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Permit Community Development Request for Permit Action IV ED TIGARD q ECE R NO 0 3- 9 TO: CITY OF TIGARD pF TI GARD Building Division Services Coordinator CM D�V�S� 13125 SW Hall Blvd., Tigard, OR 97223 Bu'�• Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: n Owner n Applicant ❑ Contractor City Staff (check one) REFUND OR Name: II '' INVOICE TO: (Business or Individual) o iJ 1: /Zl GE Ido)-IcS to j. L O Mailing Address: l ( (pq fl `o5 qO t, 4 505 V It I 0 City/State /Zip: yt‘ti Claw a 62 470,35- Phone No.: 603 - SS? - 76 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): # /76 333 hi. CANCEL PERMIT APPLICATION. PA I AD REFUND PERMIT FEES (attach receipt, if available). ®� INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: \ — 9400 2) 0 011 2.9 W Q, goo S - OC) / a 6 Site Address or Parcel #: t z l q CI a.u...) t I COL f ! 13 Project Name: W l L 5o t. i 1)6 € 1 Subdivision Name: LAD 1-5c n J Qtij (o f_ .. Lot #: 3 EXPLANATION: Pop L, , ,J [` , .x i-1 1 i 1 E-r, — D 4 FGs2i.,.�T l-inuse._ ' 11/4.- Go (2._ -rii, s Le-r. 5E F-lz-srao69- co a Signature: ,,,,, Date: //; S/ 4, Print Name: : Z. AT -)--(ski 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 sormumym Rte to Bld: Admin: Date / / ©o B _* Refund Processed: Date ,t/ B ,;yam Invoice Processed: Date j/ SAM B =J Permit Canceled: Date // S Of By .P.,7 Parcel Tag Added: Date By Receipt # Date Method Amount $ 1:\ Building \ Forms \Regl'crmitAction.doc Rev 07/26/07 7 4 e ° Community Development �; [ �� ` Request for Permit Action Rt:::\.-J3 ��_ �' i \ l� I IGARD 9 10\1 C S 2.0 TO: CITY OF TIGARD ov ® :ItGP Building Division Services Coordinator c ime NASIC 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: ❑ Owner p Applicant ❑ Contractor g City Staff (check one) • REFUND OR Name: ' ` INVOICE TO: (Business or Individual) 5.re tJ f 2t ... a€ o -i . /.0 Mailing Address: l to $ ( ( at.,J (o5� qU t. a 5b5 V 0 1 0 City /State /Zip: LAIA CY-(i3 o i 6 (37035 Phone No.: 803 - 387 - 7 (377 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): h CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). . Permit #: \1 940 S - o O I a 9 °.- C WP., oho S - ex, /. 6 Site Address or Parcel #: 1 3(gei aW 13,eDc_f klU Project Name: 1-131 L 6e Z t bQo f_ Subdivision Name: WI t..50/.1 1`t`1j 6 i Lot #: a 5 EXPLANATION: (k pi) Z l e ri 1,..)-7-- P a4-1 1 Tr E1) - D a F -G L n - r k ase At_1E(• ro(L 1, s Lo-r. `o�sg. H aoo9 ooalo c____ Signature: (6., Date: //, 1./ 4 Print Name: ! • i )1 f Z. A n -A-t ' kJ 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 Admin: Date / if e 9 : ,7 Rte to Bldg Admin: Date / s e r By . 77 Refund Processed: Date . /'/'1 By .. r, - Invoice Processed: Date . 1,1 /S , ;: By .-,rs! L Permit Canceled: Date ,«'; ,.. ,.