Permit 0
TIGARD
City of Tigard
October 11, 2012
Stone Bridge Homes NW LLC
16869 SW 65 Ave., #505
Lake Oswego, OR 97035
Re: Permit No. MST2012 -00195
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15425 SW Summerview Dr.
Project Name: Arlington Heights No. 3, Lot 99
Job No.: N/A
Refund Method: ® Check #208042 in the amount of $523.00.
❑ Credit card "return" receipt in the amount of $
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as new building plans were submitted under
permit MST2012- 00257. Refund 80% of plan review deposit.
Note: The above referenced check is for a total amount of $1,569.00 for refunds processed
for this permit and two other permits under separate cover letter.
If you have any questions please contact me at 503.718.2430.
Sincerely,
- ?r/0 4> e
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Cr ill
a Request Permit Action
r I (,\ it r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD
. Building Division Services Supervisor VO i D
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: El Owner ❑ Applicant ❑ Contractor 121 City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) C -b i ,32_ —) et ba 4,f, KE S 14.3
Mailing Address: 4 230 l0,9 LE- LADDOb ' I ` - 4t 10 0
City /State /Zip: LA4-\..E. O`ac )€-c) 02- 970 3 S
Phone No.: '5O) - Zjg 7577
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: M `J1r l a• -CDC) ! 9 5 `v ti,) 2 9,619.- 00 r' 70
Site Address or Parcel #: 1 5L-I a S 51..E 4 a.u_t-t M f 2 3 I Ct v 1(
Project Name: R 2-1-10 0o'O n) ( C°o ff TS /b '5 � Lo 1i Q 9
Subdivision Name: Lot #:
E XPLANATION: A pp L . l C/3 K -r-- „u 6 tt / r£ 1 FFM f ,J r 1 4- e-Nu-S €-
l__P.r -f.... f- tl ` go t% —CO ; ? . .t..3 01 Ro 1 9..- 60 9-0 (.0
Signature: -0 -k..( Date: (d I Li , '-
Print Name: t)t #,g, €.. Q. AID m-r--1 sk,
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 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Adnun: Date (a 4 + ?- By 1 - ' Rte to Bldg Admin: Date /0/4 /.. By -.
Refund Processed: Date f. /// //L By .. Invoice Processed: Date By
Permit Canceled: Date /g // / //L By 4,:f- Parcel Tag Added: Date By
Receipt # Date Method Amount $
I: \ Building \Forms \RegPermitAction.doc Rev 05/25/2012
City of Tigard
TiGAitti Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request fir PeriiritAction form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Stone Bridge Homes DATE: 10/4/2012
16869 SW 65' Ave., #505
a�l:e Oswego, o 5 RE@UESTED - BY . — i. s
Debbie
TRANSACTION INFORMATION:
Receipt #: 187751 Case #: MST2012 -00195
Date: 7/30/2012 Address /Parcel: 15425 SV' Summerview Dr.
Pay Method: Check Project Name: Arlington Heights No. 3, Lot 99
EXPLANATION: Per applicant's request as new plans were submitted under \.IST2012- 00257. Refund
S0% of plan review deposit.
REFUND INFORALA.TIOht•
Fee Description From Receipt Revenue Account No Refund' •
E1 unple: Building Periiiit Fee ' = Esainple: 2300000 - 43104 $Amount
Plan Review 230- 0000 - 43106 $523.00
TOTAL REFUND: S523.00
APPROVALS:
If under $5,000 Professional Staff
IF under S12,500 Division Manager
If under $25,500 Department Manager �1 -� t
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
... - .. = = .FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: /I /j// /y By: ��
I:\ Buildin \Refunds \RefindRc.uest.dnc IY) /o1 /21)10
97,-:.") Building Permit Application X1 , , ,; / 6 it ion __
, h c. 1 :- ee i 4 FOR OFFICE USE ONLY
A ,�< "-T . J W,
Rece
City of Tigard sy Dat ?� /, Permit No./137: — 0/95- ° 13125 SW Hall Blvd., Tigard, OR 97223 I' I 3 0 2012 y
J U L Plan Revie
= : -f �r
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Permit
y: 1'O /ac ...-69/70
T I GARD Inspection Line: 503.639.4175 CI Ty F 1 G . A9 0 Date Ready/By: Julia H See Page 2 for
Internet: www.tigard- or.gov Ty � ' Notified/Method: 176 Supplemental Information
BUILOti\LCIVISION
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
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 3v� 15
❑ Accessory building ❑ Multi- family Number of bedrooms: 4
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: Z
Job site address: 142.5 sW suM M EIZ.vI a4) VP • New dwelling area: 2..1/ O square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: (j V Z square feet
Suite/bldg. /apt. no.: Project name: Arlington Heights NO , j Covered porch area: 114 square feet
Cross street/directions to job site: Deck area: I q 4 square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Arlington Heights Lot no.: 99 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
DESCRIPTION OF WORK work indicated on this application.
