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Permit
I II I III o Community Development TIGARD Request for Permit Action 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 ®'City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State /Gip: Phone No.: PLEA E TAKE ACTION FOR THE ITEM(S) CHECKED ( X1 1/ J -• --._ PERMIT APPLICATION. 1 V 0 1 o,yn�/ �• ' FUNID ' ERMIT FEES (attach receipt, if available).. 3 A� j/ _el— • , : " FOR FEES DUE (attach case fee schedule and explain below). o gD i r' 2 REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). .4. i ; - t acjl0 — o °l2 IrPr ' Permit #: Site Address or Parcel #: 1 g0 7 7 M&• (J S 1 C r. Project Name: Ar I t \t ") tte yk / 2 3 ' L Sq Subdivision Name: / 1 l yvgi . J 1-lc-1\ x-113 Lot #: SI EXPLANATION: (cmjc.ej,i p.;/'rn i t - 6 hr- Cf/ J ),,reACYzir (b Y'r•SpcA' . Thy / x)10 - 0 v r)--)- 3L oft +}-eeJ ek S Spec 1 r,Ole • Y S 1 i I — W& -7 (a - r — 5 1 A t - 6 k d I , in _ - . r - / i , _ ' - -�•- - 'a , • - ' V / , _ Dat e: 01 � J/ ,. t - Signature: `� y - / 1 " Print Name: , v . Refund Policy a p P //f . I I. The Director or Building Official may authorize the refund of F r4/1 qq D a) any fee which was erroneously paid or collected. e'D b ri ) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 I mum B .» Rte to Bld • Admin: Date -. 1 B ice. Refund Processed: Date 9 // By d'" t Invoice Processed: Date By Permit Canceled: Date _//// B /,=l Parcel Tag Added: Date B-{' Receipt # /7ff /Z Date �.. //O Method e4, �� Amount $ 75'0 , c/I) I: \Building \Forms \RegPermitAcuon.do Rev 07/26/07 Building Permit Application 3/y 1/ 49(y /15120/c' _ Oat V Residential ` 1 E FOR OFFIC USE ONLY r � ' Received City of Tigard t Date /By glit �� _ r Illq 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503 639.4171 Fax: 503.598 1960 CEP 0 2 2010 Date /By Other Permit _ Q a -011. _ 1 W ` TIGARD Inspection Line' 503 639.4175 Date Ready/By Juns ® See Page 2 for Internet. www.tigard or.gov CITY OF TIGARD Notified/Method -,4(9 Supplemental Information BUILDING DIVISION 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 El Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: 2C 7 42.9 $ t El Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 2 . JOB SITE INFORMATION AND LOCATION Total number of floors: Z Job site address: ILL.-r7 j / 1 • IOthl vivta. Gadi New dwelling area: 213/ 5 square feet City/State /ZIP: Tigard, OR 97223 Garage /carport area: ( square feet Suite/bldg. /apt. no.: Project name: Arlington Heights Covered porch area: i r „r w „ square feet Cross street/directions to job site: Deck area: p square feet Other structure area: �( square feet REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: Arlington Heights Lot no.: 5 Permit fees* are based on the value of the work performed. Tax map /parcel no.: 1 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: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Stone Bridge Homes Type of construction: Address: 16869 SW 65th Avenue #505 Occupancy 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: Gayland Forsberg 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: gayland @stonebridgehomesnw.com CONTRACTOR Business name: SEE ABOVE BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State /ZIP: Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: ( ) Fax:( ) CCB lie.: 173318 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: Kit m wuk n Date: * Fce methodology set by Tri- County Building Industry Service Board. I.