Permit a CITY OF TIGARD
e ' Buildin g Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503.718.2439
INVOICE
TO: Webber Brittany LLC Customer ID: C11 -0001
Attn: John Webber Invoice No.: INV2011- 00011
12155 SW Wildwood St. Invoice Date: 3/10/2011
Portland, OR 97224 Date Due: Upon Receipt .
•
f,Case No: 71 Site Address' • . • - • : Subdivision -Lot # or Project Name Amount Due..
MST2010 - 00037 7865 SW Webber Ln. Brittany Meadows, Lot 36
Building plan review completed,
less $750.00 deposit $163.68
CDC Plan review, RES $46.00
CDC Plan review, RES - LRP $6.00
Erosion Plan Review - COT $28.60
Note: Plan resubmitted on
3/8/2011 under permit number
MST2011- 00040.
•
Invoice Total: $244.28
❑ Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2010 -00037 Customer ID: C11 -0001
Site Address: 7865 SW Webber Ln. Invoice No.: INV2011 -00011
•
Project: Brittany Meadows, Lot 36 Invoice Date: 3/10/2011
Date Due: Upon Receipt
Invoice Total: $244.28
Amount Paid: $
Office Note: Forward copy of receipt to Dianna Howse.
Please mail payment to:
City of Tigard, Building Division
Atm: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
1: \Building \Accounting \Invoice.doc 01/14/2011
Community Development
TIGARD Request for Permit Action RECEIVED
JAN 1 y zull
TO: CITY OF TIGARD Gay OFTIGARD
Building Division Services Coordinator BUILDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: WEBBER BRITTANY, LLC
INVOICE TO: (Business or Individual)
Mailing Address: 12155 SW WILDWOOD ST.
City /State /Zip: PORTLAND, OR/97224
Phone No.: 503 -684 -5522
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCF.T. PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
i® REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
tiff r Permit #: MST 2010 -00037 EX /pre/ 77� S " /7AZO // -- y TO
Site Address or Parcel #: 7865 SW WEBBER LANE
Project Name: KEYSTONE / WEBBER
Subdivision Name: BRITTANY MEADOWS NORTH Lot #: 36
EXPLANATION: JAMES M. POLAK, CONTRACTOR, DIED ON DECEMBER 23, 2010.
PLEASE REMOVE JAMES M. POLAK & KEYSTONE DEVELOPMENT, INC., AND
TRANSFER TO WEB : i ' BRITT ' LLC PER ATTACHED AUTHORIZATION .
Signature:' / „�` r ia, Date: JANUARY 18, 2011
Print Name: ► :a7r : ► 1�''�'L���' Iry e"
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admire: Date By Rte to Bldg Admin: Date , // By ; 7
Refund Processed: Date /t/ /f} By , /fil Invoice Processed: Date By
Permit Canceled: Date /Ile" By j' Parcel Tag Added: Date By
Receipt # Date e s od Amount $
I:\ Building \Forms \RegPennitAction.doc Rev 07/26/07
Keystone Development, Inc. /`7S7020/O -to d 0`3 7
4367 Haven Street
Lake Oswego, OR 97035 RECJfl
December 28, 2010
JAN 19 2011
City of Tigard Building Division
13125 SW Hall Blvd. CITY OF TIGARD
Tigard, OR 97223 BUILDING DIVISION
Re: Transfer of Residential Building Permit MST 2010 -00037
To whom it may concern:
James M. Polak of Keystone Development, Inc. was contracted by Webber Brittany, LLC to construct
a single family home on its property located at 7865 SW Webber Lane, Tigard. The City of Tigard
residential building plans MST 2010 -00037 were approved, but sadly, Mr. Polak expired in December,
2010, before the building permit was issued.
As a result of these unfortunate circumstances and for value received, Keystone Development hereby
transfers the City of Tigard building permit MST 2010 -00037 and all associated work product,
including plans and approvals to Webber Brittany, LLC and assigns. Webber Brittany LLC intends to
assign this building permit to a licensed and bonded, Oregon building contractor capable of
completing this construction project according to the standards, terms and conditions established by
the City of Tigard Building Division in the approved plans and any subsequent revisions. Should
Webber Brittany cancel the building permit, all unpaid plan review fees and cancellation fees remain
the responsibility of Webber Brittany, LLC.
