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Permit City of Tigard • COMI\IUNITY DEVELOPJIENT DEPARTVT 0 1 E a 4 11111 Request for Permit Action ../2c,/a, ,Af i I(i A R D 13125 S\ ' 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 ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Cl. ..., l .��,� 4,..„_<1 VL_ Mailing Address: 42 30 6, t ,,.., c J c i _ 5,, (DO City/State/Zip: Gv ke .L--cle /6, 7 9'7635 Phone No.: 567.-- 357 — 75 7 7 P -ASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. U REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). deo Ell° INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). n REMOVE/REPLACE CONTRACTOR ON PERMIT (do no -. -ce permit . Permit #: = SA�k�Q/. AO 7) , _ 4 � Site Address or Parcel #: /01,064 SJ �(4vyV. /l V 4-. Subdivision Name: C,q-G- V lieJ Lot #: 3 EXPLANATION ��1 2 c Ae v S v` AA t'' �-P e re,,,t L.• rt,• 44e-LOperv7/7-At /27S7-PQ/6,"'4.19/5,3, Signature: Date: 12!t//6 Print Name: ,..,,,. ,/• !! Refund Policy 1. The city's Community I kvelopment Director,Building()fticial or(;ity l Ingineer may authorise the refund of: • Any fee which was erroneously paid or collected. • Not more than 80`7°of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. .AII refunds will be returned to the original paver in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date / , /4, By '.j, Route to Records: Date,.5 Z�/ :iii••-. Refund Processed: Date By , g' Invoice Processed: Date ___</.21, 4„ By 4 / . Permit Canceled: Date S�241/' 13) PA ' reel Tag Added: Date By I:ABuilding\Forms\I?ee Permit Action_092314.doc City of Tigard • COM_AIUNITY DEVELOPMENT DEPARTFFF T 0 1 0 illIlr = Request for Permit Action .c//c,A(,, ,< - ii(i A R I) 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 ❑ City Staff Check(✓)one i REFUND OR Name: [� n / INVOICE TO: (Business or individual) ���;, ( ,�A 7 l'�` 1 /v �'' Mailing Address: 42 30 6„k i -d c J C • - S-fc_ (Op City/State/Zip: i„/fie .t,..(le /65!e / 9'7635 Phone No.: 5-87r 357 - 75'77 P ASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): CANCEL/VOID PERMIT APPLICATION. pi REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ;/,�4 MP INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CON _ ' e• :'_ do n• cancel permit). Permit #: ST?O/c— 7 JSAlkaoi.5 o.2,24 Site Address or Parcel #: M.) / , A ,714i / 4- . Subdivision Name: .,4-A r/-c-- /4,,; I 1 Lot #: 3 EXPLANATION: e--1---1. L Ax, c-'-. 5.,. 761,1 1- -t- al ,' •1 e re.vt 0 La---1.. /t.&-Gil b1/04-0 /f-737-070/6-ea/5j, Signature: � Date: 1/2-Vi(v Print Name: c Refund Policy 1. The city's Community Development Director,Building()fticial or City I{ngincer may authorize the refund of: • .thy fee which was erroneously paid or collected. • Not more than 80%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 li Y /4 By _ , Route to Records: Date S2�I Refund Processed: Date By Invoice Processed: Date s/Zk /, By Permit Canceled: Date S 7/a, By reel Tag Added: Date By I:ABuil Sing\Forms\Rc9Puimit.Actiim_(92314.di.c . .li �� 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 NW LLC Customer ID: 173318 Atm: Deirdre Britt Invoice No.: INV2016-00013 4230 Galewood St., Suite 100 Invoice Date: 5/26/2016 Lake Oswego, OR 97035 Date Due: 6/26/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2015-00297 12066 SW Turnagain Heights South View Heights,Lot 31 $767.61 Plan review fees due for plan review completed prior to request to cancel permit. Resubmitted under MST2016-00153. Invoice Total: $767.61 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MST2015-00297 Customer ID: 173318 Site Address: 12066 SW Turnagain Heights Invoice No.: INV2016-00013 Project: South View Heights,Lot 31 Invoice Date: 5/26/2016 Date Due: 