Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00212
ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/05/2017
Ttt� g Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Project: Summerfield Estates Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Add(2)sprinkler heads in freezer and cooler.
Contractor: WYATT FIRE PROTECTION INC. Owner: TIGARD RETIREMENT RESIDENCE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/05/2017 $59.16
12%State Surcharge-Building 01/05/2017 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 01/05/2017 $23.66
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 01/05/2017 $10.00
Occupancy Grp: A-3 Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD1
Density: 0.15 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $99.92
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $750.00
Residential Square Footage: 0
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ----Permittee Signature:
C ; .639.4175 by 7:00 a.m.for the next available inspeetfon date.
This permit card shall be kept in a conspicuous place on the job site until compl .••,• . e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit ApplicationRECFIVE9
{
Fire Protection System4 FOR OFFICF. LSE OSl.l'
NOV19 2 0 16 Received
City of Tigard Date/By �2 :i10 , l Permit No. ....3.1;20-14,4 ��0 �,�
Ill 13125 SW Hall Blvd.,Tigard,OR 972p,.."/ Plan Rev1ew , . p
' Phone: 503.718.2439 Fax: 503.598. ( 3/50 i Date/By: (' f 1 4_1k7 Other Permit:
TI G A R ll Inspection Line: 503.639.4175 U1/-1 `.(1
! p� Date Ready: -7 .i kris: ® See Page 2 for
Internet: www.tigard-or.gov UIL � � t' ;`9! 1 Notified Method: j/ _ Supplemental Information
1. t'nc?,
. . R TYP �` WORK .. . REQUIRED..DA I ',. FAMILY DWE l }
0 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
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
t AdORY:; CONS ' 11 � � ���'_
- work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
z iOB SITE INF TIONS - t ��• CAT � :` Total number of floors:
Job site address:11205 SW Summerfield Dr New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Summerfield Estates Upgr Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
AREQUIRED DATA:COM RC 1 E 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
a equipment,materials,labor,overhead,and the profit for the
DESCRIPTION'*ow OR work indicated on this application.
Add heads in freezer and cooler Valuation: $$750.00
Existing building area: square feet
New building area: 0 square feet
xu ® PROPER y 1 EP _ , 0 TENANT Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: light
Phone:( ) Fax ( )
New: Quz
4.;,-1,,,,,,, ,` , ® APPLICANT , ,`. 0.4' ® CONTACT PERSON :: : • 0OTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Max Colley 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:m.colley@wyattfrre.com
�� k '�* .: .,. ''
,'sem ��.. R ' �)� .�
'' fi A*t ,; . CO CTOR ' `` >r BUILDING PERMIT FEES* "
tom., �
Business name:Wyatt Fire Protection
asereJerdofesschedule
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:
Authorized signature: /��, _� Amount received:z i This permit application expires if a permit is not obtained
Print name:Max€(‘V- 7—,-"'"--
h Hey Date:12/14/16 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
i Service Board.
I:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 4404613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Des awork toob&dOrie ' " , , x �ur at. :,
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ® 1-10 heads: No plan review required.
® Alteration El 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads: 2
Additional description of work:
i Syste t i . -,A,B,,C'or Das applicable) '. ,
A.) , ercial
® Wet El Dry
Additional Standpipes 0
Information: Hazard Group Ordinary 1
Density 0.15
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 750
B.);Typeh'. Hood Fire
Sup. sion System' ,} , ..
Hood Project Valuation: $
1tF Alarmx ' i . b> x. .r.
A
Submittal shall Battery Calculations El Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.)' Residential Sprinkler(S 1, 4 .Alone System)
Square Footage: Permit Fee: '
0 to 2,000 $198.75 fa
2,001 to 3,600 $246.45 ; x 0 :
3,601 to 7,200 $310.05 „:
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
" t44 ;0. :s` 4, ,k Fire'l'i6tection pe ..,1't,. S ',.
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\1112 PERMIT APPLICATIONS\Tigard App.doc Rev 01/05/2012 2