Permit ' RECEIVED
City of Tigard • COMMUNITY DEVELOPN fa l' DEPARTMENT MAY 14 2020
71 itCITY OF TIGARD
Request for Permit Action BUILDING DIVISION
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • ww v.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner 0 Applicant n Contractor n City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or individual) David Weekley Homes
Mailing Address: 1905 NW 169th Place Suite 102
City/State/Zip: Beaverton
Phone No.: 503-213-4415
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
E T CANCEL/VOID PERMIT APPLICATION.
n REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE attach case fee schedule and provide explanation below).
Permit#: MST2020-00109 j /r- J,,E,
Site Address or Parcel#: 12079 SW Summerbrook— Lane
Project Name:
Subdivision Name: Summerbrook Lot#: 1
EXPLANATION: lease cancel builidng permit applicaiton-new plan to be built on site
Signature: Date: j tL Print Name: el
I Schiedler t
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
,o.f— g.-C.?/i e
Route to Sys Admin: Date By Route to Records: Date / 3 ze By //
Refund Processed: Date ji/l ' By „7 Invoice Processed: Date /jam) By I Al
Permit Canceled: Date qfpa By.le Parcel Tag Added: Date By
I:\Building\forms\RegPcnnitAction_ c
•
V 0
Building Permit Application ! D Y4i
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard APR 01 2020 DateReceBy:ed a 7 42O PennitN ST2 2C - /O7
n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ll ! V
j y Other Perwirid �(�Q
Phone: 503.718.2439 Fax: 503.598.1960•I r�OF� A ry Date/By: L1 i t� o pap- ?/
TIGARD Inspection Line: 503.639.4175 v� U Date ReadyBy:lll �uris. fig] See Page 2 for
Internet: www.tigarcl-or.gov 3UILDING DIVISION Notified Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
®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
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: --S359.999—33yi54 I
ElAccessory building 0 Multi-family Number of bedrooms: _3
❑Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: /1 ��_ 36 L(L1
Job site address:12079 SW Summerbrook Lane New dwelling area: 2477 square feet 07y 77
City/State/ZIP:Tigard/Oft/97223 Garage/carport area: 567 square feet
Suite/bldg./apt.no.: Project name:Summerbrook Covered area: 98 square feet
Cross street/directions to job site:SW 121St Ave and SW Summerbrook Lane Deck area square feet
Otner structure ar 48 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Summerbrook Lot no.:1 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Single Family Home to be built-2477 SQFT 3 Bedroom,2.5 bath with 567 SQ Valuation: $
FT 3 car garage, Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:David Weekley Homes Type of construction:
Address:1905 NW 169th Place Suite 102 Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)213-4415 Fax:( ) New:
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer ro fee schedule)Business name:David Weekley Homes
Structural plan review fee(or deposit): 750 , e1
Contact name:Michele Schiedler
FLS plan review fee(if applicable):
Address:1905 NW 160 Place,Suite 102
City/State/ZIP: Beaverton/OR/97006 Total fees due upon application:
Amount received:
Phone:(503)213-4415 Fax::( )
E-mail:mschicdler@dwhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:David Weekley Homes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:1905 NW 160 Place,Suite 102 Solar Installation Specially Code checklist.
City/State/ZIP: Beaverton/OR/97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:•(503)213-4415 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:213653
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Michele Sc ie er Date:4/2/20 *Fee methodology set by Tti-County Building Industry
Service Board.
L\Building\Pennits\BUP-RESPennitApp.doc 02,24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Cityof Tigard Received
g DateBy: Poona No.:
n 13125 SW Hall Blvd.,Tigard,OR 97223
as Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TiGARD
24-Hour Inspection Line: 503.639.4175 ® Electrical ®Plumbing ® Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
l Land use actions completed. See jurisdiction criteria for concurrent reviews. ►:1 ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ® ❑ ❑
3 Verification of approved plat/lot. ® ❑ ❑
4 Fire district approval required. Name of district: ❑ 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. 0 ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® ❑ 0
9 Erosion control ®plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® 0 ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ® 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
..- 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- - ® - 0 ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ® ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ® ❑ 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ® 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 El
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® 0 ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ® ❑ ❑
architect licensed in Ore_on and shall be shown to be a'ilicable to the iro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ® 0 ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® 0 ❑
25 Building plans shall not contain red lines or tape-ons. `Mirrored"building plans will not be accepted. ® ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ® ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ® ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ® ❑ 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ El
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)
Mechanical Permit Applieati
Permit Nev
•
o '�
City Of Tigard Received
DateiBy: i -r
'a 13125 SW Hall Blvd.,Tigard,OR 97223 �'7-SZLt �U �L�j
Phone: 503.118.2439 Fait: 503.598.1960 APR 01 2020 PlanRevik, r)
DatciBy: a
'`:a ether Permit:
T I GA R D Inspection Line: 503.639.d175 `I Date ReadyBy: Juri5 ?
