Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit #: MST2009 -00176
'TEGARb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/25/2009
Parcel: 2S112BD08900
Jurisdiction: Tigard
Site address: 7854 SW WEBBER LN LN
Subdivision: Lot: 0
Project: Brittany Meadows
Project Description: New SFR.
BUILDING
Floor Areas Required Setbacks Required
Stories. 2 Bedrooms: 3 First: 1168 sf Basement: 0 sf Left: 5 Parking Spaces: 2
Height: 23 Bathrooms: 3 Second: 1315 sf Garage: 420 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $270,372.00 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 1
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 0
Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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 l 500 sf: 4 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 l 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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
MORRIS WESTLAND PACIFIC LIFESTYLE HOMES
16615 MAPLE CIRCLE 11815 NE 99TH ST #1200
LAKE OSWEGO, OR Brush Prairie, WA 98604
PHONE: 503 - 601 -5041 PHONE: 360 - 213 -0864
FAX: 360 - 574 -6401
Total Fees: $16,844.09
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 wit
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0100. You d), 0.1 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C� 0. Q v 1 0.1 Y'\
9A Permittee Signature:
T
Building Permit Application
Residential
RE rot( usl: oNi.)V
City of Tigard Received ri Permit No.: ii ' � O
• 0 (
p
° 13125 SW Hall Blvd., Tigard, OR 97223 i
� SEP 0 12009 Date plan Review
' Other Pi • r
Phone: 503.639.4171 Fax: 503.598.1960 DateB : Ct1r a er ermt: � �` � a
l -i G n l l) Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: u i ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: � ' l . ` . J OM Supplemental Information
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.
® I- and 2- family dwelling El Commercial /industrial Valuation: $150,000.00
❑ Accessory building El Multi-family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
•
Job site address: 7854 SW Webber Ln New dwelling area: 2483 square feet
City/State /ZIP: Tigard Garage /carport area: 380 square feet
Suite/bldg. /apt. no.: Project name: Brittany Meadows Covered porch area: 30 square feet
Cross street/directions to job site: Bonita to 79th Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL-USE CHECKLIST
Subdivision: Brittany Meadows Lot no.: 25 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. 1
2483 sq ft new single family home with attached two car garage Valuation: $
Existing building area: square eet
■` New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Morris Westlund Type of construction:
Address: 16615 Maple Circle Occupancy groups:
City /State /ZIP: Lake Oswego Existing:
Phone: (503)601 -5041 Fax: (503)601 -5042 New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Pacific Lifestyle Homes, Inc. All contractors and subcontractors are required to be
Contact name: Russ Tiedeman licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11815 NE 99 St, Suite 1200 jurisdiction in which work is being performed. If the
City/State/ZIP: 98682 applicant is exempt from licensing, the following reasons
apply:
Phone: (360) 852 -2827 Fax: : (360) 574-6401
E -mail: russt @pacificlifestylehomes.com .
CONTRACTOR •
Business name: Same as applicant BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State /ZIP: Structural plan review fee (or deposit): 1 tO . 00
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.:
r V I 72 5 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: Af SS T ,4Al a , Date: 7A/A70 * Fee methodology set by Tri- County Building Industry
Service Board.
