Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit #: FPS2013 -00076
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
Parcel: 2S109DA16800
Jurisdiction: Tigard
Site address: 15453 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 97 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 97
Project Description: Provide new 13D fire sprinkler system for new 2,865 square foot 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 06/20/2013 $246.45
12% State Surcharge - Building 06/20/2013 $29.57
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $276.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2865
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 N. ' a ion • er. T • e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a cop •f the rules
or dire questions to OU • . calling .:'.232.1987 or 1.800.332.2344. ../
i
Issue. By: • / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection te.
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 RECEIVE
Fire Protection System NJ FOR OFFICE USE ONLY
City of Tigard JUN 1 1 2013 Received /
Permit No.:
' 13125 SW Hall Blvd., Tigard, OR 9722 Date/B : Leff 9 110.4.r. /,;0, ii y % . p /, -�07
/�T� Plan Revie•
' a Phone: 503.639.4171 Fax: 503.598.1 Vi 1 iGA� DateB : � Al RN ► Other Permit: /`(5j o� /3 - 7
TIGAxn Inspection Line: 503.639.4175 g�,DINGDNISION Date Ready " kris: 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
'New 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.
- and 2- family dwelling ❑ Commercial/industrial Valuation: $ 1- 97,
❑ Accessory building ❑ Multi - family Number of bedrooms: 4..
❑ Master builder ❑ Other: Number of bathrooms: 1
JOB SITE INFORMATION AND LOCATION Total number of floors: Z,
Job site address: I5 +5 3 ( 5)4 S o mm f ` le , New dwelling area: 2866 square feet
City/State /ZIP: /5+53
j ( / 4j ` 2 97 z 0 _4 Garage/carport area: 4/ square feet
Suite/bldg. /apt. no.: Project name:A- k)G -D4) �`a, -r < Covered porch area: 60 square feet
Cross street/directions to job site: Deck area: 1 4,j square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 97 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
Dpr) ST /�,,
DESCRIPTION OF WORK / work indicated on this application.
vi Dg, / � t'�v(/ 13D ivl c� pI ' t�/e 5y6. 6. Valuation: $
A I kl 6; l 5/ -- 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:
,APPLICANT ❑ CONTACT PERSON NOTICE
Business name: / 49 ��.4-1,,___ 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: )�1 ���i / �f� � Permit fee:
(Please refer t o fee schedule)
/r' 't4 I l , / y/ l , �
Address: 909 r . L'V /� vi2jol tv/
City/ State/ZIP: 11 3/� n/ v 9 l ZZ 3 State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: (03) & O¢ -ZZs Fax: (S03) 031- — 96 57 (Due upon application.)
CCB lie.: a 4 ()7 7 Total permit fees:
Authorized signature:
Amount received: � ( .0 Y'
wee-- 2,(7 This permit application expires if a permit is not obtained
Print name: r ,`!-T Date:06 —!/ / within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \Permits'FPS- PermitApp.doc 03 /23/06 440 -4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
;Descieoyprktolie
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:
Additional description of work:
Type of;System (Complete;A, B, 'Ck or D'as apphcal le) a „
a
A.), Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B )' TyP;e I , ,I -Iood Fire. Suppression System,:... ; A ' R ':' ,,.
Hood Project Valuation: $
: .,.
a C:)x= Fire „ Alarm: .
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
is
=W�
es d e
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50 ° ��' $ "'`'
FC Y
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
c' ��= ro e`c ori.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 /dots /FPS- PernitApp.doc 2