Permit a CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit #: MST2009-00008
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 Date Issued: 03/24/2009
Parcel: 2S104BB13000
Jurisdiction: TIG
Site address: 14146 SW WALNUT CREEK WAY
Subdivision: Lot:
Project: WALNUT CREEK SUBDIVISION
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories 2 Bedrooms 3 First 843 sf Basement sf Left 4 Parking Spaces
Height 24 Bathrooms 3 Second 1 12 4 sf Garage 395 sf Front 15 Smoke
Dwelling Units 1 Third sf Right 4 Detectors Yes
Total sf Value $0 00 Rear. 15
PLUMBING
Sinks. 1 Water Closets 3 Washing Mach 1 Laundry Trays Rain Drain 100 Catch Basins
Lavatories 4 Dishwashers. 1 Floor Drains Sewer Lines 100 SF Rain Drains Other Fixtures
Tubs /Showers 3 Garbage Disp. 1 Water Heaters 1 Water Lines 100
Bckflw Prevntr
MECHANICAL
Fuel Types Air Conditioning Vent Fans 5 Clothes Dryers 1
NAT Heat Pump Hoods 1 Other Units
Furn<100K Vents Woodstoves 1 Gas Outlets 4
Furn > =100K
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less 1 0 -200 amp 0 -200 amp' W/ Svc or Fdr
Ea add9 500 sf 3 20 1 -400 amp' 201 -400 amp 1st W/O Svc/Fdr
Limited Energy' 401 -600 amp' 401 -600 amp Ea addl Br Or
601 -1000 amp' 601 +amp -1000v
1000 +amp /volt.
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8 Stereo HVAC Security Alarm Vaccuum System Garage Opener All
Other N Other Description Ecompasing
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
MATRIX DEVELOPMENT DBA MATRIX DEVELOPMENT CORPORATION
LEGEND HOMES 12755 SW 69TH AVE #100
12755 SW 69TH AVENUE SUITE 100 TIGARD, OR 97224
PHONE 503 - 620 -8080 PHONE 503 - 620 -8080
FAX 503 -598 -8900
Total Fees: $10,555 55
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 rf work is suspended for more
the 180 d- NTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -00 -0010 through 0 • ' +0 0100 You may obtain a copy of the rules or direct questions to OUNC by - ling 503 246 6699 or 1 800 332.2344
Issue. By: _ , �- ' ►�JLL�'�L _ Permittee Signatu _.' • % VVi / Jiw /t��_)
CITY OF TIGARD X1,5 i - Z,Ob6) - coo o g
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171NauN�piq�l��l
Inspection Requests (24 Hrs.): (503) 639 -4175 =��
INSPECTION WORKSHEET FOR DATE: 4/ jj /o i TIME: PAGE:
SITE ADDRESS: 1 4 �l \, 1 i , i - t' CLASS OF WORK:
SUBDIVISION: 1 `I (O �f I'% �" LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: 5 J _-2,0q - X25'.0 PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time: / 1'Q 0
Code # Inspection Description onfirm # Contact # Message
. VC 6 (Ate—Je (C J'‘ / le
Corrections /Comments /Instructions.
J.J _i
,,, Lir lr,,.,_,,,,,,,,i
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &nr
g1/64 Date: 6 — Phone #: (503) 718-
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Jurisdiction:
Site Address: L Z /�2
Subdivision/Lot #: it )
G � �. / /��� " ! and/or L -
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)
i /
Signature: _ Date: ��7 `7�CliiJ
.
Owner/General ' ontracto /Au nthoz .T
Agent
Print Name:
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
\ 1-
STREET TREE CERTIFICATION
0
k
I, _ � 1�� / , Owner /Agent for 7 / 7ei/% 5
(PLEASE PRINT) C HOLDER)
Do hereby certify that the following location meets
City of Tigard land use and development standards
for street tree installation.
