Permit j 0 I' -
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 1 1\l
IN . r Request Permit Action
1 i , , A I: I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD / 1 0
Building Division Services Supervisor «M'
13125 SW Hall Blvd., Tigard, OR 97223 / //9//,3 /94
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) 5 ` £ r ,)l. L „ c y /IA/ 2...4 C.:—
Mailing Address: 4230 6,- (c_ I-0., t i( S' r`e_ `+-
City /State /Zip: L t 6 s,.. L5e— C7 O 3 S
Phone No.: So 3 3 8 7- 75 7 7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
i CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and_provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and de e • , anation below).
❑ REMOVE /REPLACE CON ' ' TOR ON PERMIT (do not can el a • rmit).
00/'7
Permit #: ' iS / do /3- „�.' g .2d /3 -- 00 / 10 3
Site Address or Parcel #: ' 4-g 5V s _ -.t Q (' .
Project Name: At 9 )4 5 g ( '/
Subdivision Name: 5 - -- (...._ Lot #: S 6
EXPLANATION: ,
6, J , •� j o Sc_ G ^ /0 7
Sgg- ""I- fr'O /3 60iyf /u/Z - 00
Signature: :_-/" Date: /-Z- // 3
Print Name: Ai G. , / - S
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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.
F OR OFFICE LSE ONLY
Rte to S s Admin: Date B Rte to Bld. Admin: Date,fst�® B .7,fa
Refund Processed: Date 4/ l B , %!� Invoice Processed: Date f, ® B ic
Permit Canceled: Date /� /9 /3 By P r " vAlm Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
Building Permit Application \ ` 0 1 2 / /9/j3 4C
Residential J31 V ED rOI% (l 1. i i(i: l s 1: oN I.1
�l V �.L Received P ermit No.:
City of Tigard Date/By: 7 1 4 t t 3 (De, k./6/---;s94/.5.1,0 123
• 13125 SW Hall Blvd., Tigard, OR 97223� If 1� t Plan Revi ++ 11 QQ 2 00 / al
Phone: 503.639.4171 Fax: 503.598.1968 1 6 2013 Date/By: 1 l Other Permit: �LV 3-
Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
TI GAR D CITY
Internet: www.tigard- or.gov Cil 1 OF N. ._ ed/Method: 1 Supplemental Information
BUILDING DIVISION - , yam. Agil> MINF#
TYPE OF WORK REQUI • „t 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- and 2- family dwelling ❑ Commercial /industrial Valuation' j 'Z S Z "f ' 20
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2,
Job site address: 154100 5W 9 M M RV I EW DR . New dwelling area: , square feet . 21361
City /State /ZIP: Tigard, OR 97223 Garage /carport area: 44 0 square feet
Suite/bldg. /apt. no.: Project name: Arlington Heights Covered porch area: CIO square feet 137/
Cross street/directions to job site: Deck area: I (to square feet 1057
Other structure area: -7 t' square feet]
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Arlington Heights l Lot no.: ("bp 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: $
M A t II bl
. I S SA . Existing building area: square feet
u P9I At ; 1;"1 1I PI 1 T . New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes Type of construction:
Address: 4230 Galewood St, Suite 100 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: 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 lic.: 173318 Total fees due upon application:
Amount received: zz J � c�
.
Authorized signature: This permit application expires if a permit is not obtained
I within 180 days after it has been accepted as complete.
Print name: 1F(' it_ ._� Date: -- 7//4/( 3 * Fee methodology set by Tri-County Building Industry
��' "�" ___ ((( Service Board.
