Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 COMMUNITY DEVELOPMENT Permit#: FPS2015 00170
T(G.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2015
Parcel: 2S110CB13300
Jurisdiction: TIGARD
Site address: 12080 SW AUTUMNVIEW ST
Project: Southview Heights,Lot 21 Subdivision: SOUTH VIEW HEIGHTS Lot: 21
Project Description: Fire sprinkler-New stand alone 13D system for SF
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:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-RES 11/05/2015 $246.45
12%State Surcharge-Building 11/05/2015 $29.57
Type of Use: SF Info Process/Archiving-Lg$2.00(over 11/05/2015 $4.00
Class of Work: ALT Type of Coast: VB 11x17)
Occupancy Grp: R-3 Height: ft Info Process/Archiving-Sm$0.50(up to 11/05/2015 $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: $2,910.00
Residential Square Footage: 3010
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 Notifica'•• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct •lestions to O C by calling 503.232.1987 or 1.800.332.2344.
Issued By: ) 0 /j/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti date.
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.
L
Building Permit Atoplicatioit.,
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Fire Protection System a �) FOR OFFICE USE ONLY
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City of Tigard Received
T Bate/B . 10 It7 Permit No.. PSd9U/s-.�(
C 2 7 2015 7Q
13125 SW Hall Blvd.,Tigard,OR 972243 Plan Review f�1
■ Other Permit: racy
Phone: 503.718.2439 Fax: 503.598.1960 Date/13 . AVIA' �� M7 !3
T I G A R l) Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready: // Juns: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:i',/-2745 *� 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
El Addition/alteration/replacement ❑ Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling ❑ Commercial/industrial Valuation: $2910
CI Accessory building ❑Multi-family Number of bedrooms: 5
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address:12080 SW Autumn View St New dwelling area: 3010 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 472 square feet
Suite/bldg./apt.no.: Project name:Southview Heights 21 Covered porch area: 142 square feet
Cross street/directions to job site: Deck area: 180 square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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.
Stand alone 13D fire sprinkler system for single family home Valuation: $
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:
® APPLICANT ® CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Nishihara licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::(
E-mail:a.nishihara @wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (PleaaerrJermlesschedule)
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:64077 Total permit fees:
Authorized signature:
14)A:dot Amount received: -t'
This permit application expires if a permit is not obtained
Print name:Ashley Nishihara Date:10015 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-Perm itApp.doc Rev 01/05'2012 440-46131(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:
El Addition El 1-10 heads: No plan review required.
El Alteration ® 11+ heads: Plan review required.
El Repair
Number of sprinkler heads: 23
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
El Wet El 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
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: 3010 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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
W:\Max\Southvicw Tigard App.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12080 SW AUTUMNVIEW ST, TIGARD, OR,
97224
Residential - Fire Protection System
999 Sprinkler final
FAIL
FPS2015-00170
David Young
Provide Backflow test report and approved plans for final inspection.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12080 SW AUTUMNVIEW ST, TIGARD, OR,
97224
Residential - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00170
David Young
1" Ames model 2000b serial # 29092.
Violation Summary:
Inspector Contractor