Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
li COMMUNITY DEVELOPMENT Permit #: FPS2012 -00098
TI (ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2012
Parcel: 2S109DA17500
Jurisdiction: Tigard
Site address: 15333 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 104 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 104
Project Description: Installation of 13D fire sprinkler system to 2,427 sq ft residence.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES
9095 SW BURNHAM 4230 GALEWOOD ST SUITE 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 07/03/2012 $246.45
12% State Surcharge - Building 07/03/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 07/03/2012 $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 07/03/2012 $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: $0.00
Residential Square Footage: 2427
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 ob ain a cop of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ �! , Permittee Signature:
0
Call .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 R E CV FOR OFFICE USE ONLY •
ry I ' ' j` „ Date/B Y� �&i :T / liv ,Ag_e9 -� )
City of Tigard Permit No.: /
III
- .. 13125 SW Hall Blvd., Tigard OR 972a L 012 Plan te Re w
Phone: 503.639.4171 Fax: 503.598.1x]] dd DaB : ��I �[���` ' her Permit:
TIGARD Inspection Line: 503.639.4175 CITY d+�? 1, „�, Date Ready T:y: Juris: H See Page 2 for
Internet: www.tigard- or.gov � g tl 1 y ® @h?�o ` N No ot ifi ie e d/M ethod: 7 4 1 • Supplemental I.formation
SE ;11 9d G 01 weJik� �.// �L VIIIii. ' // , • . f . ,7 k , , ./ _ -
TYPE OF WORK REQUIRED DATA: Y Au 2-FAMILY . DWELL 4 G -
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
.. CATEGORY OF CONSTRUCTION work indicated on this application.
W-}- and 2-family dwelling Valuation: $ 45C' y g ❑ Commercial/industrial
2./ 6
❑ Accessory building ❑ Multi- family Number of bedrooms: ` Q
❑ Master builder ❑ Other: Number of bathrooms: S o
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: K 3 3 1k1 5 L 1 t��ERV /. 1 ))r�- , New dwelling area: 74- 2 7 square feet
6
/ 1
City/State/ZIP: , to F--Q 9 72 Garage/carport area: 5 Z square feet O
Suite/bldg. /apt. no.: Project name: 4-42 ilea 1 +--r Covered porch area: 67 square feet
Cross street/directions to job site: Deck area: / %, square feet 2 Other structure area: •_- square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: / 0 4- 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.
P/ Vi o M614./ 13b V) P E. SpI-)M !LL . . , Valuation: $
e irJ' A( ) 24- 27 # P7 / D -- ikl Czi✓ ' Existing building area: square fcct
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:
. it-APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: l' C:CW7M-��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* . -
l � 4,..7---/-- p ne . s . , r w (Please ref to fee schedule)'
Business name: �( F ! , /Uf
Address: 9 ) 9 S�• � / { 27 .-T',
Permit fee:
City/State /ZIP: 1761 D tr_ 97 Z 2- j State surcharge (12% of permit fee):
� % FLS plan review (40% of permit fee):
Phone: (D�) 6 G Gam- - 29 Z -f Fax: 6D3 (d 54 - , 5- (Due upon application.)
CCB lie.: 6, 'p 77 s Total permit fees:
Authorized signature: 4Amount received:
This permit application expires if a permit is not obtained
Print name: /2 ,1.. ive /A _ 77 4 ),) Date: a4. --U, _42_ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building 'Permits TPS- PemutApp.doc 03/23/06 440-4613T(I I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
• 1.) g New 2.) • Modification to sprinkler heads only.
0 Addition 0 1-10 heads: No plan review required.
0 Alteration X 11+ heads: Plan review required.
Repair
• Number of sprinkler heads: 16
Additional description of work:
COlifirfe4eiat Sprfoldo,
0 Wet 0 Dry
Additional Standpipes •
Information: Hazard Group
Density •
Design Area
K. Factor - •
Sprinkler Project Valuation: $
rn
Hood Project Valuation: • $
4, t
Y ,
•
. - q; "
Submittal shall Battery Calculations LI Yes
include: Individual Component 0 Yes
Cut Sheets
• Fire Alarm Project Valuation: $
'% • 1:: r::' '
• ;-;
Itegigenta Si* (SatiCriA1ode, Sysfej
Square Footage: Permit Fee:
0 to 2,000 $187.50
-V,
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 "37 technicians.
http://www.citigard.onusicity_hallideparoments/cd/docs/FPS-PermitApp.doc 2