Please direct all communications to:
Webber Brittany, LLC Webber contact information:
C/0 John Webber idw87C@columbia.edu
12155 SW Wildwood St. H 503 - 684 -5522
Portland, OR 97224
Signed on December 28, 2010 in Lake Oswego, Oregon:
�-� E ;� An i i �� ? ! Q -�/ ¢4'/'21 } Pol_plgs
'Suz.nne Maydahl 'f.
Keystone Dev�1o Inc.
John Webber, for
Webber Brittany, LLC
RECEIVED
IN a
e Community Development MAR - 9 ' "11
TIGARD Request for Permit Action CITY OF TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 0 City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 1_,D /L a EL (,ll l y
Mailing Address: / A t 55 `�,) L ` t Lb 5'.
City/State /Zip: A02TL.M},3'b 02. 9 7;P -
Phone No.: 503 (C ',' - 5 5.
• ,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( V 0 1 r,,, CANCEL PERMIT APPLICATION. � / /O /�� � /�
❑ REFUND PERMIT FEES (attach receipt, if available). 4`(-'
r INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 1 l 0J j ao to -0003 4 5b30- oho Io-bD037
Site Address or Parcel #: • 7 S (o .w 1.0 u f./L• .L3
Project Name: —e t 'ri )' / 0 E 4- bbL✓ a
Subdivision Name: --- 612%,-0-4,0y 7tA) o5 Lot #: ;N
EXPLANATION: fit) ter OcZtJ t.2 C LJat -t .( rreb D ( cc - Et f., X /4 6 F
P _ik(∎ . ' It HST aotl — ODOgO .
Signature: C
C Date: c5/11//
Print Name: L - t- 11 .)61.f._ ik-b /.l- H -k l
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR. OFFICE USE ONLY
Rte to S s Admin: Date g QTIMINQ P_ jail Rte to Bld. Admin: Date 3 B -1/M.11
Refund Processed: Date //GA B 4.1,M Invoice Processed: Date MN= B 4 4��
Permit Canceled: Date ,3 AWM B A 1►' Parcel Ta: Added: Date B
Receipt # Date Method Amount $
I:\ Building \Corms \RegPermitAction.doc Rev 07/26/07
ti A
V
B bilding Permit Application If 0 1 0 ip � "
commercial_ � 1 R OR M:FICI: USE ()N11 Y City of Ti and Received Permit Nn.:
ii • , -6CO3
• ° 13125 SW Hall lvd., Tigard, OR 97223 M j 7 201 ! Plan Re �r_, j 1.0 l
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: V Other Permi • , Z10,,OCIO
f I C. r\ It f) Inspection Line:
Ins 503.639.4175 -r r� E�D Date Read /D luris: See Page 2 for
g g
CM ` t �n„ t' t y y y /� /�Q l Supplemental Information
Internet: www.ti ard -or. ov 11 t 1 OF No tified/Met ho d:
� j (111_D1� �( DIVISION (��t/417
TYPE OF WOR REQUIRED DATA: I- AND 2- FAMILY DWELLING
ligi 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 inated on this application.
IZI I- and 2- family dwelling El Commercial/industrial Valuation. 2.2k ,046 I
El Accessory building ❑ Multi - family Number of bedrooms: 1
❑ Master builder ❑Other: Number of bathrooms: 2 �IGF
JOB SITE INFORMATION AND LOCATION Total number of floors: 9_
Job site address: iee5 6.w w o-A LAo- New dwelling area: SOP square feet
City /State /ZIP: -11 )r I DP ' 2z 3 Garage /carport area: q-0 square feet
Suite/bldg. /apt. no.: Project name: S P HOU S Covered porch area: Ic square feet i vZkis_
Cross street/directions to job site: ,jr-1',o - ¶-p NA) '191'14 Deck area: square feet s
11)--4 00 W hig- 1„At Other structure area: 24 (Z square feet '2' j
9 -4 4 P LO`r O0 t E' f REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: j R, t1J� M I Lo t .. • D1 )Existing mit fees* are based on the value of the work performed.
icate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: t� e uipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK (�(/ rk indicated on this application.
