Permit !t CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II 2: COMMUNITY DEVELOPMENT Permit #: FPS2012 -00027
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012
Parcel: 2S109DA15100
Jurisdiction: Tigard
Site address: 15374 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 70 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 70
Project Description: New 13D residential fire sprinkler system for a 2,829 sq. ft. house.
Contractor: WYATT FIRE PROTECTION INC. Owner: COLUMBIA STATE BANK
9095 SW BURNHAM BY JECK, AL
TIGARD, OR 97223 17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - RES 03/07/2012 $246.45
12% State Surcharge - Building 03/07/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 03/07/2012 $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 03/07/2012 $15.00
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 $295.02
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 2829
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 �y of the rules
or direct questi NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspecti• date.
This permit card shall be kept in a conspicuous place on the job site until c • mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System 45) 7 FOR OFFICE USE ONLY
- illi City of Tigard 0 Da«Y , 1 .�� PermitNo.: FPS )9 )a—
° 13125 SW Hall Blvd., Tigard, OR ' .A
Phone: 503.639.4171 Fax • p� Plan Review I
���� DateB: A��iZ Other Permit: Lay �� _ 4
TIGARD Inspection Line: 503.639.417 y a Y Q t ate Ready f El See Page 2 for _�Q
Internet: www.tigard oi.gov (�V \ G�\ Notified/Method: - / �� Supplemental Information
TYPE OF WO • REQUIRED DATA: I= AND 2- FAMILY DWELLING
New construction on ❑ ther: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ equipment, materials, labor, overhead, and the profit for the
` - CATEGORY OF CONSTRUCTION • _ work indicated on this application.
Valuation: $ ,&, 4 Z
and 2- family dwelling ❑ Commercial/industrial • mot.
❑ Accessory building ❑ Multi- family Number of bedrooms: 4-
❑ Master builder ❑ Other Number of bathrooms: 2 , 5
. JOB SITE INFORMATION AND LOCATION Total number of floors: S
Job site address: 15374— 6141 61 d l/1 - Pk , New dwelling area: 28z9 square feet
City/State/ZIP: 1iC 4f2D , ()/ — 9/ 2_
Garage/carport area: 6;34- square feet
Suite/bldg. /apt. no.: Project name:A ji,j , ,j i . w/61 . 1 . 7 -4s, Covered porch area: square feet
Cross street/directions to job site: Deck area: 1 square feet
Other structure area: square feet
REQUIRED DATA; COMMERCIAL -USE CHECKLIST.'
Subdivision: I Lot no.: '1 p 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.
ViD - /I -' / 7) F!/ SPYL/Nle -� 5YST � Valuation: $
FO 14) II- G•7 09 � Q . F � 10 )c - , Existing building area: square feet
New building area: square feet
❑.,PRO'PERTY OWNER . ❑ TENANT . Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( )
New:
PPL.ICANT ❑CONTACT PERSON NOTICE • . "' .
Business name: et7A/�44... 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'
Business name: Y , 7 5 F` , 1/2 � • (Please refdr •
.514/ 60�it)1� s-r Permit fc
Address: 90 9 5- —
City/State/ZIP: - L <�4Yl og_ 9 7 2.2_3 State surcharge (12% of permit fee):
`7 / / FLS plan review (40% of permit fee):
Phone: (5O3) b84_ _ 2 ZS Fax: ( 3) 664. _ 96,57 (Due upon application.) _
CCB lie.: , 40 '77 4 Total permit fees:
Authorized signature: Ct�� Amount received:
This permit application expires if a permit is not obtained
Print name: �l .� 7 Date: D 2 -Z7 -j z_ w ithin 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits\FPS- PermitApp.doc 03 /23/06 440- 46I3T(I1 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Dcrib work to b don -.
1.) LI New 2.) Modification to sprinkler heads only
Addition 1-10 heads: No plan review required.
r=1 Alteration lifk11+ heads: Plan review required.
Repair
Number of sprinkler heads: 23
Additional description of work:
A.) Commercial Sprinkler r! •
7,=k,
Wet []Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinlder Project Valuation: $
•
.T Su
Hood Project Valuation: •
• I:. -• if'
• - _
Submittal shall Battery Calculations fl Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
I t •
•=2::=
04 itetfcfehtfail:Sioiliiklet (Sta00100:c:SSyste-E1)::
Square Footage: Permit Fee:
0 to 2,000 $187.50 ••• •.•
2,001 to 3,600 $232.50 "o'".r •
3,601 to 7,200 • $292.50 •
7,201 and greater $381.50 • •. ;.; !.;
Sprinlder 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.onus/city_hall/departments/cd/docstFPS-PermitApp.doc 2