- ;, t" y By, t t' — Parcel Tag Added: Date By Receipt # Date ` Method Amount $ I: \Building \Forms \RegPermitAction.doc Rev 07/26/07 13 (9 scA, / lm Lev. . Building Permit Applicat� '! FOR OFFICI? USE ONLY J ° City of Tigard �� �� I 0 Date/By: 0 n r" I • . i Permit No.:Or:P Og 0jl2 ° 13125 SW Hall Blvd., Tigard, OR 7z Tbf2: Review 1 Av 9 o e, 6 Il Phone: 503.639.4171 Fax: 503.5 8 atly' DaPlan p te /By: Y / Other Permit: d O'u T I G A It D Inspection Line: 503.639.4175 , , Date Ready /By: / 1 ® See Attached Checklist for Internet: www.tigard or.gov % I 'j OF 0 �/ ftr Notified/ ethod: / / `/ W� — r Supplemental Information B UII DINGD Ib t310N "P."b17 `' 666 /"�`�,1. TYPE OF WORK . REQ 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. a q Liz .. Valuation: $ ® 1- and 2- family dwelling ❑ Commercial /industrial J ❑ Accessory building ❑ Multi- family Number of bedrooms: 4 ❑ Master builder ❑ Other: Number of bathrooms: ? , 5 JOB SITE .INFORMATION AND LOCATION Total number of floors: Job site address: 1 i stir /14 ,.,/.,_ L - n , New dwelling area: � � square feet City/State/ZIP: Tigard, OR /7223 Garage/carport area: 5 ' square feet Suite/bldg. /apt. no.: Project name: Wilson Ridge II Covered porch area: a it square feet Cross street/directions to job site: SW Bull Mountain Rd. & SW 133 Ave. Deck area: square feet Other structure area: square feet ;REQUIRED:DATA: COMMERCIAL-USE CHECKLIST Subdivision: Wilson Ridge II Lot no.: .21 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. Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY 'OWNER ❑ TENANT Number of stories: Name: Stone Bridge Homes NW, LLC Type of construction: Address: 16869 SW 65 Ave., #505 Occupancy groups: City/State/ZIP: Lake Oswego, OR 97035 Existing: Phone: (503)387 -7577 Fax: (503)387 -7615 New: ® APPLICANT ® CONTACT PERSON NOTICE Business name: Stone Bridge Homes NW, LLC All contractors and subcontractors are required to be / Contact name: r �� �• licensed with the Oregon Construction Contractors Board C _. L under ORS 701 and may be required to be licensed in the Address: 16869 SW 65 Avg", #505 4 jurisdiction in which work is being performed. If the City/State/ZIP: Lake Oswego, OR 97035 applicant is exempt from licensing, the following reasons apply: Phone: (503) 387 -7577 Fax: : (503) 387-7615 E -ma jt,$ dmhholdingsco.com �""}�" CONTRACTOR Business name: Stone Bridge Homes NW, LLC BUILDING PERMIT FEES* Address: 16869 SW 65 Ave., #505 (Phase refer to fee schedule) Structural plan review fee (or deposit): City/State/ZIP: Lake Oswego, OR 97035 Phone: (503) 387 -7577 I Fax: (503) 387 -7615 FLS plan review fee (if applicable): CCB lic.: 1 / 9 3 I ? Total fees due upon application: 4 U Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has beets accepted as complete. Print name r J an e • !J 4/r j Date: * Fee methodology set by Tri-County Building Industry Service Board. l:\ Building \Permits\BUP- PermitApp.doc 03/21/06 440- 4613T(I1 /02/COM/WEB) Mechanical Permit Applicatiotit(kIVE . FOR OFFICE USE ONLY City of Tigard V el,. Aug Received q 91 i di illik‘in Per mit _ o.: k , ermtt b MIM r No.: r1 _ - I a 9 / .. 13125 SW Hall Blvd., Tiga A5R 91 r) ''' ?uuld Review -.1 0S78 D a t e 2 e Phone: 503.639.4171 Fax: 03.598 h i an ' t3ii i i.. TV DIN OG F 0 Tin nrin Da t e/ 113y a : dy/By: Date/By: Other Permit: ,..0....2 is— et)/ , Inspection Line: 503.639.4175 TIGARD Juris: Ei Set Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information :::: :: . ,:..: j . i :::..!!,..