Internet: www.tigard-or.gov G T`Y OF U Supplemental See menl Informationnr
V 1`,.. Pied Mathad:
BUILDI'�G Dl
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
— Mechanical permit fees*are based on the value of the work
®New construction ❑ Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION j RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12079 SW Summerbrook Lane Furnace 100,000 BTU(ducts vents) 1 46.75
City/State/ZIP:Tigard/OR/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Summerbrook 23.32
Duct work
Cross street/directions to job site:SW 121'Ave and Summerbrook Lane Hydronic hot water system 23.32
Residential boiler(radiator or
hydronie) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc_ 46.75
Flue/vent for any of above 23.32
Subdivision:Summerbrook Lot no.:I Other. 23.32
Other fuel appliances:
Fax map/parcel no.:TBD Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
' Flue vent for water heater or gas
New single family home to be built-2477 sqft,3 bedroom 2.5 bath home with fireplace 23,32
567 sqft 3 car garage
bog lighter(gas) 23.32 -------- -- ----
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY' OWNER ❑ TENANT
Other: 23.32
Environmental exhaust and ventilation:
Name:David Weekley Homes Range hoodlother kitchen
equipment 1 33.39
Address: 1905 NW 169th Place,Suite 102 Clothes dryer exhaust I 33.39
City/State/ZIP:Beaverton/OR/97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:(503)213-4415 Fax:( ) Attic/crawlspace fans 23.32
►�I APPLICANT ® CONTACT PERSON Other: I 23.32
Business name:David Weekley Homes
Fuel piping:
S14.15 for first four;$4.03 for each additional
Contact name:Michele Schiedler Furnace,etc.
Address: 1905 NW 1.69tb Place,Suite 102 Gasheat pump
Wall/suspended/unit heater
City/State/ZIP:Beaverton/OR/97006 Water heater
Phone:(503)213-4415 Fax::( ) Fireplace
Rance
E-mail:mschiedler@dwhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:David Weekley Homes Other:
MECHANICAL PERMIT FEES*
Address:1905 NW 169th Place Suite 102 Subtotal
City/State/ZIP:Beaverton/ORJ97006 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)213-4415 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:213653 TOTAL PERMIT FEE
�% .., This permit application expires if a permit is not obtained within 180
�^ ��,,�JJ days after it has been accepted as complete.
Authorized signature: s Fee methodology set by Tri-County Building Industry Service Board
Print name:Ken Puttman Date: 3/Z,6/2 0
I.tBuildinglPermitslMMEC_PermitApp_040113.doe •40-4617r(1110"'JCOMJWEB)
Mechanical Permit Application - City of Tigard
Page 2 -Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:1Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Applica i V ED FOR OFFICE USE ONLY
AJLCity of Tigard Received Permit#:/yST�c��a '(.�/O f
n 13125 SW Hall Blvd.,Tigard,OR 97223 z) 01 2020 Plan Rev w/
Phone: 503.718.2439 Fax: 503.598.`196 Date/By: Or!
Permit fa:
TIGARD Inspection Line: 503.639.4175 .-l� f) � Ready Dat- y: fl ® See Page 2 for
N Internet: www.tigard-or.gov y,l l la 41J�fOf'��SION Notified/Method: Supplemental Information
TYPE < ® vIV PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000:imps at 150 volts or 0 Floating buildings.
El1-and 2-family dwelling 0 Commercial'industrial 0 Accessory building less to ground,or exceeds 14,000 ❑commercial-Erse agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:68020001 Job site address: 12079 SW Summerbrook Lane lo0HPormore. ❑'°A', E", 1 2",'1-3',
City/State/ZIP:Tigard/OR/97223 0 Six or more residential writs. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Summberbrook 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 121st Ave and Summerbrook Lane FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Summerbrook Lot#: 1 Includes attached garage.
