Permit 6/5 c4ad /1-.c. - i-
I II CITY OF TIGARD MASTER PERMIT
11 COMMUNITY DEVELOPMENT Permit #: MST2010 -00070
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2010
Parcel: 2S109DA18000
Jurisdiction: TIGARD
Site address: 15243 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 109
Project: Arlington Heights
Project Description: New SF. 8/5/10 added NC B.T.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1492 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 21 Bathrooms: 3 Second: 1648 sf Garage: 645 sf Front 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $334,692.07 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Tvpes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum > =100K: 1
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'I 500 sf: 6 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir:
6p1 -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
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
STONE BRIDGE HOMES NW, LLC STONE BRIDGE HOMES NW LLC 1 MST Ersn Cntrl 503 - 681 - 4444
16869 SW 65TH AVE., #505 16869 SW 65TH AVE # 505
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035
PHONE: 503 - 387 -7577 PHONE: 503 -387 -7577
FAX: 503- 387 -7615
Total Fees: $17,459.14
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 .Pnfm. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a co• ect questions to OUNC by calli .246.6699 or .800.33 .' 4..
Issued GI_ L Permittee Signa re: ' _' ,
W ^ �/ GAR MASTER PERMIT OF TID
` o COMMUNITY DEVELOPMENT Permit #: MST2010 -00070
Ti GARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/11/2010
1,-.7-, ,, Parcel: 2S109DA18000
Jurisdiction: TIGARD
Site address: 15243 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 109
Project: Arlington Heights
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1492 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 21 Bathrooms: 3 Second: 1648 sf Garage: 645 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $334,692.07 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum > =100K: 1
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 addl 500 sf: 6 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir:
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
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
STONE BRIDGE HOMES NW, LLC STONE BRIDGE HOMES NW LLC 1 MST Ersn Cntrl 503 - 681 - 4444
16869 SW 65TH AVE., #505 16869 SW 65TH AVE # 505
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035
PHONE: 503- 387 -7577 PHONE: 503 - 387 -7577
FAX: 503- 387 -7615
Total Fees: $17,406.78
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 • ith 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.
( accords ENTION: Oregon -w r-+ ire you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00' 0010 through OAR 952 -I -0100. o ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.66 9 or 1.800.332.2344. 4 Issued = 4 Permittee Signature:
r/ y 'i
Building Permit Application RECEIVE FOR OFFICE USE ONLY
II City of Tigard APR 21 2010 Dat /By: 7 �� I o Pemtit N 9"V5/.20 /0 -46 D 0 70
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Other Permits''
Ph one: 503.639.4171 Fax: 503.598.1960 Date / By: �e I Q CU2o?0 /0 600 ( 9
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: / Jut EI See Attached Checklist for
TIGARD Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: V J 0 '7 I G Supplemental Information
LAM ,- r 1/4-11r
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
® 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.
® 1- and 2- family dwelling ❑ Commercial /industrial valuation:.3I R ! CJ � P. $ 33 02_, 07
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 2-S j
JOB SITE INFORMATION AND LOCATION Total number of floors: 2.
Job site address: ( C)24.3 SW rumt'y e✓t;1P.W onvc New dwelling area: 3 / I A. p square feet
City/ State/ZIP: Tigard, OR 97223 Garage/carport area: (o4 square feet
Suite/bldg. /apt. no.: Project name:py* 4 1k\ (.6sk4s Covered porch area: 158, square feet /(..,4,
Cross street/directions to job site: Deck area: 0 square feet j.2-
Other structure area: p(g7E :e square feet 'L-t
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 1:1 v1►,�,L�n �t y,� .' Lot no.: Oe , 7 Permit fees* are based on the value of the work performed.
" v "' 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.
Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes NW, LLC Type of construction:
Address: 16869 SW 65 Ave., #505 Occupancy groups:
City/State/ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)387 -7577 Fax: (503)387 -7615 New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Stone Bridge Homes NW, LLC All contractors and subcontractors are required to be
Contact name: �i licensed with the Oregon Construction Contractors Board
�0.G.l�Ce r'LP h under ORS 701 and may be required to be licensed in the
Address: 16869 SW 65 Ave., #505 jurisdiction in which work is being performed. If the
City/State /ZIP: Lake Oswego, OR 97035 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 387 -7577 Fax: : (503) 387-7615
/ '
E -mail: p,dmhholdingsco.com
CONTRACTOR
Business name: Stone Bridge Homes NW, LLC BUILDING PERMIT FEES*
Address: 16869 SW 65 Ave., # 505 (Please refer to fee schedule
Structural plan review fee (or deposit):
City/State /ZIP: Lake Oswego, OR 97035
Phone: (503) 387 -7577 Fax: (503) 387 -7615 FLS plan review fee (if applicable):
Total fees due upon application:
CCB lie.:
( v 9/6/10
Amount received: '7‘.-5() ,
Authorized signature: Y,;,, �„ `T-- T his permit application expires if a permit is not obtained
wa�� within 180 days after it has been accepted as complete.
Print name: Q<rti,}l.c. n c f Date: * Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \ Permits \BUP- PermitApp.doc 03/21/06 440-46I3T(I I /02 /COM/WEB)
• I • Electrical Permit Applicati�ra �V ; I OR'Ol l I(l i�SE ( )NI X
City of Tigard Received
Date/B Permit No S ��/, y Di 0, 7d
PR ; 2120
13125 SW Hall Blvd., Tigard, OR 9722 Q Plan Review
.' ', Phone: 503.639.4171 Fax: 503.598.196 D . Other Permit� _ al ,, • r 0 0
,,. : ;'�_ ^ D Inspection Line: 503.639.4175 �ITQ TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration /replacement Please check alLthat apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0.Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less t� ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system., larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 4 (10 Job site address: 15 2t5 5W I Six o or more. R occupancy.
UYY1111P.✓1/N.W Pei VC 0 or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locationsrii 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Arlington Heights ❑ Service or feeder 60d amps or more.
. }, FEE SCHEDULE
Cross street/directions to job site: Desc,iptton 1 Qt 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Arlington Heights Lot no.: 109 1,000 sq. ft. or less 1 168.54 ;," '\- 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion CO 33.92 .2035'.2
Limited energy, residential ` t/ P
DESCRIPTION OF WORK (with above sq. ft.) AL e 67.84 �j(, 2
Limited energy, multi- family
residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
. 200 amps or less 100.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Stone Bridge Homes 401 amps to 600 amps 200.34 2
• 601 amps to 1,000 amps 301.04 2 -
Address: 16869 SW 65th Avenue #505 Over 1,000 amps or volts 552.26 2
City / State/ZIP: Lake Oswego, OR 97035 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)387 -7577 Fax: (503)387 -7615 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: SEE ABOVE B. Fee for branch circuits
Contact name: Gayland Forsberg without service or feeder fee 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: gayland @stonebridgehomesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: City Electric
energy panel, alteration, or
Address: 55568 SW Schaltenbrand Lane extension. Describe: Page 2 2
City /State/ZIP: Sherwood, OR 97140 Each additional inspection over allowable in any of the above
•
Per inspection 66.25
Phone: (971) 404-1714 Fax: (503) 625 -3052 Investigation per hour (1 hr min) 66.25
CCB Lic.: 424 2 • Electrical Lic.: 26 -289C Suprv. Lic.: 35925 Industrial plant per hour 78.18
f Y )- J t 0 — 7/ 1 / i► ) 0 / 1 1 u ELECTRICAL PERMIT FEES
Suprv. Elect an signature, required: Subtotal: 43
•
Print name: Chuck Friesen Date: Plan review (25% of permit fee):
1 State surcharge (12% of permit fee): / 2 .79'
Authorized signature: TOTAL PERMIT FEE: 4. . (
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\EIC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Mechanical Permit Applicati llt - O
R eceived
`.