L: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM /WEB)
�r i ll Rp l l � , ii 7 IIyi II l9 i . •i It, Ili hi ? , ? I� Il 1 1 I '- ti i s .\ 1 J : ;! A ,
Mechanical Permit Application �� kI I I „ l Il I Im" F v xl ,) I ()Rol. 1 1(I U54 4 1, 1 O NI - 1 1r' � , l JI u' a
AA !1Q.l ll!l� I i 1 J,i �i , 01 _ '1 ^ +3 1 1,01 , I.4re;'l;' I ' l il e L'i fl I l5 v I
lil , i l , IFI1il C of ' Tigard Date /Be Permit No.:
I �t1 ;
U PI II " ° 13125 SW Hall Blvd., Tigard, OR 97223 y • Y ' '� i
Plan Review Other Permit:
V l Il 1 C 3 1, s
i � 1 ' �, Phone: Inspection .63 503 Fax: 503.598.1960 Date /By:
I I A R! ICI p Date Ready /By: Juris: ® See Page 2 for
rn tN, ,i 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 IN FORMATION AND LOCATION • Heating/cooling
Job site address: 7854 SW Webber Lane Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: Tigard, OR Fumace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts /vents) ( 17.90 I 1,Cf0
Suite/bldg. /apt. no.: Project name: Brittany Meadows Gas heat pump 14.00
Cross street/directions to job site: Bonita to 79th 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: Brttany Meadows Lot no.: 25 Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
•
DESCRIPTION OF WORK - Water heater 1 10.00 10,00
Gas fireplace C 10.00 )0,01)
Single Family New Construction 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
:� PR OPERTY OWNER I • , ❑TENANT y mer /flue /vent
Chimne /l' 10 0
. . . Other: 10.00
Name: Morris Westlund Environmental exhaust and ventilation
Address: 16615 Maple Circle Range hood/other kitchen
equipment 1 10.00 10,00
City/State /ZIP: Lake Oswego, OR Clothes dryer exhaust ( 10.00 10,60
Single -duct exhaust (bathrooms,
Phone: (503 - )601 - 5041 Fax: (503)601 - 5042 toilet compartments, utility rooms) 1 4 6.80 211D
• ❑ , APPLICANT , ® CONTACT:. PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Pacific Lifestyle Homes
Fuel piping
Contact name: Russ Tiedeman $5.40 for first four; $1.00 for each additional
Address: 11815 NE 99th St. Suite 1200 Furnace, etc. 1 S.Hb
Gas heat pump
City/State /ZIP: Vancouver, WA 98682 WalUsuspended/unit heater
Phone: (360) 213 - 0864 Fax: : (360) 574 - 6401 Water heater
Fireplace
E - mail: russt @pacificlifestylehomes.com Range
CONTRACTOR Barbecue
Business name: The Heat Guy LLC Clothes dryer (gas)
Other:
A
1.
ddress: 22100 NE 237 Ave MECHANICAL PERMTT FEES*
City/State /ZIP: Brush Prairie, WA 98604 Subtotal
Phone: (360) 803 - 4876 Fax: (360) 883 - 2969 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 173524 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: ,.,00----T This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 72 J .,. �, � 4 , 0469 ,. Date: M� * Fee methodology set by Tri- County Building Industry Service Board
I: \Building \Permits \MEC- PermitApp.doc 01/19/07 2 /COM/WEB)
. ,
Electrical Permit Application . _ . --
4 -
t - . - .
,- . .ffificifmcarh- .gaizy - • . •
.• . .• •
1 Permit 1 . (30 1 7
DaterBy:
7 13125 SW Hail Blvd., Tigard, OR 97223 Plan Review
411 li ° ' ,, I . ': Phone: 503.639.4171 Fax: 503.598.1960 Othcr Permit:
Datc/Br:
DU ..! i ]: : I ! :Ir... C ATIA.,. A A A A A i :3 . S
.
Dale Remly/B!.0
Notificd/Niciliud: 1.1m3s: 0 ee !Mu 2 for
CID 2 fu
. In Nr....1 . 1 www DA . ...1A :: DA 0 ,--------
rrnation
----
— 1
T Y OF WORK
1 PLAN REVIEW -
— 1 Pleiai:lieci;Tiiiiii;;Taoi;ly (!Mbinil 2 sets of plans wThems checked IR lowl:
0 New construction Ej Addition/alteration/replacement
' El Service or feeder •IiI(lamps or more 0 Building over three sio; ies
E ] Demolition El Other: wecre the available find( current ID Marinas and boalynrds.
CATEGORY OF CONSTRUCTION . !Nrecei !0.000 mu :.! 150 volts or 0 floaline buildings.
— :es, te urc:nd. en e‘ce15.!-■ L (JO0 0 culameieiatoise: agricaltuna
[J I- and 2-family dwelling D Commercial/industrial El Accessory build:og I !airy; for an othor in ,::,:lCutis. buildings.
