Permit 1111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 1 2 COMM DEVELOPMENT Permit #: FPS2011 -00088
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2011
Parcel: 2S109DA15700
Jurisdiction: Tigard
Site address: 15362 SW GREENRIDGE PL
Project: Arlington Heights No. 3, Lot 76 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 76
Project Description: 13D fire sprinkler system for new 1,850 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 07/19/2011 $198.75
12% State Surcharge - Building 07/19/2011 $23.85
Type of Use: SF Info Process /Archiving - Lg Sheet (over 07/19/2011 $2.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R - Height: ft Info Process /Archiving - Sm Sheet (up to 07/19/2011 $11.00
Stories: 1 11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes 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 $235.60
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 1850
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
issuan or I . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit Notification Cent- Thos- rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or .. rect questions to OUNC . allin. 563.232.1987 or 1.800.332.2344. `
Iss ed By: k $ '416_,M Permittee Signature: -I /' / /4
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
Fire Protection System 'S� FOR OFFICE USE ONLY . .
City of Tiaa1 d l' Received
b -�, fA�\ DateB 11 4%A Pernvt No.: = 41.N— ,.1.� ,
: ° 13126 SW Hal] Blvd., Tigard, OR �• 7.rr Plan Rev ��ia
• .- • o' Other Permit:
.: Phone: 603.639.4171 Fax: 603.E "�' .•• "'.0 a' DateBy: - � /��(! ���
TIGARD Inspection Line: 503.639.4175 ail Date Ready : : / Jura: 0 See Page 2 for
Internet: www.tigard or.gov \ \ \ 4 $ Notified/Method: % / / Supplemental Information
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ik y iK OF WO r . t y , x ,,IVE N: i, REQUIRED DATA I AN D Z'FA'MLY D\�'EVIIIY MI.
`Alew construction ❑ De.u' ition 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
`t t s rx L ' * � CA TEGOi Y, OF `CONSTRLTCTIO�VI 5 ' � :' "Y work indicated on this application.
and 2- family dwelling Valuation: $ /6, 2�:
❑ CommerciaUindustrial
1=1 Accessory•building ❑ Multi - family Number of bedrooms: 3
111 Master builder 1=1 Other:
Number of bathrooms:
o, ,„ "� ° JOB SITE; TNFO121 ?ON j £ .o§ $ Total number of floors: 1
Job site address: /5 Z S g.. x` ' - Pl , New dwelling area: / 0 square feet
City /State /ZIP: .ii( f Q/ 9 7 ZZ Garage /carport area: 4 W square feet
Suite/bldg. /apt. no.: Project name: ,QLI ki 6 7 - 0 , 1/4 ., pfc---1, Jt_ i s Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
RE U1 AW.A., OMl ile l USE aiTatt IST ='=
Subdivision: • I 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
equipment, materials, labor, overhead, and the profit for the
C a�� '� °. ; r ""DESCRa.WA1V''OF� i5Wi ` ' a "' _ work indicated on this application.
t ,
ii DV 161 Aiek / 13:) F1/2 12-I1,1 ILLJ2 SYS roll Valuation: $
c , J - ! rb- %2�� /D iC.& , Existing building area: square feet
• New building area: square feet
• '" 25 P ROPERTf OWNER 1� � S " D TENANiF I �' Number of stories:
Name: Type of construction:
Address: - • Occupancy groups:
. City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
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a`. . , it � gNtr ANT' _... t`�,,, ' .�: ' - ` ,'a aEil N ' T AC6 T PERSON .....,..t "IVP F« liauv iV5'' 'T C" a� ' t . e
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Business name: .` ea-r tyre_ 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: ( ) • I Fax:: ( )
E -mail:
n s,..? M � ...1 . CONTRALTO > r , k � . ? w;; b ' t $ ° , ': � o tM DING PERMIT'FEES* W': ;w xg
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l , yn ���� P , 2 tee c „�7 r y Please,re er,ta ee.sc/iedule
� /T � �(J [' _/ /`r �� � _� "a �. ( 1 �I � .�..�.- �..... �� -..,�
Business name:
Address: 9) 95 SW at) rz.) J H - A - ' '1 S ° 'r, Permit fee:
City/State /ZIP: .�`� 0 Pr� 97 -z_--z_ 3 State surcharge (12% o f per m it fee):
/ FLS plan review (40% of permit fee):
Phone: (5zS 3) 6 ,4- _-z9 -Z I Fax: (Sts)) 64 - y 57 (Due upon application.)
CCB lie.: 6, IP 77 4 Total permit fees:
Authorized signature: �r� " � __ /�W — �_, Amount received:
/ C This permit application expires if a permit is not obtained
Print name: C� >� IA- 7 Date: 7 — i i within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1:\ 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
Descr be work be *done o� . ; t :
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1.) New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration 1+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: I
Additional description of work:
Thype of System (Complete A, C olr D as ap hcab1e ;
�� ° sr x arc�'�. '{ w o r t' o r ax: ,.
..:�..' a � of �x 1� t 1 �� : ��� -:' � �z `���� ` �1 i v �, F e
' � t '� _:� a�� i<c�k� � +� ` � � v � � �a�..�.�v&.,? e ��' '"` �4� ^�t ,� �4'z5 -° x L 't�" K.�f ..:
A) Comrnerclal S prinkler e t R �s V_ a' t i
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
NII SypagjA gire Suppression 5ysiref; 7 111 , is 11 P .. z
---- Flood Project Valuation: — — — — —
ESTI ?` � c,,. R � m pirim n as ��' __ �} t < `` - f ern
�� a , t is - w, t v 1 a« -:
C .) F1re AIatTTI�����z�� a
.mot-,- .,., :�..� =.ux ` � ; ,,
_ _ _ Submittal shall -.__ _ __ - ..Battery_Calculations - -- - Y es - - -- - - - - -- - -- — include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
�#� t 01 a §� s fir, v p se
074 ` ` it.{ i f is v., ; a w 4".a, 4- �'
D�) RegldentialiSp nnkler (Stand Alone Sfstern) �,WW 4 0 � � l k t
,. „_, ..<, „ z t ...` . a xi *<�_ %; :mw: om*A r.. K .., ; r, .1 . .SAN.
Square Footage: Permit Fee
0 to 2,000 $187.50 1' ��
2,001 to 3,600 $232.50 A °.
3,601 to 7,200 $292.50
7,201 and greater $381.50� k "
Sprinkler Project Square Footage: sq. ft.
>.. qzE . , .. F u M j T F Pr F O , s . II Esue,
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.doc 2