6/26/2016 Invoice Total: $767.61 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 ., CITY OF TIGARD FEE AND PAYMENT HISTORY 1 -i"." .. _ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD MST2015-00297 - 12066 SW TURNAGAIN 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 12/29/15 Check 401256 $1.34 DC Provision Review, SF-Ping 100-0000-43112 $88.00 $88.00 $88.00 Additional Plan Review 230-0000-43106 $90.00 $90.00 $90.00 Plan Review 230-0000-43106 $588.27 $588.27 $588.27 Totals for Fees $1,517.61 $1,517.61 $750.00 $767.61 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 401256 Check 43033 Stone Bridge Homes 12/29/2015 $750.00 NW, LLC Total Payments: $750.00 Balance Due: $767.61 15,! (o 1. \ i Building Permit Application V 0 1 /���- 12 2 IS . 1 Residential FOR OFFICE USE ONLY + ' Eew " W - PermitNo11,1 „ 13125SWHallBlvdTigard,OR 97223 V P1f / ,c] �-+�ae. II Phone: 503.718.2439 Fax: 503. le. Date/By: .4)) j ' 1 Other Permit: P d ,c .ctlz �' TIGARD Inspection Line: 503.639.4175 rtO1�J DateReadyBy: a�y /. Juris: ® See Page 2 for ��`"1� Internet: www.tigard-or.gov 9 b Notified/Method: / �/ i.' 'j Supplemental Information TxkOpF wp t� REQUIRED TAS i - ' X� ('� Permit fees*are based on the value of the work performed. ®New construction �dlb�1 V1 Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement Other: equipment,materials,labor,overhead,and the profit for the 1 �0 t p T ' ' , R _ f, work indicated on this application. fu CAT t t� U UN ` PP � w,...�'�r "`�aa�� � �_�..�, . .._ �d ��.*ems -, � � . .��rr ,,,;�`� ,a/ .. ,.�. ® ..\\ 1-and 2-family dwelling ❑Commercial/industrial Valuation G�/ 732 $ 9—Til- '-- ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathroom �� .ems ,para_ltI ` 3 t > �� s.0 Total number of floors: Z Job site address: 20(4i SW Tv A1 N © ,• New dwelling area: 65 square feet348 City/State/ZIP:Tigard,OR 97224 Garage/carport area: 42"i square feet Suite/bldg./apt.no.: Project name:Southview Heights Covered porch area } square feet IS 6c Cross street/directions to job site:SW 122°"Ave&SW Beef Bend Rd Deck area: ) ) �J �I \ square feet I L) Cl D Other structure area: 1 square feet I .s. ..,..: ..tea q '> - ;" Subdivision:Southview Heights Lot no.: 31 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 � Y w t � `'' t . t a` a �� ,�����, � work indicated on this application. r s> W '/.;A ,:. .:tee. r� .,_., . ._..,;, new,single family residence Valuation: $ Existing building area: square feet New building area: square feet °p, PROPERTY < l la�y 3 Y,... 0„T)7 r�Ni` - .,,, 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: ►® �°r � 7 �e ttcy�leAs 0- i'':';' ; -', $'�r, ;<.,-<-�� z,fiaa �'r,��".� --f, sv-; P �j ;, ��� v.(��{.`It�lCr s ,�-�„ �•. � t [• �' Business name:same as above ” ' „fG: Structural plan review fee(or deposit): Contact name:Deirdre Britt FLS plan review fee(if applicable): Address: City/State/ZIP: Total fees due upon application: Amount received: Phone:( ) Fax: :( ) PIJOTOVOLTt 1CSO A P I�. Y *. . E-mail:dbritt@stonebridgehomesnw.com ,. ,,a Commercial and residential prescriptive installation of CONTRACTOi1 'j411.':,:',.....,,,. ', , ,.,,��., ,�,„ .__,.,,. . roof-top mounted Photovoltaic Solar Panel System. Business name:same as above Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 173318 Total fee due upon application: $201.60 Authorized signatures: l __1`Q _L_:� ty'j3 This permit application expires if a permit is not obtained ��` within 180 days after it has been accepted as complete. Print name:T_11...p € 't3/2..T T Date: 12/2C1/1" *Fee methodology set by Tri-County Building Industry Service Board. I:ABuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WE13) Electrical Permit Application it • � FOR OFFICE USE ONLY City of Tigard `r� Received 11 G v PlanDaleinvRe. Permit No,: fr.