New, Single Family Residential Valuation: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes Type of construction:
Address: 4230 Galewood St, Suite 100 Occppancy groups:
City/State /ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)387 -7577 Fax: (503)387 -7616 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: SEE ABOVE All contractors and subcontractors are required to be
Contact name: Deirdre Britt licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: • applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail: dbritt@stonebridgehomesnw.com
CONTRACTOR
Business name: SEE ABOVE BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: 173318
Total fees due upon application:
•
Amount received: 75o , 0-6 Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: '742m sizorn. Date: O, .21.12 * Fee methodology set by Tri -County Building Industry
Service Board.
l: \Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(1 1/02/COM /WEB)
V OL .
Building Permit Application Chec 's
One -.and Two - Family Dwelling i ,,,, i r i , FOR :OFFICE: USE .0N ):
City of Tigard JUL 3 U 2012 Received
Date/By: Tea��� ■ !J r
Permit N. S t/^
IN
U 13125 SW Hall Blvd., Tigard, OR 97223 �
Phone: 503.639.4171 Fax: 503.598.1960 ^`-� / Associated permits:
24- Hour Inspection Line: 503.639.4175 OF T GA9O ❑ Electrical ❑ Plumbing ❑ Mechanical
• - . LI i D' Internet: www.tigard- or.gov BUILOVG. dsl;'i +' ❑ Other:
W t u : .,. e
' .TH �A
E FOLLOWING IT REQUIRED ±FOR PLAN'.REVIE Y�S ; � -� i,.No■-
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state 21 ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if zr ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size le ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ® ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub - ®' ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. g ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non - Z ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing Z ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 2(
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists Zr ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. El ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ®' ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or 8 ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the .roject under review.
JURISDICTIONAL SPECIFICS- •': ,1 '7-,::',..1:;-,:-.-!-.:k..:-,-- ,
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, - ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1: \ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 4404613T(11/02/COM/WEB)
Electrical Permit Application RC .. � ,� FOR OFFICE USE ONLY
\. I
City of Tigard Receiv,. JUL 2012
Date/B PermitNo.:
1 SW Hall Blvd., Tigard, OR 97223 e � �� �/, Ai 9.S. >Z Phone: 503.639.4171 Fax: 503.598.1960 _ _ Other Permit:
Y �:°' ' s q „�
T I G A R U Inspection Line: 503.639.4175 CI j P ;,;9 Date R ea d y /B y: Juris: ® See Page 2 for
Internet: www.tigard- or.gov �B ” 1 ,ry /,
, 1 art...g0' ,\e , Notified/Method: Supplemental Information
TYPE OF WORK 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
® I - 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 -_ , "1-3"
Job no.: 141 V Job site address: x}25 gm SdMMb2Y1ew 100HP or more. occupancy.
❑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: Arlington Heights ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fir. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Arlington Heights Lot no.: 19 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
►1 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 I 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
Branch circuits — new, alteration, or ex tension, 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: SEE ABOVE B. Fee for branch circuits
without service or feeder fee, 56. l8 2
Contact name: Deirdre Britt 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: dbritt @stonebridgehomesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business Signal circuit(s) or limited -
usiness 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.: 42422 Electrical Lic.: 26 -289C Suprv. Lic.: 35925 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Chuck Friesen Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: 4"4 2 ..... ) TOTAL PERMIT FEE:
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.
I:\ Building 1PennitsiELC- PemdtApp.doc 10/01/09 440-4615T(II/05/COM /WEB
Mechanical Permit Applicat' ._„ , . _ FOR OFFICE USE ONLY
City W , . -, i .. �_ I Received
of Tigard 1 Permit ty 4 ,, s: /7,572047 0 - 4 13125 SW HalI Blvd., Tigard, OR 97.. �� •' T ' -
Date/B .:
Plan R . i
P hone: 503.639.4171 Fax: 503.598.1960 Date/By. a Other Permit:
3 ® 2012 a =a ;
T I G A RD Inspection Line: 503.639 JUL Date Rea. y /By: tans: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
yyaagg
TYPE OF W k •' '. " 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 Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
/4 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
Multi-family Master builder For special information use checklist.
