Permit FOR OFFICE USE ONLY—SITE ADDRESS:
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
' Transmittal Letter
T i c.A It D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: Levi Poling RECEIVED
MY 2 Z022
COMPANY: Wyatt Fire Portection
CITY OF TIGARD
PHONE: 5036842928 BUILDING DIVISICN3x/��
EMAIL: Lpoling@wyattfire.com
RE: 16112 SW 72ND AVE TIGARD,OR 97224 Tr,5�/— -X0�%
(Site Address) (Permit Number)
Acosta 10BP128-16112 Spec
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
3 Additional set(s) of plans. Revisions:
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): �y
REMARKS: Add 2 LLe-cep S i(A. b ez t t l'r c.r v-k S 2 o/t c r heads,
/A VeS ; bt.,,le
FOR OFFICE USE ONLY
Rout o Permit Technician: Date:3- .- 2.r 1 Initials:
Fees Due: y ❑ No Fee Description: Amount Due:
O.S )a r p1�h l W 4 dy L._-- $ C ---'
$
$
$
Special
''sNNN
Instructions:
Reprint Permit(per PE): [' Yes o ❑ Don
Applicant Notified:
Date: 714,Z2 InitialJ�•r, ,A
I:1Bu i Iding\Forms1TransmittalLetter-Rev isions_073120.doc
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114
COMMUNITY DEVELOPMENT Permit#: FPS2022-00060
Date Issued: 5/17/2022
T fGAR L' 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16112 SW 72ND AVE B18
Project: Acosta Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&F
Project Description: Fire sprinkler permit-Adding 13 heads and demo pendent where ceiling to be removed.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN: N PIVEN
TIGARD,OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/09/2022 $112.96
12%State Surcharge-Building 05/09/2022 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 05/09/2022 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 05/09/2022 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 05/09/2022 $6.00
11x17)
Additional Plan Review 05/09/2022 $45.00
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calm Provided: Cut Sheets Required:
Total $224.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,750.00
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 forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a acopy of the rules
Issued By: —7 Permittee Signature: ` (i7 r l
Cal 503.639.4175 by 7:00 a.m.for the next available Inspection date. 7
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.
Bpildint Permit Application
•---Fire Protection System FOR OFFICE USE ONLY
City of Tigard RECEIVE DateiBy: 41 9"t79 17 f2h2„0^o/_^
Deceive L /i/.L Permit No.: J V l/(1 lW
i • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie u
• Phone: 503.718.2439 Fax: 503.598.1960 APR 2 0 2022 Date/By: S ' Other Permit:
TIGARD Inspection Line: 503.639.4175 DateReady'By / Juris. See® Page 2for
Internet: www.tigard-or.gov CITY OF TIGARD No d�Method: � • II Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
I]Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:
❑ I-and 2-family dwelling ❑. Commercial/industrial
$
IDAccessory building El Multi-familyNumber of bedrooms:
['Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16112 SW 72ND AVE New dwelling area: square feet
City/State/ZIP:TIGARD, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Acosta d 0BP120-1G112;,pet 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Adding heads for tenant improvement. Demo pendents where ceiling to be removed Valuation: $3750
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax: ( )
New:
APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Levi Poling licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax: ( )503.684.9657
E-mail:l.poling@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Wyatt Fire Protection Permit fee:
Address:9095 SW Burnham
State surcharge(12%of permit fee):
City/State/ZIP:Tigard, OR 97223 FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lie.:64077 Total permit fees:
. _ / Amount received:
Authorized signature: •
(I/ 'C� O/2.O 7/1- This permit application expires if a permit is not obtained
Print name:Levi Poling Date:4/4/2A 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_031016.doc 440-4613T(11,'02iCOM/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: 13 Number of alarm devices:
O 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
❑ ii+ 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 light hazard
Density o.t
Design Area 225 sq.ft.per head
K. Factor 5.6
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Mann
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: $
W:\Permits\Permit Application Forms(Updated July 21117)\Tigard Hire Permit App.doc 2