-vs—Tip)is—,_.00014 +�t 1315 SW Ilan Blvd I igard,OR#6,C0V0.11 flan Review '- 1�!,Gt"(,Js. Phone 503.718.2439 F Ix: 503. 00,5 Date/By: Other Permit: l I GAA1t13 Inspection Ltnc: 503 639 4175 q Dale Ready/13y- turns' RI See Page 2 for Internet: www.trgard-or.gov ,�C 4. yip `onlied/Method: , Supplemental information - e .1:4 `,5 .;,; - ..'i'11' DF.,WOR . -•'" ``x1;14� .. '° 3, ,W -, ;,N; -,�.', ®New construction ❑Addition/alterat fijy)`�� I la he check all that apply(submit 2 sets of plans w/itcros checked below) ❑Service or feeder-100 amps or more ❑Building over three stories. ❑Demolition D Other V where the available fault current i a ei rz ❑Marinas and boatyards, ee Tt C31+ t-'t}t ]" 1IL' `iON ....,;.:4„--,,,,,:,,,,,,,,:"4::;::::<'9-1!„:--,--, exceeds 10,000 and s at 150 volts or ���,� € .� �, � _ ,, ,�, � p ❑Floating buildings. ®- ~- . Commercial/industrial ..ss. . .._:�,' ii ii,111iii less to ground,or exceeds 14,000 1-and 2-familydwelling ❑Accessorybuilding0 Commercial-use agricnhut;al amps for all other installations. buildings. ❑Multi family 0 Master builder ❑Other: ❑Fire pump, 0 Installation of 150 KVA or " 'T- T a ,x ,,p ❑Emergency system, larger separately derive system. • , d s sl �.as � �' � .,,,�a���La�' t�? � c � ;;' 0 Addition of new motor load of ❑:.A.,..r„-1-2",..1.3„ Job no. ($(/t) Job site address: 11,pbtp SIN I 4 PR• Six or ur more occupancy, 0 or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97224 0 Health-care facilities. ❑Supply voltage for more than ❑l lazardous locations, 600 volts nominal. Suite/bldg./apt.no.: [ Project name:Southview Heights 0 Service or feeder 600 amps or more. Cross street/directions to job site:SW 122nd Ave&SW Beef Bend Rd :<. . - Desrr' lien • 'rntNl • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision:Southview Heights 1 Lot no.: 3( 1,000 sq_ft,or less 168.54 4 Tax map/parcel no_, Fa.add']500 sq.8,or portion 33.92 1 r, Limited energy,residential ' t 6 ' 75.00 2 �,, `: .-, ,., � Qvrth above sq.0.) 1-ins ted energy,multi-tamily new,single family residence residential(with above sq ft.) 75.00 2 Renewable Energy . _ Q:Ste 1Page 2 Services or feeders installation,alteration,and/or relocation ` 200 amps or less 10030 2 Name:Stone 600Bridge Homes NW,LLC 401 amps to 600 amps 200,34 2 401 amps to 6amps 200,34 2 Address:4230 Galewood St,Suite 100 601 amps to 1,000 amps 301,04 2 Over 1,000 snips or volts 552.26 2 City/State/ZIP:Lake Oswego,OR 97035 Temporary services or feeders installation,alteration,and/or Phone:(503)387.7577 ( Fax:(503)387.7615 relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 snips to 400 amps 125.08 2 401 amps to 599 amps 168-54 2 Owner signature: Date: ,,. _ ncuw 13 ich cnits-ne ,alteration,or extension, cr react " as `� ' { ml $`• , Al Pee for branch circuits ivitk P I ............ `" above service or feeder fee, Business name:same as above each branch circuit 7,42 2 B.Fee for branch circuits ivitbotrt Contact name:Deirdre Britt service or feeder tee,first Address: branch circuit 56.18 2 Each add'I branch circuit 7,42 2 City/State/ZIP; Miscellaneous(service or feeder not included) Each manufactured or modular dwellin&service and/or feeder 67.84 2 Phone:( ) F•ax::( ) -ii---- -- 84 2 Reconnect oily 67. E-mail:dbritt@stonebridgchomesnw.com 9 : Pump or irrigation circle 67,84 r : `�°` r it )17 ---7,7,7'•--..'),','„' ''''•4' `.. Sign or outline lighting 67.84 2 Business name:City Electric Signal circuit(s)or limited-energy Sec . panel,alteration,or extension Page 2 2 Address:55568 SW Schaltenbrand Ln Each additional inspection over allowable in anuf the above — Additional inspection(I hr min) 66,25/hr