Permit T IV%
City of Tigard
June 3, 2013
Wyatt Fire Protection
Attn: Melissa Hutchinson
9095 SW Burnham St.
Tigard, OR 97223
Re: Permit No. FPS2011 -00070
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15188 SW Summerview Dr.
Project Name: Arlington Heights No. 3, Lot 57
Job No.: N/A
Refund Method: ® Check #210283 in the amount of $220.82.
❑ Credit card "return" receipt in the amount of $
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as building plans were changed and resubmitted
under FPS2013- 00039. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincere ,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Wyatt Fire Protection DATE: 5/16/2013
Attn: Melissa Hutchinson
9095 SW Burnham St. REQUESTED BY: Dianna Howse
Tigard, OR 97223
TRANSACTION INFORMATION:
Receipt #: 182912 Case #: FPS2011 -00070
Date: 6/17/2011 Address /Parcel: 15188 SW Summerview Dr.
Pay Method: Check Project Name: Arlington Heights No. 3, Lot 57
EXPLANATION: Per applicant's request as new plans were submitted and work completed under
FPS2013- 00039. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Permit Fee 230- 0000 -43104 $197.16
12% State Surcharge 100- 0000 -24001 23.66
TOTAL REFUND: $220.82
APPROVALS: SIGNATURES DATE:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
-FOR TIDEMARK SYSTEM AD INISTRATION USE 0 I,.Y
Case Refund Processed: I Date: I rv/ By: •
1. \Budding \Refunds \RefundReyuest.doc x 09/01/2010
May 16 2013 9:10AM WYATT FIRE 5036849657 p.
65/15/2813 15 :19 5835981968 CITY OF TIGARD PAGE 03/B3 „II(/
City of Tigard • COMMUNITY DEvELOPMENT DEPARTMENT 1 1
7 Request Permit ��
q It Actzon
i. A A , 13125 SW Hall Blvd. • Tigard, Oregon 97223 0 503.718.2439 • Rwes.tigard or.gnv
RE — y -r
MAY ' 2013 CITY OF TIGARD _ P i
Building Division Services Supetvi9pr �/ 1
CITY OF TIGARD 13125 SW Hall Blvd., 'Tigard, Olt 97223 N AA l Y `7 Ic-- Li
BUILDING DIVISION Phoney 503.718.24,30 Pas 3,598.1960 www.tigard•or.gov
PROM: ❑ Owner
(ehedtnnd Applicant ❑ Contractor ❑ City Staff
REFUND OR Hare:
INVOICE TO: 03uAlttffl at led,„") i '' . vi 5, r G ► L A" *0 O i . _ r •
.Mailing Address; - / l r* ir r • i AA
City /State /Zip: ■ h I r
Phone No.: (Cc) 1 4 • 41
PLEASE TAKE ACTION FOR THE I'TEM(S) CHECKED (1):
CANCEL /VOID PERMIT APPLICATION.
■ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
■ INVOICE FOR FEES DUP. (attach care fee schedule -and provide explanation below).
■ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). '
Permit #: 4, 0 ' a a • • ' i l l . . V\ , 1
Site Address or Parcel 0: 1 .
Project Name: i as . - .4 1
Subdivision Name: e,1i le\., w0 ?? Lot #:
EXPLANATION: 1 .,l - C • LA ` l t . • \ ~ r1(1 100 i 13 0
• .all �J L
J
Signature: '. �1wif.��1 ��
. :) nape; Aryl t
Print Name C i l� \.1 #
kainitarial
1. or Building Ofkin1 may autbotirc rho refund of:
9 any he which wto crttonenwly !skid of collected.
bo roc intro earl 8U% of . hind we err xe he when in mob:aann is withdrawn nr 0tictled Ware uny rc+icw ettmt by been expended
e)
41 mu not ioao then 1111 14 of rh• Gad use appricsteun tea row issued permit,.
