Permit vp
Cit ofTigard • COMMUNITY DEPARTMENT 1 0.DEVELOPMENT
III Request for Permit Action P 49W/
I I(.;A g n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 0 City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) e,::: -rC>IJ , 6)2_1 b Co tG ( /t S !V
Mailing Address: L-la_30 af}LE_ I_,...)D07J (TE_ (DU
City/State/Zip: Lc- Q )Len vI 02 g7035-
Phone No.: 5D3 - -3(n - --/ -77
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
E- CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
la INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). /
Permit #: M 1-Ji-c9{D l 55- C'C�0 Coo "f" tuQ c90 l S-O00 Ll�,
Site Address or Parcel #: 150`ij(9 `ate kl-A4S \)t £u3 19 UE_
--rico pr2-b O2 q-1 7 as L n
Subdivision Name: @�H Jt ¢w /4-�el(ff(S Lot #: 7
EXPLANATION: Ni i[...) pl q,3s ti' I'4 t 71 O?] t €_ga 1--I ,D-r-(9-c)l Go- CO I F
cl- w2a-cp1 Co- oco93
Signature: CK____, Date: Zia4/ l (p
Print Name: 1 7£.136 I 4 ( ..1->C1 M51'4\1
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 800/0 of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. .All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date 3 a3 ((p 16 Route to Records: Dat? 4e /,6 B,
Refund Processed: Date A7,41- Br / Invoice Processed: Date / By
Permit Canceled: Date .3 ,2gA,6 By Parcel Tag Added: Date By
I:ABuilding\forms\Rc 1PcrmitAction_(1 2314.doc
1111City of Tigard • COMMUNITY DEVELOPMENT
mi
Building Division
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TIGARD
INVOICE
TO: Stone Bridge Homes NW,LLC Customer ID: 173318
Attn: Deirdre Britt Invoice No.: INV2016-00011
4230 Galewood St., Ste. 100 Invoice Date: 03/30/2016
Lake Oswego, OR 97035 Date Due: 04/30/2016
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
i
MST2015 00060 15086 SW Harveys View Ave Southview Heights,Lot o 9 $570.25
Plan review fees due for plan review
completed prior to receiving request
to cancel permit(resubmitted under
MST2016-00118).
Invoice Total: $570.25
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2015-00060 Customer ID: 173318
Site Address: 15086 SW Harveys View Ave Invoice No.: INV2016-00011
Project: Southview Heights,Lot 9 Invoice Date: 03/30/2016
Date Due: 04/30/2016
Invoice Total: $570.25
Amount Paid: $
Office Note: Route copy of receipt to Dianna Howse
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
I
Building Permit Application \ J l 0 3 aq /w C
Residential RECEIVED FOR OFFICE USE ONLY
City Of Tigard DEew
Arl5Permit No.:29201513125 SW Hall Blvd. Tigard,OR ►I
: 0r 1' Other Permit:
Phone: 503.718.2439 Fax: V314(19,60— DateBy: � t ��'( ( �(Zp'(G(�GnC�
Inspection Line: 503.639.4 r TIGARD Date Ready/By: [� Juris. El See Page 2 for
TIGARD g g , UILDING DIVISION Notified/Method:v/�/� �lA*/ Supplemental Information
Internet: www.ti and-or. o PP
.. V� ) ,L
,
= • sO e o 4 ° A eD t o
,
, + , r :P'.....`;'i--4°' m , ? r. t•,),,•°q FP. .."
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
o Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
-. . t � t .„4',e4.,,,„'_'61;-, work indicated on this application.
® 2-familydwellingp
1-and Valuation:`3n1 ,r 0, J03
❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 111Other: Number of bathrooms:
1 Total number of floors:
! $ l:vxx7°V,.°',+.. „1 ,$ Dat, ;
Job site address: ' • ' . New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: • . square feet
Suite/bldg./apt.no.: I Project name:Southview Heights Covered porch area: square feet i-2. 2.
Cross street/directions to job site:SW 122"d Ave&SW Beef Bend Rd Deck area: ' ' square feet (2.T
Other structure area: -2_,ef 2.7 square feet 251
tAl;''," g RK�1st xs
Subdivision:Southview Heights 1 Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
' 1= q t b =i.p,- , AftE work indicated on this application.
..'kr„,,,,. .0...24,4"...34..,..L4.4.,....5.:".> ;tee ,: �.. ,°A • . ,...ar.