• :.: : . : ;: ,: : ' : . TYPE OF WORK ... ": .:, ::.: :, '... : , : :, New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work [El E:1 performed. Indicate the value (roundpd to the nearest dollar) of all I:1 Demolition tti Other: mechanical materials, equipment, labor, overhead, and profit. .. • . CATEGORY OF CONSTRUCTION . . " :: . ' - -.. Value: $ : . . • , ggspipmAkEQUIPMENT:/SYSTEMS [El 1- and 2-family dwelling 0 Commercial/industrial E] Accessory building For special information use checklist. El Multi-family ID Master builder 0 Other: Description I Qty. I Ea. I Total : ,...:,: . 1,:.:ii::: :, :: , ;'::,: .• .190., : sgE . *Fo*iiiIQN: AND LOCATION :::-.:::;.':, :?:::. ::'. Heating/cooling conditining or e pu Job site address: k 611)k ... 31_) \\ ‘ LOLL Lin Air o hat mp . i 14.00 (requires site plan showing placement) City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 1 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg./apt. no.: Project name: Wilson Ridge Di Gas heat pump 14.00 Cross street/directions to job site: SW Bull Mountain Rd. & SW 133" Ave. Duct work 14.00 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. 10.00 Flue/vent for any of above 10.00 Subdivision: Wilson Ridge II Lot no.: Other _ 10.00 Tax map/parcel no.: Other fuel appliances ' ;... . , :.:. --: - '''-' . ' ' • - ' ' 4liklitivi1tei■E:biSVolik ' . -. ..' • • : 1 .- :. .. .. -.' Water heater i 10.00 Gas fireplace / 10.00 Flue vent for water heater or gas fireplace 2 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 -;.. ;....._ . : . sltiiiiisiiiiiti zoiii . ... :7 ,. . . triiimv . i4i, . ,.. .. , 7. : - ,: ,.E . , ..,-.. Chimney/liner/flue/vent 10.00 • • - ' - •• • -• ' • - • 10.00 Name: Stone Bridge Home NW, LLC Environmental exhaust and ventilation Address: 16869 SW 65 Ave., #505 Range hood/other kitchen equipment 10.00 City/State/ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust / 10.00 Single-duct exhaust (bathrooms, Phone: (503)387-7577 Fax: (503)387-7615 toilet compartments, utility rooms) 6 6.80 .::::•., .::::::.:. :, : :,,. :. • i , •!: . • . .: .: : ,. : 7 ..:..; ::. • i .: F :...; Attic/crawlspace fans 10.00 Other 10.00 Business name: Stone Bridge Home NW, LLC Fuel piping Contact name: e...„,),u,:i ``)r,f--40412)rni $5.40 for first four; $1.00 for each additional Address: 16869 SW 65th Ave., 505 Furnace, etc. / Gas heat pump City/State/ZIP: Lake Oswego, OR 97035 Wall/suspended/unit heater Phone: (503) 387-7577 Fax: : (503) 387-7615 Water heater / — Fireplace / E-m*dmhholdingsco.com Range / CONTRACTOR Barbecue Business name: Comfort Zone Clothes dryer (gas) Other Address: 1032 NW Corporate Dr. r 7 . ' . .. MEtitANICAL PER141 • • • .' " - - .. . ' - , .. 1 : . City/State/ZIP: Troutdale, OR 97060 Subtotal Phone: (503) 667-5595 Fax: (503) 491-8253 Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: 110091 State surcharge (12% of permit fee) c---- ___.