Permit CITY OF TIGARD MASTER PERMIT
' 1 s •'y COMMUNITY DEVELOPMENT Permit#: MST2023-00354
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2023
Parcel: 2S108DC30800
Jurisdiction: Tigard
Site address: 15670 SW EVERGLADE AVE
Subdivision: CROSSING AT BULL MOUNTAIN Lot: 163
Project: River Terrace Crossing, Lot 163
Project Description: New detached dwelling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1901 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 970 sf Garage: 807 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2871 sf Value: $547,730.55 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains; 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bcktlw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2871
Owner: Contractor:
STONE BRIDGE HOMES NW LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD ST STE 100 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 2 Geo Tech Required
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $28,454.66
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
O69-r O1_nn1n thrnnnh fIAR Oc9-nn1-anon Von mar nhtain rnnv n n,lce nr rlirn't nunetinne to fit INC kw nallinn F01 919 10A7 nr 1 A
Issued By Permittee Signature: IklIA
3.639.4175 by 7:00 a.m.for the next available inspectio
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 lob site at the time of each inspection.
Building Permit Application
Residential E 6 FOR OFFICE USE ONLY
`J P DaleiBr 1' VW I'W11 . C3Y 1.411 1 W V W �
City of Tigard
163 `J Permit No.:
N Phone SW Hall Blvd.,Tigard,OR 97223
8.19 JUL 2 0 2023 Plan Review nn'1 �/� ^�
Phone: 503.718.2439 Fax: 503.598.1960 DaleiBy: 4 Other Permit: 4SIM{C.W UU1)
T I GA RD Inspection Line: 503.639.4175 TV�1 Date Ready,By: F� tuns_ ® See Page 2 f
Internet: www.tigardor.gov CITY I OF Tl `45'11� Notitied,'Method: V �a(,3 Supplemental Information
KW DING DIVISIQ Epie.-1 r.1 is OqHA'
TYPE OF WORK REQUIRED DATA: I-AND 2-FAMILY DWELLING
E 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,andtf the profit for the�5
CATEGORY OF CONSTRUCTION work indicated on this application. /5i 7 f 7
t / 6 e
Valuation: $
X❑ I-and 2-family dwelling 0 Commercial/industrial
❑Accessory building El Multi-familyNumber of bedrooms: 4
ElMaster builder ❑Other: Number of bathrooms:3 �J(,
JOB SITE INFORMATION AND LOCATION Total number of floors:2 �, „-7
Job site address: 15670 SW Everglade Ave. New dwelling area:2,871 square`feet 19 b
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 807 square feet 9\70
Suite/bldg./apt.no.: Project name: River Terrace Crossing Front Covered porch 0-ea:69 square feet I
Cross street/directions to job site: atio bYw� 19 -7✓4 square feet
Other strVui j a: \ CIL.lt square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: River Terrace Crossing Lot no.: 163 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
work indicated on this application.
New, single family residence Valuation: $
Would like to request SCD deferral Existing building area: square feet
New building area: square feet
ID PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes NW, LLC Type of construction:
Address: 423-Galewood St. Suite#100 Occupancy groups:
City/State/ZIP: Lake Oswego, OR 97035 Existing:
Phone:(503)387-7577 Fax:( ) New:
E APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: Stone Bridge Homes NW, LLC (Please refer mfeeschedule)
Structural plan review fee(or deposit):
Contact name: Permit Tech FLS plan review fee(if applicable):
Address: 4230 Galewood St. Suite#100
Total fees due upon application:
City/State/ZIP: Lake Oswego, OR 97035
Amount received:
Phone:( 503) 387-7577 Fax: :( )
E-mail: portlandpermits@stonebridgehomesnw.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name: Stone Bridge Homes NW, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4230 Galewood St. Suite#100 Solar Installation Specialty Code checklist.
City/State/ZIP: Lake Oswego, OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)387-7577 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB tic.: 173318 Total fee due upon application: $201.60
Authorized signature: . / This permit application expires if a permit is not obtained
l<CC���C �`"` within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: Tiana Rudolf Date: 7 26 2023 Service Board.
C\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1i02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
C. Hagard IAssoct Permit No.:
Mil■ 13125 SW Hall Blvd.,Ti ard,OR 97223 Received
g Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
TIGARD Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \es No \/.•
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 ❑
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: ❑ 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 ❑ 0
6 Sewer permit. 0 0 ❑
7 Water district approval. _ 0 0 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, x❑ ❑ ❑
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- El 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. ❑X 0 0
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 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 X❑ 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ 0
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 0 ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. i 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑x ❑ 0
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 ❑X 0 0
architect licensed in Ore•on and shall he shown to be applicable to the .ro'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 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ D 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
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, ❑ 0 0
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.