•7 esir a c n
in Mu( the building loading e mutat Ilse wh on eptfrx.e er is marled bcf i.. non revue• Clain has woo a alai
L Itch M O a in g r m'dt tee Mr issued perm In prior to any inopcction re �ua
Go cotemed m to otlnlnal Ilya in the revile method In which pgment wee rceoivod, Pima Allow 2..4 vied„ for ruomcbryt.. pain&
IA•I :(ill l(I li,-.l:O .NI)
Rte fi 5 a Adthin: • ft -
larriaM2ril Refund Processed: Ewe Dete !oA/AFR • .403- -.
DeTe 47/ ..,,�� o vn i ce nneec@�e
Pamir Cosec Doe led. Dm - ,���!i�. arcs! Ta Added: Data Reeei
* Method
r:\ Volamile ermuAetron.doc '" try n5 1 .. Amount
CITY OF TIGARD PROTECTION SYSTEM PERMIT
�t f Permit #: FPS2011 -00070
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 06/17/2011
T�'" 9 Parcel: 2S109DA13800
Jurisdiction: Tigard
Site address: 15188 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, 1ot57 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 57
Project Description: New 13D residential fire sprinkler system.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW LLC
9095 SW BURNHAM 16869 SW 65TH AVE, STE 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 06/17/2011 $246.45
12% State Surcharge - Building 06/17/2011 $29.57
Type of Use: SF Info Process /Archiving - Lg Sheet (over 06/17/2011 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm Sheet (up to 06/17/2011 $14.50
Stories: 3 11x17)
Commercial Sprinkler System:
Sprinkler Required: 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 $294.52
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 3562
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 obtai to c. .y of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
1 ,
Issued By: Perm ittee Signature:
/� _./..K..- /t/ /�
Call i .•39.4175 by 7:00 a.m. for the next available inspecti. date.
This permit card shall be kept in a conspicuous place on the job site until ..mpletion of the project.
Approved plans are required on the job site at the time of ea h inspection.
Building Permit Application
RECEIVE
Fire Protection System FOR OFFICE USE ONLY -
City of Tigard .': ''i 1 4 2011 Received
�� �
'l 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: � Permit Na o�Of'� _60� 70
Plan Review ' it O ther Permit:
Phone: 503.639.4171 Fax: 503.5981' OF TIGARD Date/By: f h STa°11-00 0 ,9/
TIGARD Inspection Line: 503.639 Date Ready/By: ` Juris: IRI See Page 2 for
Intemet: www.tigard- or.gov BUI LDING DIVISION Notified/Method: / nl1' /0 - A Y " , Supplemental Information
r - •- ' ` � ,., ,_ -- o ' • . . - T OF, VI'ORI��' , ^; ,RE v,UIR D AT = ,AND'2- FAIVII D WEI."I I
- : - 1PE� �
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ca ,
, ..,..��. �d -., z " _ .., � =� >_ . ; •.__ _ s,< • .�: '�,�_. .�_��� �sy� -err ,:: .. - � � "��
ew 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
�_ G � - _x- -
s - - 4 � � ;�_ 4 work - or indicated this application.
lcae on lns app
- CATEGOR OB_ CONS T G s . . .
1— and 2- family dwelling El Commercial/industrial Valuation: $ �-
❑ Accessory building 11 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms: 2
,,�v=- �E`; - =�� = :
a� °i *,;,, � '" ':;��:,?,,<;;;� =�= , - ^,,,� Total number .JOB ''SITEINFORiN4ATION;.AND LOGATIO `> ber of floors:
w - a „t,,. •
, ,a�a <;� .��.r °�3•�;. - -° R. .._ y. _.asa��a =+��x -_, ,. .a., u� .. „`4,*�.� ,. . -_
a
Job site address: / 03e5 5 J 5 l6'QV �'E/ ]� New dwelling area: 3 5G square feet
City/State /ZIP: -f D / 0 Jo_ 9.7 ? F - Garage/carport area: 4d e) square feet
Suite/bldg. /apt. no.: yy Project name: ,�A -7 Covered porch area: 2:3 0 square feet
Cross street/directions to job site: Deck area: '"------- square feet
Other structure area: -------'^ square feet
ir,,tz:�'tz "9";:z~r. "•:q ". :, <,x�x ,. , �'=N y;.�g;a„R::..�':oi "�,;.