1,000 sq.ft.or less 1 168.54 168.54 4
Tax map/parcel#: 1
Ea.add'l 500 sq.ft.or portion 3 33.92 107.76 1
DESCRIPTION OF WORK Limited energy,residential
New single family home to be build-2477 sqft,3 bedroom 2.5 bath home with
(with above sq.ft.) 75.00
Limited energy,multi-fancily
567 sqft 3 car garage residential(with above sq.ft.) 75A0
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:David Weekley Homes 200 amps or less 100.70 2
Address: 1905 NW 169th Place Suite 102 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Beaverton/OR/97006 601 amps to 1,000 amps 301.04 2 -
Phone:(503)213-4415 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
El APPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:David Weekley Homes above service or feeder fee, 7.42
each branch circuit
Contact name:Michele Schiedler B.Fee for branch circuits without
Address: 1905 NW 169th Place Suite 102 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Beaverton/OR/97006 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)213-4415 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:mschiedler@dwhomes.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:2890 SE Brookwood Ave. panel,alteration,or extension.
City/State/ZIP:Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503-648-4552 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:permits@garnerelectric.com Inspections for whim no fee is
90.00/hr
CCB Lie.:121159 Electrical Lk.:34 05C Suprv.Lie.:3707-S specifically listed(/hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name:Charles Garner 1.„___Date:3/27/2020 0 Plan Review Required(25"i,of permit fee):
,t tIi/fy State surcharge(12%of pennit fee):
Authorized signature: g�� �L� (/ 9GG1.ladf.' TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name:Brittany Burian Date:3/27/2020 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building:Permits\ELC,_Pennit.App ELR_EREdoc Rev 06/17/2015 440-4615T(t1/05/C'OM;W'EB
Electrical Permit Application—City of Tigard
Page 2—Supplemental information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.5E 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.2E 2
® Garage Door Opener* =1A0 kva(fee in accordance
with OAR 918-309-0040) 552.2E 2
® Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ O• ther: Each additional inspection is
charged at an hourly(1 hr min) GG.:S/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page l):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
❑ F• ire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n O• ther:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
L Building Permits\EL.C_PermitApp_ELR_ERE,.doe Rev 06/l7/2015
•
• 'Plumbing Permit Application Building FixturesBEGEIVErl
FOR OFFICE USE ONLY
City of Tigard U 1 20n Received yNl
. pp Permit N
11 13125 SW Hall Blvd.,Tigard,OR 97223�r R Date/By T�G o�j7 Q���
Plan Revte1 n I Phone: 503.718.2439 Fax: 503.59tM t fir..TpG� `t� F pate,%By thcr Penuit No.:
TIGARD Inspection Line: 503.639.4175 AKI (11t'lsi Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 1�1i1LE)I) 1�1 Noti tied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 1 437.78 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 1 25.02 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12079 SW Summerbrook Lane Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard/ORJ97223
Footing drain(no.linear ft.:230) Page 2 87.55
Suite/bldg./apt.no.: I Project name:Summerbrook Manufactured home utilities 50.03
Cross street/directions to job site:SW 121"Ave and SW Summerbrook Lane Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Summerbrook 1 Lot no.: 1 Fixture or item:
Tax map/parcel no.: Backilow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
New Single Family Home 2477 sqft 3 bedroom,2.5 bath with 567 sqft 3 car
Dishwasher 1 25.02 25.02
garage. Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:David Weekley Homes
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1905 NW 169th Place Suite 102
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton,OR 97006 Hose bib 2 25.02 50.04
Phone:(503)213-4415 Fax:( ) Ice maker 1 12.51 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:David Weeklev Homes Medical gas(value:$ ) Page 2
Printer 12.51
Contact name:Michele Schiedler
Roof drain(commercial) 12.51
Address: 1905 NW 169'Place,Suite 102 Sink/basin/lavatory 4 25.02 1.00.08
City/State/ZIP:Beaverton/OR/97006 Solar units(potable water) 62.54
Phone:(503)213-4415 Fax: :( ) Tub/shower/shower pan 2 12.51 25.02
E-mail:mschiedler(ndwhomes.com Urinal 25.02
Water closet 2 25.02 75.06
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Malmedal Plumbing
b Water piping/DWV 56.29
Address:PO Box 207 Other: 25.02
City/State/ZIP: Banks/OR/97106 Subtotal
Phone:(503)324-0759 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:102535 Plumbing Lie.no.:34-276PB
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: VNV,a. Date: O3IZ6IZOZO This permit application expires if a permit is not obtained within ISO days
Carolina Malmedal ",. .,, .�m.„ after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
!.Building Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard '
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- 1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 S1,00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof to
and including$10,000.00.