F\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-461 3T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE SSE O\I.I
-,-.,....
Cl of Tl and 1 xT r ReceivedCIIII
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 L I i nrl3 Dateigy: Other Permit
Inspection Line: 503.639.4175
TIt ARF) L.ai. Date Ready/By: Iris: ® See Page 2 for
Internet: www.tigard-or.gov Notified.'Method: Supplemental Information
TYPE OF WORIrC
t t-1 ,„.,v 1u"..r. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
X❑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:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑X 1-and 2-family dwelling D Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family D Master builder ❑Other: Description Qty. Ea. Total
JOB S11E INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 15670 SW Everglade Ave. (requires site plan showing placement) 1 46.75
Furnace 100,000 BTU(ducts'vents) 1 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: River Terrace Crossing Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Subdivision: Flue/vent for any of above 1 23.32
River Terrace Crossing Lot no.:163 Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 1 23.32
New, single familyresidence Gas fireplace 1 33.39
g Flue vent for water heater or gas 2
fireplace 23.32
Log 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
Name: Stone Bridge Homes NW, LLC Environmental exhaust and ventilation:
Address: 4230 Galewood St. Suite#100 Range hood/other kitchen 1 .
equipment 33.39
City/State/ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust 1 33.39
Single-duct exhaust(bathrooms, 6
Phone:( 503)387-7577 Fax:( ) toilet compartments,utility rooms) 23.32
IXI APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
• Other: 23.32
Business name: Stone Bridge Homes NW, LLC Fuel piping:
t rn
g:
Contact name: Permit Tech $14.15 for first four;$4.03 for each additional
Address: 4230 Galewood St. Suite#100 Furnace,etc. 1
Gas heat pump
City/State/ZIP: Lake Oswego, OR 97035 . Wall/suspended/unit heater
Phone:( 503) 387-7577
Fax::( ) Water heater 1
Fireplace 1
E-mail: portlandpermits@stonebridgehomesnw.com Range 1
CONTRACTOR Barbecue
Business name: Comfort Zone Clothes dryer(gas)
Other:
Address: 1032 NW Corportate Dr. MECHANICAL PERMIT.FEES*
City/State/ZIP: Troutdale, OR 97060 subtotal
Minimum permit fee(S90.00)
Phone:( 503)667-5595 Fax:( ) Plan review(25%of permit fee)
CCB lic.: 110091 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
Authorized signature: i,'., days after it has been accepted as complete.
Print name: David Heldstab Date: 7-26-2023 ` Fee methodology set by Tri-County Building Industry Service Board
I:A Building`.Permits'MEC-PermitApp.doc 09/09/10 440-4617T(11/02/COM/WEB)
Electrical Permit Application rry a r + FOR OFFICE USE ONLY
Received Permit t* [,{�1A,'`^ ��\f11�1yt
- City of Tigard I EI2 ,Li Date;By r VttV� JV +v 1
L,.
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 R r ., , Date/By: Related Permit 4:
Inspection Line: 503.639.4175 (' Ready Date/By: furs: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov '.Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑X New construction ❑Addition/alteration/replacement Please check all that apply(submit2 sets of plans w items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Tess to ground,or exceeds 14,000 0 Commercial-use agricultural
X❑ I-and 2-familydwelling ❑Commercial/industrial El Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑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#: 3276 Job site address:15670 SW Everglade Ave. 100HP or more. ❑'A","E".`1-z",`l-3",
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard, OR 97224 ❑Health-care facilities. ❑Recreational vehicle parks.
0 Supply voltage for more than
Suite/bldg./apt.#: Project name: River Terrace Crossing ❑Hazardous locations. 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace Crossing Lot#:163 Includes attached garage.
1,000 sq.ft.or less 2 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 2 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
New, single familyresidence (with above sq.ft.)
