Permit U CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2013 -00098
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2013
Parcel: 2S 109DA19000
Jurisdiction: Tigard
Site address: 12641 SW CANYONRIDGE CT
Project: Arlington Heights No.3, Lot 119 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 119
Project Description: Fire sprinkler for new SF
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES INC
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 07/22/2013 $246.45
12% State Surcharge - Building 07/22/2013 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 07/22/2013 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R -3 Height: ft Info Process /Archiving - Sm $0.50 (up to 07/22/2013 $11.00
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 $291.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 3330
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a • s J the rules
or dire • • estions • NC by calling 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 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 1�E� FOR OFFICE USE ONLY •
RECEIVED Received 4:n
City of Tigard o �,'D G�
Y Tigard " / z /3 vf' PernutN No n95,20/3 5�/3 ...ea / 1
13125 SW Hall Blvd., Tigard, OR 97223
1 "
1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960. 11... 1 6 2 3 1 3 Date/By: 7122_1 1 . Other Permiis74/3 QOO 7�
TIGARD Inspection Line: 503.639.4175 Date Rea : Jur s: 0 See Pap for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method:�� ` 'f/(" Supplemental Information
.BUILDINGDIVISION �uc-E-A/g
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
El Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
. CATEG ORY of , CONSTRUCTIOiN - . work indicated on this application.
r and 2-family dwelling Valuation: $ ���� • (52,, y g ❑C ommercial /industrial
1:1 Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i26, 4l sjx ` am, Yt,,_,) D61✓ New dwelling area: 3 D square feet
City/State /ZIP: •176)41Z../0 / (9/Z- 9 7Z2-.41 Garage/carport area: 5 6 square feet
Suite/bldg. /apt. no.: Project name: a )-1- [f-75 Covered porch area: 3 square feet
Cross street/directions to job site: Deck area: ' 13 square feet
Other structure area: ----- square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: ) ` 9 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.
r Pp2V / D E A,/ ix/ ) 3D F1,2 5P4-/A, SYS -- Valuation: $
- & ,l> S-3.3,0 54), F' - ` Je__-, 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:
Phone: ( ) Fax: ( )
�/� New:
p�- APPLICANT ❑ CONTACT PERSON NOTICE
Business name: G /Z/TC.b- 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:
T r
,CON.TRACTOR
... _ .. � _ BUILDING',PERMIT FEES *'
I ` t / /� p� , �� -h r , ^/ J (Please refer.; fee sc /iedide) • - . - " .
Business name: //(� !�� '
%,{ 130,_/01/7(71,7 �%(130,_/01/7(71,7 J� Permit fee:
Address:
999 c ----
City/State /ZIP: -/ii id D2 7Z State surcharge (12% of permit fee):
? _ FLS plan review (40% of permit fee):
Phone: (50 j) 6Og3 �L- Z9 z_S Fax: (503) 6 ��_9 6 57 (Due upon application.)
CCB lic.: &420 7 7 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: Lreit / / 9f1-7 I Date: D7 -/6 /3 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1:1 Building \Perrnits\FPS -PermitApp.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.) r--New 2.) Modification to sprinkler heads only:
❑ Addition El 1 -10 heads: No plan review required.
❑ Alteration 1+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: Z3
Additional description of work:
A Commercia
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation: $
z..
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D es de ti'al S rinkl r f ri` `Al ,
)::: a S.,ta d o e�S
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.
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 ments /cd /dots /FPS- PermitApp.doc 2