Permit it CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
!II. C : COMMUNITY DEVELOPMENT Permit#: FPS2013-00140
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013•
Parcel: 2S109DA16400
Jurisdiction: Tigard
Site address: 15352 SW OAKMONT PL
Project: Arlington Heights No.3,Lot 83 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 83
Project Description: 13D fire suppression system for a new 3,638 sq.ft.home.
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 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: 3638
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 th- les adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001 ''90. Y . y obtain a copy of the rules
or direct q ions to NC by calling 503.232.1987 or 1.800.332.2344.
Issued Permlttee Signature: ` / I
. AtIlVkiAL—■
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
Received
111 - SW Tigard d ^ 13 DateBy: to q/.3 Permit TPS�l3 Ott Q -
. ° 13125 SW Hall Blvd.,Tigard,OR 9722 P' FD /
Plan Re
Phone: 503.639.4171 Fax: 503.598.1960 C� DateB : ,�,, , r�P OtherPermit:pi ST9'D1 '---VU
TIGARD Inspection Line: 603.639.4176 T/N I Date Read 'e y: Iuris: H See Page 2 for
Internet: www.tigard-or.gov ` t"'h�,,llSl® otifie hod: rQ ! �J j�l Supplemental Information
TYPE OF WOR ,�I A)/ FI/
DATA:REQUIRED DAT 1-AND 2-FAMILY DWELLING
Flew 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.
SZ"-and 2-family dwelling ❑Commercial/industrial Valuation: $ ��
5F
❑Accessory building ❑Multi-family Number of bedrooms: i.--4
❑Master builder ❑Other: Number of bathrooms: '3
JOB SITE INFORMATION AND LOCATION • Total number of floors: ?j
Job site address: r S 3 5-2 C7 .( vy-m ,...a-- 12l New dwelling area: 3(p ,4, square feet
City/State/ZIP: --r a/2 6t 72.23 Garage/carport area: -7 b I square feet
Suite/bldg./apt.no.: Project name: P\rI(y-I 4„r 1-1.e�h4n.Z3 Covered porch area: 3 1<6 square feet
Cross street/directions to job site: ; J Deck area: square feet
.�ee A ( &v� R Oa.�i (`aLC p"rrL&'' ✓I.P t c) Other structure area: square feet
12.-- U a(L vy t a vu--1-- REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: e I Lot no.: p
�yr�j y�cr�(j-� �-�Q / 3 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.
Valuation: $
N No kex o vv.( -re- %irri v\tLIRxS
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 5 \ v y,Z,bri dt Q Q J-'t O vv&R.-S Type of construction:
Address: Li Z 3 d ( -,x La c,„o od (G 0 Occupancy groups:
City/State/ZIP: Let Imo. 0$X 1 a & T-70 3 S Existing:
Phone:( ) V Fax:( )
New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: W (N.A}- , p O+ -t ,,.-1 All contractors and subcontractors are required to be
Contact name: p �� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: cioq s' S ,rr P,'t Dr jurisdiction in which work is being performed.If the
City/State/ZIP: --i-3 d` 02 9? -2_2: applcant is exempt from licensing,the following reasons
Phone:(-)3)&3 1 2/Z Fax: :50) 669 1 (
E-mail: a, pal At ( ) 6, I Cow
!# CON . ACTOR BUILDING PERMIT FEES*
Business name: (Please refertafeeschedule,
SG`AAA. cf.-h a f 1 `� a 1r�5� Permit fee:
Address: I
State surcharge(12%of permit fee):
City/State/Z1P: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.) _
CCB lic.: /_ (i i,7 Total permit fees:
Authorized signature:
14
Amount received:,v,..v.„.„...__
This permit application expires if a permit is not obtained
Print name: G)�1 e,/ P Date: ( �I�' )3 within 180 days after it has been accepted as complete.
I (( * Fee methodology set by Tri-County Building Industry
Service Board.
I:\.Building)Permits\FPS-PermitApp.doc 03/23/06 440-4613T(l1/02/COMIWEB)
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
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( 3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: (i.:;3 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 FEE AND PAYMENT HISTORY
II �4
I I 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
FPS2013-00140 - 15352 SW OAKMONT PL, 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# Pavor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $363.76 p