9 Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Stone Bridge Homes NW, LLC 200 amps or less 100.70 2
Address: 4230 Galewood St. Suite#100 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Lake Oswego, OR 97035 601 amps to 1,000 amps 301.04 2
Phone:( 503) 387-7577 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: portlandpermits@stonebridgehomesnw.com 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
Branch circuits—new,alteration,or extension,per panel
El APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: Stone Bridge Homes NW, LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Permit Tech B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 4230 Galewood St. Suite#100 branch circuit
City/State/ZIP: Lake Oswego, OR 97035 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)387-7577 Fax: : ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: portlandpermits@stonebridgehomesnw.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: 2920 SE Brookwood Ave. Suite A panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Hillsboro, OR 97123 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: chelsea@garnerelectric.com Inspections for which no fee is
90.00/hr
CCB Lie.: 2322591 Electrical Lie.:34-305C Suprv.Lie.:
specifically listed(Y hr min)
���� ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: C?i.aideo, �Gl LrLPIG Subtotal:
Print name: Charles Garner Date: 7-26-2023 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
�// j TOTAL PERMIT FEE:
Authorized signature: ./ri me. - /,�
This permit application expires if a permit is not obtained within MO
Print name: Tiana Rudolf Date: 7-26-2023 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits.ELC_PermrtApp_ELR_ERE.doc Rev 06/17'2015 440-4615T(l l/051COMIWEB
. Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
DeuriPtion LQty. I Each Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 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 552.26 2
x❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
E. Vacuum Systems* >100 kva-no additional charge 0.0 i 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr l
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(14 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
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
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:ABoiLding'PermitsAELC_PermitApp_ELR_ERE.doc Rev 06/1712015
•
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
�, rjj hhheee ,I�1
City of Tigard JUL [ti.t DateBed Permit No.. 1y1�'111 jtA, 'ooi
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: `', 1 vv v
Phone: 503.718.2439 Fax: 503.598.[960 Plan Review Date/By: Other Permit No.:
Inspection Line: 503.639.4175 . Date Read i6 buns: ® See Page 2 for
TIGARD Ready illy: ft
Internet: www.tigard-or.gov Notified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
O Accessory building 0 Multi-family -
Each additional bath/kitchen 25.02
❑Master builder 0 Other. Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15670 SW Everglade Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: River Terrace Crossing Manufactured home utilities 50.03
Cross street/directions to job site: 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: River Terrace Crossing Lot no.: 163 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New, single family residence Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Stone Bridge Homes NW, LLC
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood St. Suite#100 Garbage disposal 1 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 2 25.02
Phone:( 503)387-7577 Fax:( ) Ice maker 12.51
RI APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Stone Bridge Homes NW, LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Permit Tech
Roof drain(commercial) 12.51
Address: 4230 Galewood St. Suite#100 Sink/basin/lavatory 6 25.02
City/State/ZIP: Lake Oswego, OR 97035 Solar units(potable water) 62.54
Phone:(503 )387-7577 Fax: :( ) Tub/shower/shower pan 4 12.51
E-mail: portlandpermits@stonebridgehomesnw.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR Water heater 1 37.52
Business name: Edward Mullen Plumbing Water piping/DWV 56.29
Address: S. E. River Road Other: 25.02
City/State/ZIP: Hillsboro, OR 97113 Subtotal
Phone:( 503) 640-0113 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:92689 1 ° Plumbing Lic.no.: 34-260PB State surcharge(12%of permit fee)
Authorized signature:` t TOTAL PERMIT FEE
Jeremy Crace 7-26-2023 Thu permit application expires if a permit is not obtained within 180 days
Print name: Date:
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0'O2ICOM/WEB)
City of Tigard
:/ . " COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
QA Q tia�
Building Permit #: Mil`•Ati��y "�03s I
Site Address: i (0�-d SLAI OV020LACCU Verified in Accela
Project Name: 9.1VhQ.- Tr i C_ - if�yb Lot/Unit #: 102
�c,
Proposal: tv O SIB QurficAeD Z Zone: P•eQ'`Q
Housing Type: ❑ SFR(El Single Detached ❑ Duplex❑Triplex El ADU) ❑ Rowhouse ❑Cottage Cluster❑CYU ❑Quad D Other
Required Site Plan Elements: gry( 10,1,1 3 I : 54 1.f I-e h„,e4e (' +. 5,,,}ei . R(,.cof oa 5fvr4j- 'r.
/" 3 copies of site plan on max 11x17"
re prawn to standard scale .
Lg North arrow Street and site trees shown / labeled
IE' ite address, project name, lot # n Ta-big cal^�•i=tip op at mat •
fv' treet names (N/Af r SFR)
Applicant name and phone # )
ot and setback dimensions ^ "'sion clew t--'---'
ctitility locations &easements
VFootprint of new structure and FFE H Property corner elevations
PI/Sidewalk/driveway dimensioned R<LIDA (>1,000 sf disturbance)
Er/Lot area and lot coverage percentage VErosion control
Re uired Elevation Plan Elements:
(For : caics needed only on street-facing) Summary table with calculat' rae fur"
gDra standard scale ❑ Total facade ar
❑ Building hei dimensioned 0 Total ' ow and door area
❑ Facade dimension
❑ Windows and doors dim ' ned
❑ Garage doors dimensioned
Required Floor Plan E ents:
(Not required for El Summ table that includes
❑ Each y dimensioned 0 Total floor a
ch story floor area calculated ❑ Floor area per stor
Planning Review
The following/standards have been met:
p
Setbacks Front: evfg/I e oar: 10 Side: ' Min/Max Street Side: Q/ / Garage:
�J
Height a Max. Height: 3� Proposed Height: 2—: I.
