
LA kk5T _O .i.— c ZO New building area: square feet
1 PROPERTY OWNER 0 TENANT Number of stories:
Name: L7( t'w {t t-c ilD,-tm_<> Type of construction:
Address: -1:t fox '?5 I Occupancy groups:
City/State/ZIP: TO 7(t-`��c' / 0 e 17 29 Existing:
Phone:(> '3) ( 8t1 O a I y Fax:( ) New:
0 APPLICANT N CONTACT PERSON NOTICE
Business name: '�jt kke„, \Lrrc, a t 5 All contractors and subcontractors are required to be
Contact name: [ licensed with the Oregon Construction Contractors Board
�\S C p h(C- under ORS 701 and may be required to be licensed in the
Address: `-'S‘j)( 9 c lar' l 1 jurisdiction in which work is being performed.If the
City/State/ZIP: i';�„t*�� a V- c - 2C�8 applicant is exempt from licensing,the following reasons
yrrr') t-� (� -" _V apply: _
Phone:(60) to-li07 " Fax: :( ) y
E-mail: ' C�xri5 t� \-cxcc_ \\Or^�C D I RC. '"1
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: `.-c.0 C U FlrL (-,Ii4.C( r) Permit fee:
^�
Address: t 1 (0 ( )' L i t ON /j{-,
City/State/ZIP: ' (,Tit ro A �'(�42 State surcharge(12%4 %of permit fee):
� / 9 FLS plan review(40/e of permit fee):
Phone:(5n 1010 - IT"l"7 1 Fax:( ) (Due upon application submittal.)
CCB lic.: 2(if, g Total permit fees:
Authorized signature: Amount recei ed: 'V./N. I aA
This permit application expires if a .n it is not obtaipad"
Print name: CA/0.-, cr 7 .,c Date: 3 1 L A within 180 days after it has been accepted as complete.
l * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permirs\FPS-PermiIApp 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:
gNew system Number of sprinkler heads: Number of alarm devices:
❑ 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:
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
Flood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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: $
I:\Bullding\Pemitsss\FPS_PemtitApp 031016.doc 2