I: \Building\Permits\BUP -RES PermitApp.doc 10 /01/09 440- 4613T(I1/02 /COM/WEB)
Plumbing Permit Application V 0 1 D
Building Fixtures R 0 ) 1 1 1 ( 1 1 tit ()\ I 1
RECEIVED Received I o
City of Tigard Date/By: 7 I to /3 M.1 Permit No.: / ! rc;;/0 /5 06.3/ ? ?j
I I I II
• 13125 SW Hall Blvd., Tigard, OR 97223 P Review
■ Phone: 503.639.4171 Fax: 503.598.1960 J U L 1 6 Z Date/By: Other Permit No.: Sto 49 j DO4
T I G A Ic Inspection Line: 503.639.4175 Date Ready/By: Juris: RI See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TYPE OF WORRUILDING DIVISION FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ 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: 15V W Jw SUM11\40tJ Ina VR • 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.: J 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 ( Lot no.: eb0 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New, Single Family Residential
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER ' ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 Avenue #505
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@stonebridgehomesnw.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Jardine Plumbing Water piping/DWV 56.29
Address: PO Box 186 Other: 25.02
City/State/ZIP: Estacada, OR 97023 Subtotal
Phone: (503)351 -8532 Fax: (503) 6302882
Minimum permit fee: $72.50
CCB Lic.: 108747 Plumbing Lic. no.: 93- 1185347 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: �� TOTAL PERMIT FEE
Print name: Ja Jardine Date: This permit application expires if a permit is not obtained within 180 days
y after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Petmits\PLMU- PennilApp.doc 10/ 01/09 440- 4616T(10/02/COM /WEB)
Mechanical Permit Applicati, i / I o u t l `I: (l\l.\
a
C ity of Tigard D may` 7 Oa Permit No.: H51 / 3- oa /73
114 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review C
C Phone: 503.639.4171 Fax: 503.598.1960 JUL 6 2013
- d
Date/By: Other Permit: W /L,90/3 -qc11
- t,, , ,1. D Inspection Line: 503.639.4175 Date Ready /By: Juris: El See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLLST
® 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*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
V V
Job site address: 154 Sw SUM M1\1 LEV DR. Air conditioning
(requires site plan showing placement) 46.75
City/State /ZIP: Tigard, OR Furnace 100,000 BTU (ducts/vents) 1 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
Flue /vent for any of above 23.32
Subdivision: Arlington Heights Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 1 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 ❑ TENANT
Chimney/liner/flue/vent 23.32
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 1 33.39
Single -duct exhaust (bathrooms,
Phone: (503)387 -7577 Fax: (503)387 -7616 toilet compartments, utility rooms) 5 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: same as above Furl i to
pP g
Contact name: Deirdre Britt $14.15 for first four; $4.03 for each additional
Address: Furnace, etc. I
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone :( ) Fax::( ) Water heater
Fireplace
E -mail: dbritt @stonebridgehomesnw.com Range 1.
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
Minimum permit fee ($90.00)
Phone: (503) 667 -5595 Fax: (503) 491 -8252 Plan review (25% of permit fee)
CCB lie.: 110091 State surcharge t 12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: David Heldstab Date: * Fee methodology set by Tri- County Building Industry Service Board
I:\Buitding \Permits \MEC- PemtitApp.doc 10/01/09 440- 461TC(I1/02COM/WEB)
Electrical Permit Application \ / 0 FOR OFFICE 1 51: Oyl.l
City of Tigard Drl Re ceived 7l f a /�3
j`l Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 iK r Review O
Phone: 503.639.4171 Fax: 503.598.1960 a :rely. Other Permit: Lo L a lcv 3 a:43
i i c; n l; I�
Inspection Line: 503.639.4175 „ Date Read • /By: Juris: HI See Page 2 for
Internet: www.tigard- or.gov JUL 16 LQ'lotificd/Method: Supplemental Information
TYPE OF WORK an' OFTIGA! 1 PLAN REVIEW
® New construction ❑ Addition/alteration/$ DIVISION 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
® 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 of system. larger separately system.
2 , derived syste
p, C ❑ Addddition of new motor load of ❑ "A", "E", "1 -_ , 1 3
Job no.: (4 5I Job site address: V SW cl U M MER.VI D R . 1 or or more. occupancy.
❑
0 Six or more re 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 Fee. f Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Arlington Heights Lot no.: 130 1,000 sq. ft. or less A_ 168.54 4
Ea. add'l 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential � - 7,��•� 2
DESCRIPTION OF WORK (with above sq. ft.)
NEW% cINKS M 10 I SIOEt1I
Limited energy, (with above sq. 67.84 2
residential (with above 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 I
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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® 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: without service or feeder fee, 56.18 2
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 In 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: e ..7 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.