ADDRESS: //4 6 kj W1��� 1 /t, f`"l\ 9.-
SUBDIVISION: (jtC `;y%[z/L � �� LOT: 4/7
SIGNATURE: f:17_1(_,c,,-, ' /i� _ / DATE: j/7 7z-r
WATER AGENT)
RECEIVED BY: DATE:
(CTTY OF 77GARD)
1:\ Budding \ Forms \Streetl'rceCertifieate 01/19/07
Building Permit Application
Residential RECEIVED . FOR OFFICE USE ONLY
City of Tigard Rec eived
an 28.09 _� . Permit No rna -�� Q -
woo
._ . � v `
° 13125 SW Hall Blvd., Tigard, OR 97223 JAN 2 8 2009 P lan Date R /By eview"
Phone: 503.639 4171 Fax: 503 598.1960 Date/B z 0 Z I Other Permit its (�,2o04 -OQ 64
Inspection Line: 503.639 D ate Ready B q Suns ® See Page 2 for
T I GA RD
Internet: www.tigard -or gov OF �G " -- A � Not' d / Method of ��j
f) �,. T ` Supplemental Information
BUILDING DIVISION E (`
TYPE OF WORK REQ IRED 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
❑ Addition/alteration/replacement ❑ Other: dollar) of all equipment, materials, labor, overhead, and
CATEGORY OF CONSTRUCTION the profit for the work i scated on this application.
Valuation: ' '
Z d scent 4 4-7
® 1- and 2- family dwelling 1:1 Commercial /industrial —'?"
❑ Accessory building ❑ Multi - family Number of bedrooms 3
® Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 14146 Sw Walnut Creek Way New dwelling area: 1,967 square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: 395 square feet
Suite/bldg. /apt. no.: Project name: Walnut Creek Covered porch area: square feet
Cross street/directions to job site: Barrows & Walnut Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Walnut Creek Lot no.: 047 � Permit fees* are based on the value of the work
Tax map /parcel no.: 2S104BB13000 performed Indicate the value (rounded to the nearest
dollar) of all equipment, materials, labor, overhead, and
DESCRIPTION OF WORK the profit for the work indicated on this application.
Valuation: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Matrix Development dba Legend Homes Type of construction:
Address: 12755 SW 69 Avenue, Suite #100 Occupancy groups:
City /State /ZIP: Portland, OR 97223 Existing:
Phone: (503) 620 -8080 Fax: (503) 598 -8900 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Matrix Development dba Legend Homes All contractors and subcontractors are required to be
Contact name: Steve Lucas �� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 12755 SW 69 Avenue, Suite #100 jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 -8080 Fax: : (503) 598-8900
E -mail: slucas @legendhomes.com
CONTRACTOR
Business name: Matrix Development dba Legend Homes BUILDING PERMIT FEES*
Address: 12755 SW 69' Avenue, Suite #100 (Please refer lofee schedule)
Structural plan review fee (or deposit):
City /State /ZIP: Portland, OR 97223
Phone: (503) 620 -8080 Fax: (503) 598 -8900 FLS plan review fee (if applicable):
CCB Sic.: 55151 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Steve Lucas Date: 1/29/2009 * Fee methodology set by Tri- County Building Industry
Service Board.
Hsraov9 -dam 3
Electrical Permit Application FOR OFFICE USE ONLY
RECEIVE
City of Tigard • +/ , Date/By Permit No
III - v 13125 SW Hall Blvd., Tigard, OR 97223 y
g Plan Review Other Permit
Phone. 503 639 4171 Fax: 503.598.1960 JAN 2 8 2009 Date/By
TI GARD Inspection Line: 503.639 4175 Date Ready /By lures ® See Page 2 for
Internet: www tigard- or.gov Notified/Method Supplemental Information
CITY OF TIGARD
TYPE OF WB4SILDING DIVISION PLAN REVIEW
® New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ 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 to 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 E Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system A
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
100HP or more occupancy
Job no.: Job site address: 14146 Sw Walnut Creek Way
❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: Walnut Creek ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Barrows & Walnut Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Walnut Creek Lot no.:047 1,000 sq ft or less 1 145 15 145 15 4
Ea. add'I 500 sq ft or portion � �., 33 40 - 66.84+ 1
Tax map /parcel no.: 2S104BB13000 1CO = 26
Limited energy, residential 1 75 00 75.00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Matrix Development dba Legend Homes 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: 12755 SW 69 Avenue, Suite #100 Over 1,000 amps or volts 454 65 2
City /State /ZIP: Portland, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)620 -8080 Fax: (503)598 -8900 200 amps or less 66 85 I
Owner installation: This installation is being made on property that I own which is 201 amps to 400 amps 100.30 2
not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 401 amps to 599 amps 133.75 2
701. Branch circuits— new, alteration, or extension, Lrer panel
A Fee for branch circuits with
Owner signature: Date: above service or feeder fee,
® APPLICANT I ❑ CONTACT PERSON each branch circuit 6 65 2
B. Fee for branch circuits
Business name: Matrix Development dba Legend Homes without service or feeder fee, 46 85 2
first branch circuit
Contact name: Steve Lucas Each add'I branch circuit 6.65 2
Address: 12755 SW 69 Avenue, Suite #100 Miscellaneous (service or feeder not included)
Each manufactured or modular 90 90 2
City/State /ZIP: Portland, OR 97223 dwelling, service and /or feeder
Reconnect only 66 85 2
Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Pump or irrigation circle 53.40 2
E -mail: slucas @legendhomes.com Sign or outline lighting 53 40 2
CONTRACTOR Signal circutt(s) or limited -
Business name: Garner Electric energy panel, alteration, or Page 2 2
extension Describe.
