Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00101
T IC; AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 2S109DA18200
Jurisdiction: Tigard
Site address: 15185 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 111 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 111
Project Description: 13D residential fire sprinkler system for 2,624 sq ft residence
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES
9095 SW BURNHAM 4230 GALEWOOD ST SUITE 100
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 07/17/2012 $246.45
12% State Surcharge - Building 07/17/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 07/17/2012 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm $0.50 (up to 07/17/2012 $15.00
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 $295.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2624
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: tJ Permittee Signature: It
Call 503.639.4175 by 7:00 a.m. for the next available inspe on 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 FOR OFFICE USE ONLY
3/1 . City of Tigard RECEIVED Plan Review Received m��a , _ 40 — /' l0
- ° 13125 SW Hall Blvd., Tigard, OR 97223 Date/B : � 7 �G ,
PennitNo.: � i
- Phone: 503.639.4171 Fax: 503.598.1960 JUL Date/By: (7 Other Permit:
TIGARD Inspection Line: 503.639.4175 1 V ?Q 12 Date Ready/By: 041, Juris: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
�`�l'OFTI(iARD /t � 't- r
TYPE OF ��►VDIVISION REQUIRED DATA: AN A 2- FANIILY DWELLING
flew 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.
Valuation: $ 2.47Z.
g.1,- and 2- family dwelling ❑ Commercial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: Z, 5
JOB SITE INFORMATION AND LOCATION Total number of floors: Z—
Job site address: /5/b5 3 ycl 5 U1if°J _Vl <_) DR_ . New dwelling area: 2,6,2 4 square feet
City/State/ZIP: 11 C7 j / J3 O,_ 97 22-4 Garage/carport area: 6,77 square feet
Suite/bldg. /apt. no.: Project name: / -O,(p 'c - 5 Covered porch area: 5 square feet
Cross street/directions to job site: Deck area: V & square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST -
Subdivision: I Lot no.: I i I 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
n DESCRIPTION OF WORK
-Q work indicated on this application.
® "/D e si,j (� 1 3') RE 3/1) Al ii4-k- 6?PhO)L Valuation: $
'f may/ 0 Al f rA, 2 04 - . FT: . 'A 1 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:
'L APPLICANT ❑ CONTACT PERSON NOTICE
Business name: • . eat/ —IRA- C72 4 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: 14 i T fib p,,,-,--,-7,„„, (Please cede to fee schedule)
�/ Permit fee:
Address: 90.95 �j° J J j U/2�
City/State/ZIP: - ?, 17 p 97 a2.-3 State surcharge (12% of permit fee):
I FLS plan review (40% of permit fee):
Phone: (2)3) 6,e4- - 29a g I Fax: (5D3) e,M — 966 (Due upon application.)
CCB lic.: e04 Total permit fees:
Authorized signature: Amount received:
�� This permit application expires if a pe is not obtained
Print name: VG :re/fr.) Date: D7 _ID- / Z 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(ll /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be d one: • • .
1.) ❑ New 2.) Modification to sprinkler heads only:
El Addition El 1 -10 heads: No plan review required.
El Alteration .Ll+ heads: Plan review required.
El Repair
Number of sprinkler heads:
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 I - Hood Fire Suppression System • - .
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations El 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.tigardor.us/ city_ hall / departments /cd /docstFPS- PermitApp.doc 2