Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2012 -00153
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/09/2012
Parcel: 2S109DA17300
Jurisdiction: Tigard
Site address: 15367 SW SUMMERVIEW DR
Project: Arlington Heights No. 10Z Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 102
Project Description: Provide (1) 13D Fire Sprinkler system and new 3160 sf residence
Contractor: WYATT FIRE PROTECTION INC Owner: COLUMBIA STATE BANK
9095 SW BURNHAM BY JECK, AL
TIGARD, OR 97223 17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE 503 - 684 -2928 PHONE
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - RES 10/09/2012 $246.45
12% State Surcharge - Building 10/09/2012 $29 57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 10/09/2012 $4 00
Class of Work: FPS Type of Const: VA 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm $0 50 (up to 10/09/2012 $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: $0.00
Residential Square Footage: 3160
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 i - spended for more the 180 days. ATTENTION' Oregon law requires you to follow the rules adopted by the Oregon
Utility . •tification Center. tiose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain �% of the rules
or di -ct questions to OUNC by c 503.232.1987 or 1.800.332.2344.
Is- ued By: fjd , ,/I / Permittee Signature: Ai de f
..,..# 7
Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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 each inspection.
Building Permit Applicatio • Fire Protection System FOR OFFICE USE ONLY
City of Tigard 0 C T 0 2 2012 Dae/Be: L to a_ l ft_ +L `y �P5 aor a - D o f S3
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- - 13125 SW Hall Blvd., Tigard, OR 97223 Plan Ry a E I , a �
Phone: 503.639 4171 Fax: 503.598.1960i _ - ' { Mg Other t PerNo : mit:
Inspection Line: 503.639 4175 � 1 : A ! 1 ( fib` 1 A Date Ready/By. 8 See Page 2 for
TIGARD Internet: www.tlgard- or.gov �: �� ttla nitil � Notified/Method:
`r :: / �/ Cid � -/� ill/4
l 4C y Supplemental Information
- ^/
TYPE OF':WORK . 'QUJRED DATA:I -AND i- FAMILY DWELLING
fgNew 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: $ �f3 ,
Co )
1 and 2- family dwelling ❑ Commercial/industrial r
❑ Accessory building ❑ Multi - family Number of bedrooms: 4.
❑ Master builder ❑ Other: Number of bathrooms: ..
' _ - JO$ SI•TE IIYFORIYIATION AND 'LOCATION . Total number of floors:
Job site address: /53 6 -7 5 tv 50,lmU /E- , New dwelling area: 3/62 Q square feet
City/State /ZIP: -f/ . -7 t) V/2_ 9 7 Zz4- Garage/carport area: 40 2, square feet
Suite/bldg. /apt. no.: Project name: (_j,ki - rbu /.//6 Covered porch area: 37 square feet
Cross street/directions to job site: Deck area: 2.04- square feet
Other structure area: square feet
'REQUIRED DATA: COMMERCIAL -USE CIIECK'LIST.
Subdivision: Lot no.: f) Z 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.
?72DV ltd ,&i / / /5 f)i � )°,�lAIKL, Valuation: $
y5 /t� ' 3100 6 ,CT r- l,ir-- 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:
• - `APPLICANT ' - - - .0 CONTACT PERSON , _ NOTICE '
Business name: .S .Cj(,d / �d 2,-- 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.PCRMIT FEES., *,.,:
Business name: i V4-1---1.
, i pl Pg )-7- / 0 `lv . - (Pleisi rejar'tofeeschedide," - _.
Address: �5 �J Z)/a�y � �j ! Permit fee:
City/State /ZIP: . ei j / I L) / 02 q 7 ZZ �j State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: ( 3) 4. g¢ - 2. 7 Fax: (5E1)3) 6, 0 i - 96 S 7 (Due upon application.)
CCB lic.: 61077 Total permit fees:
Authonzed signature: �� Amount received:
/( This permit application expires if a permit is not obtained
Print name: -.- 6 / / ,641---V- �ieC) Date: 1 / � / Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I \Bulding\Permits \FPS- PcmutApp 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.) Li New 2.) Modification to sprinkler heads only:
0 Addition 1-10 heads: No plan review required.
0 Alteration —Rr--4 1+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
ifjadlOtsptutiklo,
Li Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation:
t
FiteAtatiit
Submittal shall Battery Calculations I=1 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
_ "
- DOT , Regideb.nakbphinic.i.or.tD,tailionF',.yste, viA
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.
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 ugard.orms/city_hall/departments/cd/docs/FPS-PermitApp doc 2