Permit , CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IIII '` COMMUNITY DEVELOPMENT Permit #: FPS2010 -00146
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010
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Parcel: 2S112DB00200
Jurisdiction: TIGARD
Site address: 15255 SW 72ND AVE
Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Adding (23) sprinklers to second story addition.
Contractor: WYATT FIRE PROTECTION INC. Owner: BROOKS & PITTMAN RENTALS
9095 SW BURNHAM 15255 SW 72ND AVE
TIGARD, OR 97223 PORTLAND, OR 97224
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES _
Description Date Amount
Specifics: Permit Fee - COM 11/30/2010 $134.48
12% State Surcharge - Building 11/30/2010 $16.14
Type of Use: COM Plan Review - Fire Life Safety - COM 11/30/2010 $53.79
Class of Work: ALT Type of Const: VB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
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 $204.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $5,086.00
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 spy of the rules
or direct questions to OUNC by calling 503.232.1* ; or .: I:. 32.2344. __/
Issued By: i Permittee Signature: ,�
C.. I- '3.639.4175 by 7:00 a.m. for the next available inspe tion date.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
R Fire Protection System w iep , . , r .FO usE'ONLY ,
C ity of Tigard r/ O Rec eiv e d / / `fir Perm t /' _ ��
13125 SW Hall Blvd., Tigard, OR 97223 r�
�0 \ Plan Rev ew �.�(� j Other Pernut. � 1�,` "'
Phone: 503.639.4171 Fax: 503.598,1960 3 Date/By: 0 " I� ( �e to o V U/- (1�3
416A R Internet: www.tigard - or.gov D Inspection Line: 503.639.4175 NO� � � ' oti
C sate Ready/By: / Juris: E i See Page 2 for
OG 4 fied/I4etho / �d: /?A /0 Supplemental Information
� x' ' 4� ` i z... 3 v , T 30P �V0 � ;� 0 '"•P. RE LIIRED ,--
2 FAMILYiDWELL ` �
❑ New 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
o rl work indicated on this application
Ill 1- and 2- family dwelling /commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
k ' % c ° I ' .tJOB SITE INFORIYIA IOI AND LOCAT101 r Total number of floors:
Job site address: 152_5 j sJ2_,iw New dwelling area: square feet
City/State /ZIP: ' Ems/ /+� D , & 2 9 7Z-2 - 4 . Garage /carport area: square feet
Suite/bldg. /apt. no.: f Project name: 1pj'"r -n-1km j iDc:,K__s Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
. �apairow
R t ilitEl? DATA COMMERCIAL US GHFCKI:IST
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
Q t i y 1*.tw . Il'TLON WORK _ . work indicated on this application.
<: -. ,ems � , � �»� �j
� )01. SPj1 � c pee / ! ! d/t �/�jj) Valuation: $ 5�' �J coo
'i''o PL 902 .fib / r i a� 8 `f )x v D11q. G .rf Existing building area: square feet
�X � Number of stories:
/Ai( ...!
3 'r'. ` - New building area: square feet
• 6,e«'rae tad. a;. past F ' s' a^' .- ,,,.,+t, z ;e 4
t..., ®PROPERTY Q�Wowmoll . �. '� l ..� TENANT . , ,,:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
y M,1 � � �z a � � �r €� z � . � iwtla s,
I'PLICANT p� : £ ❑ CON�'A.CT PERSON : £ s �» �wma
�_ 1 . .:: a, s .47,A6, ;, , .. . -n ',INV1 ... , ,.. s, ,, � � , ... r .< �� > r NOTICE
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Business name: /U'� -–f ®0–__ 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:
I ,,.� 407' CONTRACTOR � . „ �, i u .. 0 A' BUILDINGPET2MITFEES*
Business name: y4- F--7 7 " -7D "� " "� p(Rtease refer.io feesc /iedu1e) ,A� �>
(� qq �� q p� y � p Permit fee: f 1 L( Lt if'
Address: 9l) 95- 514 iEj(,��e'1 'S (, l A
City/State /ZIP: !`a o 0� 97 2 a3
State surcharge (]2 °/n of permit fee):
j FLS plan review (40% of permit fee): tz ^7 et
Phone: (.3) 6 5L - Z9-Zt, Fax: (503 ' – 96, 57 (Due upon application.) ` `
CCB lic.: (.11-07 7 Total permit fees: t a d LI _ 1---(.4 �` / Amount received: �=� y/
Authorized signature:
�� / L
This permit application expires if a permit is not obtained
Print name: '� within 180 days after it has been accepted as complete.
C�– f f– Date 1 l — '� * Fee methodology set by Tri-County Buildi Industry
Service d. i /1
I: \Building\Permits \FPS- PemtitApp.doc 03/23/06 440- 4613T(11 /02 /CDM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
#Des�cribewo be done .fi 4 �,' �
1.) ❑ New 2.) Modification to sprinkler heads only:
A ddition ❑ 1 -10 heads: No plan review required.
❑ Alteration : 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type�of�Systern(Cornplete�A B C n or b as a hca�ble � � �` £ � N� s�
d ���'�L���^� "+aT� S ��' a � ' �` t ' � j '�2" �:.5�,�' E � J 9 o. �if�`tj"y'Ad •. k�+ 3 � Z '� �'` �;.. g ��, w` �
Ate) ComrnerctalSprin'kler r� �
�f� �'''�'I�.
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation: $
�� �- �� ��� ?k
, ....>.,K. r a+ ,. �� • C
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
� ® �) �Resiientla��Spnnkler� (tS,tandAlone�System) �, � z� � � ����
Square Footage: Permit Fee: �h
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.
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 / departments /cd /dots /FPS- PermitApp.doc 2