; .Q(JIBED ig ' C ,ONIkf IAf SPai Cti$" ; �
Subdivision: 4-12 l%lJJ 67 17/J )--1----(3 - ! S - 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
r .,;, ;; _ :; .,;•,,,•: r h , ;.,:; z,,.. ';.,,. ter; ,,,. ; •, <. z ; <:. x overhead, and the profit for the
'1,; ,.,, v..,;=.::.5.�,,,:- «.x�u -; - x.'.�?..''.d, ^< =a„ -.,.1 ,:.., - °a. i:. - -er:'�E, ,.r,- .:�';,s•9::
i T• „ DESCRIPTION• •OTv ?,012K;^r i N work indicated on this application.
. ... ,.. - . ....<..,.. ,..'zs >.`.0 =•e'. =ys._�'a�: ^,'- , ,,, - •'key: •.:3::.. .r,•rd;'�.� °- m + -,S�= .'= .�;.s;..x... ...,. .,.-. 3:: ?,'> �„ ••I�„,F'' �+•"'. <'a�4°.
7/ v 1 D i i , 1 AI n, J /11 /U 1-C-- Valuation: $
Y S I _ / j �� �� f 7 - F i . - t Y � le, E Existing building area: square feet
• !Y CJ` `� ) Cf -i 6 Q � New building area: square feet
'- n.;;i`.� , c -,. S" 5 � -_ .; �; �..�L%' iz`x` ""�.;, �,...ac ., ,::f'':> "
N <1 5,,:. . - , ERT = .Y "OWNE12 , ., 14 - :TENANTS ~� tt - -' Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State /ZIP:
Existing:
Phone: ( ) Fax: ( ) New:
�- <.. >� „�,� � pis. �,. �•.:, , ���nr .�• ;.,:� ;; �_ %- ,.�
, PP L,IC A NTw.' y{ 4„ r< sCON: :ACT~ PERS(JN. ,
a
4 „ �%,,,, ^ . < 3 ak 1,� .. ..._, ..,,.w ma .. ,, .� -.¢�,, ,5>t x.�$s, >�,. <,.. .,�. ,..., -.., ..Axs.,�.. ,. +_.�,. .<�x'.rr:, e . ^.. �, .. ,..,x .. .,. .- '�,i��i%�f3� }> �`ae1 ., ��:?. �:.��n'rc ;!,"�5�;,;s� 3 " eg'F „Y.,, " �.e'�' . �'kki:
� , - r- ;_�., �: �= I "KIVOTICE:;', ^ ~ °- `� >�::��:,,m'p � �"':�' -..
4,6 :itc' "; - p k. > ` ..:- .; 94 .s�.i,9�X:FiL:• "w'A:- aPi;#• ;iiil, id .. c s'.s,
Business name: �w•- ���-C�lF�/L 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:
a:4 � ^, a
'C TRAC
` °�., -, �: ;'t ON TOIL � ,,�m< �:,,.3•,
_ `- BUIliDING - `PER
_. }, / y4- 1 7- i..< JJj� . �! gyp., ^ ^ ) ,. - . :.- �•.,; _::�,'��1: "::��=
Business k! F1'g6 P,e_D - r C7 (/P `� ( Plense ' < r e fertb f ee Y '3elielu l e)'';... ..
ss name:
Address: 9pt� �j ,5) 6U� � A-in 6-7-, Permit fee:
City/State /ZIP: L ` (.� � Vi e 97 2._2_ State surcharge (12% of permit fee):
` A FLS plan review (40% of permit fee):
Phone: ( 5 j '(`} .7 Jy� — 7 Z S Fax: ( 3 654 - 96 S7 (Due upon application.)