NEW C- `J11 -- 6F--- b � ;■ Y luation: S
C \ u 1 ° building area: square feet
i t' Av-- �I o � New building area: square feet
ig PROPERTY OWNER I 0 TENANT Number of stories:
Name: k -('$ TO i4 AA) k - I Type of construction:
Address: PC. 00 LL-1b Occupancy groups:
City /State /ZIP: W o l "7O t o(z_, q 1 p' Existing:
Phone: (5 ) (3 5 - s 9 5( Fax: ( 5b)) bq,'1 —114 1 New:
fit APPLICANT ❑ CONTACT PERSON NOTICE
Business name: F.43-YS(1)a., DJ 10 1� G All contractors and subcontractors are required to be
Contact name: J�C M5 M Pa►� k�� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: F.-/ s A fov jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply: ' l 1 9 `
Phone: ( ) Fax: : ( ) f»iT /`a u Z - 1 ` l.1 - - j (Qv
E -mail: ��2� - y�nC�
3 cosk', ;n — 1 (f'-E
CONTRACTOR
Business name: ' a- As. A f PLici6 BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: 711'55' 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: J� _ PO Date: �� (1 Q
Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)
Plumbing Permit Application � ;_-. ,_, „ V (D ` .
Building Fixtures .. FOR OFFICE USE, ONLY
City of Tigard MAR 18 2013 . PermitNo.:�.Si2dl0- 00(537
111 1 SW Hall Blvd., Tigard, OR 97223 Plan Review
' 0 Phone: 503.639.4171 Fax: 503.598.1960',` : -• • Other Permit No.:
I I G A R D Inspection Line: 503.639.4175 , s 9 1 • 1 • _r (r'
' t Date Ready/By: tuns: I ® See Page 2 for
hwemet: www.tigard-or.gov Ju ' .....,.. 1 :, `!(:: 1J : yiCI I r l , ; Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
a New construction ❑ Demolition For spedal information use checklist
Description I 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 312.70
'®.I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building Multi-family
SFR (3) bath I 50032 x,32_
❑ Multi -famil
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: 16...6 Catch basin or area drain 18.76
C) �t `; 1i; - j� �Pr�� Drywell, leach line, or trench drain 18.76
City/State/ZIP: 'f (E/j 0 0 011 o-�-
� Footing drain (no. linear ft: ) Page 2
Suite/bldgJapt. no.: I Project name: s py HCt> S Manufactured home utilities 50.03
Cross street/directions to job site: Do VIA- a- p T ¶N 1 ' - 00 SLO 1 MI Manholes 18.76
rn , 00 4uj � i Rain drain connector 18.76 _
119g. 1-4-4P O` 1 ) Sanitary sewer (no. linear ft : ) Page 2
1 `� Storm sewer (no. linear ft_: ) Page 2
Water service (no. linear ft.: _j Page 2
Subdivision: ?"12-6 IV�1� Y I Lot no.: -S Co Fixture or item:
Tax map /parcel no.: Back low preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�
✓ Clothes washer 25.02
OM CCOS �G'M -S10611- rAron I%( f ri iri Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
S'-' '- - W -
Fixture/sewer drain/floor sink/rdrsewercap 25.02
Name:
O i '� �� � �' Floor 25.02
Address: C' Garbage disposal 25.02
City/State/ZIP: L f} u• t- o 1 Ce--- Hose bib 25.
Phone: ( 3!) `_30 (7 c Fax: ( FP,)) & - 1141'% Ice maker 12.51
APPLICANT ❑ CONTACT g A � PERSON Interceptor /grease trap 25.02
Business name: { STC 4 p,� V p�Q lev ' 3 1 1 1 o
Medical gas (value: $ ) ! 2 ,
M MES �1 • 5 v1-, 12.51
Contact name: , Roof drain (commercial) 12.51
Address: AW t / Atbo% h- Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I F ax:: ( ) Tub/shower /shower pan 12.51
25.02
E-mail: fe*Az cc {M . Ae Urinal
y Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: p.0G1 l 1•el�6 1 1oC- [pC-}1 p4?M ) Water tin WV 56.29
PP €ID
Address: fl h ) t S t)-% �J`( � Other. 25.02
City /State/ZIP: Siv4 :02 1 cf.- 9,14b Subtotal 500.
