Permit 1 y a CITY OF TIGARD MASTER PERMIT
11 1 COMMUNITY DEVELOPMENT Permit #: MST2009 -00170
T [GA R17 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/11/2009
Parcel: 2S102CD05100
Jurisdiction: Tigard
Site address: 13979 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 1
Project: Fletcher Woods
Project Description: New SFR.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1207 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1385 sf Garage: 722 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $295,130.97 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =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' 500 sf: 5 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 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: PHONE: 503 - 387 -7577
FAX: 503 - 387 -7615
Total Fees: $17,005.89
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 - • • - - with approved plans. This permit will expire if work is not started within 180 days of issuance, or it work is suspended for more the 180
days. • ENTION: Ore• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0i -0010 through OAR 9 2 -0• -r 00. • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
/ •
Issue •
=y: - L Permittee Signature:
Building Permit Application
ReSIdeIItlal RECF Fl)R (H I R I I ‘,1 ()NI l
Re ceiv
City Q� .y 1
11,1 `J Of Tigard g DateB p��� _ ) PemiltNo.: �re� � � _ v
13125 SW Hall Blvd., Tigard, OR 97223 AUG 1 4 2009 Plan Review r Iff
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: 619 War 117 OtherPennit: ?r
Inspection Line: 503.639.4175 r Date Ready/By:
T I G A R D / J J V1 See Page 2 for
Internet: www.tigard- or.gov CITY OF T GARD Notified/Metho : /LUp l Supplemental Information
rh
TYPE OF WORK 74 REQUIRED DitrA. : 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
' n: CATEGORY OF CONSTRUCTION work indicated on this application.21 � - 33
- ; '' �
® -and 2- family dwelling 0 Commercial/industrial Valuation: S�n .6 OD
El Accessory building ❑ Multi - family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 3,
o , t tuts an ,It b fsper " Total number of floors: 2
,....:
Job site address: 1 51AI 1 1 � 7 A jE . New dwelling area: 2,59 Z square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: 7 Z Z square feet
Suite/bldg. /apt. no.: I Project name: Fletcher Woods Covered porch area: T square feet
Cross street/directions to job site: SW 95 Avenue & SW McDonald Street Deck area: 3 e square feet
Other structure area: QS square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
'
Subdivision: Fletcher Woods I Lot no.: ' 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.
Valuation: $
Existing building area: square feet
New building area: square feet
i #. ❑ PROPERTY OWNER [� TENANT Number of stories:
Name: Stone Bridge Homes 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:
8
1 F
� ,�t' eA � il/Vti rtt: � a `` 4 � °' i .' ' f' ® ^. s ` 4 •'_ ,x g'vz', c� x -ap ., ,q� - -�
ri - .,�,5, s '�tia� -_r. .,« ..�.�.». {k`r a. >�.:�`�`'""
Business name: Stone Bridge Homes All contractors and subcontractors are required to be
Contact name: Gayland Forsberg licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16869 SW 65th 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 J Fax: : (503) 387 -7615
E -mail: gayland@stonebridgehomesnw.com
Business name: SEE ABOVE
Address:
Structural plan review fee (or deposit):
City/State/ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: 173318 Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Gayland Forsbe Date:
Ga t g � within 180 days after it. has been accepted as complete.
y (JI� z /0C1 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Petmits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02 /COM/WEB)
,..Electrical Permit Application FOR OFFICE USE ONLY •
Received /l �7
City of Tigard
Date/By:
� Q9 Permit No.:.11.9r9.04:711-00/ ! e)
1111 Y
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit: aev261A'j �Q('� Al
TIGARD Inspection Line: 503.639.4175 Date Ready/By: inns E1 See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
® New construction ❑ Addition /alteration /replacement
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 ❑ 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 ", "I -2 ", "1 -3 ",
Job no.: , Q Job site address: Q 1 A - ,�, 1 SixHP or more. occupancy.