Address: 2920 SE Brookwood Avenue #A Each additional inspection over allowable in any of the above
Per inspection 62 50
City /State /ZIP: Hillsboro, OR 97123 Investigation per hour (I hr mm) 62 50
Phone: (503) 648 -4552 Fax: (503) 642 -7925 Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
CCB Lic.: 121159 Electrical -305C Suprv. Lic.: 3707 -S Subtotal $286,96 24.5
Suprv. Electrician signature, requir Plan review (25% of permit fee) $71.74
• State surcharge (12% of permit fee) S3d-4,3' 1, i 4'
Print name: Chuck Garner / /l' .. a - 29/2009 TOTAL PERMIT FEE. g39971
Authorized signature: This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
" Number of inspections allowed per permit
Print name: Date: COW vo 7 7 .5 '
izz ei
84,06
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rRESI•DENTIAL VORK:ONLY:-',', , ?, .i'
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
® Audio and Stereo Systems*
® Burglar Alarm
® Garage Door Opener*
® Heating, Ventilation and Air Conditioning System*
• Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
A4 S i acral — avzro 8'
Mechanical Permit Application ��) ��j FOR OFFICE USE ONLY
City of Tigard RECEH . ED Received
li . Date/By Permit No
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 JAN 2 8 2009 Date/By Other Permit
T I GA RD Inspection Line: 503 4175 .�.�� p��y Date Ready/By him El See Page 2 for
Internet. www tigard- or.gov � OF IGAlIL Notified/Method. Supplemental Information
TYPE OF WO SING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® New construction ❑ Addition /alteration/replacement 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 Qty I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 14146 Sw Walnut Creek Way Air conditioning or heat pump
(requires site plan showing placement) 14 00
City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts /vents) 1 14 00 14.00
Suite/bldg. /apt. no.: Project name: Walnut Creek Furnace 100,000+ BTU (ducts /vents) 17 90
Gas heat pump 14 00
Cross street/directions to job site: Barrows & Walnut Duct work 10 00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 14 00
Subdivision: Walnut Creek Lot no.: 047 Flue /vent for any of above I 6.80 6 80
Other: 10 00
Tax map /parcel no.: 2S104BB13000 Other fuel appliances
DESCRIPTION OF WORK Water heater 1 10 00 10 00
Gas fireplace 1 moo woo
Flue vent for water heater or gas
fireplace 2 10.00 20.00
Log lighter (gas) 10 00
Wood/pellet stove 10 00
Wood fireplace /insert 10 00
® PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 10 00
Other. 10.00
Name: Matrix Development dba Legend Homes Environmental exhaust and ventilation
Address: 12755 SW 69 Avenue, Suite #100 Range hood/other kitchen
equipment I 10.00 10.00
City /State /ZIP: Portland, OR 97223 Clothes dryer exhaust I 10 00 10 00
Single -duct exhaust (bathrooms,
Phone: (503)620 -8080 Fax: (503)589 -8900 toilet compartments, utility rooms) 5 6 80 34 00
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans , 10 00
Other. 10 00
Business name: Matrix Development dba Legend Homes
Fuel piping
Contact name: Steve Lucas $5.40 for first four; $1.00 for each additional
Address: 12755 SW 69 Avenue, Suite #100 Furnace, etc. 1
Gas heat pump
City /State /ZIP: Portland, OR 97223 Wall /suspended/unit heater
Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Water heater 1
Fireplace 1
E -mail: slucas @legendhomes.com Range 1 5 40
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other
Address: 13150 Clackamas River Drive MECHANICAL PERMIT FEES*
City /State /ZIP: Oregon City, OR 97045 Subtotal $120 20
Minimum permit fee ($72 50)
Phone: (503) 557 -2200 Fax: (503) 557 -0919 Plan review (25% of permit fee) -- 30.95 --
