Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 11 CO MMUNITY DEVELOPMENT Permit #: FPS2013 00054
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2013
Parcel: 2S 109DA15800
Jurisdiction: Tigard
Site address: 15410 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 77 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 77
Project Description: 13D fire sprinkler system for 2,675 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 05/02/2013 $246.45
12% State Surcharge - Building 05/02/2013 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 05/02/2013 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R - Height: ft Info Process /Archiving - Sm $0.50 (up to 05/02/2013 $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: $2,425.00
Residential Square Footage: 2675
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 No on - - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a •• • •f the rules
or dir= questions to OU • • c. ling 503.232.1987 or 1.800.332.2344.
Is- ued By: / ` Permittee Signature: � ,
-
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 c• pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
' Fire Protection System REC
O VE2 ��3 D Re FOR OFFICE USE ONLY
ce
III City of Tigard Da : 4/ PermitNo.: F/.95ao/.�-G�5
e Phone: 503.639.4171 Fax: 503.598.1960 13125 SW Hall Blvd., Tigard, OR 97223
APR
Pl an Review
g Date/B : O / GE Other Permit: a:4/3 ... Q � 7 ,
TI GARD Inspection Line: 503.639 C Date Read y: a r Juris ® See Page 2 for
Internet: www.tigard- or.gov G FT[GARD No tiiiied/Method: 5 Supplemental Information
BUILDING DWI ION Nalco u)t1 1
TYPE OF WORK REQVIRED DATA 1- AND 2 - FANDLY DWELLING
Alew 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.
Land 2 family dwelling ❑ Commercial /industrial Valuation: $ 2! Z� Av
❑ Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2 , 5
Y g � - to" *',t,r ', - ,1°, ' Total number of floors:
, JQB SI TE_INixiiii ' ,9AN) ,X 1 t i,t ". ., ;•.
Job site address: / 4-) D S1, Su 1, L Y /t ) DR-. New dwelling area: 26„76 square feet
City/State/ZIP: ii (3 D ` OIL 97z_14 Garage/carport area: 4D0 square feet
Suite/bldg. /apt. no.: Project name: ,&k —fox) )-05-1 Covered porch area: / "3 square feet
Cross street/directions to job site: Deck area: 9 ( square feet
Other structure area: square feet
Subdivision: Lot no.: 77 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
l‘i ' ' $ '"'°4,,,A‘,,„ ` () a �� work indicated on this application. e l l
T I t 't ci / � t / / ?1 f /,Z $P /Z /oic � i c- Valuation: $
`
7 .5 �A -- ) 26 sQ t F . e /Qe/li( Existing building area: square feet
New building area: square feet
:` 1 dP R % IER -: .. w = " ; : , ' a il w i , �• , « Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
g
Phone: ( ) Fax: ( ) New:
+I « i���'ke 3x '[ ,.�• %�5� •i Alt N r� g
§ r, . I ANT°" a >G c' * a i� B T �P ) A t ;.. , , r: x• s *7 a +,,,'
Business name: sG Gt,,t) ltbic 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: 101-7-7— !/ A E ' p� � D�o� (Please refer to fee sckedute1
9-0.3..s- S ),,./ 1�Jtm.79 2 5-7-:
Permit fee:
Address:
City/ State/ZIP: fiQ4%v/ Diz ` � 7ZZ3
State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: ( 5 4 8(. — 9 Z S Fax: (503) d:434-- 9697 (Due upon application.)
CCB lic.: t .4(:),7 7 Total permit fees:
Authorized signature: Amount received:
/ This permit application expires if a permit is not obtained
Print name:Ev6 M / 27 Date: 4 -3,d -r 3 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Pamits\FPS- PamitApp.dot 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 -10 heads: No plan review required.
❑ Alteration 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: ZZ
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: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ 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.tigard.or.us /city_ hall /depart meats /cd /docstFPS- PerrnitApp.doc 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15410 SW SUMMERVIEW DR, TIGARD, OR,
97224
Residential - Fire Protection System
999 Sprinkler Final
07/01/2013 00:00
FPS2013-00054
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15410 SW SUMMERVIEW DR, TIGARD, OR,
97224
Residential - Fire Protection System
910 Sprinkler Rough-In
05/15/2013 00:00
FPS2013-00054
PASS
Violation Summary:
Inspector Contractor