Permit Et CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
F '1
COMMUNITY DEVELOPMENT Permit#: FPS2015-00180
t l,i Date Issued: 11/25/2015
TEbARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
. ,:, .7* ::,1, Parcel: 2S110CB12700
Jurisdiction: TIGARD
Site address: 12021 SW AUTUMNVIEW ST
Project: Southview Heights,Lot 15 Subdivision: SOUTH VIEW HEIGHTS Lot: 15
Project Description: Stand alone 13D fire sprinkler 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 11/25/2015 $246.45
12%State Surcharge-Building 11/25/2015 $29 57
Type of Use: SF Info Process/Archiving-Lg$2.00(over 11/25/2015 $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 11/25/2015 $17.50
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 $297.52
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2720
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 copy of the rules
or direct stions to O C 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 .: e.
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.
Building Permit Application
Fire Protection System ryEf V E ®IE i t FOR OFFICE USE ONLY
M 1
Received Permit No.:
City of Tigard Date/By: /►//7�t S 60p10Y5---00 NO
114 a 13125 SW Hall Blvd.,Tigard,OR 97223 0 O V 1 7 2015 Plan Review '��`� ) I 2 11.5179-0/S o
Phone: 503.718.2439 Fax: 503.598.1960 Date/By 4 l Other PermitGO S
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: / tum ® See Paget for
g g Notified/Method: // �5 /s0g I Supplemental Information
Internet: www.ti and-or. ov BUILDING DIVISION e�►�k.P,,
TYPE OF WORK RE MED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $2639
® 1-and 2-family dwelling 0 Commercial/industrial
buildingNumber of bedrooms: 4
0 Accessory 0 Multi-family
0 Master builder 0 Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address:12021 SW Autumnview St New dwelling area: 2720 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 584 square feet
Suite/bldg./apt.no.: Project name:Southview Heights 15 Covered porch area: 100 square feet
Cross street/directions to job site: Deck area: 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
0 PROPERTY OWNER 0 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 (Please refer tofee schedule)
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:64077
Total permit fees:
Vacoll& Amount received:Authorized signature: .4This permit application expires if a permit is not obtained
Print name:Ashley Nishihara Date:11/17/15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Pemtits\FPS-PermitApp.doc Rev 01/052012 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:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ® 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 25
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 ❑ 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: 2720 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.
C:AUsers\Ashley\Documents\Projects\2015\Southview Heights\Southview Tigard App21oc Rev 01/05/2012
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
12021 SW AUTUMNVIEW ST, TIGARD, OR,
97224
Residential - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00180
David Young
1" Ames model 2000D, serial # 29069
System on at time of final inspection.
Violation Summary:
Inspector Contractor