--—-. TOTAL PERMIT FEE Authorized signature: This 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:\BuildineermitAMEC-PermilApp.doc 12/03 440-4617T (11/02/COM/WEB) Electrical Permit Application RC Ii' . FOR OFFICE USE ONLY • . IL_ _ , City of Tigard " wed e C ) I V Date/B : i iffArre_Mil Permit No.: Y 0 ,# a r '. — 0 f 114 11 ' 13125 SW Hall Blvd., Tigard R 97 . UG 2001 Plan Review i g- p g : Phone: 503.639.4171 Fax: 503.598.1960 ' Date/B : Other Permit: / ' ja98 ny wo Juris: 0 Sec Page 2 for TIGARD Inspection Line: 503.639.4175 CITY OF TIG A • IC a o t t7fi Re ed a /M dY e l t B h Y o . d: Internet: www.tigard-or.gov Supplemental Information . ,:: , :. , ., . :.. TJOF ' WO P'4 . Ifl8IQN:: . - . .: - ' . ' ' .:.----: . ' Please check all that apply (submit 2 sets of plans w/items checked below): Eg New construction 0 Addition/alteration/replacement 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. .. : • : --i : 7 ''' ' ' ' :::. CATEGORY OF CONSTRUCTION 'r, - .". ' ' • - r ' exceeds 10.000 amps at 150 volts or 0 Floating buildings . less to ground, or exceeds 14.000 0 Commercial-use agricultural Ej 1- and . nd 2 dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 Multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or , , , . ... . . . . 0 Emergency system. larger separately derived system. , .,...:,,.. : '....' . _::::■ , : JOP, :. SITE INFORMATION: AND 7LQCATION :;. .::' '! ': ':",: : ' 0 Addition of new motor load of Job no.: 1 DD e Job site address:i i more. (.31 I A .4.... .\ 1 Li )) •er 1 100HP or ..4 0 Six or more re residential units. occupancy. 0 Recreational vehicle parks. City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for more than 0 Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: I Project name: Wilson Ridge II 0 Service or feeder 600 amps or more. *EE!iseligroursu; Cross street/directions to job site: SW Bull Mountain Rd. & SW 133 Ave. Description I Qty. I Fee. I Total I • New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Wilson Ridge H I Lot no.: 0 S 1,000 sq. ft. or less / 145.15 4 Ea. addl 500 sq. ft. or portion 2_ 33.40 I Tax map/parcel no.: • Limited energy, residential 75.00 2 , . L:::. ..:-...,, ; :t-. f ..,, r • ,,, • .-,. ; .- _ :,:,-;?,,,...._, ...; DESCRIPT : Of WORK - „::,., . - :::„.....:-:.,,•,,,, : (with above sq. ft.) Limited energy, multi-family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less / 80.30 2 . . . .. . . - ;:'::.:•::• 00101**IY;ONER ;7-..:!7.:..,.1 -;21," : 1, !.t . r: ...,!Et TENANT :_-:.: ,:- .::';. ':'-, / DI amps to 400 amps 106.85 2 , Name: Stone Bridge Homes NW, LLC 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 16869 SW 65 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 I 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 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with 7 00400 , :;::!;!: '' O*r*Of1*-0**;::,::-=' above service or feeder fee, 6.65 2 each branch circuit Business name: Stone Bridge Homes NW, LLC B. Fee for branch circuits without service or feeder fee, Contact name Citialld liSrsbe.rd first branch circuit 46.85 2 Address: 16869 SW 65th Ave., # Each addl branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Lake Oswego, OR 97035 Each manufactured or modular 90.90 2 ' dwelling, service and/or feeder Phone: (503) 387-7577 Fax: : (503) 387-7615 Reconnect only 66.85 2 E-mal, L 0 dmhholdingsco.com Pump or irrigation circle 53.40 2 ; iY:: :•:.;.:., 9 .,:,.. .. , -•'.."::! .;: :',f::: L;::::1:_ j: •::: ;CONTRACTOR :: ' ]: . Y : :; ' :: :."