• City of Tigard Pem»t No
P ate/BY: /1S��o i _ 0 /
• 13125 SW Hall Blvd., Tigard, OR 97223 q P R :212010 Plan Review
' " Phone: 503.639.4171 Fax: 503.598.1960 •
Date/By: Other Permi / 0/0 — 000 6,, D
- -1:1 G A l: 11, I nspection Line: 503.639.4175 Date Ready/By: orris: 1E1 See Pe 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: S pplemental Information
BUILDING DIVISION
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.
CATEGORY OF CONSTRUCTION 1 Value: $
® 1 -and 2-family dwelling C RESIDENTIAL; EQUIPMENT / SYSTEMS FEES*
y g ❑ ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address:
i 24 S W .1 frywnl ,f f tC4J on Vt. (requires site plan showing placement) 46.75
City /State/ZIP: Tigard, OR Furnace 100,000 BTU (ducts /vents) 46.75
( Suite/bldgiapt. no.: Project name: Arlington Heights Furnace 100,000+ BTU (ducts /vents) 54.91 54,1
Heat pump 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
� Flue/vent for any of above 23.32
Subdivision: Arlington Heights Lot no.: 1 Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION' OF WORK Water heater 1 23.32 '�, -32..--
New, Single Family Residential Gas fireplace 1 33.39 • 3je
y . Flue vent for water heater or gas .
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER . I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: _ 23.32 _
Name: Stone Bridge Homes NW, LLC Environmental exhaust and ventilation
Address: 16869 SW 65' Avenue #505 Range hood/other kitchen ii G
equipment 1 33.3 l
City /State/ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust I 33.39 3.'✓(
Single -duct exhaust (bathrooms, 16 O
Phone: (503)387 -7577 Fax: (503)387 -7616 toilet compartments, utility rooms) , 23.32 '
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: same as above
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc. 1 ('t, ("
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
1.
E -mail: Range
• CONTRACTOR Barbecue
Business name: Comfort Zone
Clothes dryer (gas)
Other:
Address: 1032 NW Corporate Drive MECHANICAL PERMIT FEES*
City /State/ZIP: Troutdale, OR 97060 Subtotal 3 (•7
Minimum permit fee ($90.00)
Phone: (503) 667 -5595 Fax: (503) 491 -8252
Plan review (25% of permit fee)
CCB lic.: 110091 Ll /3 l fi State surcharge (12% of permit fee) I , l TOTAL PERMIT FEE 3 44 , 2.1
t This permit application expires if a permit is not obtained within 180
Authorized signature: I days after it has been accepted as complete.
Print name: David Heldstab Date: * Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits \NEC- PermitApp.doc 10 /01/09 440 -4617T (11 /02JCOM/WEB)
Mechanical Permit Application ,V . I (iiz I icy.l�st ()NIA'
R eceived
City of Tigard Permit No.
`J g Date/By: 5 :
IA1 I D 6 n 71n t
q 13125 SW Hall Blvd., Tigard, OR Q Plan Review
I1 Phone: 503.639.4171 Fax: 5 t,+, .0 `J yd � Date/By: Other Permit:
1 . �, �t r� Inspection Line: 503.639.4175
Internet: www.tigard or.gov A� �` Date Ready/By: 121 See Page 2 for
P� Os N. Notified/Method: Supplemental Information
- A.O 43) TYPE OF W�`� COMMERCIAL FEE* SCHEDULE — USECHECKLIST
❑ New construction ❑ Addition/altera*keplacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
' RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: `s �L z �� n
Air conditioning
y/ 7;
/Vy r . (requires site plan showing placement ) 1 46.75 (v ,
City /State /ZIP: Fumace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 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: Lot no.: UC Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
", a -1 t Vt �� Flue vent for water heater or gas
�"Y!` J fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent
23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
. ❑ APPLICANT ❑ CONTACT ;-PERSON : Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( )
Fax:: ( ) Water heater
Fireplace
E -mail: Range
• CONTRACTOR • Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: • MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal It( ,"7S
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) S', 61
TOTAL PERMIT FEE S$. ` t
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building 1 Permits \MEC- PermitApp.doc 10/01 /09 440 -4617T (11 /07/COM/WEB)
Plumbing Permit Applicati .. . _ .. ,.