Valuation: $
new,single family residence
Existing building area: square feet
New building area: square feet
` itc) ` f A � � ..4„0„--A,',� ❑ Number of stories:
Name:Stone Bridge Homes NW,LLC 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)387.7615 New:
Business name:same as above ` x4,/,,(:''...,,f.04''':!..1-•-•,4:4-' r
Structural plan review fee(or deposit):
Contact name:Deirdre Britt
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP: mac)
Amount received: 7 5`0-
Phone:( ) Fax: :( )
', t ,t t
E-mail:dbritt@stonebridgehomesnw.com ; . . 4, M ,• '
i 4 -,,,,,,-:,,,,,,44::::-.=,a,,,,„;„1--, Commercial and residential prescriptive ins Ilation of
roof-to ii ounted PhotoVoltaic Solar Pan stem.
.. , GOIV•1•l1�Gbl'Uli _ .,, ;- ,,r. :i� y�� P Y
Business name:same as above Submit two -• of roof plan with : ection details
and fire department ac - .Ion: •`rth the 2010 Oregon
Address: Solar Installation Special -o.• •ecklist.
City/State/ZIP: Permit Fee(i•• des plan revie , $180.00
• administrative fees):
Phone:( ) Fax:( ) State . charge(12%of permit fee): $21.60
CCB lic.:173318
Total fee due upon application: $201.60
Authorized signature: F This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: *Fee methodology set by Tri-County Building Industry
• - Service Board.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
s .
Electrical Permit Applica RECEIVED FOR OFFICE USE ONLY
City of Tigard Rcce'red 4' 9/5 A Pen"it Ne''':l'i .V615---ece)(100
Date/By. ,
'4 1312.5 SW Hall Blvd TigardPkfflRCVieSV
. OR 97APR li 2 9 2015 503.718.2439 Fax: 503.598„1960 Date/By: Other Permit:5.42;P_,ge„)/S--eritif)C/
TIGARD -
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By:
Internet: www,tigard-or.govplemental Information
4, *DI .
G,"91VIS:'C:f\iN,::'I,17imc'71 Sup!,,,,c-...„';44.4:-‹*, t ; , of plaits Eg New construction 0 Addition/alteration/replacement li':13Z:i'cl eceokrall.leie;l::11())polyaii(i;s7iin.,-,::s oopLiding over three stories
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
10 000 amps at I 50 volts or 0 Comnsercrtl use lb.rlr.Liltilr it
Floating buildings.
',„r"..,::ii-,:,'•::,,,;',''',3;1';: ,: '.-,Z, :ZodiViVilViii,141"034Ar;411:Vire,.itik:Frrt:V.ItY':','. exceeds ' . .
El 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps forall other installations, buildings.
12 Multi-family 0 Master builder 0 Other: , HFE:1,7,,,Pc:s.ste., 0 Installation of 150 KVA or
0 AddiLn c):f„Yew motor load of 0"0/CI;
1001IP or mote,
Job no.: ° Job site address: " ' . Six or store residential units, 0 Recreational vehicle parks.
City/State/Z1P:Tigard,OR 97224 0 Health-care facilities, 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Southview Heights 0 Service or feeder 600 amps or more.
--'''tili`fii2:41Ef‘.':".:',041:t2i.SiZI;if 7411.11Trit.:4.;;A.4,:,',, ••,,r,z.,;•,,,,%K,f,zo,?,,,,
Cross street/directions to job site:SW 122"Ave&SW Beef Bend Rd .ono-onion Ql.y. eft, Total *
New residential single-or multi-family dwelling unit.
Includes attached garage.
1
Subdivision:Southview Heights I 1,ot no:: . 1,000 sq,ft,or less 168.54 4
Ea,addl 500 sq.IL or portion -k 33.92 1
-
Tax map/parcel no.: Limited energy,residential 75.00 2
(With above sq.ft) I
Limited energy,multi-family 75.00
new,single family residence residential(with above sq.ft 2
.)
Renewable Energy Z1,2::, '."....::,.1:1;See Pagel ' :.-• , • ,;'•
Services or feeders installation,alteration,and/or relocation
201 amps to 400 amps 133,56 2
Name:Stone Bridge Homes NW,LLC 401 amps to 600 amps 200,34 2
. ,
Address:4230 Galewood St,Suite 100 601 amps to 1,000 amps 301,04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Lake Oswego,OR 97035
Temporary services or feeders installation,alteration,and/or
Phone:(503)387.7577 I Fax:(503)387.7615 relocation
200 amps or less 59.36
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
. .