CCB lie.: 72623 State surcharge (12% of permit fee) M. , -- 3-6-1--
TOTAL PERMIT FEE $ 153 86
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.' 4 b'Z
Print name: Steve Lucas Date: 1/29/2009
• Fee methodology set by Tn- County Building Industry Service Board
Plumbing Permit Application /14s U7JrJe1
Building Fixtures RECEIVED FOR OFFICE USE ONLY
■ City of Tigard R eceived
Permit No
JAN 2 8 2009
Date/By 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503 639.4171 Fax 503.598„). �Y , OF �G DateBy Other Permit No
T 1 GARD Inspection Line: 503.639 4175 ��;;jj jj M Date Ready /By' funs ® See Page 2 for
Internet: www tigard -or gov BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description Qty I Ea I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (Includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1�4 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath l 399 00 399 00
Each additional bath/kitchen 45 00
® Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 14146 Sw Walnut Creek Way Catch basin or area drain 16 60
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: Walnut Creek Footing drain (no linear ft. ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: Barrows & Walnut
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) ( Page 2
Storm sewer (no linear ft.. ) 1 Page 2
Subdivision: Walnut Creek Lot no.: 047 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 2S104BB13000
Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16 60
Clothes washer i 16 60
Dishwasher i 16 60
® PROPERTY OWNER ❑ TENANT Drinking fountain 16 60
Ejectors /sump 16 60
Name: Matrix Development dba Legend Homes Expansion tank 16 60
Address: 12755 SW 69' Avenue, Suite #100 Fixture /sewer cap 16.60
City /State /ZIP: Portland, OR 97223 Floor drain/floor sink/hub 16.60
Phone: (503)620 -8080 Fax: (503)598 - 8900 Garbage disposal I 16 60
® APPLICANT ❑ CONTACT PERSON Hose bib 2 16 60
Ice maker 1 16 60
Business name: Matrix Development dba Legend Homes Interceptor /grease trap 16 60
Contact name: Steve Lucas Medical gas (value $ ) Page 2
Address: 12755 SW 69' Avenue, Suite #100 Primer 16 60
City /State /ZIP: Portland, OR 97223 Roof drain (commercial) 16 60
Sink/basin/lavatory 1/0/11/4 5 16 60
Phone: (503) 620 -8080 Fax: : (503) 598-8900
Tub /shower /shower pan - 3 16 60
E -mail: slucas @legendhomes.com Urinal 16 60
CONTRACTOR Water closet 16 60
Business name: Wolcott Plumbing Water heater I 16 60
Address: 1075 W. Historic Columbia River Hwy Other.
City /State /ZIP: Troutdale, OR 97060 Subtotal 399 00
Minimum permit fee: $72 50
Phone: (503) 667 -1781 Fax: (503) 667 -9891 Residential backflow minimum permit fee. $36 25
CCB Lie.: 112220 Plumbing Lic. no.: 26 -824PB Plan review (25% of permit fee) - 99 75
State surcharge (12% of permit fee) 47 88
Authorized signature: 4s.
� ! TOTAL PERMIT FEE .6 6 43
U ura�Ct>cA
Print name: Gloria Hawes Date: 1/29/2009 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. 4c
*Fee methodology set by Tri- County Building Industry Service Board J
° Building Division
One & Two - Family Dwelling
TIGARD Fees Checklist
PERMIT INFORMATION: (' n
Permit #: _ - Plan #: Date: (, I
Site Address: ( ' CO 0T C? P LK Parcel #:
Subdivision: J- L 3t7(- C Lot #: 4,47 Zoning:
Jurisdiction: Tl& Setbacks: Front: Rear: Left: Right:
Class of Work: 000 Stories: First Floor:, pA r
Type of Use: Height: 2 Second Floor: f I 2A
Construction: Floor Load: G Third Floor:
Occupancy Group: J Dwelling Units: Bonus Room:
Valuation: Bedrooms: Total Floors: (9 W-1 d�
Bathrooms: ` j Basement:
Decks: Garage: u'
Porches: 5 I Other:
FEES: Description: Fee Amount: Amount Paid: Balance Due:
Plan Check: Building: '2(, ( j 75U CC.)