Phone: (9 ) 69_5- - 152 Fax: (5b ) 625- l4-' - Minimum permit fee: $72.50
CCB Lic.: Lt(o 0 Plumbing Lic. no.: -2&.6 Pe' Plan review (25Y °of permit fee)
State surcharge (12% of perm it fee) 6-Q 0 �
Authorized signature: . --., . = •r• .---. / TOTAL PERMIT FEE 5 ,'!
This permit application expires if a permit is not obtained within 180 days
Print name: n V� Date: \1 t O after It has been accepted as complete.
P 1 6 -1 - 1 Fe: M t_ `Fee methodology set by Tri- County Building Indusvy Service Board.
l: lauildingWamitstPLMU- PermitApp.doe 10101/09 • .40- 1616T(1W02/COM/W®)
Electrical Permit Applicatio ro lz o r r i c E ( ! ' l . : ONLY
1114 • City of Tigard ®I 'IkEill.IIMIM Pemtit No.: 126 • • GO0 ,
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Outer Pumit:
-r i i n 1: 1> Inspection Line: 503.639.4175 Date Ready/By: Loris: ® See Page 2 for
Internet www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Cg-New construction ❑ Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2-family g ❑ Co mmercial/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" "I -3 ",
Job no.: *" 36 I Job site address: '1b& 5 ) k Pf- LA E 100HP or more. ° aney.
N� A ( a ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
ty I�� 1 1 �, 223 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: .see L \-\ otIce. ❑ Service or feeder 600 amps or more.
job site: �N ,'rA u^ M R 1-rUp FEE SCHEDULE
Cross street/directions to
� � yA � � t» I Oh. I Fee. I Total I
we 01 SU,I "(q�( New residential single- or multi - family dwelling unit.
- ry NO 6 ' 4 u 0 Includes attached garage.
Subdivision: 139-( N 1 PA Vo11I5 Lot no.: t o 1,000 sq. ft. or less ( 168.54 I (cg.6
Ea. add'I 500 sq. ft. or portion " 33.92 tL1( Z (0 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) i 67.84 a g A, 2
Limited energy, multi - family
67.84 2
N Pv3 ec 1 T & C7 r `0 N -- Si t4C 1 p A m (Ly' ra n I [ Ncf /, residential (with above sq. R)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ri PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: ! s" oR e/ uitirj'
401 amps to 1,000 D 200.34 2
601 amps to 1,000 amps 301.04 2
Address: too 1301- 41(17 Over 1,000 amps or volts 552.26 2
City/State/ZIP: LA K ps ln1 p op- C r( DM' relocation
services or feeders installation, alteration, and/or
Phone: (93 ) Fax: ( tom, 200 amps or less 59.36 1
� 3 H -4-736 qtr 3 > 6 �� ~ �,� I 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
'APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: y � I N B. Fee for branch circuits without
F"`� S�N� � �1- � M�' 1 ' I�' service or feeder fee, first 56.18 2
Contact name: ` P AlaS iN/ • Povisr- branch circuit
Each add'I branch circuit 7.42 _ 2
Address: l Me, As jGV_ Miscellaneous (service or feeder not included) ,
Each manufactured or modular
67.84 2
City / State/ZIP: i dwelling service and/or feeder
Phone: ( ) Fax:: ( )
Reconnect only 67.84 2
` t � g a s - t N Pump or irrigation circle 67.84 2
E -mail: J 0 2 C
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: U �1 I.Q �G � � panel, alteration, or extension. Page 2 2
Y Each additional inspection over allowable in any of the above
Address: • 2_- -1, 50 G .) IS Th Ave_. 5v I'i 10th Additional inspection (I hr min) 66.25/ hr
1 i Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: t O i Lad N V i (,Le ( 91 6 1 0 Industrial plant (1 hr mm) 78.18/ hr
Phone: (5)' ) E3 — 9 (p Fax: (51: re>2.-e,4-84-- Insp ections for which no fee is 90 / hr
I specifically listed (%a hr min) ' CCB Lic.: / gg1 .3 l ct II iical Lic.: _ , rv. Lic.: 3051 S ELECTRICAL PERMIT FEES
Subtotal: 33, 1 4
Suprv. Electrician signature, requi d: L / a t, _ . lti I I Plan review (25% of permit fee):
r --
Print name: f 2.I- 1ti I lige Date: 3.... State surcharge (12 %of permit fee): AC) t 58
Authorized signature: TOTAL PERMIT FEE: ..3 7,3, 1 - I . a This permit application expires if a permit is not obtained within 180
Print name: JAIL �S ' ea , • I Date: 3 i ('n l ro days after it bas been accepted as complete.
