Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
` I COMMUNITY DEVELOPMENT Permit#: FPS2022-00064
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/21/2022
Parcel: 2S110AD12200
Jurisdiction: Tigard
Site address: 10891 SW ANNAND HILL CT
Project: Annand Hill Partition,Lot 1, Primary Subdivision: ANNAND HILL CT PARTITION Lot: 1
Project Description: Fire Sprinkler permit:new residential system for tri-plex. 1A
Contractor: WYATT FIRE PROTECTION INC. Owner: BLUE PALOUSE PROPERTIES LLC
9095 SW BURNHAM 333 S STATE ST STE V452
TIGARD, OR 97223 LAKE OSWEGO, OR 97034
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-MF 06/20/2022 $102.20
12%State Surcharge-Building 06/20/2022 $24.53
Type of Use: MF Plan Review-Fire Life Safety-MF 06/20/2022 $81.76
Class of Work: NEW Type of Const: VB Info Process/Archiving-Lg$2.00(over 06/20/2022 $2.00
Occupancy Grp: R-3 Height: 25 ft 11x17)
Stories: 3 Info Process/Archiving-Sm$0.50(up to 06/20/2022 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0.05 Design Area: 250
K Factor: 4.9
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $220.49
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,376.00
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 copy of the rules
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/f/k1Issued By: , / Permittee Signature:
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 RECEIVED
Fire Protection System APR 2 8 Z022 FOR OFFICE USE ONLY
City of Tigard Received „RI;_/
CITY OF TIGAFii� Date/By: / (N' ON )L�— Permit No.: ,p /L.[
III
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review t L I u S cj� cv I
Phone: 503.718.2439 Fax: 503.598.196081jILDING DIVISION Date/By: ..s4 J r— J Other Permit:
7 1 G A R O Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-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
❑Addition/alteration,'replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwellin Valuation: $ 30 2 z
g ❑Commercial/industrial r J
ElAccessory building El Multi-family Number of bedrooms:
II Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 'I airq/ SW Annand Hill Ct New dwelling area: square feet
City/State/ZIP:Tigard OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Annand Hill Triplexes tA 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.
Install complete residential fire sprinkler systems for triplex. Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell 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:r.campbell@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection
(Please refer to fee schedule)
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:
Authorized signature: V 1
n n Amount received:
1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.Print name:Ronin Campbell Date:4/28/2022
* Fee methodology set by Tri-County Building Industry
Service Board.
t:\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: 29 Number of alarm devices:
❑ Addition or El 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 13D
Density 0.05
Design Area 2 heads
K. Factor 4.9
Sprinkler Project Valuation: $7130
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: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Ice:
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 2017)\Tigard Fire Permit App.doc2