�, (J 1501-19 1� 1' 4,64.IE , ❑ix 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: Fletcher Woods ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW 95TH Avenue & SW McDonald Street Description I Qty. I Fee. 1 TOW 1
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Fletcher Woods Lot no.: l 1,000 sq. ft. or less 1 145.15 (ij,j• 4
Ea. add'1 500 sq. fl. or portion 5 33.40 1 1`7 - 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) ' 75.00 2
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: Stone Bridge Home 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 16869 SW 65th Ave. #505 Over 1,000 amps or volts 454.65 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 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
® • APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: SEE ABOVE B. Fee for branch circuits
Contact name: Gayland Forsberg without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
' dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: gayland @stonebridgehomesnw.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: City Electric Signal circuit(s) or limited -
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
Phone: (971) 404 -1714 Fax: (503) 625 -3052 Per inspection 62.50
Investigation per hour (1 hr min) 62.50
CCB Lic.: 42422 Electrical Lic.: 26 -289C Suprv. Lic.: 35925 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 3k , t'---,
Print name: Chuck Friesen Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 3 -, 4- V
Authorized signature: ..,,, - ''''2..........D TOTAL PERMIT FEE: '-3 49 , 6 1
Print name: Date. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed p� �� e
I:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(I1/05/COM /WEB `L/ LL2 � 1 � —
Mechanical Permit Application FOR OFFICE USE ONLY
-
Received �/ hQ
City of Tigard Date/By: / 7 v / Permit No.: UL/n /y�G
111
" 1 3125 SW Hall Blvd., Tigard, OR 97223 y" rL7 7 �! 7v
Plan Review ( e . n ���
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: /(r/ �� X� p
Inspection Line: 503.639.4175 Date /
TIGARD p 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
® 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. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: , 3q�a CJ q 15 �v (requires site plan showing placement) 1 14.00 1k
City /State /ZIP: Tigard, OR 97223 1 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) , 17.90 ■ 7,cp
Suite/bldg. /apt. no.: Project name: Fletcher Woods Gas heat pump 14.00
Cross street/directions to job site: SW 95TH Avenue & SW McDonald Street 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: Fletcher Woods Lot no.: I Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF, WORK Water heater 10.00 (0"
Gas fireplace 1 10.00 10
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
® PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: Stone Bridge Homes Environmental exhaust and ventilation
Address: 16869 SW 65th Ave. #505 Range hood /other kitchen
equipment 10.00 ( °— City /State /ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust I 10.00 (e
Fax: 503 387 -7615 Single -duct exhaust (bathrooms,
(503)387-7577 ( ) toilet compartments, utility rooms) -
Phone: 6.80 2
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Stone Bridge Homes Fuel t to
n g
Contact name: Gayland Forsberg $5.40 for first four; $1.00 for each additional
Address: 16869 SW 65th Ave. #505 Furnace, etc. 6, L‘D
Gas heat pump
City /State /ZIP: Lake Oswego, OR 97035 Wall /suspended /unit heater
Phone: (503) 387 -7577 Fax: : (503) 387 -7615 Water heater 1
Fireplace
E - mail: gayland @stonebridgehomesnw.com 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 k tA,P5e.5
Phone: (503) 667 - 5595 Fax: (503) 491 - 8252 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 110091 State surcharge (12% of permit fee) 12, 1
� TOTAL PERMIT FEE I I 1 7
Authorized Signature: T his permit application expires if a permit is not obtained within 180
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 \MEC- PermitApp. doe 01/19/07 440 -4617T (I I /02 /COM /WEB)
, , Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
- City of Tigard Received
Date/By: �"`�
V / D 9 Permit No. sr,�r ! 70
n 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review J�
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit N 2 3 �O p'
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris. 63 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. 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 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 -aer
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
m? JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 5 q GV� �Slii g . Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97223 v } Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Fletcher Woods Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW 95TH Avenue & SW McDonald Street
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Fletcher Woods I Lot no.: ( Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Stone Bridge Homes Expansion tank 16.60
Address: 16869 SW 65th Ave. #505 Fixture/sewer cap 16.60
City/State/ZIP: Lake Oswego, OR 97035 Floor drain /floor sink/hub 16.60
Phone: (503)387 -7577 Fax: (503)387 -7615 Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: SEE ABOVE
Interceptor /grease trap 16.60
Contact name: Gayland Forsberg Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: gayland ®stonebridgehomesnw.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Legacy Plumbing Water heater 16.60
Address: 8985 Hazelwern Way Other:
City/State/ZIP: Portland, OR 97223 Subtotal 39 -
Minimum permit fee: $72.50
Phone: (503) 816 -8887 Fax: (503) 297 -4587 Residential backflow minimum permit fee: $36.25
CCB Lic.: 159281 Plumbing Lic. no.: 26 -517PB Plan review (25% of permit fee)
Authorized si nature: -y�� State surcharge (12% of permit fee) , r
g // �, .--.-----_ TOTAL PERMIT FEE A/A, , :.