Owner signature: Date: _ Branch circuits-new,alteration,or extension,per panel
''41**fitifY14* A alZvflers terr.‘‘iiiilclocrirfceeiclesirwfietell, 2
7A2
Business name:same as above each branch circuit
B.Fee for branch circuits without
Contact name:Deirdre Britt service or feeder fee,first
56,18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:, Each manufactured or modular
67,84 2
Phone:( ) Fax'' '( ) dwelling,service and/or feeder
....
Reconnect only 67,84 2
E-mail:dbritt@stonebridgehomesnw.com Pomo or irrigation circle 67,84 2
TATVrfr.411441,;• -•7 rilirAinte :,45-4''001t:0; ,,,-0,-24, ,,;4.:,,,:s,,;,,,,,, -,',;,,,,:,,c.:,i-7, Sign or o„dine lighting 67.84 2
Business name:City Electric Signal circuit(s)or lirnited-energy See
panel,alteration,or extension, Page 2 2
Address:55568 SW Schaltenbrancl Ln Each additional inspection over allowable in any of the above
Additional inspection(I hr min) Ill 6625/hr
City/State/ZIP:Sherwood,OR 97140 Investigation(I lir min) 66,25/hr
Phone:(971)404.1714 Fax:(503)625.3052 Industrial plant(I hr min) 78 IR/hr
inspections ibr which no tee is
C C.13 Lc,. 42422 Electrical I ie• ""6 189C J Supry I ic- 35925 s)::eilically listed(l'i hr min) 90.00/lir
---- -- ---- ---,------- ---- ELECTRICAL-PERMIt:FEES
Suprv. Electrician signature. required: e.„..-- D Subtotal:.. . .. ...._....._____
Pliant:view(25%nil'permit lee)•
Print name: Chuck Friesen 1)ate:
, Stale surcharge(12')/0 of permit lee):
Authorized signature: TOTAL l'11(S111 ITT.
Print name: 1)ate:
1
Mechanical Permit ApplicatiRECEIVEDFOR OFFICE USE ONLY
City of Tigard Received 619/S � 1 ^fet /
Ihl 7t3v: Permit No;r!'ST��r �oU
III 'll 13125 SW Ball Blvd.,'I•igard,OR 97223 APR2015 pi):,,,,::::::,
hn Review
Phone: 503.718.2439 Pax: 503,598,1960 2 9 Other Permit: '6 2�)/5.--G" be-Mi
Dale/13y'
TIGARD inspection Line: 503.639.4)75 CITY OF TIG A RD Dale Ready/E3y. tuns. ® See Page 2 for
Internet: www.tigard-or_gov BUILDI /`, Notiliecl/Method: Supplemental information
NG DIVISION —
,� T � b 1VC� *Sc$EDU it cfIE
__ � � �'� � � _ ICOIl1hiFR�15l+ F>Eiw
' _ ' �_ ''' Mechanical permit fees*ate based on the value of the work
, ,�..�..
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value $
` >:`� ,� s i r,4?rt i ,q',r.I �""4. f't', �'",F" ! Ig'-'6�,.' s u`, ,acs
":
Plumbing Permit Applic�tjQnCEIVED
Building Fixtures FOR OFFICE USE ONLY
RCCelvU) Permit No,:
City of Tigard APR 2 9 2015 Dale/BY �9 /S / �?T2o/5-�,e ,O
i1 13125 SW flail Blvd.,Tigard,OR 97223 Plan m IZevicw C
i u ` Phone: 503.718.2439 Fax: 5 1Other Permit No:;vILt�-e_lop,""-CY�7�j
- �TIGARD Uale/By.
T1CaA1tU Inspection Linc: 503,639AlffUILDING DIVISION R
Dalerllt Is ions: El See Page 2 ror
Internet: www.tigard-or.gov I Notified/Method: Supplemental Information
f
®New construction 0 Demolition For special information use checklist.
Description IMIN Ea. Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
ast r ,z 0 2 @ �+� v t SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath500.32
❑Accessory building ElMulti-familytW--
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
; ,S r5 ® i}' ��� ,_,:.� i ~Site utilities:
_
. ,. � ' �' I ::� - Catch basin or area drain I 8.76
Job site address:
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
looting drain(no.linear II.: ) Page 2
Suite/bldg./apt.no.: Project name:Southview Heights Manufactured home utilities 50.03
Cross street/directions to job site:SW 122id Ave&SW Beef Bend Rd Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear IL: ) Page 2
Storm sewer(no.linear tt.: ) Page 2
Water service(no.linear It.:_) Page 2 `
Subdivision:Southview Heights I Lot no.: ' Fixture or item: -
Tax map/parcel no.: Backflow preventer 31.27
` fiai4Backwater valve 12.51
Clothes washer 25.02
new,single family residence
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
j„£'' 3 14-,,. , :) -,1•„•4
Expansion tank 12.51
Name:Stone Bridge Homes NW,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Ili Address:4230 Galewood St,Suite 100
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
r a®i ' $ hltcrceptor/grease trap
J ERZ 25,02
Business name:same as above Medical gas(value:$ ) Page 2
Printer 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
- � -
1,-mail:dhrittGa?stonebridgehomesnw.com Urinal 25.02
' `.r Water closet- 25.02
' .. CON'TRA-..1 Pl' ._'. , '
Water heater 37.52
-
Business name: Max Plumbing
Water pipin is WV 56.29
Address:PO Box 5597 Other. 25,02
City/Stale/''/.IP: Beaverton,OR 97006 Subtotal
._.