❑ Y- . ., A Landscape
❑ A, d. . N/A Screening (Quad only)
w'A F. N/A 0/0Window Coverage
■ Y �/ Garage (SFR Only) Parking (Other Res)
, Entrance (SFR, Rowhouse, Quad only)
El Yes �y
• des Other building design standards (Rowhouse only)
❑ Yes 5+''� A Accessory Structure Standards
CI Yes o Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additicnal standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
El Yes 0 N/A Unit Count:
O Yes d N/A Lot Width and Size
❑ Yes IL N/A Pathway
Additi nal standards for Courtyard Units and Cottage Clusters only:
❑ Yes N/A Unit Area:
❑ Yes N/A Floor Area (per story)
O Yes N/A Courtyard
O Yes N/A Fence
❑ Yes ❑ No /A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ NoA Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ N/o estop intake
OpP151irrt:C"and
ve Lands: ❑ Yes .0'No
Use Case #s: -OLCCDS ❑ Conditions m t
plicant notified of land use expiration IrS A?' /a? frxa (Xs- Dy �/`1,=,
Approved By Planning: 6ate: 1-/26/e
Notes _
Revision 1: $Approved ❑ Not Approved .A Date: grill)(,)-?
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: #1:La3
Site Plans #:
Building Plans #:
Building Permit #: H'Building permit # entered on page 1
Workflow Routing: 'fanning {ngineering 4'ermit Coordinator 9' uilding
Workflow Sign-off: VS ign-off for Planning (include notes from planning review)
Route Documents: ingineering: (1) copy of permit application, (1) site plan, (1) building plan
an9i original plan review routing form.
Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.•
?
Permit Technician: Vt./11 ✓ Date: 11Ii{P '1AZJ
Notes:
Engineering Review
❑ PFI Permit:
t,glope at building pad: 30 %
!v�t-Conditions met prior to issuance of permit
f9'Easements (encroachments) per engineering conditions of approval and plat
l8'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes -No
Assess Water Quantity Fee in-lieu: ❑ Yes WNo
LIDA Facility on lot: ❑ Yes a-No Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
O NOT Approved: Date:
Notes:
Approved By Engineering:
p � _ Date: r,....,
Revision 1: A proved ❑ Not roved Date: ,.3
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
e kL n:DC Exemption: 0 Applied for ❑ Received l�uoes not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes ❑ N/A tJ Deferred— i
.
Parks SDC: Yes 0 N/A Deferred ♦ ,t,, / �
LIDA ❑ Yes �N/A ( 1
OK to Issue/Approved by Permit Coordinator: Date: 'C " ft (i7-3
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
'-' e �c�G-k..
c
2. 5
lll IIII
A GEOTECHNICAL
e REPORT IS REQUIRED Building Division
Ti GARD >; BEFORE THE FOOTING • e & Two-Family Dwelling
INSPECTION CTION IS APPROVED Fees Checklist
."•Y 7^l'''' Est:..:IV &'t+E`:'1'4r ragi ari.
PERMIT INFORMATION: Application Date - FEE VERSION J 1 L Z22
Permit #: S WSJ bU I Plan #: `7.-5
I Floors:
Valuation: � � • S�� ' Covered Porch: i „Q Basement
Bedrooms: 1 ' 1 Deck: 1 1 Y 1"Floor ! er b /
WC (toilets) 3 Deck Cover: 11 S 2'd Floor q-1 lD
Lavatories t L Patio Cover 3'd Floor [L`_1
Tub/shower �ll / Accessory Struct. R-3 Total Zca-7 I
Laundry Tray �_ . Water Heater l /�Ua Elec Garage O 6-7
Exhaust Vents l2 Gas Flue Vents Total for Elec.
�`C�f 11 U
p
Backflow Prey. �� Heat Pump / # for Electrical Le
BBQ ,-- Gas Fireplace 1,0---- #Fuel Lines
FEES: Description: Fee Apples: Fee Entered:
DC Prov Revw: Planning ✓J
Info Proc/Arch: Lg$2.00 (over 11x17) 1/LP
Info Proc/Arch: Sm$.50 (up to 11x17) Gr.
Metro CET: Residential Use f
School CET: District: I t` \
Tigard CET: Admin c✓
Tigard CET: ODHCS ✓
Tigard CET: AH ✓
Electrical Permit: Permit Fee: ✓
Limited Energy:
12% State Surcharge ✓
Mech. Permit: Permit Fee: ,V
12% State Surcharge ✓
Plumbing Permit: Permit Fee: ✓
12% State Surcharge ✓
Erosion Control: w/Permit-Ping
1 ,��1r — OvK� s 3 ' S '�
I:\Buildin\Po Pla,Check _ _ .doc 12/21/22 bv.`\ �'S \_c_. --- I 1,
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