1:\ Building1Pertnits iELC- PermitApp.doc 10 /01/09 44(1- 4615T(11 /05/COM/WEB
Ifi I ` Building Division t i
Development Code Provision Review LI
; I 0
T I G A R D Residential Projects
Building Permit No.: H `DT an 13 - b b t 7 3
Project /Subdivision Name: Ct- t -+ir . k \o, h(✓� ! \ .3 , Lot #: ?O
Site Address: 1 4 Loyd �.t� o§u.,�► . 6' v •
CWS Service Provider Letter:
Required: Yes ❑ No l-
Received: Yes ❑ No 0
Plans Routed:
/ Original Plan Submittal Date: 1 Le Routed By: (I --J
1St Revision Submittal Date: OAS ❑ Site Plan Only Routed By: ...W
2n Revision Submittal Date: ❑ Site Plan Only Routed By:
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 it S �--ON , C i at (503) 718 - 2'}2 - 7 or G� .S — @tigard-
or.gov) it
Land Use Case No. S4PPZ Z1P CCOO 1
Zoning Q
Er Setbacks: � \ 1 ■ 1 t i
ront 1 Rear Sid G Street Side lO Garage
air Building Height: 5 Actual Building Height tZIO
Lam' Visual Clearance
al ements 0\/\)( I ,, f
D" Sensitive Lands Type: �7 C() S1 1 / ►YI I,n oLif Vp1 / -vAlV
(Street Trees (
❑ Protected Trees
Notes:
Original Plan: Approved E Not Approved ❑ Date: 1 \ k -(AV9
Revision 1: Approved I Not Approved ❑ Date: 11
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
Z Actual Slope: 2- {-
Notes:
Original Plan: Approved 1. Not Approved ❑ Date: /I b 3
Revision 1: Approved � Not Approved ❑ Date: 4S b ( 3
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 I% No ❑
Date Routed to Building: .1 i
/ 1/0
Page 2 of 2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
ql DI STONE BRIDGE RECEIVED OBE e 1451
LOT: 80
•J HOMES NW AUG 6 2013 DATE: R:7/31/13
423o GALEWOOD ST. SUITE 100 PROPERTY: ARLINGTON
HEIGHTS
LAKE OSWEGO, OR 97035 t _ 1 CITY OFTIGARD CITY: TIGARD
(5 387 -7577 IW1r Am BUILDING DIVISION SCALE: 1"=20'
V 0 t PLAN No.: 222 —STD.
b
al
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IN ,;, S ,,) A
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P
BUILDING SQFT. ,t,
MAIN FLOOR: 1,059 SQ. FT. / j,
UPPER FLOOR: 1,311 SQ. FT. (0�
PORCH: 90 SOFT.
LOT COVERAGE STREET TREES
LOT AREA: 4,553 SQ. FT.
BUILDING AREA: 1,710 SQ. FT. 0 PERCENTAGE: 38.1% - EASTERN - GERGIS GANADENANADENSIS-
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. LOT 'S0
DRIVEWAY MAY DIFFER DUE TTO OCAT ON OF UTILITY BOXES, 4,563 eq. Ft.
STREETLIGHTS, AND OTHER SITE CONDITIONS.
I' s � � City of Tigard • COMMUNITY DEVELOPMENT
Building Division
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TIGARD
INVOICE
TO: Stone Bridge Homes Customer ID: 173318
4230 Galewood St., Suite 100 Invoice No.: INV2013 -00006
Lake Oswego, OR 97035 Invoice Date: 12/19/2013
Date Due: Upon Receipt
Case No. Site Address Subdivision - Lot # or Project Name Amount Due
MST2013 -00173 15468 SW Summerview Dr Arlington Heights, Lot 80 $422.53
Note: This permit was cancelled
and replaced by another house plan
on permit MST2013- 00248.
Invoice Total: $422.53
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2013 -00173 Customer ID: 173318
Site Address: 15468 SW Summerview Dr. Invoice No.: INV2013 -00006
Project: Arlington Heights, Lot 80 Invoice Date: 12/19/2013
Date Due: Upon Receipt
Invoice Total: $422.53
Amount Paid: $
Office Note: Please forward copy of receipt to Dianna Howse for file.
Please mail payment to:
City of Tigard, Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
I: \Building \Accounting \Invoice.doc 01/14/2011
Ili CITY OF TIGARD FEE AND PAYMENT HISTORY
1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
MST2013 -00173 - 15468 SW SUMMERVIEW DR, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Plan Review 230 - 0000 -43106 $751.34 $751.34 $750.00 7/16/13 Credit Card 192248 $1.34
Plan Review 230- 0000 -43106 $341.19 $341.19 $341.19
DC Provision Review, SF - Ping 100 - 0000 -43112 $70.00 $70.00 $70.00
DC Provision Review, SF - LRP 100 - 0000 -43117 $10.00 $10.00 $10.00
Totals for Fees $1,172.53 $1,172.53 $750.00 $422.53
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
192248 Credit Card Andrew Thomas - Stone 07/16/2013 $750.00
Bridge Homes NW
Total Payments: $750.00
Balance Due: $422.53