Phone:(971)275.0198 Fax:( ) Minimum permit lee '672 511
,.__. .....
Plan icy kw (25'" utpermit fee)
('('11 Lie.: 194644 Plumbing l ic.no.: 1'1111183
State surcharge(12%otpermit lee)
Allthollnd signature: le' ,,,. ,,,t,, /t J" '"...ic'' 1(11 AI.PI 12MI f FIT 1
PI int name:Jason I1r4e ler Date: l l hrs pettnil application expires if a permit is not obtained It Rhin IRO days
alter it has been accepted as complete.
"M. mahnd:d,,,', i he I io ourav Itmldine Indoor\ \,,,e!loam
\I{u 1:11 .1 rinu.;.l I 'ti I'anniiAlrl;dei w„."1!....
City of Tigard
11111 -.dr COMMUNITY DEVELOPMENT DEPARTMENT
V Building Permit Review — Residential
Building Permit #: M STd0R5 ,ocp(co
Site Address: 150 (o s w' N-ci ry eAl. V-eA,,1 t k r
Project Name: SOLA-tnv crivv k }n AI Lot #: 9
(New dwelling=subdivision name;Yiddition or Alteration=last name of owner)
Planning Review
Proposal: Ni Ems/ .S F C�
Verify site address/suite# exists and active in permit system.7No ver Terrace Plan District: ❑ Yes
Site Plan Elements:
Three(3)copies of site plan Existing structures on site II/�}
Site plan must bg on 8-1/2"x 11"or 11 x 17"paper prootprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) loor elevations
North arrow YJUtility locations(required for new,may apply for additions)
,ite address,project or subdivision name and lot number -Bl-cation of wells/septic systems IV
Applicant information(name and phone number) Erosion control(including drainageprotection,silt fence
/Lot dimensions and building setback dimensions design,location of catch basin,etc.) A ,
Lot area,building coverage area,percentage of coverage and %treet names
impervious area(applicable if R-7,R-12,R-25&R-40) IleStreet tree gli se and location
Property corner elevations(2 foot contour lines if more than existing trees to be retained with drip line,and tree
4 foot differential) protection measures
XfClean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI)Permit:
�:d
ire
u
Re Yes applicant was notified ❑ No Applied ❑ Yes ❑ No,stop PP PPlid For: intake
XLand Use Case#: Z CA - 2-013 -0000Z--
7 Zoning:
0O00L"Zoning: _7
Setbacks: Front ( S Rear 1 S Side S Street Side 1 0 Garage Z<
Landscape Requirement: 2() %
Lot Coverage Maximum: ---6-6"
"Building Height: Maximum Height 3 S Actual Height 2 el
0 Visual Clearance
-easements A
Sensitive Lands:i f Pc ❑ Yes 71 No Type
to Urban Forestry Plan N A
7.Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: (11700- i l oCL.e.w`.. Date: 4 j 20} LS
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_031015.docx
f
Building Permit Submittal _
Original Submittal Date: ///91W/
5
Site Plans: #
Building Plans: #
Building Permit#: 0—Enter building permit#above.
Workflow Routing: in"Planning C'Ingineering 'Permit Coordinator a—Building
Workflow Sign-off: 0—Sign-off for Planning(include notes from planning review)
Route Application Documents: El- Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: CO. acl%az-kl' Date: �//y/5'_
Engineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
Et-Tasements (encroachments)per engineering conditions of approval and plat
RWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes CdrNo
Assess Water Quantity Fee in-lieu: El Yes [No
LIDA Facility on lot: El Yes CKNo
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: -2.9—if
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: ❑ Approved El Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
OK to Issue Permit
Approved by Permit Coordinator: /f/�% 4 Date: �t3 /"�
I:\Building\Forms\BldgPermitRvw RES_031015.docx