Permit 4 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00090
T I G A R D 131 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16578 SW 72ND AVE 89
Project: Gingerbread Traditions Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,E
Project Description: Install (5) new sprinkler heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 684 -2928 PHONE: 503 - 624 -6300
FAX: 503 -684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/11/2012 $72.61
12% State Surcharge - Building 06/11/2012 $8.71
Type of Use: COM Plan Review - Fire Life Safety - COM 06/11/2012 $29.04
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $110.36
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,285.00
Residential Square Footage: 0
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 • • ..rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted b the Oregon
Utili otification C- • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain . coao the les
or • rect questions to O C b . Iling 503.232.1987 or 1.800.332.2344. j
I ued By: % / ,i `l Permittee Signature: /
Call 503.639.4175 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 inspection.
• Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard RECE i - ) RDeateeived N AM Permit No.: Mao / a . oaO p
IN - ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I I y Date/By: Other Permit: 644 . 129/41c /129/41c Inspection Line: 503.639.4175 JU N 1 1 2012 Date Ready/By: kris: 0 P� See Page 2 for
TIGARD
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGA:' D
TYPE OF REQUIRED DATA: l'- AND 2 -FAMI1 Y DWEY LING
❑ New 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 work indicated on this application.
• El m
1- and 2- family dwelling XComerciaUindustrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /6 S ? 3 I,-f iZN New dwelling area: square feet
City/State/ZIP: 7 , / f � � e 7 z z4 Garage/carport area: square feet
Suite/bldg. /apt. no.: 1fr /7 Project name:4/06Eag4544 ' owitx. s Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
•
REQUIRED DATA: COMMERCIAL -USE CHECKLIST -
Subdivision: I 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
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK;: • , . work indicated on this application.
TR /D6- 5 Ateto SPtINx-L &r 4 S e Valuation: $ i , Z ' e
Pv -L- M--� 6v —_ Lo1 - m15 - . . Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER . ❑ TENANT .. . Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/ State/ZIP:
Existing:
Phone: ( ) Fax: ( )
New:
PPL.ICANT ❑ CONTACT PERSON " NOTICE
Business name: j /. evil-re i,12.... 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:
. CONTRACTOR . BUILDING PERMIT FEES*
Business name: )/ .74 .- f/j n/20 i .77D,41 • (Please refer to fee schedule, " - .
Address: 9093 4 ) /3 V 14 s r Permit fee
City/ State/ZIP: / ' a/ 9 `? 2- j _ State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: (scs) 6 8L. - Z9 Z' I Fax: (S 3) (, - 9 ( 5 `l" (Due upon application)
CCB lic.: Go. 4-07 7 Total permit fees:
Authorized signature: _ Amount received: 1 /r4 • 3!v
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
s lete.
Print name: 6ix; / v � /-- �� ` Date: oe, -pb p/Z Y P P
* Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \PermitsWPS- PermitApp.doc 03/23/06 440 -4613T(11 /02/COM/WEB)
•
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done: .
1.) ❑ New 2.) Modification to sprinkler heads only
El Addition Vt., 1 -10 heads: No plan review required.
❑ Alteration El 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: S
Additional description of work:
Type of System (Complete A;, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
•
Density
Design Area
K Factor
Sprinkler Project Valuation: $
B.) Type L- Hood Fire Suppression System
•
Hood Project Valuation: $
•
•
C.) Fire Alarm • •
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
•
D.) Residential Sprinkler (Stand Alone System) -
•
Square Footage: Permit Fee: •
0 to 2,000 $187.50 •
2,001 to 3,600 $232.50 •
3,601 to 7,200 $292.50
7,201 and greater $381.50 •
Sprinkler Project Square Footage: sq. ft.
• - . Fire - Protection,Permit Fees
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