Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01 /2012
Parcel: 2S109DA18800
Jurisdiction: Tigard
Site address: 12706 SW WILLOW POINT LN
Project: Arlington Heights No. 3, Lot 117 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 117
Project Description: New 13D residential fire suppression system for a 2,725 sq. ft. home.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES
9095 SW BURNHAM 4230 GALEWOOD ST, STE 100
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 05/01/2012 $246.45
12% State Surcharge - Building 05/01/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 05/01/2012 $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 05/01/2012 $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: $2,685.00
. Residential Square Footage: 2725 •
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 ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ! !cation Cente Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di ct questions to OUN .y calling 503.232.1987 or 1.800.332.2344.
Is ued B Y: k . Ii t
. / I Permittee Signatu e: q q
J --
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 , � � i FOR OFFICE USE ONLY
i(,\ ''1
City of Tigard � ^Orl Date/B : Received Pin Review Permit No.: '],� ]� ��
° 13126 SW Hall Blvd., Tiga 72 3 1. vf. i to
OU J
,
• - Phone: 5 03.639.4171 Fax \- J`398.1� 11 ® DateB 4 � Other Permit: 4 •�- -i`� a. a -v . �, 51
Inspection Line: 503.639.4170 pQ ���
TIGARD Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov r `it� •��� ��
No..ed/A4ethod: Supplemental Information MOW-
TI:PE OF . ' t, i. REQUIRED DATA :.I =.AND 2 4 . .-F AM ILY DWELL'ING "
I KNew construction 10 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.
- "
, - . CAT >;GORY; - . : . .. PP
J and 2-family dwelling Valuation: $ 2 &.6 -
y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms: 49-
0 Master builder ❑ Oth Number of bathrooms: 2, ' -
:-- -.. JOB :..:. •.. "_...�'
Total number of floors: •
SITE INFOR114A JO .. - AN 2.
Job site address: / 2.7 61,d �l , po i � 6 New dwelling area: 2-72. square feet •
-1
City/ State/ZIP: / Die 9 2 r / Garage/carport area: 734_ square feet
Suite/bldg. /apt. no.: Project name: ra b/'/-)--73 Covered porch area: 14 square feet
Cross street/directions to job site: Deck area: '74-() square feet
Other structure area: square feet
REQUIRED pA"TA COMMERCIAL :4ln CHECIOS'];'
Subdivision: I Lot no.: /17 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 v 'J /D� Af ele/ /_,3D Fi 1 S pl- u - Y ' 6 , Valuation: $
a i" � �E JEW 's /M / /�lCU , � � . /`- Existing building area: square feet
New building area: square feet
❑;. PROPE12TY. OWNER , 0 ❑ TENANT" ' . . Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: •
Phone: ( ) Fax: ( - )
New:
• r. ,...'': . , • PPLICAN,T ❑ ; CONTACT PERSON '
��77 /j 7 5/ L c ,NQ27C a e e � it d , b ...';
Business name: 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
applicant is exempt from licensing, the following reasons
City/ State/ZIP: apply:
Phone: ( ) • Fax:: ( )
E -mail:
CON., ':: . t - ' .. : v .
,
_ • ... �. ,, ... TRACTOR: _ _ :1...: • . � �,'BUIL DING.P , �' ''
i � ' � '�• ' . � • I - . (Please rej dr � l'b fcesc7iedide1 � �: -`' -
Business name: /A/ r 4-7 7 / /`3 ) , �ic�77 ,/J .. ES .: -"
091 j 3k/ 2 j 'Mi n s Permit fee:
Address: 9
City/ State/ZIP: � 6 4in � P/ e9 7 z 3 State surchar (12% of p ermit fee): —
FLS plan review (40% of permit fee):
Phone: (! . 6,T, - 2._z S Fax: (50) 664- -9E,57 (Due upon application.)
CCB lie.: 6.4 071 Total permit fees:
Authorized signature:
7 Amount received: '
This permit application expires if a permit is not obtained
Print name: `/ /�4 , _ 94/ J Date: 04 -20 -i Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
r:\ Building \Permits\FPS- PemtiLApp "doc 0323/06 4404613T(I1/02/COM/WEB)
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
,P 4c,t
1.) New 2.) Modification to sprinkler heads only
El Addition 0 1-10 heads: No plan review required.
0 Alteration figt11+ heads: Plan review required.
[CI Repair
Number of sprinkler heads:2
Additional description of work:
T061Syetkii (CM4106
A.) ;: " - :T. A:: •
'Commercial Sprinkler, : • r .
Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
13.) Type I Hood 'Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
_
43.) 4esidetitiOSpritikler (Stand Atone SS7stori).
- .
S 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 ProtectionPermit 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.citigard.onusicity_hall/departments/cd/docs/FPS-PermitApp.doc 2