\Building\Permits \BUY -RES PermitApp.doc 10/01/09 440- 4613T(1 I /02 /COM/WEB) CD1 Electrical Permit Applicati�q FOR OFFICE USE ONLY , Received III _ City of Tigard Date /B Permit No ° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Phone 503.639 4171 Fax 503 598 1960 Date/B Other Permit TIGARD Inspection Line. 503.639 4175 Date Ready/By Jam ® See Page 2 for Internet www tigard gov 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 stones ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings. ❑ Multi- family ❑ 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.: Job site address: /�/� ' / / , 100HP or more occupancy I � I26I1 )W I Y'�U�� U /d�/A l.t)1/► � ❑ Six or more residential units ❑ Recreational vehicle parks City/State /ZIP: Tigard, OR 97223 ❑ Health -cart 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 Qiy. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Arlington Heights Lot no.: 59 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 ® 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 salt, 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 extension, per panel Owner signature: Date: A Fee for branch circuits irrth ® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: SEE ABOVE B Fee for branch circuits Contact name: Gayland Forsberg fi branch service or feeder fee, 56 18 2 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: gayland @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 Lie.: 42422 Electrical Lie.: 26 -289C Suprv. Lie.: 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: �._..) TOTAL PERMIT FEE 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 per permit t \ BwIding \Permits\ELC- PcrmiApp doc 10/01/09 440 -461ST( I I /05 /COM/WEB Mechanical Permit Application FOR OFFICE 11SL ONI,i- City of Tigard Received Permit No. a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone 503.639 4171 Fax 503.598 1960 Date/By. Other Permit TI G A R D Inspection Line 503 639 4175 Date Ready/By Suns ® 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 ❑ Multi - family 0 Master builder ❑Other: For special information use check list Description I Qty I Ea I Total JOB SITE INFORMATION AND LOCATION Heating/cooling / `/- ' y� Air conditioning Job site address 2\p�� UN I / ` 0(/�'f V " /(Y (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 Hydronlc 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.: 59 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 $14.15 for first four; $4.03 for each additional Address: Furnace, etc Gas heat pump City/State/ZIP Wall /suspended /unit heater Phone. ( ) I Fax.. ) Water heater Fireplace E-mail. Range CONTRACTOR Barbecue Busincss 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 lic.: 110091 State surcharge (12% of permit fee) C ` TOTAL PERMIT FEE v 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 Tn- County Building Industry Service Board I\ Budding \Pernots\MEC- PermitApp doe 10/01/09 440 -4617r (I I /02 /COM/WEB) Plumbing Permit Application. l , \J Building Fixtures �) D FOR OFFICE USE f)ta.V City of Tigard Received Permit No.. 13125 SW F lall Ms d.. Tigard. OR 97223 3 lkne By; Plan Res icw Phone: 503,639.4171 Fax: 503.5926.1969 1)atc,73 }: Other Permit No•: E' I G A R Ll Inspection Line: 503.639.4175 Date Ready :By: tun: ® See Palm for Internet: www'.tigard- or.gov Notiticd1Slethod: Supplemental lnrurmotiun TYPE OF WORK FEE* SCHEDULE ® New construction ❑ Demolition Fur special inJunnorion ur checklist, Description I Qty. I laa. I Total ❑ Addition!altcnuion /rcplaccment ❑ Other; New 1-2-family dwellings (includes RIO ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) hash 312.79 ® I - and 2- family- dwelling ❑ C'oi nercial/industrial SFR (2) path 4 37.71 SIR (3) bath 5110.32 ❑ Accessary building ❑ Multi- family Each additional hath!kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ■ sy. IL I Page 2 .DOB SITE INFORMATION AND LOCATION Site utilities: Zt(, ') "] 15W �()V✓t 1/ / iJf ct e;LYT Catch basin or area drain tti.76 Job site address: l)r•wcll, leach line, or trench drain 18.76 City/State/ZIP: Tigard. OR 97223 l ooline drain Inn. linear ft.: _ I hue 2 Suitt:M'hldg.ytpl. no.: ` Project name: Arlington Heights Manufactured home utilities 59.03 Cross strectidirections to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear IL: _ ) Page 2 Stone sewer (no. linear lt.: _ ) Page 2 Water service inn, linear lt.: ► [ Page 2 Subdivision: Arlington Heights I Lot no.: 51 Fixture or item: - Tax mapiparccl no.; Back flow prt:venter 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 New, Single Fancily Residential Dishwasher 25.02 Drinking Ibunwin 25.0/. Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Stone Bridge Homes Fixturclsewer cap 25.02 Floor drain sink/hub 25.02 Address: 16869 SW 65 Avenue #505 Garbace disposal 2a.02 C i ty1State/Zl P: Lake Oswego, OR 97035 (lose bib 25.02 Phone: 1503)387 -7577 Fax: (503)387 -7615 lee maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/greasetrap 25.02 Business name: SEE ABOVE Medical gas (value: $ F Page 2 Primer 12.51 Contact name: Gayland Forsberg Roof drain ( COMM ere ial) 12.51 Address: Sink/basin/lavatory 1 _ 5.02 City /Staie'LIP: Solar units (potable water) 62.54 Phone: 1 t I Fax:: ( 1 Tubt,howerrshowcr pan 12.51 E-mai gaylandra ?stonebridgehomesnw.eonc Urltlal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Legacy Plumbing Waterpiping,T)N'V 56.29 Address: 8985 Hazelvern Way Other: 25.02 City /State:ZI P: Portland, OR 97223 Subtotal Phone: (503) 816.8887 Fax: (503) 297 -4587 Minimum permit fcc: 572.50 Plan rrview (25% of permit feet CCB Lie.: 159281 Plumbing Lie. no.: 26 -517PB State surcharge 4 o1' permit tee) Authorized signature: 777,4461 t_ FOTAl. PER f►9 FEE Print name: Mall Nelson I Date: I This permit application cspirrs Ito penal' is nut obtained math in 180 claytt after It has been accepted o% complete. •Fee nteduxlcdo■ sct by fri. County !Wilding Indusu) Service Board. 1.'.1 ltaltinii •PmnlisI'L%tll- IkrnntArp.,5e 10411'04 44.1- 400 (11.;0:t'tltilM'1:111 I II I III o Community Development TIGARD Request for Permit Action 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 ®'City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State /Gip: Phone No.: PLEA E TAKE ACTION FOR THE ITEM(S) CHECKED ( X1 1/ J -• --._ PERMIT APPLICATION. 1 V 0 1 o,yn�/ �• ' FUNID ' ERMIT FEES (attach receipt, if available).. 3 A� j/ _el— • , : " FOR FEES DUE (attach case fee schedule and explain below). o gD i r' 2 REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). .4. i ; - t acjl0 — o °l2 IrPr ' Permit #: Site Address or Parcel #: 1 g0 7 7 M&• (J S 1 C r. Project Name: Ar I t \t ") tte yk / 2 3 ' L Sq Subdivision Name: / 1 l yvgi . J 1-lc-1\ x-113 Lot #: SI EXPLANATION: (cmjc.ej,i p.;/'rn i t - 6 hr- Cf/ J ),,reACYzir (b Y'r•SpcA' . Thy / x)10 - 0 v r)--)- 3L oft +}-eeJ ek S Spec 1 r,Ole • Y S 1 i I — W& -7 (a - r — 5 1 A t - 6 k d I , in _ - . r - / i , _ ' - -�•- - 'a , • - ' V / , _ Dat e: 01 � J/ ,. t - Signature: `� y - / 1 " Print Name: , v . Refund Policy a p P //f . I I. The Director or Building Official may authorize the refund of F r4/1 qq D a) any fee which was erroneously paid or collected. e'D b ri ) 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 I mum B .» Rte to Bld • Admin: Date -. 1 B ice. Refund Processed: Date 9 // By d'" t Invoice Processed: Date By Permit Canceled: Date _//// B /,=l Parcel Tag Added: Date B-{' Receipt # /7ff /Z Date �.. //O Method e4, �� Amount $ 75'0 , c/I) I: \Building \Forms \RegPermitAcuon.do Rev 07/26/07 OBE: 1430 1 STONEBRIDGE *�. � • HoMECs NW 1.1...0 EVISE LOT: 59 16869 sW eet.1s avIC . fp el 0s 9 DATE: 8/6/10 L•ts 08•160, 011100i 97086 PROPERTY: ARLINGTON (509)987 -7577 HEIGHTS ', �. CITY: TIGARD ..,...., A� • -----4 SCALE: 1 ° =20' . _ . .. ... ,..,... .. . .. ...:. ;" w ! 3, 3 is •'.l 1.2r ..i PLAN No.: 241 l� :tN " � � COTTAGE ELEVATION .gad[, f . • - 402 400 . JO • • % 4 01' ' ' • V ,.. . 00 1 i i i e ' . 3A 7 / •. 396 6 e ,' ` � • X396 or i' 400 i s 406 / `• , � 408 410 /Ai .. 412 d l 9A. \`\( /, -‘ EL•394' 414 * 416 ` ?