Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
.11,1
. • • COMMUNITY DEVELOPMENT Permit#: FPS2013-00110
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2013
Parcel: 2S109DA18900
Jurisdiction: Tigard
Site address: 12687 SW CANYONRIDGE CT
Project: Arlington Heights No.3,Lot 118 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 118
Project Description: Install 13D fire sprinkler system at new 2,678 sq ft residence.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW LLC
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 08/20/2013 $246.45
12%State Surcharge-Building 08/20/2013 $29.57
Type of Use: SF Info Process/Archiving-Lg$2.00(over 08/20/2013 $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 08/20/2013 $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: 2678
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 •f the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permlttee Signature:
Cali Si ,y 7:00 a.m.for the next available inspec n 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.
l3uildin6 Permit Application
y Fire Protection System FOR OFFICE USE ONLY
iih City of Tigard RED!EWED DateBy, 6,6j� / PermitNo.:y �•
- 131_o SW Hall Blvd.,Tigard,OR 97223 Plan Revte ( Other Permit: -�/
Phone: 503.639.4171 Fax: 503.598.196AUG 6 2013 Date/By: /`%r b (q l� 1-i r '5 (3d
TIGARD Inspection Line: 503.639.4175 Date Ready/By: / / Juris: E1 See Page 2 for
Internet: www.tigard-or.gov CITYOFTIGARD Notified/Method: '/143 Supplemental Information
}(� �►[� 6 ate. u !!! Mo,J;S� , .
. ....YPE OF `�ORI� DIVISION v REQUIRED DATA:1 AND 2-FAMILY DWELLING '' .
iew 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.
, nd 2-family dwelling ❑Commercial/industrial Valuation: $ 247-6. °
.a °'
❑Accessory building ❑Multi-family Number of bedrooms: 4
❑Master builder ❑Other: Number of bathrooms: 2,S
-• < . .JOB'SITE'INFORMATION AND LOCATION Total number of floors.
Job site address: 12bg7 .i,( c Gyip /I New dwelling area: 76,7 square feet
City/State/ZIP: -12(14-4...-D, ®/a 9722 Garage/carport area: 6Zs square feet
Suite/bldg./apt.no.: Project name: 1- /a-�75 Covered porch area: ( 4 square feet
Cross street/directions to job site: ��`� Deck area: square feet
•
Other structure area: ....-- - square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST-
Subdivision: Lot no.: 11 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.
PiaAll0 C� S / 5vr/a/i)/� 7 . Valuation: $
At/m/, 'g/ (70 ,p, F --`L3 ��/��— Existing building area: square feet
m/ 5"s7 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: •
' APPLICANT .: ❑ CONTACT PERSON NOTICE
Business name: '') k7Vg— 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 BUI1:DI.NG. ERMIT FEES'*
Business name: 1,s) '1 -� 2 /i2c" Pi '-7 -72t- (Please rejdrtoJdcsc%iedhlel'� '
Address:9r 9.5- 'i.A./ /271)/2/0471-m Permit fee:
City/State/ZIP: C��n 0,_ G9zz State surcharge(12%of permit fee):
/ - FLS plan review(40%of permit fee):
Phone:6V3) 6,E3¢ -ZC/Zda, I Fax:(L,'1)3) -9657 (Due upon application.)
CCB lic.: 1J94D77 Total permit fees:
/ Amount received:
Authorized signature: i /vI/c,�11
This permit application expires if a permit is not obtained
Print name: G- i// ` -7`5!�?-7J Date: -b4. —)--7- within 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 03/23/06 440-4613T(11/o2/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) _New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration -0. 11+ heads: Plan review required.
❑ Repair h
Number of sprinkler heads:2.4
Additional description of work:
Type of System (Complete;A,B; C:or D as.applicable): ':,' F.
A:) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
„:8„) I - Hood Fire SuppressionuSystemi ,
Hood Project Valuation: $
C:)= Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone 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;Pro"tection Pe iri t%Fels '
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/docstFPS-PermitApp.doc 2