Permit (10) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114
' COMMUNITY DEVELOPMENT Permit#: FPS2016 00156
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2016
T[t�'a g Parcel: 2S103BD11800
Jurisdiction: Tigard
Site address: 12610 SW 121ST AVE
Project: Nix Subdivision: 2008-056 PARTITION PLAT Lot: 2
Project Description: Stand alone fire sprinkler system per NFPA 13D
Contractor: JET FIRE PROTECTION LLC Owner: NIX, DAVID C
1935 SILVERTON RD NE NIX, JULIA A
SALEM, OR 97301 12630 SW 121ST AVE
TIGARD, OR 97223
PHONE: 503-588-5262 PHONE: 503-314-0798
FAX: 503-364-2204
FEES
Description Date Amount
Specifics: Permit Fee-RES 09/21/2016 $310.05
12%State Surcharge-Building 09/21/2016 $37.21
Type of Use: SF Info Process/Archiving-Lg$2.00(over 09/21/2016 $4.00
Class of Work: ALT Type of Const: VB 11x17)
Occupancy Grp: R-3 Height: 24 ft Info Process/Archiving-Sm$0.50(up to 09/21/2016 $10.00
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 $361.26
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $6,225.00
Residential Square Footage: 3826
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 a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next availab = ' pection 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 LSE ONLY
City of Tigard Received
Date/By: 9 /a,/40. c' Permit No.: ,5(90/6 -tom/S
II II 13125 SW Hall Blvd.,Tigard,OR S't33 Plan Review
C Phone: 503.718.2439 Fax: 503 598.1960 Date/By: 9 ~,Q` ) 6 -i-j- Other Permit:/1/4../ -1-c90/6,--610:Vi<0
Inspection Line: 503.639.4175 NDoattefiRed MeadyeBhyo:d: 9,7,,,,9,7,,,,,,,,,,e,TGARD "'"°6-1.- Jus: SupSpleemga2l fIonrf
ormationInternet. www.tigard-or.gov
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iti
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®New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
e 1. w: work indicated on this application.
a, w
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $6225
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
f `•. , , ;, : t xN,_.rt,°`A, ,, t e , : t k Total number of floors:
Job site address:12610 SW 1215`Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97233 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Nix Residence Covered porch area: square feet
Cross street/directions to job site:South of SW Walnut Deck area: square feet
Other structure area: square feet
•G eJ 1 I a t �1 1 t) '1 ' ,
Subdivision: I Lot no.: 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
.• ` : f work indicated on this application.:x ' ,•'•;.t,
1wi A
Stand Alone Sprinkler System per NFPA 13D Valuation: $
Existing building area: square feet
New building area: square feet
mit t. i-, Number of stories:
Name:Dave Nix Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:(503)522-2500 Fax:
( )
New:
•
Business name:Jet Fire Protection All contractors and subcontractors are required to be
Contact name:Rich Rohr licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:See Contractor jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
.� Phone:(S03) 3t 3 _2_3 3,5(- I Fax::( )
E-mail:rich.r@jetindustries.net
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Business name:Jet Fire Protection
Permit fee:
Address:1935 Silverton Rd.NE
City/State/ZIP:Salem,OR 97301
State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)588-5262 Fax:(503)364-2204 (Due upon application submittal.)
CCB lic.:_62 %(Q A.2, -- Total permit fees:
Authorized signature: Amount received:
�/ This permitapplication expires if a permit is not obtained
Print name:Richard Rohr Date:8-30-16 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_031016.doc 440-46 1 3T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
® New system Number of sprinkler heads: Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
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INEEMZINEINIMININ ❑ Wet ❑ D
Additional Standi.es
Information: IMEEZEIEMIMIE ❑ Yes ❑ No
Hazard Grou.
Densi
Desi Area
K. Factor
5. • • o•-ctValu• '. ,• $
'.�" n R,:a ✓r a "� -Ss x , + `7k 3� x �,`% s 4,1*tK ?'
Hood Pro Sect Valuation: $
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Submittal shall Batte Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Pro•ect Valuation: $
” �' - �*:x tt✓ Yy 'r�w � �T , v ' &
�vettoa # � ;
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S.uare Footate: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 .4y -„7,4
7,201 and I eater $404.39
Sprinkler Project Square Footage: 3014 sq. ft.
•N. i.,,';
Pro'ect valuation subtotal see A,B &C above : $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s.uare footase see D above : $ 246.45
State Surcharte 12%of sermit fee : $ 29.57
FLS Plan Review 40% of sermit fee : $ 98.58
TOTAL: $ 374.60
C:\Users\rich.r\Downloads\FPS_PermitApp.doc 2
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12610 SW 121 STAVE, TIGARD, OR, 97223
Record Type:
Residential - Fire Protection System
Inspection Type:
999 Sprinkler final
Result:
FA I L
Comments:
Provide approved Backflow test report.
Alarm wires not connected at this time.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
January 24, 2017 at 3:30:11
PM
Record ID:
FPS2016-00156
Inspector:
David Young
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12610 SW 121 STAVE, TIGARD, OR, 97223
Record Type:
Residential - Fire Protection System
Inspection Type:
999 Sprinkler final
Result:
PASS- NoCofO
Comments:
Tel: 503.718.2439
Inspection Date:
Record ID:
FPS2016-00156
Inspector:
David Young
1.5" Apollo model # DCLF4A serial# 771277 located in garage.
Violation Summary:
Inspector Contractor