..:::: il,.,:±.:!..,:..f. . .:,:'. Sign or outline lighting 53A0 2 Business name: City Electric Signal circuit(s) or limited- energy panel, alteration, or Address: 8900 SW Burnham St. F-27 extension. Describe: Page 2 2 City/State/ZIP: Tigard, OR 97223 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 443-1092 Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: 42422 Electrical Lie.: 26 Suprv. Lic.: 35925 Industrial plant per hour 73.75 :, : • : _.:- ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): - _ State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: •■••". Print name: C\nt 't c v_ 1--- c - Date: • This permit application expires if a permit is not obtained within 180 • \ / ... i e. e_.( days after it has been accepted as complete. * Number of inspections allowed per permit. iAl3uilding \Permits \ELC.PermilApp.doc 12/03 440.4615T(10/02/COM/WEB /4 Plu bin Permit A lie GAI Vg FOR OFFICE USE ONLY Cit of Tigard l; Date/By: 0 /�} d8 ,' R 9 ` Permit No.: N �� Oi v 13125 SW Hall Blvd., Tigard, OR . Plan Review • C • Phone: 503.639.4171 Fax: 503.598 1 2 1 �O 3 Other Permit No. .�jr(�� . Date /By: O "" /v`1a 8v1� TI GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: El See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information 8I1$�ING DIVISION * T : U ® 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 24920 ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR(3) bath ! 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. R) Page 2 :. ... .. � .. JOB :.: ! • . . - , ., ..:.. ; • . . )�:QC A7IUN : :, :: Site utilities _ .. ,:.:... S util Job site address: j F l 6 Lt ,,..) n r Le_, 1.--1/1. . Catch basin or area drain 16.60 City/ State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: f Project name: Wilson Ridge H Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: SW Bull Mountain Rd. & SW 133 Ave. Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Wilson Ridge II I Lot no.:� Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: } �. ,_..: = sorption valve 16.60 Ab orpti 1 16 ' : . D E9CRIPTIOl! f : UF . WORI :, - : � , - . Pa e 2 ... , ._ '2,.;'•;4 - ,._ :. .' . , : . .: : :: � . - . . � . _ ., _- .. -�- - .... _ ■ . .. :i � :, ac ow preventer •. � .. • : . . � � B 1dJ g Backwater valve 16.60 Clothes washer / 16.60 Dishwasher / 16.60 ::. - _ Drinking fountain 16.60 ®: iPROPERTY:iOWNER' .' `: ,7,: ❑".TEr.NAN % , - : Ejectors/sump 16.60 Name: Stone. Bridge Homes NW, LLC Expansion tank 16.60 Address: 16869 SW 65 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 ose r 7 16.60 ®.