� `, 394 b 420 418 ♦ @ +Qi `• / i ti s, ' . 4k# 16 ‘1.° ' sy . 0 a. %. *::::: _..� y � •. + .�►� :>r... / GF•D42m,` . ' ,. ♦..„ � ,, :s4 �� ;, : ',, ':. :::alb` , ` op 418 .Y.. 4 3*. � ..°.......:.: ._•„ �• \' .� `7 • , 996 416 8 • 02 1 � `� _. .91 © 414 = ` . • / .. ♦ 404 • 8'� 406 412 �`�� "1/410 , 1 ,� s v 4,40. - - -408. ,,,,, j LOT COVERAGE STREET TREES LOT AREA: 5,160 SQ. FT. BUILDING AREA: 2,106 SQ. FT. P — PYRJS GALLEREANA PERCENTAGE: 36 6% ORNAMENTAL PEAR 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 SS DRIVEWAY MAY DIFFER DUE TO LOCATION OF UTILITY BOXES, 5,160 eq. ft. STREETLIGHTS, AND OTHER SITE CONDITIONS. x.,. . M :al4`IW..0 a" -0ii <C.+Ntt'Y:�.V }YP! RYA- )RflF•t*AmC 4'6.dNF V:4Tede#fq.fr%. �. 1 111Y•,144�':: .. c. - • i I L L qt VAR • srrE RIVJEW ;Bumper° "glow t10.: PM/460 () 0 . 677 -- PLANNING DIVISION: Required Setbacks: a Approved 0 Not Approv,ed Side: . Street Side: LQ___ Front. Garage: ..2€2._ Rear: S . . Visual Clearance: KApproved 0 Not Approved Maximum Building Height 31. feet CWS Service Provider Letter Required: 0 Yes 0 No lieceived Date: ql- ENGINEERING DEPARTMENT: Actual Slope312.°/0 El Approved 0 Not Approved Site PI 11 E1 Approved o Approved !; By: Date: Notes: ar 2 4A._ &.%b • E ' 1111111111111EL TIGARD-SIT — I .7- RMIT NO: Approvsd 14431.APPITrfed I • - Wet Tfees s NOt Approved Approved .Date: • • • Notes: RESIDENTIAL ENERGY CHECKLIST MEASURES Floors Fenestration Walls Ceilings HVAC WE Misc. RECEIVED v rn SEP 0 2 2010 C D CO co I c2. cn D o0 0 . m C 0, ca 71 C CITY OF TIGARD ° o `° o �„ rn BUILDING DIVISION �, _ 93 �° N CO cr t �A g 8 § ua d m o CI y 9 i s N -. a I j a O = ' R. V n . < n 5 I � 7 a C- i . g g (D t D f5 f D I y • -, N Co CD co 7 co \ to - . n 0D t7 (D a a v a s to a o it g m • m 9 w -, co to m 8 a y co D. 0 0 0 n, m o n, m m v, s w c' o= 2 D to y 2 o 9 7 I'D 1 y � y PD o in -' O a O a g (, = S a F4 a t a a '0 IA V a `t N 0 N ° ° -' '' 7 N m f r. D a to to g (D � 5 o o w w m 5 c m c - m m - c - c a - o m- -,, �, a a9 m o o @ m to d °•_:, = 3 a m a m m tD -- o m rn ., o c � o m y u �, C C �, c: m— m o if - C C - C C C C 0 O 0 y � o -' o, = 0 • -° a. c a a 2 < m x �7 T o o a b o o A F w 1 w 8 m c 3 c c� > > : g g- W W W m .• g N o N V > y 7 ri. o Additional Measure Path o to o cn n) a o .A o m c, cn oo CD o m > „ w v- Cl) 0 2 2 CO c, m illy ighefficiencyHVAC NNE._.,_.u•�■�� �� = �. __:`JE-i j .� ..1€ :.;I..:,ar.,. 4 2a High efficiency ducts — certified- sealed ---- ■ ■■■■■ ■ , - ■■ , ■ t ■ ■' ., C � ,_ . , E 2b High efficiency ducts — all interior ■■■ ■ ■■■.■ ■•::: ■ ■ , ' ■ ■ .. .... ■ . _. ; ■ �- . _ 7: -;� 3 High efficiency building envelope ■■■ •f ._c ■■■■■■ f ;i■■ -. . . ■ ;: „ �, ,�)E . ■ , =! � :.� k ,, �.::. ) 4a Zonal elec ht, ductless fa or ht pump -hi eff ltg ■■■ ■ '■ ■■■■ ■ ro ;;_■ ■ ■■ i i I I ,; �� . (:,-_, ti i s ductless Earn or ht U -032 '' �'• 1 ` +i +'� � 1 Zonal elec ht 4b per- 1111 cl ` . . .•• .11 � - � , �f , 1 �! . ; Zonal ceilin s lec ht, ductless Earn or ht pump- improved . • . I ', ': 0� 1 ` i , �I i : + i [ - , i 1 4d Zonal elec ht, ductless furs or ht pump -R24 wall ' : ; l a ` "; ■ j 5 High efficiency windows /ceilings /lighting 555[1 _�: ,■ a . '::111111111 R '':--.1:.,..-- ! C i ■ i y , L .3 E' •.) 6 High efficiency windows/ceilings/water ht 7 High efficiency water heating/lighting •; ":j I. ,1' (. MEM O.�F_ IIII ' :O N _ __.._.ME . � ' _.: t . • a E i s 8 Solar photovoltaic ■■. ■ ,■■■■■ MI -■ ■ as I w ,i i J 9 Solar water heating ■■ ■ ■■■■. ■ _µ� ■ ■ :. ._ ` al _ _ i.__ ' _ :. _ E'cm [ g ! f A Skylights with vinyl, wood, or thermally broken aluminum frames and low- emissivity coatings shall be deemed to satisfy this requirement if total skylight area installed is 2% or less of total heated space floor area. B Hinged doors only does not include sliding glass doors. Sliding glass doors are categorized with windows. Glazing that is either double pane with low -e coating on one g Y gg gg g g P g c surface, or triple pane shall be deemed to comply with this U -0.40 requirement. D Must have a U- factor of 0.047 or less. See Table N1104.1(2) for acceptable assemblies/U- factors. E R -38 standard scissors truss is U- 0.042. 