City/State/ZIP:Sherwood,OR 97140 _.. investigation(I hr nun) . . .66.2$!hr Phone:(971)404.1714 Pax:(503)625.3052 Indusuial plant(1 hr min) 78.1 S/hr -- Inspections Ibr which no Ee is CO)Lie.: 42422 i Electrical Lie.: 26-289( ,J Suprv. Lie : 35925 specifically listed('4 hr min) 90.00!Itr Suprv. Flectricien sign;rturc, required: �. --. ELECTRICAL PERMIT FEES Subtotal nn1 name: _u]ck Friesen Date: tevic r 125'3;,01 perntit ree)P : ---------- St ate surcharge(12"S,of permit reel: Aul xu ret signature.: 1O Al.PLRM11-I IT" Print name- 7 his prrnnt ylphca lion cspirrs ire pct nut is nal uhtaincJ within IAII_-- l3 Ile: Jags after it has tern aeceplenl as rnngelerr. - Nuuibci ut inspections allowed pen Peril 1 Is = 5 Ii-H Y;.m;•�-p t I n I--Cr.d. 5.•, 21 of, I ,L- I ,H '.i ibl t \it ' ' 1 Mechanical Permit Application "` FOR OFFICE USE ONLY ' 1t ce,veyl Cit of TigardD L/I;v Y g' Permit No:pe),51-- s 13125 SW I I III Blvd.,Tigard,OR 97223 C \\411 A �'f © 7 Plan Review i 0 ' Phone: 503,718.2439 Fax: 503,598<196t . bo`� Otherl'ennit p Date/13y- TIGARD Inspection Line: 503.639 4175 J e Ready/0y: Juri,: f 0 See Page 2 for Internet: www bgard-or gov o'C GP 1' 1/Method. !I Supplemental Information .,- 1f i t ,,,,,,„,,,,c0ovi- � COA1M111 RC14L FFL S HEDULE USE 1;1101*Nl `�- ' Mechanical permit lees*ate based on the value of the work 2 ®New construction I=1Addition/alteration/rt�cnt performed.Indicate the value(rounded to the nearest dollar)of all ' ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ r ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. �I ❑Multi-family ❑Master builder ❑Other: Description Qty. 1.... Ea. j Total ; .` 7 ,2' lleating/cooling: Air conditioning 4G 75 1 I lob site address: 12019(0 SSV 7ORNA6ArIN No.. Furnace 100,000BTU(ductshents) i 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100#000+BTU(ducts/vents) 9 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Southview heights _Duct work_ 23.32 Cross street/directions to job site:SW 122'd Ave&SW Beef Bend Rd Hydronic Itot waters tern 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,.in-duct,suspended,etc. 46.75 1 Flue/vent for any of above,, , 23.32 r Subdivision:Southview Heights Lot no.: 31 Other: 23.32 - Other fuel appliances: lax map/parcel no.I- '' Water heater ' 23,32 it f, t na t 4 .s • . ,' Gas fireplace/inscfl '.33.39 " � ""` Flue vent for water heater or gas new,single family residence fircelace 23.32 Log lighter(gas) 23.32 Wood/pellet stove ; 33.39 Wood fireplace/insert 23.32 MChumney/liner/flue/vent Other [ 23.32 � 2332 `I ? .'.._ „i ,422';7:. ..- Yz 4,.,4 , . ,, knvtronmntal exhaust and ventilation: Name:Stone Bridge Homes NW,LLC Range hood/other kitchen `.m.-."`___`._.. equipment 33.39 . Address:4230(:alewood St,Suite 100 Clothes dryer exhaust 33,39 t City/State/Z1P:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms, -"- -- toilet compartments,utility rooms) 23.32 Phone: 503 387 7577 Fax 503 387 7615 ) i ) � ) Attic/crawlspace 23 32 s =sr�r ° - - * Other: 2332 1 wls ;I• fans Fuel piping: Business name:same as above $14.15 for first four;$4.03 for each additional Contact name:Deirdre Britt Furnace,etc, Address: Gas heat pump . Wall/suspended/unit heater City/State/ZIP; I Water heater t Phone:( ) Fax::( ) _ -- Fireplace — — Rune .... I,snail dontt(u)stonebridgehomesnw'eOnt 13dncecuc CO$iR C 011. Clothes dryer(gas) Business name:Comfort Zone Other. hIE"�C.I1Ais1M�Cr�I,PER;411fiFElz " 4 : I' Address: 1032 NW Colpurnte Dr Subtotal City/Stale/'LII "hruuttla le P. ,OR 97116(1Mnunmum permit fee('690.00) Nan review(25%of permit lee) Phone (503)667 5595 1 IIx.(503)491 8252 -... --� __ ___ _ Slue surcharge(1'?,,,of permit fee) , 1'('l2 tic 1101191 TO I AI PI Rlylf l I I 1 ...__.._ ._...._..__ _.....__...._ _..__._. _. .._...__-- ....._......___ ----- `1"bus permit.application expires if a permit is not obtained within 180 dao c.tree it has been acccplut as complete. A ltl h(lrl/e'(I 41gI If 11 lire; ,�- " —.------ I nrcdlodadoec �I b.• III-Comity Buldinu Indu.uy Sirvicc 110,11(.1 PI Int r u It I)rvld lleldst ib hate: I'll-: ,i,\'v k,1 II) Plumbing Permit Application :,' '' Building Fixtures FOR OFFICE USE ONLY Received City of Tigard ��� Penatt Nn,: � C (���-dQ Dale%131 n 13125 SW Hall Blvd..,Tigard,OR 97�,?3r, r °:) Vhl J Plan Review ':" Phone: 503.718.2439 Fax: 5Oc %�� Date;By. Other Permit No.: TIG 1RD Inspection Line: 503.639.4175 `` "L polo Ready.Ry: t[ris: 0 See Page 2 for Internet www ti f,ard or gov ,v M ��o olilcd[M shod Supplemental Information � C ::''157441-4-V' CYPIv'Ohs WDA FEE* SCLIEDU* J z . I7c en tion For s rein!in urination use checklist ®New construction ❑ tj I h a. I Total ❑Addition/alteration/replacement New 1-2-family dwellings(includes 100 ft.for each utility connection) a' r '5-'4s 4 " � '944 SFR I hath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: , Fire sprinkler( sq.ft.) Page 2 e "�'f r 9 r h1, t;t8 i Lit $ '' '';-:,..A.-'4:1'03i4 site utililie t - - Job site address: 1Z0I1(p S IN -ry N A�pdj t Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 - - Footing drain(no.linear 11.: ) Page 2 Suite/bldg./apt.no.: I Project name:Southview Heights Manufactured home utilities 50.03 Cross street/directions to job site:SW 122°a Ave&SW Beef Bend Rd Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no;linear 11.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision:Southview Heights Lot no: 31 Fixture or item: Tax map/parcel no.: Back flow preventer 31.27 t ' � � �--: to a t , ,. CA , l,, Backwater valve 12.51 Clothes washer 25.02 new,single family residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 r,G yrtr, 'i:1:1''':- Expansion ,e','.i.- r.E/�4S�,.e.- ...4„mow,-,� r.-�..a.,; akx swz ',,-.,:',.<;,--,,,. ....• : ., [? nsior lank 12 51 Name:Stone Bridge Homes NW,LLC Fixture/sewer cap 25.02 • Floor drain/floor sink/hub 25.02 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 . ), # ; 1 a� e y f- t ii: y Interceptor/grease trap 25.02 .:,, , ads-r.-a,,,". s• Medical gas(value:$ ) Page 2 Business name:sante as above 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:dbrit tr.&)stonebridgehmnesnw.com Urinal 25.02 • - Water close! 25.02 ' *�)�:` CDP11Rt1CTO1 - ts' ' Water heater 37.52 Business name: Max Plumbing Water piping./!)WV 56 29 Address:PO Box 5597 Other. 25,02 City/State/ZIP: Beaverton,OR 97006 Subtotal _ Phone.(971)275,0198Pax:( ) Minimum permit Ice' $72 5() Plan revlew (25;S,(il permit Ice) CCR Lie.: _'12--- Plumbing I ic.nu.: - • - Stile siircliarue(I 20'ut permit Ice) Authurved signature: (' ,=,•/L.--+ _ PERM('�� nit"`.- L � .�+ f O FAL FIT PI int ndnne .I:nxoll l lft[ilct Dale: i I lips pu mit application tpir tr a pia mil is nal obl.nntit nulhnt ISO date ---- allci it hat been accepted a,annplctr. "Ir�nr,ihud:rlot;i'-.4 is In-111,11115 Iladdiat Indn.Iu, Sc,s cc nnatd VII I:In�u'ei',' 0.411 SIV-V:�n•.li,�p1 d,.e I�vb i,^-i: al .-'b nil Inr,Cl1 UA.1.)1'1-1) 1. Plumbing Permit Application - City of Tigard r Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: r4'(-0 "Poral.