❑ y ❑ ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 14' SW SU MMatv, +, Pt Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: Tigard, OR Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Arlington Heights 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: Arlington Heights Lot no.: 1'1 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
New, Single Family Residential 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 Chimney/liner /flue /vent 23.32
❑ TENANT Other: 23.32
Name: Stone Bridge Homes NW, LLC Environmental exhaust and ventilation
Address: 16869 SW 65 Avenue #505 Range hood/other kitchen
equipment 33.39
City /State /ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
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: Deirdre Britt $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: dbritt@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
Phone: (503) 667 -5595 Fax: (503) 491 -8252 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: 110091 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: David Heldstab Date: * Fee methodology set by Tri- County Building Industry Service Board
L:\ Building \Pennits'MEC- l'emitApp.doc 10/01/09 440-4617T(11/02/COM /WEB)
Plumbing Permit Application
Building Fixtures , 0-
City of Tigard Received pe�mitNo.�P�/.� ^ /yam/
a 13125 SW Halt Blvd., Tigard, OR 97223 ,JUL
3 0 2012 Date /By _ y.Sr e�i "Q P
Phone: 503.639.4171 Fax: 503.598.1960 Plan Rev
_ ( �; Plan Re t_ l Other Perini[ No.:
T I G A R D Inspection Line: 503.639.4175 Cr G� 4 1GARlSd Date ReadyBy: luris: ® See Page 2 for
Internet: www.tigard- or.gov (�f1 14 p. c rt ic e Oi otified/Method: Supplemental Information
TYPE OF WORK 7 1 t FEE* SCHEDULE
CO New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling 12 Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
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 9415 SW S UMM GIW ND I DA , 7)12. Catch basin or area drain 18.76
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.: 99 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
New, Single Family Residential
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: 4230 Galewood Street, Suite 100
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: Deirdre Britt 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: dbritt (l1 stonebridgehomesnw.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Max Plumbing Water piping/DWV 56.29
Address: po Box 5597 Other: 25.02
City/State/ZIP: Subtotal
ty Beaverton, OR
Phone: (971) 275 -0198 Fax: ( ) Minimum permit fee: $72.50
CCB Lie.: 194644 Plumbing Lic. no.: PB1083 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: 2.�L / f �'" �,�..�,/L��. - - -. TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within 180 days
Jason lBrner after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board.
1:\nuilding \Permits \PLMU- PermitApp.doc 10 /01 /09 440.4616T(I0 /02/C:OMAVEn)
. . . ... . . ..
:....
11 e " Building Division ',
Development Code Provision Review
T I c n Residential Projects,
•
Building Permit No: /7S7 /? ' 1 /9 S '
CWS Service Provider Letter Received: 'Yes ❑ No ❑ N/A 0
Routed Plans:
Original Plan Submittal Date:
1 Revision Submittal Date: • 0 /,:k.- Site Plan Only
2 ^d Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact at 503 -71: _ or �_ @tigard- or.gov)
Lad Use Case No. / Name i 1,..' ' �/
1Zoning Z. "7
0 Setbacks:
v Front /5 Rear / 5 Side 5 Street Side 7U Garage 7-- C2
"Maximum Building Height 3_6' Actual Building Height 5 2- '
I" Visual Clearance
EI
IJ Sensitive Lands Type:
Notes:
Original Plan: Approved Not Approved ❑ Date: rI 7 /
Revision 1: Approved la- Not Approved ❑ Date: 15 - 2 - - I L.. CriiI
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
Actual Slope: -.2 5 f
Notes:
i
Original Plan: Approved„.Er Not Approved ❑ Date: y�, Ni12
Revision 1: Approved Not Approved ❑ Date: I� 2
i
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
1
Page 1 of 2 ,
P i
Ckerii I Ciales 5o3 - 718 7 !C o' 1a•d - .9 0 U.
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard- or.gov)
❑ Street Trees
❑ Protected Trees I
Notes: ? u kc-4C. ci ' ' (D S !. n vT Sk u-,.a v o p k -
prT4 c l; an c ha 6,rrrvd �4Jh p{i el- epruv�ed
Pla n. PIe ue_ rn r102- re td.r re ', rkb.ni .
Se-C a 4 cl, e-ct-- etans.
Original Plan: Approved ❑ Not Approved Date: I /. A
Revision 1: Approved L� Not Approved ❑ Date: c`g— Z- -, ‹
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ii) o 1 % 3 n "
Date Routed to Building:
1
Page 2 of 2
Albert Shields
From: Albert Shields
Sent: Tuesday, July 31, 2012 3:41 PM
To: dbritt@stonebridgehomesnw.com
Subject: MST2012 -00195
,
Deidre, Cheryl's comment on review of this site plan is "protected tree #1056 not shown on plan & no protection
shown. Street tree is Raywood Ash per approved plan. Please make revisions and re- submit."
Albert Shields
1
i
STONE BRIDGE. OBE: 1470
• - _ H O LOT: 99
�,0�7' DATE: 07/31/2012
� i? O Z. , ; , a i ''
4230 GALEWOOD ST. SUITE i ® PROPERTY: ARLINGTON
.; ;r _ ,
LAKE OSWEGO, OR 97035 . BEIGHTS
(5 3 a: i'1 A 1 ?012 ` CITY: TIGARD
� � $ SCALE: 1" -20'
�p CIMO1 T GA 338 S PLAN No.: 261 —OPT11
ID1L1il1U Il1klc oyi ll.�lioN \� 336 V DRAWN BY: DF
334
...'''"'...'
n Oq� \ 332
ti�
`\ 30
338 • . \ h w :
; s.
