Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00167
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/06/2012
Parcel: 2S 109DA14000
Jurisdiction: Tigard
• Site address: 12677 SW MOUNT VISTA CT
Project: Rowe Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 59
Project Description: Modification of existing 13D fire sprinkler system for remodel of rec room to (2) bedrooms and (1) bathroom.
Contractor: WYATT FIRE PROTECTION INC. Owner: ROWE, WILLIAM S & MARY J
9095 SW BURNHAM PO BOX 409
TIGARD, OR 97223 CHEWELAH, WA 99109
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Fire Protection System Permit - RES 11/06/2012 $53.78
Plan Review - FLS 11/06/2012 $21.51
Type of Use: SF 12% State Surcharge - Building 11/06/2012 $6.45
Class of Work: ALT Type of Const: VB
Occupancy Grp: R -3 Height: ft
Stories: 1
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 , ' $81.74
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $560.00
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, or if 'work. is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • - • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a c• , of the rules
- or dir -ct questions to 0 b C by ca ' • e 503.232.1987 or 1.800.332.2344. j
Iss d By: AL NOILe/i Permittee Signature: 1/• � p .i1401
Call 503.639.4175 by 7:00 a.m. for the next available inspection • 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 FOR OFFICE USE ONLY
3 -. City of Tigard + D Date/By: (0 �� � Permit No.: `95 �� /t 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: / CI' • (, I y Other Permit:
TIGARD Inspection Line: 503.639 OCT 2 8 2012 Date Ready : y: S s: 8 See Page 2 for
Internet: www.tigard - or.gov Notifi thod: (( / 4 / ( ur 2.- Supplemental Information
CITY OFTIGARD # 4 /A ti ..fDL,
TYPE OF SING DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
.ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Land 2-family dwelling Valuation: $ 56!) �'
y g ❑Commercial /industrial '
111 Accessory building ❑ Multi - family Number of bedrooms: A �� A--‘705
❑ Master builder ❑ Other: Number of bathrooms: ) am) 41/YE--1 7
JOB SITE INFORMATION AND LOCATION . Total number of floors: 3 :=ls-77 .
Job site address: ! 77 6 j(li nDo/P r V`l fi- cf New dwelling area: square feet
City/State/ZIP: . .(; / / c)2_ q7 774_ Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: j 4E 1 LJ r Lj ' ! Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure are . square feet
REQUIRED DAT : COMMERCIAL -USE CHECKLIST
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
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK, work indicated on this application.
_ C/4" % G /.L $ p /I» V - -c 1 t� N s t Valuation: $
/ ` (/, Y / �� ! / � D �� � � � 6 � Existing building area: square feet
to /o . . /...1/
/29P/ifs * #j/1- . New building area: square feet
El 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: o� p ��
�� C
w/v7 /G �-- l 12L1:2- 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 PERMIT FEES*
Business name: Y�,� � , 4D` -t /DAJ (Please refer to fee schedule) .
/ J'� / Permit fee:
Address: 190,---. ,(/tl 6 17.1 l — —
City /State /ZIP: - 0k 9 . 7Z 2_j State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: (5D3) 684 -Z-Ze5 Fax: (503) !off -965` (Due upon application.)
CCB lie.: &4-07 7 Total permit fees:
Authorized signature:
_.-e--t..-e_.--- thi-l'..' _., Amount received:
This permit application expires if a permit is not obtained
Print name: ,----v6 14--T Date: `D /Z�i z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1:1BuildinglPermits\FPS- PermitApp.doc 03/23/06 440- 46I3T(1 I /0 2/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
�Describ`e
work to b'e done
1.) ❑ New 2.) Modification to sprinkler heads only:
c , 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
T e ,o£ S stenCom`° lete'A, B' C :or'D;.:as`:;a` li
A:) Commercial Sprinkler.
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinkler Project Valuation: $
'B:), „Type I - 'Hood`Fire;:Suppress on,Syste r%,.
Hood Project Valuation: $
C) Fire
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
e e
s d'e tia S` St�idAh'n�
( a o e'Sysfiem� - �.��'.
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 P'rotec'tion 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/ dry_ hall/ departments /cd /dots /FPS- PermitApp.doc 2