Print name: Matt Nelson Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits \PLMF- PennitApp.doc 12 /27/06 440- 4616T(lo /02/COM/WEB)
PWU ENGINEERING INC.
Email: pwuengineerincacomcast.net
Ph /fax: (503) 941 -9221
Lateral Structural Calculations:
Job #: DM9026
SBH Job #: 1378 -132
Date: 08/09/09 ALIA 1 1
Project: Lot 1, Fletcher Woods, Tigard, OR
Stonebridge Homes
c:D
(cc
IMO
22 \
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I P \1
Expires: 06/30/2010
The following calculations are for lateral wind and seismic engineering only. Gravity loading and the design of foundations
are outside the scope of this design. The design is based on information provided by the client who is solely responsible
for its accuracy. The engineering represents the finished product. Discrepancies from information provided by the client
invalidate this design. PWU Engineering shall have no liability (expressed, or implied), with respect to the means and
methods of construction workmanship or materials.
PWU Engineering Inc. shall have no obligation of liability, whether arising in contract (including warranty), Tort (including
active, passive, or imputed negligence) or otherwise, for loss or use, revenue or profit, or for any other incidental or
consequential damage.
,
_
• Building Division
One & Two - Family Dwelling
T I G A R D Fees Checklist
PERMIT INFORMATION: -, ,
Permit #: �J .. — QC t 7 Plan #: Date: 4 . .
Site Address: - t 3 7 j q - 4-,- Parcel #:
Subdivision: Lot #: Zoning:
Jurisdiction: Setbacks: Front: Rear: Left Right:
Class of Work: Stories: First Floor:, ( -LI `-
Type of Use: Height: 2..1, Second Floor: r ?-,F3
Construction: Floor Load: Third Floor:
Occupancy Group: Dwelling Units: Bonus Room:
Valuation: '2 (50; edrooms: Total Floors: '2-5:1Z d'
Bathrooms: .3 Basement:
Decks: Garage: 724
Porches: ( 5 Other:
FE Description: Fee'Amount: AmtGutrt :Bce.
Plan Check: Building:
Extra Set:
Permit: Building: t/
Tax: t....---
Metro CET: b/'
School CET: //
Mechanical t -
Tax: t/
Plumbing: ✓
Tax: 1/
Electrical: L./-
Tax: i/
Low Voltage: ✓
Tax: tr
CDC: CDC Ping. Rev.:t/
CDC LRP Fee: t/
SDC: Parks: i...--
TIF Res.:
TIF MT: lijT
Erosion Permit: I./
Erosion CWS: T/"
Erosion COT: �../...
Water Quality:
Water Quantity:
SUB - TOTAL:
Sewer: Permit
Inspection:
SUB- TOTAL:
TOTAL MST & SWR:
I:\ Building \Forms \ResPlanCheckFees.doc 01/19/07 Page 1
PLUMBING FEES (for special information use checklist) MECHANICAL FEES (residential equipment/systems) '
_ Description I Qty. I Fee(ea.) I Total Description Qty 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 - 1' 100' 55.00 Water heater 10.00
Gas fireplace 10.00
Footing drain - each additional 100' 46.40 Flue vent (water heater /gas fireplace) 10.00
Manufactured home utilities 110.00 Log lighter (gas) 10.00
Manholes 16.60 Wood/Pellet stove 10.00
Rain drain connector 16.60 -
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
Water service 1S 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
Dishwasher 16.60 Fuel Piping
Drinking fountain 16.60 **($5.40 for first 4, $1.00 each additional)
Furnace, etc. * *
Ejectors /sump 16.60 Gas heat pump **
Expansion tank 16.60 Wall /suspended /unit 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'] 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
r C e Lan
Et"
U nlimite d `
ARBORIST REPORT
Subject: Tree Protection Inspection
Address of the Report: 13979 SW 95 Ave.
Tigard, Oregon
Date of the Report: September 2, 2009
Report Submitted To: Jim Delmore
Stone Bridge Homes NW, LLC
16869 SW 65 Ave., #505
Lake Oswego, OR 97035
iimdC venturearoo.com
Albert Shields
City of Tigard
Permit Coordinator
albertt tgard- or.gov
Todd Prager
City of Tigard
todd aAtigard- or.gov
Current Inspection
This is the first Tree Protection Inspection for this site. The building perimeter has been staked. No other
activity was taking place at the time of this inspection. Two inspections per month will occur for the duration
of work on this site.