S• '.: ,. : .': .. '' �S / 326
36 S
r , m Q < ��f . - �
0
336
6 ' ' / 'i!
326' i g44 1 ,4 1 74 1
334 6. `,
662 SOFT. A■40----7/46-, \if; �; 3 -CR - FFEA. =3 ,, B > 321
332 40 Alo. 6- W '
( 0 A t '
970 SOFT .0.
49 4/1
4 BDRM. 32 •
2 ,51 S • F X 322
328 / FF.E - 365'
330 / 320
2 /., 318
325
C ( /O /1
326 — % ' ki
Y i 01056 322 4 0, Arn i
324 FEE • a ECTION
COVERED
31- DECK /19#°316
322 �e
WMEI 0E--.
EL• C 314
318
I
316 •$16' 312
if
314 i SILT FENCE
312 39 �' -. ' f/ 310
310 ;/
EL•3'
LOT COVERAGE LEGEND
LOT AREA: 6,025 SQ. FT. 0
BUILDING AREA: 2,412 SQ. FT. — STREET TREES: ( 0 — PROTECTED TREE:
PERCENTAGE: 40Z% RAYWOOD ASH FIR 29.5' dia.
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 0 99
DRIVEWAY MAY DIFFER DUE TO LOCATION OF UTILITY BOXES, 602S 6q. ft.
STREETLIGHTS, AND OTHER SITE CONDITIONS.
Albert Shields
From: Deirdre Britt <dbritt @stonebridgehomesnw.com>
Sent: Wednesday, August 01, 2012 8:16 AM
To: Albert Shields
Subject: RE: MST2012 -00195
Attachments: 1470 - 261 -PLOT PLAN.pdf
GOOD MORNING ALBERT,
PLEASE SEE ATTACHED PLOT PLAN REVISED TO SHOW PROTECTED TREE & STREET TREES
Det rol re. 6ri.11 I Architectural Drafter
Stone Bridge Homes NW I www.StoneBridgeHomesNW.com
office. 503.387.7573 I fax. 503.387.7615
4230 Galewood St., Suite 100 I Lake Oswego, Oregon 97035
A Unique Homebuilder Delivering Quality and Value to Oregon Residents
CCB# 173318
You
Tube Ill
From: Albert Shields [mailto:albertCaltigard- or.govl
Sent: Tuesday, July 31, 2012 3:41 PM
To: Deirdre Britt
Subject: MST2012 -00195
Deidre, Cheryl's comment on review of this site plan is "protected tree #1056 not shown on plan & no protection
shown. Street tree is Raywood Ash per approved plan. Please make revisions and re- submit."
Albert Shields
DISCLAIMER: E -mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
1
STNE O = OBE: 14 '70
` JUL OT: 99
HOMEBsRII\DINNGE ° 2012 DATE: 07/08/2012
423o GALEWOOD ST. SUITE goo V � � � �� A�� PROPERTY: HEIGHTS
LAKE OSWEGO, OR 97 ' TYCF PG ` •^ 'ft� ,�,,q
(5 3 - 7577 - i '?` o `� d " ���' C ITY: TIGARD
SCALE: 1 " =20'
4. 338 336 84/ PLAN No.: 261 —OPT11
4, DRAWN BY: DF
334
�� EL•338' 4 \
30
' .w ' 32 00
1 3 38 ../ .. .' c • :: . i.s /. � 0 326 /
S• y ": p� .
336 h
0 - 4.--3". : , :: . :.: ::.. r . ...:. :: . :. : .,, � ' \
336 h ' `� �
" 1)-1-, lir ` , 326'
334 e ailiii.,
662 SOFT. ~iiiii \:
l 3 -CAR . =3 • - FFE = 4
I
332 :57. '
to ,910 SOFT -0.
t
4 BDRM. . 324
2 -12 B • 322
FFE.- ' fit
330 328 dif
320
0. 0 318
328 7
326
i'v AY)
7
324
COVE
DECK = 316
322
5' ME PE-- E
o 314
EL 231/3
318,
316 x316 ' 312
314 V SILT FENCE
312 • I 310
310 .0
EL ■309
LOT COVERAGE LEGEND
LOT AREA: 6,025 SQ. FT. I"
BUILDING AREA: 2,412 SQ. FT.
PERCENTAGE: 40.0% — STREET ORNAMENTAL PEAR
NOTES: -PYRUS CALLERYANA—
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 *BS
DRIVEWAY MAY DIFFER DUE TO LOCATION OF UTILITY BOXES, 6028 6q. ft.
STREETLIGHTS, AND OTHER SITE CONDITIONS.