• Number of inspections allowed per permit.
1: tBuilding \PermitsNEI.C- PermitApp.doc 10/01/09 440- 4615TO t/OSMCOM/WEB
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.: •, L , o • .: 7
:� ° 13125 SW Hall Blvd., Tigard, OR 97 ® ,i Plan Review WV
Phone: 503.639.4171 Fax: 503.598. 0 DateBy: Other Permit:
T I Ci A R u Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
8 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*
-I- and 2- family dwelling ❑ Commercial /industrial ❑ 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: 7/%75 sw LJ je-f- LANe- (requires site plan showing placement) 46.75 ��J�""
City /State /ZIP: "tr I 0 2. Furnace 100,000 BTU (ducts/vents) i 46.75 -75 7S
( �, 2 2Furnace Fumace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: l S ViOUSt Heat pump 61.06
Cross street/directions to job site: BONI TA r.a01.() t "TV p,r1 01J Su.1 1C1 Duct work 23.32
Hydronic hot water system 23.32
1 10 4j of SW t8 LANi; Residential boiler (radiator or
214D L01 L.-rT hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
dR- 1T'ANY L no.: 3 (o Flue /vent for any of above 23.32
Subdivision:
MS Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater I 23.32 - 2.5 :2-
, Gas fireplace I 33.39 - 33:31
N °wo co Hsi c. - 5t1�[."''/ 1 -- 1( L`{ 12ES if r-v- 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
I - PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 23.32
Other: 23.32
Name: S1-°N 5- I w � p3 () - Environmental exhaust and ventilation
�-' � fi0 Range hood/other kitchen
Address: Pc3 CO!,( 4 equipment i 33.39 3
City /State /ZIP: Ll'Ikell OS WV k ('AL Clothes dryer exhaust , 33.39 3.'
Single -duct exhaust (bathrooms,
Phone: ( ) ( - -13cc Fax: (50-3) (e �A -lit toilet compartments, utility rooms) 23.32 114 ,Lb
tg APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
'- 5 -1+�i - E' +, LD PI NG Fuel 23.32
Business name:
t � Fuel piping
Contact name: jAPV-S M • P ' A$_- $14.15 for first four; 54.03 for each additional
Address: S-t�� Q S Gas h ea t etc. �4 , I'S
heat pump
mp
City /State /ZIP: 1 Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
it Fireplace
E -mail: iP'43 L 01Vte bSi %n et Range I
CONTRACTOR Barbecue
Business name: '�..1 - (, �1� mop c_014-112_01.,_ Clothes dryer (gas)
Other:
Address: I3i S CLAc -1 S 12xV MECHANICAL PERMIT FEES*
City /State /ZIP: 0 9.e..6 - ' 09- ell 6,15 Subtotal 3a,`
Phone: ( ra 55i _ en.2 I Fax: (> ) 551, C I % Minimum permit fee ($90.00)
�` Plan review (25% of permit fee)
CCB tic.: 12.69...- /1� I o b Irk State surcharge (12% of permit fee) , I Z
TOTAL PERMIT FEE j t I i
Authorized signature: This permit application expires if a permit is not obtained wit in Igo
( days after it has been accepted as complete.
Print name: .j . 'QL±(, 3
Date: '(1110 . • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440-4617T (11 /02/COM/WEB)
•
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: \BuildingWermits\MEC- PermitApp.doc 10/01/09 2
BM36 4..
7865 SW Webber Lane •
MST2010 -0037 RECEIVED
KEYSTONE
DEVELOPMENT NOV 12 2010
CITY OF TIGARD
BUILDING DIVISION
November 8th, 2010
City of Tigard
Community Development
Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Debbie Adamski
Senior Building Dept. Technician
RE: MST2010 -0037
7865 SW Webber Lane
Permit plans have been approved earlier this year, regarding MST2010-0037. I had to put off starting
this house because I travelled to Seattle in June to obtain a bone marrow transplant. I have an
aggressive form of leukemia called CMML. I spent over 4 months @ the Seattle Cancer Care Alliance. I
returned home October 23rd. I was hoping to take up homebuilding again. However, I still suffer from
the aftermath of high dose chemotherapy. It will take at least 6 months to recover enough to "get back
to normal ". Therefore, I am requesting a 6 month extension hopefully starting this house in the Spring
of 2011.
