Permit � p CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2013-00141
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S 110C B 10000
Jurisdiction: Tigard
Site address: 15376 SW ARLINGTON TER
Project: Arlington Heights No.3,Lot 88 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 88
Project Description: 13D fire suppression system for a new 3,848 sq.ft.home.
Contractor: WYATT FIRE PROTECTION INC. Owner: STONE BRIDGE HOMES NW LLC
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 10/15/2013 $310.05
12%State Surcharge-Building 10/15/2013 $37.21
Type of Use: SF Info Process/Archiving-Lg$2.00(over 10/15/2013 $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 10/15/2013 $12.50
Stories: 3 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 $363.76
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 3848
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 Notifica • enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1090. You ay y tain a copy of the rules
or direct a•-stions to •• C by calling 503.232.1987 or 1.800.332.2344.
Issued :y: , /, •, L i. Permittee Signature:
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 FOR OFFICE USE ONLY •
City of Tigard `1Q�3 DateBea �� ;�, PermitNo.: —+ 40 _ di
" 13125 SW Hall Blvd.,Tigard,OR
11111
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 603.698.1961 � �00� Plan Review
: �S�%Kama
a M T�, r /5
TIGARD Inspection Line: 503.639.4175 `C, Date Ready/By: r 2 Juris: El See Page 2 for
Internet: www.tigard-or.gov ®� �� Notified/Method:�o/J / 7 Supplemental Information
TYPE OF WC _ REQUIRED DATA:1-AND 2-FAMILY DWELLING
..B New 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.
iz -and 2-family dwelling ❑Commercial/industrial Valuation: $ 3 y 3 l�
1
❑Accessory building 111 Multi-family Number of bedrooms:
5
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: l 5-37 6 514) 4v (i v ivy? /-C( ( New dwelling area: %946 square feet
City/State/ZIP: O 9 7 ZZ 3 Garage/carport area: 94 0 square feet
/
Suite/bldg./apt.no.: Project name:flo I^ r N-ei ` 8% Covered porch area: '(pS— square feet
Cross street/directions to job site: Arks) 0 • . l Deck area: c oueredL square feet fif
b._ ha ♦O 1- : •L k G O tht',• ,, ;IA Other structure area: square feet
-e/t/r \ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ;� Q�'''1 n q�tvn 4-4 .l -, I Lot no.: S Permit fees*are based on the value of the work performed.
Tax map/parcel no.: J 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.
x V nu.) k Q , 0/ c, S Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: ._ y e b
■f ft O Vl�"5 Type of construction:
Address:L12 3 U Ski -C woo /6-0 Occupancy groups:
City/State/ZIP: / I! e 05 0 '70 3 Existing:
Phone:( ) Fax:( ) New:
I;YAPPLICANT ' (� ❑ CONTACT PERSON NOTICE
Business name: i tJ a a-j- '�y.� tt ro' _C. h o� All contractors and subcontractors are required to be '
Contact name: Pau (Az licensed with the Oregon Construction Contractors Board
``-��'' `` under ORS 701 and may be required to be licensed in the
Address: 1409 r r.ha.kni Dr-. jurisdiction in which work is being performed.If the
Phone:ate/ZIP:M ot 0 f.�722-5 applicant is exempt from licensing,the following reasons
( apply:
Phone:( ) Fax: :( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Sa„„ p �� 1\ pplicci,4
(Please refer tojee'schedule`'�• Permit fee:
Address: -- -
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lie.: 1n Total permit fees:
Authorized signature:, C Amount received:
1— This permit application expires if a permit is not obtained
Print name: As h vIeAJ) ,RI , Date: t0/7/ i 3 within 180 days after it has been accepted as complete.
__JJ * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\PermitslFPS-PetmitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) .0 New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) 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: $
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: 3()Ltb 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
CITY OF TIGARD
IIIFEE AND PAYMENT HISTORY
Q
g 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
FPS2013-00141 - 15376 SW ARLINGTON TER, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-RES 230-0000-43104 $310.05 $310.05 $310.05
12%State Surcharge-Building 100-0000-24001 $37.21 $37.21 $37.21
Info Process/Archiving-Lg$2.00(over 230-0000-43135 $4.00 $4.00 $4.00
11x17)
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $12.50 $12.50 $12.50
11x17)
Totals for Fees $363.76 $363.76 $0.00 $363.76
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $363.76