Extra Set:
Permit: Building: `
Tax:
Metro CET:
School CET: G( c ,
Mechanical
Tax:
Plumbing:
Tax:
Electrical:
Tax:
Low Voltage:
Tax:
CDC: CDC Ping. Rev.:
CDC LRP Fee:
SDC: Parks:
TIF Res.:
TIF MT:
Erosion Permit:
Erosion CWS:
Erosion COT:
Water Quality:
Water Quantity:
SUB - TOTAL:
Sewer: Permit:
Inspection:
SUB - TOTAL:
TOTAL MST & SWR:
I \Building \Forms \ResPlanCheckFces doc 01/19/07 Page 1
PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment/systems) 4 1
Description I Qty. I Fee(ea.) I Total Description Qty I Fee(ea.) I Total
New 1- & 2- family dwellings . Heating/Cooling
(includes 100 ft. for each utility connection) Air conditioning or heat pump* 14.00
SFR (1) bath 249.20 Furnace 100,000 BTU (ducts /vents) 14 -00
SFR (2) bath 350.00 Furnace 100,000+ BTU (ducts /vents) 17.90
SFR (3) bath 399.00 Gas heat pump 14.00
Each additional bath /kitchen 45.00 Duct work 10.00
Rain Drain, single family dwelling 65.25 Hydronic hot water system 14.00
Fire sprinkler - sq ft. 0 to 2,000 115.00 Residential boiler
Fire sprinkler - sq. ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14 00
Fire sprinkler - sq. ft. 3,601 to 7,200 220.00 Unit heaters (fuel, not electric)
Fire sprinkler - sq. ft. 7,200 and greater 309.00 (in wall, in -duct, suspended, etc.) 14.00
. . Site Utilities Flue /vent (for any of above) 6.80
Catch basin/area drain 16.60 Repair units 12.15
Drywell /leach line /trench drain 16.60 Other Fuel Appliances
Footing drain - P 100' 55.00 Water heater 10.00
Footing drain - each additional 100' 46.40 Gas fireplace 10.00
Manufactured home utilities 110.00 Flue vent (water heater /gas fireplace) 10.00
Manholes 16.60 Log lighter (gas) 10.00
Rain drain connector 16.60 Wood/Pellet stove 10.00
st Wood fireplace /insert 10.00
Sanitary sewer - 1 100' 55 00 Chimney /liner /flue /vent 10.00
Sanitary sewer - each additional 100' 46.40 Other: 10.00
Storm sewer - 1" 100' 55.00 Environmental Exhaust & Ventilation
Storm sewer - each additional 100' 46.40 Range hood /other kitchen equipment 10.00
g eq P
Water service 1 100' 55.00 Clothes dryer exhaust 10.00
Water service - each additional 100' 46.40
Fixture or Item Single duct exhaust
Absorption valve 16.60 (bathrooms, toilet compartments,
Backflow preventer 27.55 utility rooms) 6.80
Backwater valve 16.60 Attic /crawl space fans 10.00
Clothes washer 16.60 Other: 10 00
Fuel Piping
Dishwasher 16.60 * *($5.40 for first 4, $1.00 each additional)
Drinking fountain 16.60 Furnace, etc. **
Ejectors /sump 16 60 **
Wall/suspended/unit pump
Expansion tank 16.60 Gas heat
heater **
Fixture /sewer cap 16 60 Water heater **
Floor drain/floor sink/hub 16 60 Fireplace **
Garbage disposal 16.60 Range **
Hose bib 16.60 BBQ **
Ice maker 16 60 Clothes dryer (gas) **
Interceptor /grease trap 16.60 Other: **
Primer 16.60 Total:
Roof drain (commercial) 16.60 Mechanical Permit Fees
Sink/basin/lavatory 16.60 Subtotal: $
Tub /shower /shower pan 16.60 Minimum Permit Fee $72.50 $
Urinal 16.60 Plan Review Fee (25% of Permit Fee) $
Water closet 16.60 State Surcharge (12% of Permit Fee) $
Water heater 16.60 TOTAL PERMIT FEE $
Other:
Other
Plumbing Permit Fees ELECTRICAL FEES (residential single- or multi- family)
Subtotal $ Description Qty. Fee Total Insp
Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less 145.15 4
Plan Review (25% of Permit Fee) $ Ea. add'l 500 sq. ft. or portion 33.40 1
