Permit q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit rt: FPS2015-00202
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
2S110CB12800
Jurisdiction: TIGARD
Site address: 12037 SW AUTUMNVIEW ST
Project: Southview Heights,Lot 16 Subdivision: SOUTH VIEW HEIGHTS Lot: 16
Project Description: New 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 12/30/2015 $246.45
12%State Surcharge-Building 12/30/2015 $29.57
Type of Use: SF Info Process/Archiving-Lg$2.00(over 12/30/2015 $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 12/30/2015 $21.00
Stories: 3 11x17)
Commercial Sprinkler Svstem:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density. 0 Design Area: 0
K Factor. O
Commercial Fire Alarm System:
Fire Alarm Required. Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $301.02
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation. $2,697.00
Residential Square Footage: 2830
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 180days 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 questions ttoo/OUNC by calling 5D3.232.1987 or 1.800.332.2344. >
Issued By: ,(- // Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspectio ate.
This permit card shall be kept in a conspicuous place on the job site until completion oft project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection SystemRece
City of Tigard C'�` ' c� Date;Bed f5 Pennit NO.:
• 13125 SW Hall Blvd,Tigard,OR 9722 Q�� Plan Re
B
gee Paye 2 for
Phone: 503.718.2439 Fax: 503.598.1960 -i' D e/B . �( Other Permit S
Inspection Line: 503.639.4175 r.`V� Ready
Internet: www.tigard-or.gov ,Y,`v `�``1,`� dified/MMhod: I gupplemeold iofOrmadOu
... V Y
TYPE OF WOr " ':i ,REQUIR DATA;Y?AND,2-FAMILYDWELLBVG'
®New construction ❑ Demo lion 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
��UCTION-. - work indicated on this application.
CATEGORY OF COIF
® I-and 2-family dwelling ❑Commercial/industrial Valuation: $2697
❑Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ❑Other; Number of bathrooms: 2.5
JOB`SITE INFORMATION'AND LOCATION Total number of floors: 3
Job site address:12037 SW AUTUMN VIEW ST New dwelling area: 2830 square feet
City/State/ZIP:TIGARD,OR 97224 Garage/carport area: 703 square feet
Suite/bldg./apt.no.: Project name:SOUTHVIEW HEIGHTS LOT 16 Covered porch area: 91 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA-.COMMERCIAI USE CHECKLIST
Subdivision: Lo[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 FIRE SPRINKLER SYSTEM FOR NEW SINGLE FAMILY HOME Valuation: 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:
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.nishiharagwyattfire.com
CONTRACTOR BURRING PERMIT FEES*
Pleas err "sAedrle
Business name:Wyatt Fire Protection Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) Due upon a lication.
CCB he.:64077 Total permit fees:
Authorized signature: �/nf Amount received:
,r10t' This permit application expires if a permit is not obtained
Print time:Ashley Nishihara Date:12/30/2015 within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I:BuildingPmnitsFPa-PemdApp.doc Rc 01/052012 440-0613T(11102/C0MwEm
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done: `'r
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: 31
Additional description of work:
TyOe of S "stein" C6}& ylete A;B15 C or D ds'`a 4cable LL t
3"
'i�i'
A.) Coirimerc�al Spttnitlet fi
❑ Wet ❑ Dry
Additional Standpipes _
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B. T e 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: 2830 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 onsquare 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.
kG:\\12N\Permit Applications\Southmw Do clopment.doe Rev 01/05/2012 1)
CITY OF TIGARD FEE AND PAYMENT HISTORY
13125 SW Hall Blvd., Tigard OR 97223
503.639 4171
FPS2015-00202 - 12037 SW AUTUMNVIEW ST, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-RES 230-0000-43104 $246.45 $246.45 $246.45 12/30/15 Check 401294 $0.00
12%State Surcharge-Building 100-0000-24001 $29.57 $29.57 $29.57 12/30/15 Check 401294 $0.00
Info Process/Archiving-Lg $2.00(over 230-000043135 $4.00 $4.00 54.00 12/30/15 Check 401294 $0.00
11x17)
Info Process/Archiving-Sm $0.50(up to 230-000043135 $21.00 $21.00 $21.00 12/30/15 Check 401294 $0.00
11x17)
Totals for Fees $301.02 $301.02 $301.02 $0.00
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
401294 Check 22286 Wyatt Fire Protection, 12/30/2015 $301.02
Inc.
Total Payments: $301.02
Balance Due: $0. 0
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
12037 SW AUTUMNVIEW ST, TIGARD, OR,
97224
Residential - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00202
David Young
Sprinkler head installed below OH door in office.
Violation Summary:
Inspector Contractor