0 Multi-family 0 Master builder 0 Other; 0 Fire pinup. 0 Imiallation or75 KVA or
LJEnergency system. larger separately derived sr:tein.
JOB SITE INFORMATION AND LOCATION ! 0 Addition ninety motor load of
Job no.: Job she address: 7854 SW Webber Lane 1 10;)111' or imln.2. occupancy.
Dsbe or elMe reSitlept em15. 11 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 1 f__1'.1ealt.1! raci!i:fes. 0 Supply voltage Ibr More dem
Dna:eau:ow: ira::um COO volts nominal.
Suite/bldg./apt. no.: Project name: Brittany Meadows j El Service or fe::der 6UU amp; ur mute. •
—
— — FEE SCHEDULE
Cross street/directions to job site: Bonita to 79t1 m!eriptipa Icp 11:. Trad j_l___
New residential single- or multi-family dwelling unit.
Includes attached garage.
i
Subdivision: Brittany Meadows I Lut no.: 25 , LI,003 sq. 11. or less I 145.15 /45, /5 4
t_ - ---1 EL add'i 500 scl. 0, 6:- portion 3 33.40 /60,Z0 1
Fax titap/pareel no.: 1 •
DESCRIPTION OF WORK (i
Limited enemy, residential
.i,iiit t elbave. sq. 6. ) 75.00 7
__
Limited energy, mann-family
Single family new construction i
resdential (willt Uore sq. 11.) 7.5,00 1
—
- - Serviees or fecciers installation, alteration, and/or relocation
. --___
200 amps or less 80.30 2
. ------,-- .. --
El PROPERTY OWNER 0 TENANT 201 amps to 400 rains 106.85 2
-
401 amps lc 600 ainp5 160.60 .7
Name: Morris Westlund
— - - 601 amps to 1,000 amps 240.60 2
Address: 16615 Maple Circle L Ov.,:r 1,000 amps o: volts 454.65 ---
2
City/State/ZIP: Lake Oswegc, OR 1 Temperery services ur feeders installation, alteration, ond/or
!
-- relocation
— - _ _
Phone: (503)601-5041 I Fax: (503)601-5042 I 200 amps or less 66.35 1
I Owner installation: This installation is being made on property that I own \vIii is no.t 1-r Y si L n La' s ______________ I 0030
intended for sale, lease, rent. or exchange', ticetirding to ORS 447, 449 , 6'70, and 701. i 40! amps to 599 amp 133.75 2
■ Branch eircults -- new. +liter:10mi, or CX1C115i011, per panel
Owner signature: Date: _
---- A. Fee for branch circuits with
El APPLICANT
d.. IE CONTACT PERSON above service or feeder ice.
6. _ 65
each branch circuit
Business name: Pacific Lifestyle Homes 13. Fee for branch circaits
how SillViCC' ill' feeder ice_
Contact name: Russ Tiedeman _ F 46.85 2
irst branch cin.:nit
Address: 11815 NE 99 St., suite 1200 Each itdd'l brunch cileuit 6.65 1
_
.
Miscellaneous (service or feeder not inc)uded)
City/Statc/ZIP: Vancouver, WA 9ri.1(82 1 Ea:Miriam:facia:a! re modular
90.90 2
- dwellitia, service and/or feeder
Phone: (360) 213-0864 I Fax: : (360) 574 1
6685
Reconnect only .
....._. ...