State Surcharge (12% of Permit Fee) $ Limited energy, residential 75.00 2
TOTAL PERMIT FEE $ Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Electrical Permit Fees -
Subtotal: $
Plan review (25% of permit fee) $
State surcharge (12% of permit fee) $
TOTAL PERMIT FEE $
I - \ Building \ Forms \ResPlanCheckFees doc 01/19/07 Page 2
ti
FIXTURE UNIT WORKSHEET - WATER METER
Contractor Name Matrix Development dba Legend Homes
Billing Address 12755 SW 69 Avenue #100, Portland, OR 97223
Address of New Meter 14146 Sw Walnut Creek Way
Lot # 047 Subdivision Walnut Creek
Please fill in the number of each fixture as detailed on the plans, then multiply
quantity by the point value given to arrive at the point total. Add all point totals together
for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
Bar Sink 0 X 1 = 0
Bidet 0 X 1 = 0
Closewasher 1 X 4 = 4
Dishwasher 1 X 1.5 = 1.5
Hose Bibb 1 X 2.5 = 2.5
Hose Bibb, ea. Adt'l 1 X 1 = 1
Kitchen Sink 1 X 1.5 = 1.5 ,
Laundry Sink 0 X 1.5 = 0.0
Lavatories 5 X 1 = 5
Water Closet, 1.6 gpf 3 X 2.5 = 7.5
Bathtub /Whirlpool 1 X 4 = 4
Shower Stalls 1 X 2 = 2
Bath/Shower Combo 1 X 4 = 4
Under 34 ='/4" Over 34 = 1" Total Fixture Points 33
Meter Size 3/4" Meter Cost
****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
FOR OFFICE USE ONLY
Fixture Count Verified with Plumbing Permit
Meter #
Receipt #
Emp. Name
'PLOT PLAN v22,m9 As
LOT *047 WALNUT CREEK C' r
14146 SW WALNUT CREEK WAY "
NE :SECTION 4, T.25, R.1W, W.M. J b I•• 20'-0"
CITY OF TIGARD +v�l ,, ::; , _ C , , � ' 8 . , - -�'
WASH INC=TON COUNTY, ORECxON _ BU � FC C + _. _
LEGEND G D
C
•
___W" 111111 18766 SB 691h cos. OFFI8 6
(03) 93o -6080
� 0 ,•.. u BORE 100 FAX (603) 699 -9900
4 PORTLND. 08. 97223 CCB/ 65181 - ' •
. ' SW WALNUT CREEK;W4 '
ID , 234
1 e�r -, . 234
STREET TREE.: : _ 74 a • • r k I , r
CHANTICLEER PEAR I �_. DE WALK
2" Caliper //"/' 0
0
1 ` .. • 236.0 . \ • . 0 i ' 1 8 PUE
-- 7 - \4- - ---4— T" — : — \ , — - - -- ��
I s
tifl 1
�
I' ' 236.8 . • a 6 6.00'
5.99' I . ' 7- 235.2'
/
� /
I �� �� 1
1
231.2 /�
I
W 1 / , l LOT
LOT �- 7 ,,i_ 46
48 'Ar , 3 ,369QFT' j \ 235
a r WILLOW V I °°
238 z 1 FR ••238.5 01
\ 1 Foe. •231.0'/ , Z
W — \I SANITARY SEWER ' I 5.94 \ / \ 1 STORM DRAIN ■ 4'
I \
o EROSION FENCE N 231.8 236' / \ L
— cE OF STREET s \ \ _ e
10 WATER METER 239 --1. _ — 1 236
I — 231
O MANHOLE 240 1
—' — — — — 1 — 238
® CATCH BASIN 241 68 13'26 "E 43.00' _ -239
� 5 88 19'26" E" E 53.50'• • ' - 240
( PROPOSED ••
STREET TREES ' LOT 39'' . .. ..
ES STREET LIGHT N
FIRE HYDRANT y,• . ( 4
PROVIDE EROSION r _ ._ ._- .... _...,. .. _ _.._., - `
• CONTROL FENCE "r
PER COMMUNITY
EROSION PLAN
SETBACKS :
FRONT YARD • 15 FEET
GARAGE • 20 FEET
REAR YARD • 15 FEET
SIDE YARD • 4 FEET
STREET SIDE YARD • 10 FEET
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: AA • i' • •' ftga o
PLANNING DIVISION: ' /''• roved ❑Not Approved
Required Setbacks: Y� "APP
Side: 4 Street Side: i0
,- Rear: Z...___ Front. G age: Not Approved
Visual Clearance: [ Appr ved ❑ pP
, .-o-, Maximum Building Hei feet Yes ❑ No
IL' CWS Service Provider Letter Required: 0 Received
B a -I - Date: Vg-00
ENGINEERIN DEPARTMENT:
Actual ' ope: % Approved ❑ Not Approved
-A roved
Site PI , , : Approved 0 • • of • , proved
Date: a p Y •
Notes: qe ri kw`""
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO: Irytgr2s,a4. Og9nyci
Street Trees: Approvi d ❑ Not Approved
Protected rees:
�T T BY ' O 1 (?0/p
•
Notes: