Permit Building Permit Application °— EXP I R ED
Residential ��� I OR OFFICE USE ONLI
City of Tigard C� `d 12 o ' Permit No. tf ro a - r )(Q 2
• 13125 SW Hall Blvd.,Tigard,OR 223 $ Plan Review
III
Phone: 503.639.4171 Fax: 503.598.1Q(>Q.� 12��� Date/13 : Other Permit: �q�-�(,�1Q7 t
T I G A RD Inspection Line: 503.639.4175 ��1111'' PR� Date ReadyBy: luris See Page 2 for
Internet: www.tigard-or.gov 'AG �� Notified/Method: Supplemental Information
.,- tit nF ,,,A\■ —�
7z - # � � .EAAF t -,REQUIRED DATA:_1-AND2FAMILY DW ELLING
®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: S130,000
El Accessory building El Multi-family Number of bedrooms: 2
❑Master builder 0 Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: 1/U gg 9 W ma 1 I e:y-y New dwelling area: 1329 square feet
City/State/ZIP:Tigard,OR Garage/carport area: 556 square feet
Suite/bldg./apt.no.: Project name:Village at Summer Creek Covered porch area: 25 square feet
Cross street/directions to job site: Deck area: 128 square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL-USE CHECKLIS `
Subdivision: Lot no.:-70 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: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:JLS Custom Homes Type of construction:
Address: 16280 NW Bethany et Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)533-4006 Fax:(503)533-4306 New:
El APPLICANT ❑ CONTACT PERSON K ° ,.
NOTICE
Business name:JLS Custom Homes All contractors and subcontractors are required to be
Contact name:Nicole Paulsen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16280 NW Bethany et jurisdiction in which work is being performed.If the
City/State/ZIP:Beaverton,OR 97006 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)533-4006 Fax::(503)533-4306
E-mail:nicole @jlscustomhomes.com
' V °. 4._ -_ -CONTRACTOR
Business name:JLS Custom Homes BUILDING PERMIT:FEES*
Address: 16280 NW Bethany ct
(Please refer to fee schedule)
City/State/ZIP:Beaverton,OR 97006 Structural plan review fee(or deposit):
Phone:(503)533-4006 Fax:(503)533-4306 FLS plan review fee(if applicable):
CCB lie.:139970 Total fees due upon application:, 750.E
al � I Amount received: � '�.��Authorized signature: 1 ' I This permit application expires if a permit is not obtained
' within 180 days after it has been accepted as complete.
Print name:Nicole Paulsen Date: * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RES PermitApp.doc 11/6/07 440-4613T(11/02/COM/WEB)
Mechanical Permit ApplicatiogECEIVED I'OR OFFICE IISL oNL.I
City of Tigard It Received T
t • 13125 SW Hall Blvd.,Tigard,OR 97223
Date/By Q Q ,
1 2
Phone: 503.639.4171 Fax: 503.598.1960 MAY 2008 Plan Review Date/By: OtherPetmit� /2_,. ..)e)8,_460 7 f
T I(,A f D inspection Line: 503.639.4175 Date Ready/By tuns H1 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method. Supplemental Information
MIV
®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.
gs u . . ,. �.� a ,c °°� Value $
100.40 s yc IUtK
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑ Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
, _ ? *.FS .° a , S°
Heating/cooling
1 q Air conditioning or heat um 1
Job site address: I,��1 S� ��\\Ot� 1��/'�/ (requires site plan showing placement) 1 14.00
City/State/ZIP:Tigard,OR 1 Furnace 100.000 BTU(ducts/vents) 1 14.00
Furnace 100.000*BTU(ducts/vents) 17.90
Suite/bldg./apt.no.: Project name:Village at Summer Creek • Gas heat pump 14.00
Cross street/directions to job site: 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
Flue/vent for any of above 6.80
Subdivision: Lot no.:.1 Li
Other: 10.00
Tax map/parcel no.: Other fuel appliances
' r _ t 7}l(1 mQ7Is*** :t lfp'f Water heater I 10.00
Gas fireplace 1 10.00
Flue vent for water heater or gas
fireplace 2_ 10.00
Log lighter(gas) 10,00
Woodipellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00 4 x mo ; f 3 ► r +a s
Other: I 10.00
Name:JLS Custom Homes Environmental exhaust and ventilation
Address:16280 NW'Bethany et Range hood/other kitchen
equipment I 10.00
City/State/ZIP:Beaverton,OR 97006 Clothes dryer exhaust i 10.00
Single-duct exhaust(bathrooms, '' II
Phone:(503)533-4006 Fax:(503)533-4306 toilet compartments,utility rooms) "T 6.80
. >r, [ at0 •k t , ;0 **** Attic/crawlspace fans 10.00
Business name:JLS Custom HOmes
Other. 10.00
Fuel piping
Contact name:Nicole Paulsen $5.40 for first four;$1.00 for each additional
I
Address: 16280 NW Bethany et Furnace.etc,
Gas heat pump
City/State/ZIP:Beaverton,OR 97006 Wall/suspended/unit heater
Phone:(503)533-4006 Fax::(503)533-4306 Water heater
Fireplace
E-mail:nicole @jlscustomhomes.com Range ft
s s∎OPSr iltk( Yq_ Barbecue
Business name:TBD Clothes dryer(gas)
Other: I ,
Address: .
City/State/ZIP: Subtotal
Minimum permit fee($72.50)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
CCB lic.: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: l Date: , • Fee methodology set by Tri-County Building Industry Service Board
1\Buildmg\Permns\MEC-PermilApp.doc 01/19/07 440.4617T111 t171Cf1M/WFRi
Plumbing Permit Application
Building Fixtures RECEIVED roll ui•rl( I 1st,. (P\1.1
g Received 5/g R eg Permit No.. Bravo U-eao(p ,
City of Tigard Datdvy. ,r
II • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review r
Phone: 503.639.4171 Fax: 503.591 1 2 200 Date/By: Other Permit No.: (§,cleat�o$-rkr) 2
T I(.;\is n
Inspection Line: 503.639.4175 Date Ready/By: hail: ® See Page 2 for
Internet www.tigard-or.gov a RD Notified/Method: Supplemental information
$ `t _ r..,_,...1.:;?, t�1 7 1•.v�-n I <' '1 -j"`.... r u> t k
i ii a For special information use checklist.
❑New construction ■ Demolition
Description 1 Qty. ] Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
24910
❑ 1-and 2-family dwelling ❑Cornmercial/industrial SFR(2)bath 350.00
❑Accessory building ❑Multi-family SFR(3)bath 399.00
❑Master builder Each additional bath/kitchen 45.00
❑Other:
Fire sprinkler( sq.ft.) Page 2
'1'1' . .>- WF -t +c< ,„ q .L. N
Site utilities
Job site address: )4 021...\ Svc l e lCAJl M)....) 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:Village at Summer Creek Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: I Lot no.:--7 Water service(no.linear ft.:_) Page 2
Tax map/parcel no.: f Fixture or item
Absorption valve 16.60
..-„;--.- -;:!..,-...r,,,,, ._ _• -, „ ,,,::.,;#..c,'.,, t. : ” Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
}• _. �,- �, t s,,y . :1, Drinking fountain 16.60
Ejectors/sump 16.60
Name:JLS Custom Homes Expansion tank 16.60
Address:16280 NW Bethany ct Fixture/sewer cap 16.60
City/State/ZIP:Beaverton,OR 97006 Floor drain/floor sink/hub 16.60
Phone:(503)533-4006 Fax:(503)533-4306 Garbage disposal 16.60
,�- Hose bib 16.60
e. a . - Ice maker 16.60
Business name:JLS Custom Homes
Interceptor/grease trap 16.60
Contact name:Nicole Paulsen Medical gas(value:S_) Page 2
Address:16280 NW Bethany ct Primer 16.60
City/State/ZIP:Beaverton,OR 97006 Roof drain(commercial) 16.60
Sink/basin/lavatory 16.60
Phone:(503)533-4006 Fax::(503)533-4306
Tub/shower/shower pan 16.60
E-mail:oicole®jlscustomhomes.com _ Urinal 16,60
LK , T + : ,r,,,'-', ,: y'-;:- Water closet 16.60
Business name:TBD Water heater 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( ) Residential backflow minimum permit fee: 536.25
CCB Lic.: Plumbing Lic.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Budding1PermitsWLMF-PermitApp.doc 12/27/06 440-46t 6T(1NM/COM/WEB)
i3SO
Electrical Permit Application ECEIVED
City of Tigard
Permit No..
• 13(25 SW Hall Blvd.,Tigard,OR 972 1 q RDateBY 5 /o- a // 1- 4148.'. 2
' Phone: 503.639.4171 Fax: 503.598.1'�!.iY 1 2 ZOO$ Pla»Review
DateBv. Other Permit:6w/ZB,40072
T I Ci A It D Inspection Line: 503.639.4175 OF TIGARD Date Ready/By. lurir r HI See Page 2 for
,T... ' h_s-' d Supplemental Information
Internet: www tigard-or gov CI F? Notified/Method Spleme
ry 1�
. . , ''r ..,,Rz'—" ��-�'� ✓ � ,.._ �t. t irk ^ r��.�,g`V ..
®New construction ❑ Addition/alteration/replacement Please check all that apply(submit;sets of plans wlitems checked below)
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑ Other: where the available fault current ❑Mannas and boatyards.
.:'...1.4. �y ,;R :� �}�,,,,,� r br �] �,-, _ _` x exceeds 10,000 amps at 150 volts or ❑Floating buildings.
9t5e
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
,r v- _ a ❑Emergency system. larger separately derived system.
st< 3 H�1FO1t OAli L .,I....-- ',-.
., .-... ._. .,.. ..,- �„ ,. �u.,. .�....e•., .� ,�.-,� ❑Addition of new motor load of ❑"A" 'E" "1-2" "1-3"
Job no.:
Job site address: 110K(-1 Ss�r Six or or more. occupancy.
N I `lti�Six or more residential units ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR El Health-care facilities ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: ii Project name:Village at Summer Creek ❑Service or feeder 600 amps or more.
T e.4Tt!!}7i'`;_`EsMIl~1DuM . t.'.''_ ! .
Cross street/directions to ob site:
,) Description 1 Qty. i Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: [b 1,000 sq.ft.or less 1 145.15 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion l 33.40 I
Limited energy,residential 75,00 2
Fis'(IR .7.10 (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
Wi* -Ye® P RQpI' 'v ry . kit: 3 ik(** -te 44°4" 201 amps to 400 amps 106.85 2
Name:JLS Custom Homes 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 16280 NW Bethany ct Over 1,000 amps or volts 454.65 2
City/State/ZIP:Beaverton,OR 97006 Temporary services or feeders installation,alteration,and/or
relocation
Phone:(503)533-4006 I Fax:(503)533-4306 200 amps or less 66.85 1
Owner installation:This installation is being made on property that 1 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
4 r x,1i; q B t s 4 : iqjk ,. .H.: 1 ,A yft above service or feeder fee,
6.65 2
each branch circuit
Business name:JLS Custom Homes B.Fee for branch circuits
Contact name:Nicole Paulsenq first service or feeder fee, 46.85 2
first branch circuit
Address: 16280 NW Bethany ct Each add'(branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Beaverton,OR 97006 Each manufactured or modular 90.90 2
Phone:(503)533-4006 Fax: :(503)533-4306 Reconnect
dwelling.t only and/or feeder
Reconnect only 66.85 2
E-mail: nicole @jlscustomhomes.com Pump or irrigation circle 53.40 2
3 . _t _i " a t..„;@ONtd5R.s.fAORC,g �` .k Sign or outline lighting 53.40 I 2
Business name:TBD Signal circuit(s)or limited-
energy panel,alteration,or
Address: extension.Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:( ) I Fax:( )
Investigation per hour(1 he min) 62.50
CCB Lic.: 1 Electrical Lic.: Suprv.Lic.: Industrial plant per hour 73.75
LBCIERIC44,1r ':ERMIT REFS
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:
i This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I,\Building\Permits\ELC•PermitApp.dac 05/223/06 440-4615T(1 I/OS/COM/WEB
UPI " Building Division
One & Two-Family Dwelling
TIGARD
Fees Checklist
PERMIT INFORMATION:
Permit #: rnST c C(0 2 Plan #: e I�sto rn Date: 5. 29 •Og
Site Address: 110) 9. t ) M0.1,Qw Tearr0.Ce, Parcel #:
Subdivision: Vt\\Do,e 0,...k u�,,Mt r Cr ( Lot #: 70 Zoning:
Jurisdiction: 'rj q `Setbacks: Front: Rear: Left: Right:
Class of Work: --.l Al e1,o Stories: 3 First Floor: -7&` '
Type of Use: m Height: Second Floor: s 8 3 .
Construction: 56 Floor Load: Third Floor: 618 1"
Occupancy Group: 3 Dwelling Units: Bonus Room: ,e)Valuation: 2. 4Bedrooms: rp�, Total Floors: 1,..355' 1
Bathrooms: 3 Basement: S
Decks: i 2$ *' Garage: B42 0'
Porches: Z0 Other:
FEES: Description: Fee Amount: Amount Paid: Balance Due:
Plan Check: Building: lo--i ..-- $ 50.00
Extra Set:
Permit: Building: 0 .9"7
Tax: 1 2_14.37-—
Metro CET: I g 3
School CET: 1
Mechanical 0. U
Tax: 10•VD
I0
Plumbing: 39.q. Ud
Tax: Li-7 .
Electrical: 2\ k 9`5
Tax: 2.5-43
Low Voltage: 2S
Tax: 23
CDC: CDC Ping. Rev.: • 4111
CDC LRP Fee: AIre
SDC: Parks:
TIF Res.: Wit"
•
TIF MT: 41 RIO
Erosion Permit: 1,
Erosion CWS: — r 6 0
Erosion COT: • •• fa
• Water Quality: ,e5
Water Quantity:
SUB-TOTAL: __1_ ,, _ 1 a.130, L L
Sewer: Permit:
Inspection:
SUB-TOTAL:
TOTAL MST & SWR:
I:\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page I
PLUMBING FEES (for special information use checklist) MECHANICAL FEES (reside_ntial equipment/systems)
Description I Qty. I Fee(ea.) I Total Description Qty 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) 1 17.90
SFR(3)bath d 399.00 Gas heat pump 14.00
Each additional bath/kitchen 45.00 Duct work 10.00
Rain Drain,single famil 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- 15, 100' 55.00 Water heater 10.00
Footing drain-each additional 100' 46.40 Gas fireplace 10.00
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- 1 100' 55.00
Sanitary sewer-each additional 100' 46.40 Chimney/liner/flue/vent 10.00
Other: 10.00
Storm sewer- 151 100' _L_ 55.00_ _ Environmental Exhaust&Ventilation
Storm sewer-each additional 100' 46.40 Range hood/other kitchen equipment t 10.00
Water service- 1" 100' i 55.00 Clothes dryer exhaust 10.00
Water service-each additional 100' 46.40
Fixture or Item Single duct exhaust
Absorption valve 16.60 (bathrooms,toilet compartments,
Backflow preventer 27.55 utility rooms) 6.80
Backwater valve 1 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. 1 **
Ejectors/sump 16.60 Gas heat pump **
Expansion tank 16.60 Wall/suspended/unit heater **
Fixture/sewer cap 16.60 Water heater 1 **
Floor drain/floor sink/hub 16.60 Fireplace 1 **
Garbage disposal 1 16.60 Range I **
Hose bib � 16.60 BBQ **
Ice maker t 16.60 Clothes dryer(gas) *5
Interceptor/grease trap 16.60 Other: **
Primer 16.60 Total:
Roof drain(commercial) 16.60 Mechanical Permit Fees
Sink/basin/lavatory VO /y 16.60 Subtotal: $ 9 13. 0.
Tub/shower/shower pan 16.60 Minimum Permit Fee$72.50 $
Urinal 16.60 Plan Review Fee(25%of Permit Fee) $
Water closet 3 16.60 , . State Surcharge(12%of Permit Fee) $ 10.S to
Water heater 1 16.60 TOTAL PERMIT FEE $
Other:
Other:
Plumbing Permit Fees ELECTRICAL FEES (residential single-or multi-family)
Subtotal $ 39 t. oG Description Qty. Fee Total Insp
Minimum Permit Fee$72.50 $ 1,000 sq.ft.or less 1 145.15 4
Plan Review(25%of Permit Fee) $ Ea. add'l 500 sq.ft.or portion 33.40 1
State Surcharge(12%of Permit Fee) $ 4-1. Limited energy,residential 75.00 2
TOTAL PERMIT FEE $ Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Electrical Permit Fees
Subtotal: $ Q t l. _
Plan review(25%of permit fee) $ 2
State surcharge(12%of permit fee) $
TOTAL PERMIT FEE _ $
I.\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page 2
CITY OF TIGARD FEE AND PAYMENT HISTORY
r:-113125 SW Hall Blvd.. Tigard OR 97223
i
503.639.4171
T1GA.RD
MST2008-00062 - 11084 SW MALLOW TER
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
[BUPPLN] Pln Rv Deposit 245-0000-433000 $750.00 $750.00 $750.00 5/13/08 Check 2720080000 $0.00
0000001630
[CDCPLN] CDC Pln Rev 100-0000-433060 $46.00 $46.00 $46.00
[LRPF] LR Planning Surcharge 100-0000-438050 $6.00 $6.00 $6.00
[BUPPLN] Pln Rv Balance 245-0000-433000 $673.38 $673.38 $673.38 6/19/08 Check 2720080000 $0.00
0000002164
[BUILD] Bldg Permit 245-0000-432000 $1,035.97 $1,035.97 $76.62 6/19/08 Check 2720080000 $959.35
0000002164
[TAX] Build 12%State Surchrge 100-0000-207020 $124.32 $124.32 $124.32
[METCET] Metro Const Excise Tx 245-0000-229202 $183.55 $183.55 $183.55
[BEACET] Beaverton School CET 245-0000-229204 $1,355.00 $1,355.00 $1,355.00
[MECH]MEC Permit 245-0000-431010 $90.50 $90.50 $90.50
[TAX]MEC 12% State Surcharge 100-0000-207020 $10.86 $10.86 $10.86
[PLUMB] PLM Prmt 3Bth 245-0000-431000 $399.00 $399.00 $399.00
[TAX] PLM 12% State Surcharge 100-0000-207020 $47.88 $47.88 $47.88
[ERPRMT] ELC Permit 220-0000-431510 $211.95 $211.95 $211.95
[TAX] ELC 12% State Surcharge 100-0000-207020 $25.43 $25.43 $25.43
[PKSDC]SF Park SDC 270-0000-450000 $5,215.00 $5,215.00 $5,215.00
[TIF-R]TIF Resident 210-0000-448001 $2,960.00 $2,960.00 $2,960.00
[TIF-MT)TIF Mass Tr 210-0000-448005 $240.00 $240.00 $240.00
[ERPRMT]Erosion Control 100-0000-207307 $64.00 $64.00 $64.00
[ERPLN]Erosn Pln Rv CWS 100-0000-207308 $20.80 $20.80 $20.80
[EROSN] Erosn Pln Rv COT 245-0000-433010 $20.80 $20.80 $20.80
Refund-[BUPPLN] Pln Rv Depos 245-0000-433000 $-750.00 $-750.00 $-750.00 6/19/08 Check Refund 2720080000 $0.00
0000002163
Totals for Fees $12,730.44 $12,730.44 $750.00 $11,980.44
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
27200800000000002163 Check Refund 06/19/2008 $-750.00
27200800000000002164 Check 912156 JLS CUSTOM HOMES 06/19/2008 $750.00
27200800000000001630 Check 912156 05/13/2008 $750.00
Total Payments: $750.00
Balance Due: $11,980.44
CITY OF TIGARD RECEIPT
N. � 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 27200800000000002164 - 06/19/2008
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2008-00062 [BUPPLN] Pln Rv Balance 245-0000-433000 $673.38
MST2008-00062 [BUILD] Bldg Permit 245-0000-432000 $76.62
Total: $750.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 912156 TAAA CONY 06/19/2008 $750.00
Payor: JLS CUSTOM HOMES
Total Payments: $750.00
Balance Due: $11,980.44
Page 1 of 1
!III g. CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 27200800000000002163 - 06/19/2008
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2008-00062 Refund-[BUPPLNI Pln Rv Depos 245-0000-433000 $-750.00
Total: $-750.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check Refund TAAA CONY 06/19/2008 $-750.00
Payor:
Total Payments: $-750.00
Balance Due: $11,980.44
Page 1 of 1
!Ili II CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 27200800000000001630 - 05/13/2008
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2008-00062 [BUPPLN] Pln Rv Deposit 245-0000-433000 $750 00
Total: $750.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 912156 TAAA CONV 05/13/2008 $750.00
Payor
Total Payments: $750.00
Balance Due: $11,980.44
Page 1 of 1
Viiiaje At Summer 4" STORMLINE. WATE- METER ummer Creek , . .
RECEIVED .. wf, . 2" Paper Birch Tree
4" SANITARY SEWER. O
MA 1X2008
Stan Pan, 9 'TIGARD `
ud D0 N[S[ON '
2. PUE B [NGD 4" SANITARY SEWER. I < < . #Cots ' 69, 70, 71,
72/ 73
4/ ■ : • ,>3 2" Paper Birch Tree
C) CO ' /411*,/(/1 n1 r s:' G� a7 (.`` Unit B �v�
4 SANITARY SEWER. C� ® iT / / $
AZ �' / Unit E r '?'' ..
1. PROVIDE A MINIMUM 8" DEEP GRAVEL BASE FOR ALL 4" SANITARY SEWER. Q t 2 Paper Birch Tree
DRIVEWAY AREAS. ♦ r ` -.4,
2. MAXIMUM DRIVEWAY SLOPE SHOULD BE VERIFIED WITH .,� 0 t Unit E > �_�. �/ zr 14�' `� _,•THE BUILDING DEPARTMENT PRIOR TO CONSTRUCTION.
3. PROVIDE A MINIMUM 4" DEEP GRAVEL BASE FOR ALL / �� \ j
SIDEWALK AND PATIO AREAS. .� '° �° . • �) •
4. PIPE ALL STORM DRAINAGE FROM THE BUILDING TO A 4" SANITARY SEWER. Z� ^, Unit E '0 `,. ��. 1 ��
DISPOSAL POINT APPROVED BY THE BUILDING / 2" Paper Birch Tree
DEPARTMENT. 4" STORMLINE. k ., -�'° I ' p `�
5. PROVIDE AND MAINTAIN POSITIVE DRAINAGE AWAY ` , �? py �i
FROM BUILDING ON ALL SIDES. " / II c �
10" Water line ' 1 U
Unit B ��? C---...)� w
"glir 6. NON—STABILIZED FILL MUST NOT EXCEED 2:1 SLOPE (I i
r,
2" Paper Birch Tree
\ `a ' t� Qq
��� IG
7. NO CUTTING OR FILLING SHALL TAKE PLACE WITHIN • ►.. ./> ,i ?e .,
"� •° CITY OF TICARD- — •
THE DRIP LINE OF AN EXISTING TREE UNLESS THE Q�a4,N REd'iE
EXCEPTION IS APPROVED BY THE BUILDING DEPT. - `l'--'-- ---------- -- --\� BU _11. SITE
41(
8. AFTER COMPLETION OF CONSTRUCTION, THE CONTRACTOR - -- __ FANNING DIVISION:
MUST EITHER LANDSCAPE THE SOILS, MULCH THE SOIL OR _• • 8 I�ittired Setbacks: .d S6*ue
SEED THE EXPOSED SOILS. ` . K Ilk, pp+roved (] Not A ved•
Side: lQP
. .� •�..� '. .. —__. Street Side:
• • << d , - Front.
9. PROTECT STOCK PILES FROM OCTOBER 1st THRU '' ` • �' '' Gara e:
2" Eastern Redbud < usual Clearance:NIA Rear: _
APRIL 30th PER THE EROSION CONTROL HANDBOOK. ❑ Approved Not A
< Maximum Building pproved
SW RQSEM�4RY � 1, Height•� feet
LANE "`` sery ice Provider Letter Required: ❑ Yes
5' Side alk b No
_ ❑ Received
CITY OF TIGARD-SITE PLAN REVIEW ENGINEER-N DEPARTMENT:Date: 5 - _v g
r BUILDING PERMIT NO: 1�/pra e-c ), Actual Slope % Approved
Site Pl.� IPP !❑ Not Approved
'•y B _ _ A r :Rived
Street Trees: Approved ❑ Not Approved `P ��.' Date: Not
Protected: Approved ❑ N red ' * " ; ` (7 Notes:
Bytes: ���� Date` � Qi NORTH V � � 1" = 20,_
No _ 0
DATE 4/8/08