10 -inch deep rafter vaulted ceiling with R -30 is U -0.033 and complies with this requirement. F Must have a U- factor of 0.031 or less. See Table N1104.1(2) for acceptable assemblies/U- factors. . Must have a U- factor of 0.025 or less. See Table N1104.1(2) for acceptable assemblies/U- factors. c Air handler must be sealed combustion -air unit with air supply ducted from outdoors and is located within the conditioned space when all- interior ducts are utilized. • • • ' City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 •K . n 1/1.1 x1 March 17, 2011 ,.- _.__. Stone Bridge Homes Attn: Kristen Maaranen 16869 SW 65 Ave., #505 Lake Oswego, OR 97035 Re: Permit No. MST2010 -00122 Dear Ms. Maaranen: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 12677 SW Mount Vista Ct • Project Name: Arlington Heights, Lot 59 Job No.: N/A Refund: ® Check #201376 in the amount of $600.00. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Plan review was incomplete; refund 80% of deposit. New building plan for this lot was resubmitted on 2/10/2011 as permit number MST2011- 00122. If you have any questions please contact me at 503.718.2430. _ Sincerely, • O't Dianna Howse Building Division Services Supervisor Enc. I: \Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 2 ° City of Tigard T I G A R D Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action 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 NW, LLC DATE: March 4, 2011 16869 SW 65 Ave., #505 Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse Attn: Kristen Maaranen TRANSACTION INFORMATION: Receipt #: 178812 Case #: MST2010 -00122 Date: 7/23/2010 Address /Parcel: 12677 SW Mount Vista Ct Pay Method: Check Project Name: Arlington Heights, Lot 59 EXPLANATION: Plan review incomplete and new plans submittted on this lot. Refund 80% of plan review deposit. REFUND INFORMATION: ' • Fee Description From Receipt - Revenue Account No: • . Refund • Example: Building Perniit.Fee Example: - 2300000 -43104 - , ' $ Amount Plan Review 2300000 -43106 $600.00 TOTAL REFUND: $600.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager • If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board . `FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY . - • .. . Case Refund Processed: Date: ©m B : Emlj 1:\ Building \Refunds \RcfundRcqucst.doc x 09/01/2010 CITY OF TIGARD RECEIPT n l:. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD & A/o Receipt Number: 181815 - 03/17/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010- 00122 $- 600.00 Total: $- 600.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 201376 DHOWSE 03/17/2011 $- 600.00 Payor: Stone Bridge Homes NW LLC Total Payments: $- 600.00 Balance Due: $601.34 Page 1 of 1 • CITY OF TIGARD RECEIPT n g . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Dr iE tA/i} c. Receipt Number: 178812 - 07/23/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00122 Plan Review 2300000 -43106 $750.00 Total: $750.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 31590 BTAGGART 07/23/2010 $750.00 Payor. Stone Bridge Homes NW, LLC Total Payments: $750.00 Balance Due: $1.34 Page 1 of 1 1111 CITY OF TIGARD RECEIPT q g .. . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 178812 - 07/23/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00122 Plan Review 2300000 -43106 $750.00 Total: $750.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 31590 BTAGGART 07/23/2010 $750.00 Payor: Stone Bridge Homes NW, LLC Total Payments: $750.00 Balance Due: $1.34 Page 1 of 1