• Tree protection fencing is in place as shown in the Tree Protection Plan for this site.
• Fenced tree protection areas are free from material storage, waste material and equipment.
• All tree protection measures as stated in the plan for this site appear to be in place and being
maintained.
• All protected trees appear to be in good health at this time.
Sincerely,
•
011.• I
Kay Kinyon
Tree Care & Landscapes Unlimited, Inc.
Certified Arborist by the International
Society of Arboriculture, #PN -0409
Residential and Commercial Spraying •Fertilizing•Pruning•Landscape Installation•Landscape Maintenance•Consultation
MEMBER: Tree Care Industry Association•International Society of Arboriculture•Oregon Landscape Contractors Assoc.
State Licensed Tree Service #62635•Landscape Contractor #5659•Chemical Application @000231•Insured
P.O. Box 1566•Lake Oswego, OR 97035•503- 635- 3165•Vancouver 360 - 737- 2646•Fax 503 -635 -1549
Visit our website at www.tclu.com•E -mail: info @tclu.com
f ,.� RECEIVED ED
w v ii EP 06 2009
STONE • RIDGE
so E� i w ><_t. OFTIGARD MT: 1 BATE: �j3,�tl
ar i $ W 11 0 0 O a S $ Ai 15 �� BUILDING DIVISION p g p : FLETCHER —FOODS
(e►oa)a Er? — .�a '7-7 CITY: TICAED
r,'•s L.7. SCALE: 1-,2•-20'
t
FLAN No.: 132
3 CAR GARAGE
ao' -cs •
PP: 760 1 1 6 th I
iT I • EL •74E.` .Al..
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9
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MI
r " 944
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ssa �� 1 • 6344TREET OT I�h ft p R L ON D
LOT NG 4 J
PEI - RTAGE= 32
0 MITIGATION SGHEouLE
—91 mt, f 3ts8
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ALL tK2.42 E Ar.lt7 7F'Rtt LINES : E :}Ttt Altfi € r grallifFEW LochtIONS.
ALL Dt1ENSIORS MD %UWE FOOTAGE ARE APPIROVE1ATE FIGURE&
: RETAINING W.�LL FlEIG --rra AND LOCATIONS ARE EVTRTATES. LOT +'1
t �
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i ,�t Ph uE To Loc 7 T{� 11tiLlt 50',---6, 8,503 ark. f ..
!_tray tts. , 0 WE ca4prrIMS
C W . .Rd' m Ir l -cyy
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: ► - 1 hro't zpo4—vo 00
PLANNING DIVISION:
Required Setbacks: ❑ Approve ❑ Not Approved
Side: 5 _ Street Side: 11
R Front. z Garage: Rear: t<
Visual Clearance: ❑ Approved ❑ Not Approved
` " Maximum Building Height . feet
('WS Service Provider Letter Required: ❑ Yes ❑ No
/ 0 Received
13% W t Dai bate: `f f4f a
' E EPAK i iviENT:
Actual Slope:% L ' pp roved ❑ Not Approved
Site Plap: Approved ❑ Not Approved
. By: ,�y x .74 Date: 9-49-5*
Notes: c .. 't e ki.4/44/►e4.4.4ru o - r,�1
CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO:
Street Trees:
Protected T e : pproved ❑ Not A
� � proved ❑ N ot Approved
B : lD6 r Approved
Approved
Notes: Date: 9 0 U Y
Nt 9/4v,.( Cr ' 7. - e
•
1
City Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
II
Wednesday, December 16, 2009 "
'PI G A it D
Stone Bridge Homes, NW <=.,;:
16869 SW 65th Ave., # 505
Lake Oswego, OR 97035
RE Transportation Development Tax (TDT) Refund.
Permit No. MST2009 -00170 for 13979 SW 95th Ave., Fletcher Woods.
At the time the above building permit was issued you paid a Transportation Development
Tax (11)1) fee of $4,599.00.
Effective December 1, 2009, Washington County approved a Temporary Discount on TDT
charges and has made that discount retroactive to July 1, 2009.
The enclosed check represents a refund to you of the difference between your original TDT
payment for your project and the new Temporary Discount charge. The amount of the
credit refund is $920.00.
Please call at 503 - 718 -2426 if you have any questions.