Thank you for your consideration.
Sincerely,
M. Polak sG(1
President 9
l t
\ 15
Design & Construction / P.O. Box 476 Lake Oswego, Oregon 97034 / (503) 635 -4736
I.
° Building Division
Accessibility: Barrier Removal Improvement Plan
TIGAI&D
•
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty -five per -cent (25 %). •
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
•
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: • $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
•
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
• alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08
II 111
172.00' 171.00' 170.00' k'. AA i L '. :9 `' 1 •
/ �' I1M f RECEIVES Sk
/ / / I 169.00'
/ / / }/ MAR 2 3 2010 MARK STEWART
- �� /S88 ° 56 ' 1eE / ♦., HOM DESIGN
4 r ..... • : _ NO - - 3 -a 0 r — — — ° %�� CITY OF TIGARD •
v / BUILDING DIVISIC N
/■ I / /- 168 .00' _ •
, , � /. /1 CP VOID
: • .
. . . . . . ...... . • ____, I / / I 22582 S.W. MAIN ST. /
/ ./ CV Sherwood. Oregon 97140
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J I /. , `' , .. (503) 579.4132 F /
— _ / e ' �� / www.morkstewort.com
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5' CITY I >'
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SIDEWALK I I �-A \ I j .� , 1
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✓ - Builder Marketing
J(" 3 STORM
= 1 ■ I �� j • ... I DRAIN Interior Design • • r / I a - Since 1982
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— — �.._ — — c t and
� • — by ark Stewart York
5' CITY • A SANITAR Y Stewart & Associates Inc. 4We WATER
SIDEWALK / 1 I AT �' D ?. ; 1 I r �- METER Important Disclosure •
4 d
Please Read:
2" Caliper \ •
'.�1 I �. The Wons you now aae.a..d we
Trident I fer tn. aon.tnntlm l OK hen. only.
Maple St Tree and nomin... pI te
I I woe without the walen event hen
e.. designer York Stewart. Ina. pion.
POWER we copyrighted and It Y ur
a .ttle.
SW WEBBER LANE I CATV �:� � SWOP,
erst a to
I PHONE " tmly po .ert. ANY violation of d.
I I PEPS copyrighted design. and Won.
furthermore It ts understood that It Y
COMPLETELY ln. construct the n of the 1 1 contractor to a 'expansibility U. nom.
.1— _ —__�_ __ _-- ___ — — __ d.svli.d herein. f any f particular
the larske
d dlnln In. e . e f ln. 'Mt " '
)eesN NO r on
Lark Stwerl o dt h a a ekta
lake NO r t .Epity 1w N. My bind% motormen.
I of this plan to My co. v My WIArp
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°'`p"KEYSTONE
DEVELOPMENT
pug i BRITTANY MEADOWS
LOT #36 BRITTANY i MEADOWS NORTH nrAsaMS 4 -15 -2010
GRAM Br. J.G.
SCALE: 1 "= 8'— 0 " PAGE MAP
• I •
i s ..:. --:. .0 K.._:
■
CITY OF TIGARD - SITE PL4 'REVIEW
BUILDING PERMI• NO.: Mr,]►,( jfjugellf-
PLANNING DIVISION:
Required Setb�eks: aApprovedD
Side: S 0 Not Approved
Street Side: A
Front. 9efrage: . l5 �
Rear:
V ;stagy' Clearance: 0, ,s proved ❑ Not App roved
• %I.xlt :'.in Building Height•. fee;
w: Service Provider Letter'Required: ❑ Yes 0 No
,0
r
I Z17i r Received
• i N
GINEERING EPARTMETDate: 3/a3�1L�
Actual Iope:a_ % ' Approved ❑ Not A' proved
Site Fla 3 Approved
B ❑ of , •-pproved
A' -Date: (�J
Notes: i I • ,
•
I
CITY OF TIGARD • SITE PLAN RtV3EW
BUILDING RERMIT'NO:
Street Trees: Approved CI . Not Approved .
Protected Tree Approved N Approved
BY:. Pl , .r Date: 111 IO
.. /
Notes:
1
•
1