•
B
. . •. _. .. uilding Fixtures APR ; 212010 Recei i clli < i 1 1Gl .l tir ONi V
City of Tigard
Date/By: Permit No.�S� 20 /O - DOD 7b
,: ®' • • 13125 SW Hall Blvd., Tigard, OR 972A y OF T IGA RD Plan Review
Phone: 503.639.4171 Fax: 503.598. 801 y Other Permit N uI/l a 0V
T 1 c A R I) Inspection Line: 503.639.4175 BUILDING DIVISION Date Date/By:
Juris: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE. OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath ( 500.32 % ,"
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 r'7 2s} -314 S I/ Catch basin or area drain 18.76
171 /r(GYV If1w) Sri v� Drywell, leach line, or trench drain 18.76
City /State/ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: , ) Page 2
Suite/bldg. /apt. no.: I Project name: Arlington Heights 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: Arlington Heights I Lot no.: loc Fixture or item:
Tax map /parcel no.: • Backflow preventer 31.27
. DESCRIPTION OF WORK Backwater valve 12.51
' Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER • I ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 Avenue #505
Garbage disposal 25.02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: (503)387 -7577 Fax: (503)387 -7615 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: SEE ABOVE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Gayland Forsberg
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: gayland @stonebridgehomesnw.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Legacy Plumbing Water piping/DWV 56.29
Address: 8985 Hazelvern Way Other: 25.02
City /State/ZIP: Portland, OR 97223 Subtotal 5 .
Phone: (503) 816 -8887 Fax: (503) 297 -4587 Minimum permit fee: $72.50
' Plan review (25% of permit fee)
CCB Lic.: 1 ;3 S �..- Plumbing Lic. no.: 26 -517PB State surcharge (12% of permit fee) ( X*
Authorized signa • • : 3/3 7 /1 TOTAL PERMIT FEE 5 , ".". j
Print name: Matt Nelson Date: This permit application expires if a permit is not obtained within 180 days
/ cZV `� after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
IABuilding\Permits\PL_MU- PermitApp.doc 10 /01/09 440- 4616T(l0 /02/COM/WEB)
I) .
v '
STREET TREE CERTIFICATION
4 . "tw „ �, , s -? r � -te u�a `. - .. 3', r s',
% ',
� r -� '. �; �' x ftn Iry �°
I
■ I VII,' ' � y , T O wne r / ` ge f ``° � :« __ , 4,
(PLEASE PRI NT) ,4 � (PERMIT HOLD `
} p 7
1 `
Do here c rti `th the ollo a lo .cat i on
meets
y fY' f wlnkg
City o f Ti ° e a n d `rtdeve lopm ent standards
P fo s t tree n on
T
� -' 4n'u. n u Q
(it 'a -'ri r 1 a � a ��r �' '$''. j`"a• '5' 4 �i �_ r
a rt } k , :. '' = "m`. s �
/L /v /D 6d a 70
ADDRESS: 43 5 fit ° . _
SUBDIVISION /9A1;- LOT: /1(:))7 A
/ (-_,
\
SIGNATURE: f= fre - 19.
DATE: 1
� � / ACE -lir (---. RECFIVFD BY: DATE:
J
(CI 1 Y OF TIGARD)
I: \Building \Forms \StreetTreeCertificate 01/19/07
r
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: 5 240 - C)C07 Jurisdiction:
Site Address:
Subdivision/Lot #: l
and /or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: Date:
/
wner /General Contrac or /Authorized Agent
Print Name: ,] 1 If2 (c.S G?� -Q- -�
ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code 8318.
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, J/ /4 in t4- ( - >Q � •�Z , am the general contractor or the owner- builder
at the following address:
Site Address: / C a
City:
Permit #: l G -2 0
0/1.57 20/0 O
Subdivision/Lot #: /� ( S /c-',,24
and/or
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918 - 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture - sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: Date: – 10
General Contractor or 0 'er -.:Oder
I:\Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08
STONE BRIDGE AirmaJ OBE:1480
1-3 O7141E9 NW LLC LOT: 109
10809 sW satatb. A.WA.. 164 . 0.015 —DATE: 04 /18/2010
L& K I O S T I G O. O R I G O N. 970115 -. --9 PROPERTY: ARLINGTON
(503)387 -7577
HEIGHTS
r-� CITY: TIGARD
RECR\IF : , z • , SCALE: 1 " =20'
PLAN No.: 298
APR 2 ] 2010 PRAIRIE ELEVATION
CITY OF
BUILDING DIVISION .
�U g
�� 6 4303
EI.. = - m 428 426 4252 nu
W. - „ �, 4222 SW
/ �� 1
Fill r a - .. - loam' RETAINING; 0 4252 TW 422
� �
: 4221 lea
fit
: ' 423 �d f'pf
el
vi �
14 iiiiii :�. �: 9
1"
b
(
UI
64E5 ea. F7 .'
0 9' m 3 CAR CON CRETE ",' ?
�' �n A _pa -421 ,, = DRIVEWAY
101 3,I40 e Ft
9 4 ` -
6L :.. r •
4 ODF!" L .,
n 420
2 1/2 .4TFI 22 ; .' : •% 420 ��
f 1011 3' N
la _ ;,,..d........ __ _ _ ___, . _ 2' I • ... ; 1 -Ilt
1 )1 ; 418
14 II
r ,:a'' d3' '
/ - -- - - - - -- , 422 16.. gE�R
5
2, 11 ! , - • - -- --- -- - - - - 4 2 � I ST O_ 2
m c. fir rl -i_ � , T, 4 � . � a J WATER
Z9 4212 /111
s �
0 422 4111 oil 98+vp' RETAINI � , "4 7 _ —•– y
r / L 4212 TW M
426 424 p 4111 BW
3
ill 01
3m'-I'
LOT COVERAGE LEGEND
LOT AREA: 5,948 SQ. FT.
BUILDING AREA: 2 ,392 SQ. FT. — STREET TREES:
PERCENTAGE: 402% RAYWOOD ASH
- FRAXINUS OXYCARPA-
NOTES:
ALL GRADE AND PROPERTY LINES ARE ESTIMATES OF CURRENT LOCATIONS.
ALL DIMENSIONS AND SQUARE FOOTAGE ARE APPROXIMATE FIGURES.
ALL RETAINING WALL HEIGHTS AND LOCATIONS ARE ESTIMATES.
THEY MAY VARY AND BE SUBJECT TO CHANGE. LOT 11 109
5T EETLIGHTS MAY OTHER SITE LOCATION UTILITY BOXES, 5,948 eq. ft.
■ • .
4
I5 S0,14 ryi er 01 ) a__
. ,
CITY OF TIGARD -SITE PLA REVIEW
BUILDING PERMIT NO.: n s-r) io - o op? 0
PLANNING DIVISION: ,
Required Setbacks: air 0 Not Approved
Side • Street Side. /
, • -ill k Gara2e: :27 Rear: I-.
'learance ErAppipved 0 Not Approved
ld.. 1-lei.,21ii ,3$_ fee
i 1 i • • ,, I ,lier Required: 0 Yes 0 No
I
0 Received
1 L ■ ::NGINEERING DEPARTMENT:
Actual ' ope: % g Approved 0 Not Approved
Slite PI : Approved 1110;ot pproved •
Date:_ .
Aoks: a pe..c.
CITY OF TIGARD - SiTE PLAN REVIEW
BUILDING PERMIT NO: /ti...C77,2/z) — a a , 4
Approved 0 Not Approved
Street Trees:
Approved 0 Not Approved
Protectecareef
By: la ricl I ilir Date: C 'pi()
Notes:
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.
I: \Building\Permits\MEC- PermitApp.doc 10/01/09 2