Permit r 4
• CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
•
COMMUNITY DEVELOPMENT Permit #: FPS2013 00051
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2013
T t GARD Parcel: 2S109DA16900
Jurisdiction: Tigard
Site address: 15439 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 98 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 98
Project Description: Install 13D fire sprinkler system in 4,245 sq ft residence
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW LLC
9095 SW BURNHAM 4230 GALEWOOD ST, STE 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 05/23/2013 $310.05
12% State Surcharge - Building 05/23/2013 $37.21
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 05/23/2013 $6.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm $0.50 (up to 05/23/2013 $15.00,
Stories: 3 11x17) i
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 $368.26
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 4245
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 adop -• by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain coy of th- rules
•
or direct questions to OUN b - • • • 503.232.1987 or 1.800.332.2344.
Issued By: — Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for the next available insp• ction date.
This permit card shall be kept in a conspicuous place on the job site u til completion 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
/
City of Tigard B EC E IVE D Receive d
Date/13y: 4 / R9• /.3 / PernutNo.: f' � j � ol3 13125 SW Hall Blvd., Tigard, OR 97 e J
Phone: 503.639.4171 Fax: 503.598.1960A f117 2 2 2O 3 Date/By: Plan Revi
I� ( ?, Other Permit: t o i 3 7!-
TIGARD Inspection Line: 503.639.4175 PR RR Date Readyy , .. J • is: El See Page z for s
Internet: www.tigard- or.gov Notified/Method: AgX,S Sf I Supplemental Information
TIGARD
CITY OF ,SiE�r„ �, /4)7674-62757‘0-5::'
TYPE OF UlitD Nb DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
0 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.
dwelling Valuation: $ 3 i-8
and 2-family g ❑ Commercial/industrial
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 3,5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: /5+39 ,5 ki SUS EV «) DK_i V5 New dwelling area: 42.4S square feet
City/State/ZIP:-17a/112_0/ a g_ q7 ZZ4 Garage/carport area: 130 square feet
Suite/bldg. /apt. no.: Project name: aJjU 7 j,) L (a'H— 5 Covered porch area: S7 square feet
Cross street/directions to job site: Deck area: -2_2) square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: 98 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.
;i1PV /De / /� L / 3D pj 5P /zhv 557 7'J Valuation: $
I /e W 4245 S � F r 'A Existing building area: square feet
J es ! 40��L, 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:
PPLICANT ❑ CONTACT PERSON NOTICE
Business name: 5' t r2 -1 z,/z -- 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 Q, '�20' — (Please refer la fee schedule)
q p� / Permit fee:
Address: :% 6� B0giJ f/,i 2- S - r ,
City/State /ZIP: _0 g.4 �2 9 -7z2:3 State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: (% 6 B¢ - Zc) Z 8 Fax: (03) 6 0¢ -965'7 (Due upon application.)
CCB lic.: & 0 '77' Total permit fees:
Authorized signature:
Amount received:
✓� �� C^ This permit application expires if a permit is not obtained
Print name: " 5.
/ L Date: 4 - 22 -` within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1: 1BuildinglPermits \FPS- PemutApp.doc 03/23 /06 440 -4613T( I 1 /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 El 1 -10 heads: No plan review required.
❑ Alteration ^ /_11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 8E5
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/departments /cd /docstFPS- PermitApp.doc 2