Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
.111 8' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00123
T [GA D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S109DA17700
Jurisdiction: TIGARD
Site address: 15305 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 106
Project: Arlington Heights No. 3, Lot 106
Project Description: 13D sprinkler system for new SF.
Owner: FEES
STONE BRIDGE HOMES Description Date Amount
16869 SW 65TH AVE #505 Permit Fee - RES 10/22/2010 $246.45
LAKE OSWEGO, OR 97035 12% State Surcharge - Building 10/22/2010 $29.57
PHONE: 503 - 387 -7577
Contractor:
WYATT FIRE PROTECTION INC.
9095 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 - 684 -2928
FAX: 503 - 684 -9657
Type of Use: SF
Class of Work: FPS Type of Const: VB
Occupancy Grp: R -3 Height: ft
Stories: 2
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 $276.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 3145
Fire Alarm Valuation: 0
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 t e rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Ys may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or : • .
Issued By: - Signature: `1
Call 503.639.4175 by 7:00 a.m. for an inspection that busine-- day.
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.
iii B' lding Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
Received
City of Tigard Date /B / PermitNo.:
a 13125 SW Hall Blvd., Tigard, OR 97 T Plan Revie i► Other Permit:
11 14
Phone: 503.639.4171 Fax: 503.59 6b ` 2010 Date/B 1. I I J r
TIGARD Inspection Line: 503.639.4175 Date Ready/BY: 0 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: I • I1 - Supplemental Information
BUILDING DNIS,QN 0 Ott , .� five 5.0t, TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
i t;alew construction ❑ 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
X -1—and 2- family dwelling ❑ Commercial /industrial Valuation: $ 2i54-Z.
❑ Accessory building ❑ Multi- family Number of bedrooms: L
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION ,9--, / , Total number of floors:
Job site address: 15305 k �—v' ()1.-414 - 1 f l t
/ - New dwelling area: 5 14 square feet
City / State/ZIP: -` c3 i / y art l/1� �}C
n A_ 9 7 Z j� Z � 4- � Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: ,50 /0
4d1 WC , Covered porch area: 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.
? T t Y / L 1 i2 i �1-"l , ) 16D S r iz. ` !a " 4i 1 L - 5 s c Valuation: $
( 7 / ? 61 ,/ n !" D -LC-- I cJ - Existing building area: square feet
J 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:
A PPLICANT �.,' / � ❑ CONTACT PERSON • NOTICE
Business name: C �y am! / /tI r /f-//. �-/-0/e 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:
CONTRACTOR BUILDING PERMIT FEES*
I A) / �! / f P, -- r� r /3 �O� (Please refer to fee schedule) Business name: r ! �� � (� � / /
9095 6N j l � jL ; -, � ' Permit fee:
Address: V � 7 ,
City/State/ZIP: - 7 G, L7 C// 1 7ZZ3 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 6g¢ - z9& Fax: (503) 6 ,4- - 9 7 (Due upon application.)
CCB lic.: &4077 Total permit fees:
Amount received: T
Authorized signature: ' ' I `
�"� — (�
Print name:t 1.A --r�� Date: p - This permit application expires if a permit is not obtained o within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building dusty
Service Board.
I:\ Building \Permits\FPS- PermitApp.doc 03/23/06 440- 4613T(II /02 /COM/WEB) 1'
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 0-1.1+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 2�
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 $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.
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 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 /docstFPS- PermitApp.doc 2