Permit y CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
: ! COMMUNITY DEVELOPMENT Permit #: FPS2011 -00024
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/31/2011
Parcel: 2S 109DA 14100
Jurisdiction: TIGARD
Site address: 12651 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 60 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 60
Project Description: Install 13D residential fire sprinkler system.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDEGE HOMES
9095 SW BURNHAM 16869 SW 65TH AVE #505
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -2928 PHONE: 503 - 387 -7577
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - RES 03/31/2011 $246.45
12% State Surcharge - Building 03/31/2011 $29.57
Type of Use: SF Info Process /Archiving - Lg Sheet (over 03/31/2011 $4.00
Class of Work: NEW Type of Const: VB 11x17)
Occupancy Grp: R - Height: ft Info Process /Archiving - Sm Sheet (up to 03/31/2011 $11.00
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 $291.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation:
Residential Square Footage: 2444
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 obtai. c- •y o the rules • or direct questions to OUNC by calling 503.232.1987 • : •
Issued By: Permittee Signature:
Call 5 '` .: 5 by 7:00 a.m. for the next available inspec, on date.
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 RECEIVED FOR OFFICE USE ONLY
14 +' City of Tigard DateB da� Permit No.: F I.�7C�d�Q��p(
13125 SW Hall Blvd., Tigard, OR 97223 a _ 1 ?011 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960" Date/B 't : `� I OtherPernv[.
I.
TIGARD Inspection Line: 503.639.4175 Date Ready/By: 8 See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGA No[fied/Method: �'' suppler- ^tal Information
DING DIVISIO
4 Y fi : TYPE OIi WORT{ ° '& REQUIRED DATA, 1 AND 2 FAMILY DWELLING y..xa::
N ew 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
,; ,' work indicated on this application.
- Valuation: $ 2-Z-Z 4 , t
and 2-family dwelling `
CATEGORY OF
1 dwellin Commercial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: IA- `
,; ` ' 4 JOB SITE INFORMATION A LOCATI01 Total number of floors: e--..
Job site address: / 2W 5/ Haw,- V/ S -2-4. c ! ' New dwelling area: -4 square feet
City /State /ZIP: -11� yP1�D 1 0� g 722_4— Garage/carport area: square feet
Suite/bldg. /apt. no.: "/` Project name: A+L m i4 - la i - Covered porch area: square feet
Cross street/directions to job site: tS 1)/ 1$f V/ ) . /4— I Deck area: - square feet
tt Other structure area: square feet
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
d- r s q 1 r ;� u °` + fi x work indicated on this application.
`) 20 v / � / J 1v / �) Rg $ / / VI — / T Valuation: $
-7 PJ2.1 MI kL - s' "7"1 l /, G.T4- Existing building area: square feet
'r . 6 j DSV e_ , New building area: square feet
C) ro� + I t f u 3 % ° *- � R Number of stories:
< a
:07, > � ..�- .F.�''3w .e e: g., � 3:,x t. .o,�eT+�re. •,,�x. ,. _ . .� t �,... .�., R
Name: OtJ E 7 1:7 0,„ a e 6 Type of construction:
Address: / /t62 ! 5 1.051.--- 4t) le- 6D5 Occupancy groups:
City/State /ZIP: kA -/!.\ QGJ LAD CEO D2, 97c 3s Existing:
Phone: (5..;, 3S "7''75 7 Fax: ( ) New:
s 3. TM4U SCANT ' s a s tV ❑ CQ�vI P'T PPWP g O t t q as
Fk�. , � .�... k' ;� i, ,2 ..;., s"{' k F� �;: Er w a k .ter , , zu7.'i „ c f .a T � G + o a
Business name: S (� // 7 " j'77� 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:
40.' ..r , .`. ONT £ ii _'kkQAiag : .i, i Rw. •_"
_ o ��;;�� ,.ate , � � �� � �; ,1 �+ ' B �JII�DINGPE,RIT �'EPS* ��
Business name: i 4 l f s F / r' PD ' ���N 44 4 4 x. (P1ease'reJer to:7 . y i.
Address: 909 ,s j( ) ,. 7 / 7 5 Permit fee:
y �, State surcharge (12% of permit fee):
t 7
City/State /ZIP: / ()� 9 7 20_ FLS plan review (40% of permit fee):
Phone: (5D 3) (. a¢ - 29 Z Fax: ($p &M 3) M 9 . . 7 (Due upon application.)
(
CCB lic.: &40 77 Total permit fees:
Authorized signature: Amount received: —40
wK This permit application expires if a permit is not obtained
Print name:� — " _) Date: S -1 _ l' within ]SO d ays after it has been accepted as complete.
* Fee meth by Tri - C ou Building Industry
Service Board. U)
I:\ Building \Permits\FPS- PemutApp.doc 03/23/06 440- 4613T(11 /02/COM/WEB) 211.
Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www. tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor j2r City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address: [/
City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (/):
VOID
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
111 ��� �I
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). / � -��
Permit #: 6 AO r 1 - 0000 � k 7 �/
Site Address or Parcel #: /9457 AO eoa,Jr V /ir, ci
Project Name: g2Li /J610A) / 4,0//7 -6
Subdivision Name: Lot #:
EXPLANATION: C 1 :b i.J3(Zp,3eo P yPP
P � 1 hoct boo(oA •
Signature: Y O_Q) 141 Date: 5 I, //,
Print Name: E 4 3, l
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date _ MMIMEr Rte to Bid Admin: Date 31= B 'A•
Refund Processed: Date A/ .L By -ell Invoice Processed: Date By
Permit Canceled: Date J /3/0 By r Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07