E-mail: russt@pacifielifestylehomes.com Pump or irtirtation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 7
_
Signal ctretitqs! or li
Business name: Garner Electric
enemy panel, alter:mon, or
:i
Address: 2920 SE Brookwood Ave, Suite A intenson. Describe: Page 2 1
_
City/Slate/ZIP: Hillsboro,OR 97123 Eaelt additional iilspection over allowable in any of the nbove
. Per ins nxtion
Phone: ( 3) ioL(?. (,/(_-; -,,
— 2 \ i , , ,,„.1 ---, -7 67,•--) ,--
P. . (■,.‘ 3 ' V I I I ; • ( 7 / . - / /,, ---) I Investigation per )ou ir m
r ti lin) 62.50 —
I - it _
CCB Lie.: 121159 1 kleetrical L.f. ic 34 ,„,., SAry. Lig.: 3707 hider:trial plant per hour 73.75
---4-- 7'7`'? - 7; 7 77ti : 7- ' - ELECTRICAL PERMIT FEES
___
Suprv. Electrician signature, required: ( ,te:''.:/ /1 ...: '. Subtotal:
t ..._
_
.. , 1 - s i.,...,j"--1 DI."....:7----77- Plan rcview (25'li of pcnnit fee):
Print name: I 11 i / C (._ (..::, .,,,,—)/-7)./cr l
a,o.. 2 ,
% -, t/ , _ ■ ,--, ,....._ . State surcharge (12% °rpm fee):
.Authorized signature:
TOTAL PERMIT FEE:
ibis penult application expires if a permit Is not oluninvil within iilfi
Print Ilrilile: .".. rs .. 4 ...- , , , _ ,.._ 1 Dr t - ----- -------
I c. 9 2 i _, eiar; ane,- ir Ims been accepted 11S cumplele.
/ Number of imiumtim.s allowed per permit
1 05 l l(;6:5'r I.:15,COM'WEel
I
Plumbing Permit' Application D r n -, . a ,
L . : �i .- 4 . I�11 i r. ' full II, It 1 (R, ! gi I-.. I -. _
Building Fixtures ' I "1�i' I al �a 9tl;' ,, I I r 1, 11 1 ,O1 11(1 I UtiI C)v 1 1 1 ' 1 ;i
_P ® c. f4 d lI"I4 Il „.1 {i $l� 11 1 1 , I�tIi 1l . I:i} n rcV, ,Uf ' 11 I� h'm .� , II " n Fk II rl ,j. IIf � f
Ih ll? 2009 R }
�
h
Ie df 1 l , l l , a ; City Of Tigard V 1 Date /B Permit No.: i t 1sT? nQq 00� . 74"
ii 13125 SW Hall Blvd., Tigard, OR 97223 y
� � I q € r' Plan Review
1 l, I a ,1 Phone: 503.639.4171 Fax: 503.5�98.I I Q (�- i . 1.1 Date /By: Other Permit No.:
c , Inspection Line: 503.639.4175
iIII �' s("f(�+ I�o.j a1�rF {1�'ate;Ready /B 7urs: ® See Page 2for
ill I .
l l A RD ?
• if i111,,Ir l Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK • FEE* SCHEDULE, • .
® New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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
® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath ( 399.00 311,00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
' . - ' JOB. SITE INFORMATION AND LOCATION Site utilities
Job site address: 7854 SW Webber Lane Catch basin or area drain 16.60
City/State /ZIP: Tigard, OR Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Brittany Meadows Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Bonita to 79th
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Brittany Meadows 1 Lot no.: 25 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
Single Family New Construction Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
®. PROPERTY .OWNER . l ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Morris Westlund
Expansion tank 16.60
Address: 16615 Maple Circle Fixture /sewer cap 16.60
City/State /ZIP: Lake Oswego, OR Floor drain/floor sink/hub 16.60
Phone: (503)601 -5041 Fax: (503)601 -5042 Garbage disposal 16.60
Hose bib 16.60
®. APPLICANT ® CONTACT PERSON
Ice maker 16.60
Business name: Pacific Lifestyle Homes
Interceptor /grease trap 16.60
Contact name: Russ Tiedeman Medical gas (value: 5 ) Page 2
Address: 11815 NE 99 St., Suite 1200 Primer 16.60
City/State /ZIP: Vancouver, WA 98682 Roof drain (commercial) 16.60
