Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2011 -00090
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011
Parcel: 2S109DA15600
Jurisdiction: Tigard
Site address: 15346 SW GREENRIDGE PL
Project: Arlington Heights No. 3, Lot 75 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 75
Project Description: 13D Fire sprinkler system for 4,036 sq. ft. home.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES
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 07/20/2011 $310.05
12% State Surcharge - Building 07/20/2011 $37.21
Type of Use: SF Info Process /Archiving - Lg Sheet (over 07/20/2011 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm Sheet (up to 07/20/2011 $11.00
Stories: 3 11x17)
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 $362.26
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation:
Residential Square Footage: 4036
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, • • • .. is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'otification Cen - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy the rules
or . ect questions to OUN by n. 50 or 1.800.332.2344.
I - -ued By: ` ` 4 `-4 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 comp etion of the project.
Approved plans are required on the job site at the time of each inspection:
Building Permit Application
Fire Protection System S��� FOR OFFICE USE ONLY . ,tt Y t �
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City of Tigard �Q`` Date/13 /�� Permit No.: l i !l
'I 13125 SW Hall Blvd - Ti OR 9722 .1 „ �
. . fla n Review .
rtV A�
II ' .. Phone: 503.639.4171 Fax: 503.598.196 `` G ��� teBy: �� � � Other Permit: m�� �G l
— I! _ l
TIGARD w Inspection Line: 503.639.4175 ,V G 4 \ El Ready :y: See Page 2 for
Internet: ww.tigard- or.gov ON � �� - Notified/Method: 7 ` j. Supplemental Information
G Ti 9 1 ��. /
t x,t ' s ' y . .' . �/ afr- -: - k v fit
.,' ,a. r ; N lt , T] 1' E UR 1 OR „ : ,a , h , • w _ . : . a n - , ate REQ UIRED DA TA . AND 2 F,ANiII DNVELLIRG
1XNew 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 ca MARS work indicated on this application. ,
�� . and 2- family dwelling CI Commercial/industrial _ Valuation: $ ( �� �,
ED Accessory building CI Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 3
r � '" J0 S ITE I N FO12111A AND _ * W A r Total number of floors: 3
Job site address: / r 34-fn :S l 6tt P� •-7 wo '7 New dwelling area: 4-. square feet
City /State /ZIP: -7764 �Y /)/2 - / / z_z- - Garage /carport area: ( 3ta, square feet
Suite/bldg. /apt. no.: Project name: l LU/ i a7n l t , t•1-`5 Covered porch area: square feet
Cross street/directions to job site: • Deck area: j/ 4 square feet
Other structure area: _rte square feet
3 d 4 a ri ,
' REQUIRED DAT I COMMERGIAIa USE CHEi CV,IST
. Subdivision: Lot no.: Permit fees* are based on the value of the work erfonned
_
*
P
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, ment, ma erials, labor, r overhead, and the profit for the
p materials, o d a e r
- , G ax DES OT WOR €r work indicated on this application.
V /Q Apepo I '3 D T 1 11:_ 6p/t/AiLe/Q S'Y5 . Valuation: $
c r Existing buildin area square feet
New building area: .. "' square feet
3 PROPERTY" OA�'NER *) &0 ::. ❑ ,, ` Number of stories: '
Name: Type of construction:
Address: - Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
P
al ,.r, ,= PLICANT a sa M 0:0 fi t' `' eili et w
xr. � �'C N�'ACT PERSON �' �.� � �
B usiness name: 6E56 CY c—T(%,_ 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:
4 wt 0 r- r s k BUILDING PERMIT E EES P §fit" a
, , C ONTRACTOR
r� T . ., , ,. ,�aa:,;ag„ j P.lense „reier`.to e,,,- hedi r ur s ,,
Business name: ���, r/� / 7
Address: 9D 9 6bv 7 ;,(hw 5/ Permit fee: —
City/State /ZIP: / ?a �o D J 7 a Z State surcharge (12% of permit fee): —
`/ i FLS plan review (40% of permit fee):
Phone: (5t)3) ( L�- - 2� Z€% Fax: (53) 6,84_ -9 , (Due upon application.)
CCB lie.: & 4- D 77 Total permit fees:
Authorized signature:
g-
Amount received:
Cam This permit application expires if a permit is not obtained
Print name: 6 '( : ,,i 6 / /A- / 4.J Date: 07 — i t within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(I I /02 /COM/WEB)
eY
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Descry
f
k�e work t b� done 4 � tim m vgg, aino t oo
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration .111+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 3 7
Additional description of work:
. ,Type o „,p4p -M {Complete, A,ap,3 C ox_ as appca�e) 04: . a , '
x fi i „ x 3 ' I a"' € it 4 ' SITZ' A OM � 3IR a` d� a* ` ' 'y;. R ,, °z`'� OMIN ;
A. Comm ercial S °r nkler AIMA V F O O �. 0 V
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinkler Project Valuation: $
•
lJANNYPAti . g0i0 Fxrt; PPP O.5,AP ; PYAIG ntat a :� N,ROMM � * - r "
Hood Project
z a t� I. y " z , , S °� " i ,� t �R .r O S is `S�z -Ka j' . , i r
C) iViie Alarm � A ,S O r I 'i a r W k tt2 ; -,a € a
Submittal shall _Battery_Calculations -- - El — Yes — — —
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
`� ` a �* �eyu, ti k - 3 � sz q a AF ai 'F l "�" *� � �"`� -. A' � x � s� * s' i'� z `a
°=,D) Residenal Sprinkler (Stand AoneiSy�ste) � Nr �f g , p a
Square Footage: Permit Fee: '� 1`'"�?�k"�
0 to 2,000 $187.50 0 i �� fteb F
2,001 to 3,600 $232.50
1 � � � i b
3,601 to 7,200 $292.50 „
7,201 and greater $381.50 ittenaNtilliOigieglhalatt,
Sprinkler Project Square Footage: sq. ft.
�; �Fs :wg�..4 F� ��*�� ��.� �,� � ��, a -' S x ';� r rep, ���, ,���s eK x � '�' ?�' �
:: F Ti" otectzon. P Fees t k z , , , � ,. _ pos ..,: � ,. .
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 /FPS- PermitApp.d 2