CCB lic.: 4-07 7 Total permit fees:
Authorized signature: 1 Amount received:
�' This permit application expires if a permit is not obtained
Print name: E06,67c/ 77fr/VA., Date: 4, -/44/ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I:\ 1 3u ilding\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T( 11/02/CO WWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
_
Describe:workto be donez a± 3 s
am p. ^ :
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration 5441+ heads: Plan review required.
El Repair
Number of sprinkler heads: '-9
Additional description of work: •
o rn ^Iaete'.• .X:. .:,, �:��,.:':;,, ;�,,��� _ fix -�
as I
,FP
.3 ¢, .xt ., r,_ \ , , 31 as 3 - _- 'c, '+3. , ems. .iti::. ^'� "•::S` ' E'.u`�'ti'�i ..d:r EFir
. -. ,. ^v�r _ ,. _,,., .., ." .• r.;.. '_ = r, °_ , a, : a`a` :t:.' ' a.'fi -, `sir= :,: =:xam.:sS::.x::.«•i;. ,.
, as .,.- .,. a:....k:- ._,..., ...: :a „_.,. ., , ,, '_?,`'�"'.., ; ra�j�; ; . �,S�a: r
?a. -.v, y ... ; ;. > y.'`,`[;�,r.;;. ,
.r. ^ ' k , .r. <, aaa:, , �: -:,r "'�,” .;�:':,,,,:. �� >;,vc'�, _ ,`:za',.��: =
eti ' ^'t 33,a tip= 9, -'.v'..'.` -- "a v�`"` .i9 <_ . L.<„^
As' C:ammercial S, ' riiikler A5 'fib �3, .^ . -_ _. yy4.
ter, ,u.. � w,, 1 ,�„
El Wet ❑ -_ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinkler Project Valuation: $
•
s1 a '. �� „?���.'.�'�?`az .F �,�€'•,'E ,;..m �`; ,;`.- �,°:- s ?';";' >�.:,�s �:^�svF :a�,:a Ev;: ;��>: rst��rw,r: =xF,
` ^ PP ,,.,,.�. ,'- :_;'„-a,r� ;a ,�, "'::, ,,.».''.'?` "i^`��ti is �`;:. ,.,,,
- Hood - Project Valuation: — —
� ;:•' " x <: Wit- .�L� "�:<�A ' u,A:d'T - ;x;;w
y�:�. : i' �`kn�vT. ,, j3' s��.'x:- e�.� ' ^, - "1' fi s..,,z >....w .
, rt .. :, .S
a ` ,.. .�'.�." ^" ".. 4aX.n > °a - , ` •.;,t
5
�x,e e3
*�� -�:<:, `i'` - -�'
= <. . ; �,,�:a.,s�•a'��:�: -:. , ,,v <,. du._,
Submittal shall .. Battery.Calculations -- ❑- Yes -- - - --
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
.. . <, _:..<.,.,« ��a�.. ., ;;, x.,.- ,_. .a3- �^;•p .a.:F'.,r . -� �;x ,,. ' ;.r� z.,:'.. =�:; ', ,;,�': ,: ±%ti.;:, <`^' , `;�l
9b -.'�,; .xv.'" a; .;» c,u... ,da. ~&a- :: a te" ,.y,t , f, . .. ` ,: ..-.S ''
iyo Res`idefi a`l rtrikl eS" , m,' „ v
��; f 3 -14 .,,.
ti` S er .Sta'nd <;A1one. :ste -�,,. ��� '`,.���.�. °- �`.; >�,,�...__ �.,,`,�.,F:�:_' <:,
" ,:, -,
Square Footage: Ae
Permit Fee: :`M = ...:�': �,,. � � �.,,.�
0 to 2,000 $187.50���� •
001 to 3,600 $232.50 Ne "�
2 ';° <' `Nf;
3,601 to 7,200 $292.50 "
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
<a• <. =s' ;=s=ue' ; < =_`�.: _.,�<,.
. , .+,a -, 9�'.a, - '��' � gwa7� k "; "[[;pit?;:, r�i:a' "; :.
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.
http: / /www.ci.tigard.or.us/ city_ hall/departments /cd /dots /IT'S- PermitApp,doc 2