Phone: (360) 213 -0864 Fax: : (360) 574 -6401 Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E - mail: russt @pacificlifestylehomes.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Malmedal Plumbing Water heater 16.60
Address: PO Box 207 Other:
City/State /ZIP: Banks, OR 97106 Subtotal
Minimum permit fee: $72.50
Phone: (503) 324 -0759 Fax: (503) 324 -0580 Residential backflow minimum permit fee: $36.25
CCB Lic.: 102535 umbing Lic. no.: 4509 JP Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: D L�� �' I ��. //
„,� ��
`mil / r-Y TOTAL PERMIT FEE
Print name: Russ Tiedeman I Date: 9/1/09 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 \PLMF - PermitApp.doc 12/27/06 440- 4616T(10102 /COMIWEB)
` :, • .ti • • • • • • • • • • • e • • • • •
ti • • • • • • • • •• •• • • •
• • • • • • •• • • • •••
• • • • • • • • • • • • • • •
F r •• • • • • • • •
.� ••. , ee
• • ? - • •
o ••• • • o •
• •
e• • • • • •• • •
• • • • • 0 • • •
CITY OF TIGARD • SITE PLAN REVIEW
BUILDING PERMIT NO.: H T oEDQ ? - •••
PLANNING DIVISION: • • • •
Required Setbacks: C -Approved p: oJe
Not apprd • , ;
Side: . Street Side: tO t‘
Front._ Ga ge: Rear:
Visual Clearance: Q ❑ Not Approved
V\ Maximum Building Height : feet
CWS Service Provider Letter Required: 0 Yes ❑ No
Received
B.) Date: q 3(0
ENGINEERIN DEPARTMENT:
Actual Slope:% aA proved ❑ Not Approved
Site PI • Approved ❑ Not Approved
By: g� j ii , , Date: 9-9-9'
- 9- 9
Notes:Qe a t ed-A— ct?v✓> cA-u V.-0 4--
CITY OF TIGARD - SITE PLATY REVIEW
BUILDING PERMIT NO:
Street Trees: ( Approved ❑ Not Approved
Protected�es.: i X41 b Approved Not Approved
By: ✓ 7�" Date: 7 , - Of
Notes:
H,itf 1- Sc t( +A/4l Sal wt►, (S' /dCw. //C t)lagt
A
' City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
1,1 U
Wednesday, December 16, 2009
��TT -GARD:
Pacific Lifestyle Homes ' . . •
• 11815 NE 99th St., #1200
Brush Prairie, WA 98604
RE Transportation Development Tax (TDT) Refund.
Permit No. MST2009 -00176 for 7854 SW Webber Ln. Brittany Meadows
At the time the above building permit was issued you paid a Transportation Development
Tax (TDT) 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 m at 503 - 718 -2426 if you have any questions.
ert Shields
Permits /Projects Coordinator
503- 718 -2426
•
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard - or.gov • TTY Relay: 503.684.2772
li
City of Tigard •
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 PermitAction 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: Pacific Lifestyle Homes, Inc. DATE: 12/10/09
11815 NE 99 St., #1200
Brush Prairie, WA 98604 REQUESTED BY: Dianna Howse
AMS
TRANSACTION INFORMATION:
Receipt #: 175347 Case #: MST2009 -00176
Date: 09/25/09 Address /Parcel: 7854 SW Webber Ln.
Pay Method: Check Project Name: Brittany Meadows
EXPLANATION: Refund amount discounted for TDT per Washington County.
REF1- 1.ND,INFORMATIONc :
"F?ee D.escri - ption'From Recet i
' • •:P - P
l
oUSt'
TDT - Transportation Development Tax 4050000 -43320 $920.00
TOTAL REFUND: $920.00
APPROVALS:
If under $5p0C Professional Staff
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
' °.;::FOR =ACCEIA SAS_ TEM':ADIVIINISTRATION. USE .; ; r .....
Refund Request Reviewed: Date: By: .
�.� >� ,11
Case Refund Processed: Date: `^ �
r �' � r r- B Y : / .
/OA / 7y
I: \Building \Refunds \RefundRequest.doc 04/13/09
, •
• • CITY OF TIGARD RECEIPT
q
a . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 176351 - 12/18/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2009 $ 920.00
Total: $- 920.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check • 102174 DHOWSE 12/18/2009 $- 920.00
Payor: Pacific Lifestyle Homes Inc.