Inspection of existing plumbing or for S 10,001.00 to$25,000.00 S148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of nonnal business 90.00/hr S25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof to
Reinspection Fees 90.00/hr and including S50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ t Plan review is required for anyof the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Thnt 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3»
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food g'
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
Cs\Users\Malmedal\AppData\Local\Microsoft\Windows\Temporary Intern7tt Files\Content.Outlook\6XKYAOWA\68020001 Plumbing Permit.doc
City of Tigard
w Ilk aCOMMUNITY DEVELOPMENT DEPARTMENTV ri
D
T c nz r Building Permit Review — Residential
Building Permit #: /15 Two a o CO 1 d 9
Site Address: `20-19 5vJ SuYY1rAvx IoYcO - -a l ei
Project Name: 5UY111'Yler\nrODY-- Lot #: l
Planning Review
Proposal: NcV4 !'QUc'e
AVerify address/suite# active in Accela. JIn River Terrace: 3K'No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: ,Erosion Control
11:3-copies of site plan on 8-1/2"x 11"or 11 x 17"paper Kgiftetained trees with drip line and tree protection measures
. ,Drawn to scale(standard architect or engineer scale) ,Tootprint of new structure(including decks)and FFE
,North arrow B'Utility locations&easements(required for new and additions)
›iiSite address,project or subdivision name and lot number ri Sidewalk/driveway approach
ltpplicant information(name and phone number) [1 .cation of wells/septic systems
'Lot dimensions and building setback dimensions Street tree size,type and location
N4Square footage of buildings to be demolished Street names
/Existing structures on site Comer elevations(2'contours if more than 4'differential)
NALot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? To
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? O s Di:No
Nitt- Water Services—Service Provider Lette (lot platted prior to 9/10/1995):
Required: CI Yes,applicant was notified XiNo Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Ill SDC- .aE/ 6-2,2,/9'L applied for: ❑ Yes XI No Received: ❑ Yes ❑ No
Er Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified 0 No Applied For: 0 Yes ❑ No,stop intake
tgi, Land Use Case#: 5V F52zi "D000 \ 1 Zoning: R-4-s
Ti Required Setbacks: Front: 20 Rear: t- Side: Street Side: 15 Garage: 20
/'1 Building Height: Max. Height: �JO Actual Height: \—1
fr.' andscape Area: % littLot Coverage Max:
Entrance .t .Set back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows Minimum 12%of area of all street-facing facades ck i StisCQ Yr\.oe:fS reid►k-ehw•"-1'--
Garage Garage door is behind widest street-facing wall Yes ❑ No,one of the following is met:
i3 ID ends no more than 5'from wall and there is a covered porch extending beyond garage.
J ab/o!extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
Garage door width is ❑ 12'or less ..IEc-50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof cave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance Urban Forestry Plan
It--Sensitive Lands: ❑ Yes No Type:
Conditions met prior to issuance of building permit
INotes:
Et Approved By Planning: -cri Date: -4 (2
Revisions (after Building Submittal on Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: '////
Site Plans: # 3
Building Plans: # 3
Building Permit#: Ef Enter building permit#above.
Workflow Routing: 0—Planning [—Engineering trtnit Coordinator Ilding
Workflow Sign-off: O'Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1)copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Lnilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Zc2r � /o4__- Date: �i'/'7/2-c'�
Engineering Review ¢�
Slope at building pad:
[tJ/onditions "Met"prior to issuance of building permit
®]asements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes GrNo
�/ LIDA Facility on lot: CI Yes En'No
[ Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 4/:4 l2�
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions(after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
�`[�11 SDC Exemption: ❑ Received ❑ Does not apply
.(SDC Fees Entered: Wash Co Trans Dev Tax: gf� Yes ❑ N/A
El Trans SDC: �1 Yes ❑ N/A
Parks SDC: lit Yes ❑ N/A
LIDA ❑ Yes N N/A
0 OK to Issue Permit
Approved by Permit Coordinator: P(+`— Date: 4 O,j2Q
I:1BuildinglFonns\BldgPennitRvw_RES_122419.docx