Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1114
2 • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00150
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S109DA14300
Jurisdiction: Tigard
Site address: 12603 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 62 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 62
Project Description: Provide new 13D fire sprinkler system for new 3,132 sq. ft SF
Contractor: VVYATT 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 09/26/2012 $246.45
12% State Surcharge - Building _ 09/26/2012 $29.57
Type of Use: SF Info Process /Archiving - Lg $2.00 (over 09/26/2012 $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 09/26/2012 $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: 3132
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 copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
_
r
Call 503.639.4175 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 unt' completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
.s "
•
Fire Protection System R FOR OFFICE USE ONLY •
City of Tigard Received 6 /�l1� Permit �i�
SEP 2 ® 2p1ga T m �a -oorSa
13125 SW Hall Blvd., Tigard, OR 97223 _ Da a n R iew
Phone: 503.639.4171 Fax: 503.598.1960 _ I Other Permit: 1 1- OD(7'�
�a z . 6 _ . LIST
TIGARD Inspection Line: 503.639 CIT f t . ° T IG " 1 e ReadyBy: Q , curs' 0 See Page 2 for
• Internet: www.tigard- or.gov DuI i�N0 l)altl „pi ed/Me thod: / e � r 1 'r V Supplemental Information
TYPE OF. WORK = • - REQUIRED DATA: 1- AND.2=FAMILY DWELLING.
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 'CONSTRUCTIONt, , work indicated on this application. • . ,� .,....... 1
l- and 2- family dwelling ❑ Commercial/industrial Valuation: $ Z / g VDU
9
❑ Accessory building ❑ Multi - family Number of bedrooms: L
❑ Master builder ❑ Other: Number of bathrooms: 2.--
c= _ ••. `SIT- Ea 1VFOR111ATION '.AND' . ., - : ,
Total number of floors:
Job site address: /z60 3 K PICV 7 7 V I � c 1 New dwelling area: 1 / / � � square feet
Cit$' /State/ZIP: �i %C.,� 4 Of / < z 2_ / `
Garage/carport area: D square feet
Suite/bldg. /apt. no.: Project name: uk a/4 (- f 6 r $ Covered porch area: 6 5 square feet
Cross street/directions to job site: Deck area: 2ZZ square feet
Other structure area: - square feet
REQUIRED DATA': COMMERCIAL -USE CHECI LIST` -
Subdivision: I Lot no.: (, Z 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
"� O1 K ` work indicated
s • • ..rte '��DE9 CR8TION = � OF _ " � °� ,- _ _ , on this application.
��'/ z e / [w) /3-71 F fiZE 5i(7 /e/ i l a'�l Valuation: $
, C I - i� � ' - ' I J I f � ' 1� r � N � Existing building area: square feet
7 ?5 i D -e4 C-.> . New building area: square feet
®' PROPERTY ,, ' i ❑: TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone: ( ) Fax: ( • )
New:
r: p'PPL:ICANT,.. • a CONTACT PERSON;; : ;,� - 't . -
-., `/— - .. _ __ .,...._ � NOTICE -�` - r
Business name: - tom' �Z ro,- 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: ( ) I Fax:: ( )
E -mail:
. i . , ,i--f, - .. - CON.TRa1CTOR •. ;? ' ' BUILDING:PERMI.T ' FEES w ;.:1
B
I/ v f ! � � / 1 - Le ' D' ` - '} (p1ebse rejaufd jce:'sc /iedrde,' q _
Business name:
Address: c q - � frt / 23v 9/419"7 -i Permit fee:
� State surcharge (12% of permit fee):
City /State/ZIP: -! <G Z,40 OX,
/ FLS plan review (40% of permit fee):
Phone: c,503 3 d,04 -Z9 _ Fax: (503) 6S4 —96 57 (Due upon application) 6'9- CCB lic.: �o4p 7 7 Total permit fees: C ,
Authorized signature: /� Amount received:
.�/� ' This permit application expires if a permit is not obtained
Print name: G' ,oi- p/-4 -,J Date:o9 - Zp -(Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
is 1 Building \Permits\FPS- PermiLApp.doc 03/23/06 440- 4613T(1 I /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
- Describe work - be done: _ • ,
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 - heads: No plan review required.
❑ Alteration 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: Zs
Additional description of work:
_Type of System (Complete. A, B, C or D as ,applicable),: :;••• •
• A-.Y Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K Factor
Sprinkler Project Valuation: $
B:); ,Type :I - Hood Fire. Suppression. System - :. -
Hood Project Valuation: I $
C.), Fire Alarm •
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
•
Resid'ential;Sprinkler (. t rid Al n '
S. a o e System •
Square 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 Protection'., Permit 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.ci.tigard.or.us /city_ hall/ departments /cd /docs /FPS - PermitApp.doc 2