Total Payments: $ - 920.00
Balance Due: $920.00
Page 1 of 1
. . F:' :: •;=� CITY OF TIGARD •- _- iz:;::`:� RECEIPT
ph 13125 SW Hall Blvd., Tigard OR 97223
- ' ' 503.639.4171 •
?IGA*RD
Receipt Number: 175347 - 09/25/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2009 -00176 Building Permit 2300000 -43104 $1,531.91
MST2009 -00176 12% State Surcharge - Plumbing 1003100 -24001 $47.88
MST2009 -00176 CDC Plan Review, RES 1003100 -43112 $46.00
MST2009 -00176 CDC Plan Review, RES - LRP 1003100 -43117 $6.00
MST2009 -00176 12% State Surcharge - Building 1003100 -24001 $183.83
MST2009 -00176 Metro Const. Excise Tax - Residential 2300000 -24011 $324.45
Use
MST2009 -00176 Tig -Tual School CET - Residential 2300000 -24102 $2,483.00
MST2009 -00176 Park - Single Family Unit 4250000 -43300 $5,370.00
MST2009 -00176 TDT - Transportation Development Tax 4050000 -43320 $4,599.00 . - '
MST2009 -00176 Erosion Control 1003100 -22002 $88.00
MST2009 -00176 Erosion Plan Review CWS 1003100 -22003 $28.60
MST2009 -00176 Erosion Plan Review COT 2300000 -43102 $28.60
MST2009 -00176 Water Quantity - Res 5200000 -43122 $275.00
MST2009 -00176 Furnaces >= 100K BTU 2300000 -43102 $17.90
M5T2009 -00176 Duct Work 2300000 -43102 $10.00
MST2009 -00176 Water Heater 2300000 -43102 $10.00
MST2009 -00176 Gas Fireplace 2300000 -43102 $20.00
MST2009 -00176 Range Hood /Other Kitchen 2300000 -43102 $10.00
MST2009 -00176 Clothes Dryer Exhaust 2300000 -43102 $10.00
MST2009 -00176 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $27.20
Utility Rooms)
MST2009 -00176 Fuel Piping 2300000 -43102 $6.40
MST2009 -00176 12% State Surcharge - Mechanical 1003100 -24001 $13.38
MST2009 -00176 Permit Fee - Elect (per dwelling unit) 2200000 -43103 $278.75
MST2009 -00176 12% State Surcharge - Electrical 1003100 -24001 $33.45
M5T2009 -00176 SFR - Baths 2300000 -43101 $399.00
MST2009 -00176 Plan Review 2300000 -43106 $245.74
Total: $16,094.09
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 2560 LSELLERS 09/25/2009 $16,094.09
Payor: Pacific Lifestyle Homes, Inc.
Total Payments: $16,094.09
Balance Due: $0.00
Page 1 of 1
– — — – — – —S VV__ – -VV F___B
°
..40
co
N
.''' :1(c) 1
T O
Z v LC7 c6 J
rn pC w¢¢ N
N 8 j n w 5 / 1. 62
he.T�li '�' /1 165
� a tc7 z r .. — . ': _ 1
8 P.U.E. J aoosF:� N ti i • co cv 44'4
' ' '. .• \ 20 Setback CI ) 162 I
4 Ns'
182 f�
2" Caliper 6-4 w
" Trident Maple s 4 =
{ 15 -30' Spacing " � SHERIDAN 5' V
co
nt
2483 SQ. T.
`- 3
•.•• 1� • W u 164 SGD
• • • • SGdL�
1:•
•• •
•••• 'Lot 25 _ 8410P6Un I 1 ..20
•••• I •••• I 80 SF \
. 383 SF I DRIIfN AY,
• • • • • • • I
• • • • • • • • , ill L is• seroaa. J 10/03/07 R. Y
• • • • _
• • • • 0 Q� N DAIL
•. • Y_
•••• • • • • • •• cv �%
• • • • • • • /t6'V /S6Q
• • •
50.b0
4 �(j' j �
- , • , L : �'IGove\•�dgM 36% 164 161 Q
.... i_ot §F= 21.383 •
• GI .� •
House SF= 1597
* at
an
Impervious Surface= 480 SF
Paco N0:
1