Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00135
T EG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012
Parcel: 2S109DA14500
Jurisdiction: Tigard
Site address: 12642 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 64 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 64
Project Description: Install 13D fire sprinkler system in new 2,316 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 08/23/2012 $246.45
12% State Surcharge - Building 08/23/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 08/23/2012 $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 08/23/2012 $14.50
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 $294.52
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2316
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 qu -: ions to CUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B • ( Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio ate.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
• Building Permit Application
Fire Protection System MI ; • :. • t� ..h 11 FOR OFFICE USE ONLY ,
City of Tigard AUG i1 a 1
Date/Bea Permit tNo.:�
, / .49 40 3
1111 : .• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 DateB : IAA r � Other Permit: wy a�,.0 1 fg
TIGARD Inspection Line: 503.639.4175 CQ 3 }'i • ; :/, ,•. Date Ready :y: Iuris: 0 See Page 2 for
Internet: www.tigard- or.gov , A M��� ;1 ,, c I t ,, Notifie. etbod: a_ _� r, Supplemental Information •
TYPE OF WORK REQUIRED DATA: 1 - AND 2- FAMILY DWELLING
r ATew 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: $ "O
0.- and 2- family dwelling ❑ Commercial/industrial 21 S
❑ Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2.S
JOB SITE IN " F ORMATION AND LOCATION Total number of floors: 2-.
Job site address: 1264'2 5 /mpow vi ST /- -- PL New dwelling area: Z3 1 4 square feet
City/State/ZIP: 'r/ (� / , D � 9-7a2_4
Garage/carport area: 4 z( square feet
Suite/bldg. /apt. no.: Project name: A.R_(„iN4 -per fl-eits.tr5 Covered porch area: 10 9 square feet
Cross street/directions to job site: Deck area: 'L 1 3 square feet
Other structure area: ------ square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: 6 4 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.
PIc .v v11) ICJ 1317 FILE 6G"/r� Z- 1NK(- tY5. Valuation: $
C.*-) N t, W / 21 / Cpl , F ) T. ekLs i veNC& . Existing building area: square feet
` t �� l 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: S6 CON AA.0 /( 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:
CONTRACTOR BUILDING PERMIT FEES *
Business name: l �� G (Please refer to fee schedule
r "' y , , f/it � p/21) .y � , Permit fee: 1
Address: 90 9.5 5 1/�.I $U/1 / / -,%' /' ! s T.
L� 04 9 7ZZ State surcharge (12% of permit fee):
City/State/ZIP:
�6 J FLS plan re (40% of permit fee):
Phone: (603) 684- - 29 Z $ Fax: (5 1p 84- 9i, $ 7 (Due upon application.)
CCB lic.: es:, 4-0 77 Total permit fees:
Authorized signature: Z..,:vy--___.--. Amount received:
This permit application expires if a permit is not obtained
Print name: E-v E l ,� q - ��, Date: 8 -1C�. Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
Luau ildingUPermits \FPS -Pcrmi App.doc 03/23/06 440 4613T(I I /07ICOM/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
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration S....11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 2-1
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: $
•
13.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System) • .
Square Footage: Permit Fcc:
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- Permi[App.doc 2