•:.4P..Q1`ICIANT:' CONTACT' PH,RSOIV ce ma er / 16.60 Business name: Stone Bridge Homes NW, LLC �,� ,� Interceptor/grease trap 16.60 Contact name: �: 71X.1 Medical gas (value: $ ) Page 2 Address: 16869 SW 65th Ave., #50 Primer 16.60 City/State/ZIP: Lake Oswego, OR 97035 Roof drain (commercial) 16.60 Phone: (503) 387 -7577 Fax: : (503) 387 -7615 Sink/basin/lavatory 45 16.60 Tub /shower /shower pan 2 16.60 E -mail dmhholdingsco.com .. Urinal ;O CTOR 1 6.60 3 - Business name: Jardine Plumbing Water heater / 16.60 Address: PO Box 186 Other. City /State/ZIP: Estacada, OR 97023 Subtotal Minimum permit fee: $72.50 Phone: (503) 630 -5436 I Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic,: 108747 Iv lumbing Lic. no.: 3 -320PB Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature.-- � TOTAL PERMIT FEE Print name: Jay Jardine 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. i:\Building \Permits \PLM- PermitApp.doc 12/03 4404616T(I0 /07/C0M/WED) OBE: i OO9 -v � °k- • .. STONE BRIDGE '1 ' OT: 23 F HOMES NW LLC J �1 A TE: 7 /24/08 161369 SW 045t.22. AVE.. 46 moa PROPERTY: WILSON- RIDGE -II L L ♦ =E OSWEGO, OREGON 9703a CIT TIGARD 2120, ' (603)387 -7677 Ak3G CALF: 1 =20' it TIGP No.: 714 - n . ` , VLSI ANDARD ELEVATION i; . +: �W ►' CITY OF TIGARD - SITE PLAN REVIEW 9 �' t BUILDING PERMIT NO: "Si •0 : - oo i ^ • ��:J S 4,4 ` ' Street Trees: A `• Approved ❑ ■ Not Approved Protected T,,-,. • ( A, Approved 0 , « pproved Y. g p rc . l '' S,o��, r ,./ Date: G �.. o c 6 "" / /A , Notes: - ' r f;; 4 ' 513 ' 568 : A te‘ J'.:, 1 • „pi O: I • • e, 5 14 �n eq. ft. EL•966 1/2 bath . PPE. -8139 511 % EI rj i dt ie - ,,.. e,.., .9; ,,„: i 9��. ft. 6.” � , ad FFE •913' U: ° s. Si < EL •561 I • `iirc .. [,13' .'\ " Q% _ _ 568 566 '1 lr �� :. 513;_.:.. . ` _ • :'513. 7 ' u! 512 ij 5 0d 9 5 gy p, • 913' c i s �1 CITY OF +IGARD - SITE PLAN REVIEW R- o t�, BUILDING PERMIT NO.: 1-dAjr ea 1 .,g 4, LOT COVERAGE 6 ■ PLANNING DIVISION: LOT AREA: 5,533 SQ. FT. n { Required Setba s: al Approved 0 Not Approved BUILDING AREA: 1,859 SQ. FT. /b PERCENTAGE: 31.31 le Side: Street Side: From. ' S G rate: _� Rear: /S r! 13 Approved LEGEND �: % Clearance: pp 0 Approved ' %.Grim +itn Building Height }i feet OyI', L � WA 1: er vice Provider Letter Required: ❑ Yes ❑ No \ . — - STREET TREES 1 ❑ Received iiAT 42ED1Ur1 0 nau� f" n - 6RAXIMUS OXYCARR4� }- Lz : 0i.c d .i1 of Date:,8 /. -/ /,t /-7 /!e Loc..c.s/ i :. ENGINEERING DEPARTMENT: 6 Actual S pe :? % ® Approved ❑ Not Approved t li Site PIa ‘ 13 of pproved NOTES: By: Date: 6 08 ALL GRADE A � B t TY R LIN t> LS R S T MA ES OF CURRENT LOCATIONS. L ALL DIMENSIONS AND SQUARE FOOTAGE ARE APPROXIMATE FIGURES. LOT •23 : : ALL RETAINING WALL HEIGHTS AND LOCATIONS ARE ESTIMATES. 5,933 sq, rt. k' THEY MAY VARY AND BE SUBJECT TO CHANGE. r I. ` o ° Building Division One & Two - Family Dwelling - T i c n R D Fees Checklist PERMIT . . • - Permit #: MS r or, y - 1 Plan #: DM 7, c/ Date: 9 - S" - c- Site Address: ) 3 i o 5,3 /tJ =: (.:.2. ,. .1./. Parcel #: Subdivision: RI"-, 5 i n) r2 s 1� G t AM. Lot #: d Zoning: R 7 Jurisdiction: TT Setbacks: Front: 7: 3- ' Rear: / 5- , Left: .;- , Right: S 1 Class of Work: NfvtJ Stories: 2 First Floor: la) o Ph Type of Use: 5r Height: .p , -1 1 Second Floor: J6/s Construction: A Floor Load: .5 PS F Third Floor: . Occupancy Group: p__ Dwelling Units: / Total Floors: P7 2. 