III i--g-V ------------------
Albert Shields
Permits /Projects Coordinator
503- 718 -2426
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
Ph .3
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Stone Bridge Homes DATE: 12/10/09
16869 SW 65`' Ave., #505
Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse
AMS
TRANSACTION INFORMATION:
Receipt #: 175187 Case #: MST2009 -00170
Date: 09/11/09 Address /Parcel: 13979 SW 95th Ave.
Pay Method: Check Project Name: Fletcher Woods
EXPLANATION: Refund amount discounted for TDT per Washington County. • REFLJNDJNFORMATIONs. :.:.• ; E . .. .... .
Fe e'`-Descrip'tion From= R eceipt Revenue Account N ,.
x 1 .. •245= 0000 = 43 : *• Mnountt:
�E itaripl `er;; Pei-irit ee, ,,',:l.
. . :jE ,amp e� , . . $.... ..... ..
TDT - Transportation Development Tax 4050000 -43320 $920.00
TOTAL REFUND: $920.00
APPROVALS:
If under $S,pO ' Professional Staff u�� ,, ` ,
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
..,: . : :s._'; ,, v",.- FOR=ACCELA SYSTEM ADMINISTRATION USE ONLY-: ;'• .:;". ">
Refund Request Reviewed: Date: . .,.' r;./f ``f` By: „..:;,.
Case Refund Processed: Date: . .'gp r ii . t;,; By: 4
C6'G .. /002 I F Y
I: \Building \Refunds \RefundRequest.doc 04/13/09
CITY OF TIGARD RECEIPT
E _ . 111 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
.'�
Receipt Number: 176345 - 12/18/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2009 - 00170 $ 920.00
Total: $- 920.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 102189 DHOWSE 12/18/2009 $- 920.00
Payor: Stone Bridge Homes NW LLC
Total Payments: $ - 920.00
Balance Due: $920.00
•
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Page 1 of 1
• • v - au ^• xs
= 'L CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
:1 ;; 503.639.4171
' 1 A RO,
Receipt Number: 175187 - 09/11/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2009 - 00170 Building Permit 2300000 -43104 $1,636.16
MST2009 -00170 12% State Surcharge - Plumbing 1003100 -24001 $47.88
MST2009 -00170 Plan Review 2300000 -43106 $73.18
MST2009 -00170 CDC Plan Review, RES 1003100 -43112 $46.00 •
MST2009 -00170 CDC Plan Review, RES - LRP 1003100 -43117 $6.00
MST2009 -00170 12% State Surcharge - Building 1003100 -24001 $196.34
MST2009 -00170 Metro Const. Excise Tax - Residential 2300000 -24011 $354.16
Use
MST2009 -00170 Tig -Tual School CET - Residential 2300000 -24102 $2,592.00
MST2009 -00170 Park - Single Family Unit 4250000 -43300 $5,370.00
- MST2009 -00170 TDT - Transportation Development Tax 4050000 -43320 $4,599.00 ' '-
MST2009 -00170 Erosion Control 1003100 -22002 $88.00
MST2009 -00170 Erosion Plan Review CWS 1003100 -22003 $28.60
MST2009 -00170 Erosion Plan Review COT 2300000 -43102 $28.60
MST2009 -00170 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $312.15
MST2009 -00170 Limited Energy 2200000 -43103 $75.00
MST2009 -00170 12% State Surcharge - Electrical 1003100 -24001 $46.46
MST2009 -00170 Air Conditioning or Heat Pump 2300000 -43102 $14.00
MST2009,00170 Furnaces >= 100K BTU 2300000 -43102 $17.90
MST2009 -00170 Water Heater 2300000 -43102 $10.00
MST2009 -00170 Gas Fireplace 2300000 -43102 $10.00
MST2009 -00170 Range Hood /Other Kitchen 2300000 -43102 • $10.00
MST2009 -00170 Clothes Dryer Exhaust 2300000 -43102 $10.00
MST2009 -00170 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $27.20
Utility Rooms)
MST2009 -00170 Fuel Piping 2300000 -43102 $5.40
MST2009 -00170 12% State Surcharge - Mechanical 1003100 -24001 $12.54
MST2009 - 00170 SFR - Baths 2300000 -43101 $399.00
MST2009 -00170 Plan Review 2300000 -43106 $240.32
Total: $16,255.89
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 30445 DADAMSKI 09/11/2009 $16,255.89
Payor:
Total Payments: $16,255.89
Balance Due: $0.00
• Page 1 of 1
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