Permit rt�f CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN
Q s � Permit #: FPS2010 -00041
COMMUNITY DEVELOPMENT
T t GARB 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/30/2010
; X* W.4 Parcel: 2S109DA13900
Jurisdiction: TIGARD
Site address: 12685 SW MOUNT VISTA CT
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 58
Project: Arlington Heights
Project Description: (13) new sprinklers.
Owner: FEES
STONE BRIDGE HOMES NW, LLC Description Date Amount
16869 SW 65TH AVE. #505
LAKE OSWEGO, OR 97035 Permit Fee - RES 07/30/2010 $246.45
12% State Surcharge - Building 07/30/2010 $29.57
PHONE: 503 - 387 -7577
Contractor:
WYATT FIRE PROTECTION INC.
9095 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 - 684 -2928
FAX: 503- 684 -9657
Type of Use: SF
Class of Work: ALT Type of Const: VB
Occupancy Grp: R -3 Height: ft
Stories: 3
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 $276.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 3521
Fire Alarm Valuation: 0
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 Noti • - ion Cen :. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direc •uestions to OU - •y ailing 503.246.6699 or 1.800.332.2344.
Issue By: / / / t Perm ittee Signature:
', /l�'.•1. • i J
Call 503.639.4175 by 7:00 a.m. for an inspection that business .ay.
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.
- j; Permit Application 11
Fire Protection System . , OR OFFICE USE ONLY `
CI of Ti and .L' .9 i ' 1V Received
`J g
- Date
B : Permit No.
Ili
13125 S W Hall Blvd., Tigard, OR 972 3 `TI : w' • l
g ,1 Plan Review h��i�
- Phone: 503.639.4171 Fax: 503.598.1960 �v '� ��® , Date
: .� �tb i '—`�� a Other Permit: irr)S if V ' I
i� ° e- VL Jura: Fa See Page 2 for
TIGARD Inspection Line: 503 1+ �1� Date Ready/By: Jur
� w / ���� g
Internet: www.tigard- or.gov 1 - .� r � N. tied/Method: ' a& Supplemental Information
TYPE OF WO , . , REQUIRED DATA 1 AND ,2 -FAMILY DWELLING
*0-1:iiew 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. p
`' Valuation: $ 30 / g r
and 2-family dwelling El Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2 ,5
'` , JOB SITE' INFORMATION AND LOCATION: Total number of floors:
,,- ,, :..
Job site address
/16 e 5 5 How % V I rj 1� �- New dwelling area: 35Z/ square feet
City/State /ZIP: --ri6 0 k 9 7 z..2-z-4 Garage /carport area: ,0 square feet
Suite/bldg. /apt. no.: Project name: S yyj yyj yi j i *-14_ 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: 1 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.
Iwo viD 6. koz..0 t 31:3 vP4.1m4:L ie 6y5 . L Valuation: $
✓ rR.' / D�—A 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:
APPLICANT s . ;. 0 CONTACT PERSON NOTICE
Business name: elk 7 C bp,.._ All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) • Fax:: ( )
E -mail:
CONTRACTOR . i ,, BUILDING; PERMIT FEES*
, . -,, (Pletde rekr io fee setiedrrle)
Bus name: � i 1 / 'P 7Y1 C ��L
j-� W � Permit fee:
9V
Address: g 5 a 0gm-1 e �,.� r.
ty -- ri o i`' l3 �4 9 7z2.4... State surcharge (12° of permit fee):
City/State/ZIP:
j FLS plan rev (40% of permit fee):
Phone: ( 3) bg4- - 2.9 ZS Fax: ( 3) (> 4- 9�7 (Due upon application.)
CCB lic.: 6407 7 Total permit fees:
Authorized signature: Amount received:
z e___ This permit application expires if a permit is not obtained
i - ( J !? / 4/�1� Date: 7 -� -/� within 180 days after it has been accepted as complete.
Print name: �
* Fee methodology set by Tri- County Building Industry
Service Board.
i \Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(11/02/COM /WEB)
•
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
T.ype_of System as
Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B ) „System;;... ',.. R,... : .
Hood Project Valuation: $
C.).Fire Alarm.
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D )�� Res>identiial`Spnnkler (Stand %Alone�Systein) _� _ `�” �'�' '
Square Footage: Permit Fee:
0 to 2,000 $187.50
'x 2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50 ''414
Sprinkler Project Square Footage: g 5 9,1 sq. ft.
"_` Fire; ProtecttonPermtt:�'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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
htt p : / /www.ci.tigard.or.us /city_hall /departments /cd /docs /PPS- PermitApp.doc 2