Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 11- 11. COMMUNITY DEVELOPMENT Permit #: FPS2011 -00063
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011
TIGAR , Parcel: 2S109DA14800
Jurisdiction: TIGARD
Site address: 15294 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 67 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 67
Project Description: 13D fire sprinkler system for new residence.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW LLC
9095 SW BURNHAM 16869 SW 65TH AVE #505
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -2928 PHONE: 503 - 387 -7577
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - RES 06/09/2011 $246.45
12% State Surcharge - Building 06/09/2011 $29.57
Type of Use: SF Info Process /Archiving - Lg Sheet (over 06/09/2011 $4.00
Class of Work: FPS Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm Sheet (up to 06/09/2011 $11.00
Stories: 2 11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard:
Density: 0 Design Area: 0
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 $291.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2884
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 obt. a copy o the rules
or direct questions to • .....- by calling 503.232.1 • t • .:41 _ -v .
Issued By: j _ - ermittee - Signature: r /
Call 5 03:6 3• , ,J? 7:00 a.m. for the next available inspec on date.
This permit card shall .e ' • p in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
BLiildin Permit Application
_-. .
Fire Protection System FOR OFFICE USE O NLY Received
City of Tigard �� Date
By. . a / AU PermitNo.. II " , -
." 13125 SW Hall Blvd., Tigard, OR 9 '. '
7 1
Plan Review
Phone: 503.639.4171 Fax: 503.598 `. O `10 Date/By: �C fj � Other Permit: j ,, —40_ 'r
TIG Ins Line: 503 n n� Date Rea. :y: Juris: r. See Page 2 for
Internet: www.tigard- or.gov \` I\F ` �� G 1 0 1 Notified/Met (p /
s 7 / / � `� - Supplemental Information
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,g—New construction ❑ Lzcmolition 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
i:' .a >_:. :i= = work indicated on this application.
- ' z.la -:., � . CAgECORY OF:rGON6TRUC 1'ON7, t :Mia , . �€ Ns»._ ,
nd 2-family dwelling — Valuation: $
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rid g ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 2 / Z
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s%� =JO �?SITE�.I1�F Z,. s'����.�;a�� " " "'� Total number of floors:
B' UR11 ATI01 < D ft44 : lO ,
Job site address: / 5 _ ZY4 s , 0` /. m V / �'- PIE , New dwelling area: 8 &4- square feet
City/State /ZIP :. 6 D P 7 9 Z Garage/carport area: 4 1 8 square feet
I
Suite/bldg. /apt. no.: Project name: Diva 1i (/ 5 Covered porch area: square feet
Cross street/directions to job site: Deck area: /SO square feet
Other structure area: -- square feet
"'°REQ )IREU 0AVA QOMMEROIA14.USE`CI 'EGEEI5T
Subdivision: Lot no.: & 7 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
.., and the profit for the
�� a s,�;> j � �. ; 3 equipment, materials, labor, overhead, a e r
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� / � � tmt; ma work indicated on tins application.
Pap V ifC /l.C/ D c 7 /O /�' e-- �-- Y_'5' Valuation: $
(67 ) (/�i4..) Ze:3&4- 5 , FT , C��SI n� Jne. _ Existing building area: square feet
New building area: square feet
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®„;,, ,OPE1tTY QWN'ER, 4 4.4' 'T:ENANT .�<.�•;-.,,:-y ,',. Number of stories:
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Name: Type of construction:
Address: • Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( )
New:
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i —•' ,--- Wi �-f .---• li�(.JS'C All contractors ' i, -r�.` ,ntra: or s and sub
gig °r, ri;a3r; sty' subcontractors . : > • .. <, ,• Frt" ui s:, red to b �? a �;; :' �„-,
Business name: ntracts contactors are requi be '
Contact Warne: 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:
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Business name: k /77, � '� � DA) me, : ;i ce: : °: , Pl ease;° ref "to elsc heifemc, , /, F "°:t!s 5- ilwe ,, i
�+ %' (A.( / y � �, 1 Permit fee:
Address: 9� J 5 �o /C../vp471 6-7-
City /State /ZIP: X64 0 J� 9 7 ZZ3 State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
8
Phone: (W3 > -9 Z Fax: (5(,)3) , s'
¢ - 9 7 . (Due upon application.)
CCB lie.: (4) 7 7 Total permit fees:
Authorized signature: T,..,r...e..._..a?...----z...__---________- Amount received:
This permit application expires if a permit is not obtained
Print name: ,i6.`) /A --7- <f Date: 6 - /I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits \FPS- PerrnitApp.doc 03/23/06 440- 4613T(I1 /02 /COM/WEB)
•
•
I
• City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration heads: Plan review required.
❑ Repair
Number of sprinkler heads: 03
Additional description of work:
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❑ Wet ❑ Diy
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes •
Cut Sheets
Fire Alarm Project Valuation: $
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S e Sta d`.:A1one
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, _- � ,., .., $
Square F
ootage: Permit Fee: ''' C ,.Ak''',."'Ik ; •
0 to 2,000 $187.50 k� 3 �
F, ,•.,4 5,';
3,601 to 600 232.50 � � �,�: , 4 _
2,001 to 3
$292.50 m
.3;�;�m •��" ��:;,..'`�,�
7,201 `,•„`.-';_`',, . °'s,,.:`',:_,.,, ''�,
7
and greater • $381.50 �',�' M4 <-1W_;' G'.?
Sprinkler Project Square Footage: sq. ft.
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Project valuation subtotal (see A, B & C above): k $
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/depart ments /cd /docs /FPS- PermitApp.doc 2