0 Valuation: 2 g ? tf 7 Bedrooms: i/ Basement:: Beaverton CET: Bathrooms: 3 Garage: ii Tig-Tual CET: - / Decks: Other: TVFR: n) rr) Porches: ,216 Geo /Grading: Ain FEES': Description: Fee Amount: Amount Paid: Balance.Due: Plan Check: Building: ) 7 U • , ci .PS 3. C9 Extra Set: 69 - .•.'" (. (: .:] . Permit: Building: 15 . d c /5:1(.7;4; Tax: 1 /O. S,J / eio .22 -- Metro CET: "Y 9- C' 3 0J 1 q • % School CET: '7 .. ck) D!.2 Utz ' Mechanical. Ov« q 7. 30 e, 7. 30 Tax: 1 I . G$ 1/6A Plumbing: r, v« 3ci t o . C/f) 34 t . c e) i Tax: 11 1.9 . ? 9 7- Sr Electrical: ; , 4,1'l• = ;s� ;.• -.% S c ea ./S' � l,? /5" / Tax: - i 7. 1/A 3? 496 i Low Voltage: — Tax: C : CDC Ping. .Rev.: 1/6 .cV 7 ' .'22 CDC LRP Fee: £' , 4. (ft.) S ; Parks: 5 ) 4 7 . 1' .9D Ja;/ ,- ,- - TIF Res.: 3/ V • GO 3/ • TIF MT: .g O • UU a :v 00 Erosion Permit: $N •ct') '00.60 Erosion CWS: ..:de (r;; _ di eco Erosion COT: De 4-0 92 (- () Water Quality: Water Quantity: — SUB- TOTAL: / 6 5l• `J .1_ ?5 _ ph, 9 N. a z Sewer: Permit: Inspection: �. - . e .,> SUB - TOTAL: - • 1 '-)•. TOTAL MST & SWR: /g ;., ‹? ` /•'.r, . ).r I: \Building \Forms\ Res PlanCheckFees.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 I Qty J 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) I. 17.90 i 7. SFR (3) bath 4 399.00 , Q4 .no 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 /p Gas fireplace 10.00 1v - 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 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 Water service - 1 100' / 55.00 Range hood/other kitchen equipment / 10.00 / U - Water service - each additional 100' 46.40 Clothes dryer exhaust / 10.00 / c: - . • .• Fixture or Item . . Single duct exhaust Absorption valve 16.60 (bathrooms, toilet compartments, _ Backflow preventer 27.55 utility rooms) 6.80 ?// Backwater valve 16.60 Attic /crawl space fans 10.00 Clothes washer 16.60 � Other: 10.00 • Fuel Piping Dishwasher 16.60 * *($5.40 for first 4, $1.00 each additional) Drinking fountain 16.60 Furnace, etc. / ** Ejectors /sump 16.60 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 2 16.60 BBQ ** Ice maker / 16.60 Clothes dryer (gas) ** Interceptor /grease trap 16.60 Other: ** Primer 16.60 Total: e 576/o Roof drain (commercial 16.60 Mechanical Permit P ees Sink/basin/lavatory/1 /L.i a 16.60 Subtotal: $ 9 7. 30 Tub/shower/shower pan '3 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) $ //, i. Water heater 1 16.60 TOTAL PERMIT FEE $ �r /) i r G Other: t Other: ELECTRICAL FEES (new residential) Plumbing Permit Fees Subtotal $ 3°/ Description Qty. Fee Total Insp Minimum Permit Fee $72.50 $ 1,000 sq. ft. or less L 145.15 .-3 /, _ 4 Plan Review (25% of Permit Fee) $ Ea. add'1 500 sq. ft. or portion 5 33.40 1 State Surcharge (12% of Permit Fee) $ G 7,5,E Limited energy, residential 75.00 2 TOTAL PERMIT FEE $ t/� /� • St Each manufactured or modular dwelling, service and /or feeder 90.90 2 Electrical Permit Fees Subtotal: $ 3/7./_,_, Plan review (25% of permit fee) $ State surcharge (12% of permit 'fee) $ 37. t((, TOTAL PERMIT FEE $ r.3 , i 4,6 r 1: \ Building \ Forms \ResPlanCheckFees.doc 01/19/07 Page 2