Permit �y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
s COMMUNITY DEVELOPMENT Permit #: FPS2012 -00179
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2012
Parcel: 2S109DA17000
Jurisdiction: Tigard
Site address: 15425 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 99 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 99
Project Description: Fire sprinkler system.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW
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 12/20/2012 $310.05
12% State Surcharge - Building 12/20/2012 $37.21
Type of Use: SF
Class of Work: FPS Type of Const: VB
Occupancy Grp: R -3 Height: ft
Stories: 3
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 $347.26
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 4075
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
issu. • :-, or if wor uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ity Notification Center. o r les 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 b : IlingArd,g/ilt, .03.232.1987 or 1.800.332.2344. ,
Issued By: Permittee Signature: 7 / /
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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System RECEIVED Received FOR OFFICE USE ONLY
- ' 13125 of Tigard Date/By: : Al 40Z Z ::'' Permit No��OS .2O4^s — po'
13125 SW Hall Blvd., Tigard, OR 97223 D 1 0 01 Plan Review j . . her Pe S
Phone: 503.639.4171 Fax: 503.598.1960 1 Date/By: I Z ` 1 7 sr�0 %2 a9a 7
TIGARD Inspection Line: 503.639 Date ReadyBy: Juris. ® See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: /�/I k Supplemental Information
1 I _1 ION r' wi
• ,r.. tr .. ,ro- ;. �» s*r j ��r��e € � .76:',`,,,' '�'Y� •�jr. ,g 3 .�1; °��'1"prngg��� �.- °,"...� ,,- .-�aar .mot- s .
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0 14ew 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
+. -� ;;;;',2,777.T.
"T ` yo- tEo O 4 u p 7 " k work indicated on this application.
= nd 2-family dwelling Valuation: $ a7Z9, °°v
y g ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 3 ,5
r 1 maw -
2 "� ",. , tl 'L t+ ,} 1 rY iuo • .e Total number of floors:
Job site address: 15425 60f31/nr,(10E !L New dwelling area: 4075 square feet
City/ State/ZIP: - j i (7f 9 7 Zz4 Garage/carport area: " " � 6 z 39 square feet
Suite/bldg./apt. no.: I Project name: f /ICtf-7 Covered porch area: /D r square feet
Cross street/directions to job site: Deck area: Z 3D square feet
Other structure area: - square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: l Lot no.: 99 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
i i) ",51 s 0 (,I, or a t i ? :; work indicated on this application.
PiC.1/1' /Di✓ A/ l3D / J SP,e //V /G-LEfL YS /E7,/ Valuation: $
�L
,i ‘ `Y ! ! ! � ) 4075 3P Cr ,(� 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:
- -- g
Phone: ( ) Fax:( ) New:
'\PI'L.ICANT ❑ CONTACT PERSON NOT
Business name: 6 Z_at/T ;j9C - 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*
k l /,
Business name: _ 7 / P
e � „ — (Please refer to fee schedule)
Permit fee:
Address: 9p95 Ski A0/2-4A44 67
State surcharge (12% of permit fee):
City/State/ZIP: ij64/j / Di2 g 7 Z Z 3 FLS plan review (40% of permit fee):
Phone: ( 5-03) & �¢ — 2_9 z de, Fax: ( 503) 6, g¢ - 16,57 (Due upon application.)
CCB lic.: (40 7 7 Total permit fees:
Authorized signature:
Amount received: 34_7 ' -co
....e.,.....e__ /-7.--e-C/r This permit application expires if a permit is not obtained
Print name: ✓ Al ,64-2-- Date: j Z 91) / within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1: 1Building \Permita\FPS- PemitApp.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:
❑ Addition ❑ 1 -1 0 heads: No plan review required.
❑ Alteration11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 3 7
Additional description of work:
, Type of System (Complete A, B', C or D as ,applica�bl'e): �f � -
A.) Comiriercial,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: $
C.) Fire Alarm ; = . , _ •
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets -
R (Stand < 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`Protectio.n =Permi't 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 /docs/'FPS- PermitApp.doc 2