Permit CITY OF TIGARD
. FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2011 -00105
Date Issued: 09/09/2011
-SWARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S109DA17900
Jurisdiction: TIGARD
Site address: 15271 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 108 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 108
Project Description: New 13D residential fire sprinkler system.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES
9095 SW BURNHAM 16869 SW 65TH AVENUE #505
TIGARD, OR 97223 LAKE OSWEGO, 97035
PHONE: 503 - 684 -2928 PHONE: 503 - 387 -7577
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - RES 09/09/2011 $246.45
12% State Surcharge - Building 09/09/2011 $29.57
Type of Use: SF Info Process /Archiving - Lg Sheet (over 09/09/2011 $4.00
Class of Work: NEW Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm Sheet (up to 09/09/2011 $11.00
Stories: 2 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 $291.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation:
Residential Square Footage: 3439
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 of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
,..
Issued By: - "I'm, Permittee Signature:
i
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion date.
This permit card shall be kept in a conspicuous place on the job site u I completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System v —" FOR OFFICE USE ONLY •
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City of Tigard Received OA —permtNo. / r
7 1
- '" 13126 SW Hall Blvd., Tigard, OR 97223 AUG 3 ®2011
Plan Rev e� DateB „ f y // 44 /fJ�
Phone: 503.639.4171 Fax: 603.698.1960 Date/By: 7 Other Permit/A7:20/1 0
TIG Inspection Line: 503.639.4175 CITY � TI i�, i Date Read p p 8 See Page 2 for
Internet: www.tigard- or.gov t c P Notified /Method: / ( I� ! ` Supplemental Information
BUILDING a DIVISION 1 i ti /Ss 9
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,1ew construction [j] Demolition Permit fees* are bas the value oft • k�er rnmed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
;; <- .u.., . "1 i ;., . - �,:, ` �; "�::�=':��_<. P az •-, work indicated on this application.
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C ?,TE G ORY;OI 'GO , N S ,, TRUCTI O I �
.1. -and 2- family dwelling II] ConunerciaUindustrial Valuation: $ �/ 5 Q
111 Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
Total number of floors:
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Job site address: / ' 7 $ /il SV mm _' /J et , (> ,) New dwelling area: square feet
City/State /ZIP: - -`�- D pit 9 72....7., 4- Garage/carport area: square feet
Suite/bldg. /apt. no.: (Project name: 1 )U: 6 -r / :!6 J- 7 z Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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. Subdivision: Lot no.: 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
Fs , and the profit for the
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equipment, materials, labor, overhead, a e r
:F .%` =``t Nk* DE .C IQN OFa�WORK I 4 4 4- "e ' work indicated on this application.
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}' V / L / �L &L(- 3 JJ ,5 ! Valuation: $-5
ry � `may Existing building area: - - square feet
New building area: square feet
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, T.,� ® " PROPI✓RTY 1 0�1!NER< , " x s _ ;: ® :;, ; T EI VAN T 0 s� ' :� w - Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( )
New: •
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Business name: ' 5- D/LI � Ct 7,- /4 - c; . r "_�: €'� ��.. �,.
All contractors and subcontractors are requi red 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:
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BUILDINGaPER1VII 4
Business name: k.l �T p i/2 _ 6 2,e r g ,� .( P !eas e ,re J e%t ojae's-ciiedn ie j' < '? . �.....-�
Address: 9095 ' / . 3u/ZA) .6 1 Permit fee:
City/State /ZIP: L ii p n 9 7 Z Z State surcharge (12% of permit fee):
f FLS plan review (40% of permit fee):
Phone: (C 15 2-
64. , Fax: (503) 6&ei-_ 9 ,57 (Due upon application.)
CCB lic.: (1J 4-07 7 Total permit fees:
Authorized signature: �. Amount received:
� %' / �� , This permit application expires if a permit is not obtained
Print name: Va (,"/ ,u9- 77//! ") Date: ^ Z9 - ii 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
L \Building\Permits \FPS- PernitApp.doc 03/23/06 440- 4613T(1 l /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
D eseribework to be `clone s 3 $
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:
•
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❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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- Hood - Project Valuation:
w _. ,. •, �; .:. ,;,�:rS•iJ "�° ,..,. �,[+:f •" ;;32.23, k�;: eY „ F :.
_ SubmittaLshall _- — _Battery_Calculations - -❑ Yes - - -- -- - —
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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Square Footag e: Permit Fee: ;_ =, ° , :
`�`` =, > > , k'` �.: �»Q�;� ;' �,
M �,�
0 to 2,000 $187.50
2,001 to 3, 600 $ 232.50 t:40 ,;,
3 601 to 7 200 $ ;..,,.f ;'y2'a'>.
292.50
7,201 and greater $381.50;
Sprinkler Project Square Footage: sq. ft.
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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