` a. Square;F�ootage- iPertm�'iee,��� , Footing drain- I" 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2.001 to 3,600 $169.69 3.601 to 7,200 $233.20 Sewer- 1st 100' 62,54 7,201 and Ecater $327.54 Sewer each additional 100' 37,52 Water Service-1st 100' 62,54 Medical Gas S stems: Water Service-each additional 100' 37,52 Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000 00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 —1--i.5-,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for „ i e IVY ''-;r6144' each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001,00 to$25,000.00 $148,50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge—1/2 hour) and including$25,000-00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000,00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge—2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge—1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees* ',3,11Flitoosiggyssiow ►a 1# e 1100-b- fill'r ptueet t v ft: Plan review is required for any of the following. J riClr 11 tr rYterli ? a (1cfKleate:i Baptistry/Font Please check all that apply. Pub/Shower ❑ Any new commercial building with water service 2"and Bath = -Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" Car Wash Drain ' q E Isometric orEIIser slag ,,. ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic—food related that meet the qualifications above- -Commercial-food related -Industrial-food related lee Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-loud related -Service Swimming Pool Filter '' washcr-clothes Note: If the fixture work tinder this permit results in an Water Extractorincrease of sewer EDUs,a sewer permit will be issued and Walcr('h'sct-Toilet fees assessed for the sewer increase must be paid before the plumbing, permit can he issued. t)thcr I'ixuncs. P:\City Pavan Applicaliuns\Southview I!eights`.SV-I'I,5'11'-Permil,\pp.de0C) ..,/''72; V 0 I '' City of Tigard Il ■ ll COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review — Residential TIGARD Building Permit #: M ST30(5-- ,q,-7 Site Address: 12066 SW TurnAin Dsc. Project Name: S otA-Ww\s ew H-e\A 5 Lot #: 31 (New dwelling= subdivision nYme;Addition or Alteration=last name of owner) Planning Review Proposal: (\ev4 S ❑ Verify site address/suite#exists and active in permits stem. .13( River Terrace Neighborhood: ❑ Yes al No Si} Plan Elements: V7hree (3)copies of site plan xisting structures on site ie plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished Vil rawn to scale(standard architect or engineer scale) elevations orth arrow ri Utility locations(required for new,may apply for additions) tte address,project or subdivision name and lot number ocation of wells/septic systems Applicant information(name and phone number) Lir rosion control(including drainage way protection,silt fence t dimensions and building setback dimensionssign,location of catch basin,etc.) Nlot area,building coverage area,percentage of coverage andL,�J treet names }pervious area (applicable if R-7,R-12,R-25&R-40) L�QStreet tree size,type and location ZdProperty corner elevations (2 foot contour lines if more than $Existing trees to be retained with drip line,and tree 4 foot differential) protection measures X Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: El Yes,applicant was notified ❑ No Applied For: RI/Yes ElNo,stop intake 7 Land Use Case#: SUB2013 —0040C oning: R Lid' Setbacks: Front k S t Rear ( S t Side S1 Street Side -- Garage 20� N4 `t Landscape Requirement: 20 % V/Lot Coverage Maximum: $b % t Ltd 1:uilding Height: Maximum Height 3 5 Actual Height 3 0 m Visual Clearance Easements 7 Sensitive Lands: ❑ Yes g No Type iirban Forestry Plan [d Conditions "Met"prior to issuance of building permit Notes: \ / Approved By Planning: 1 11 ii - a of Date: 12(2.1 I l S Revisions (after Building Su• ittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 070915.docx Building Permit Submittal Original Submittal Date: fd/�9/t j Site Plans: # L( Building Plans: # Building Permit#: ter building permit above. �� Workflow Routing: arming ngineeringfit Coordinator wilding Workflow Sign-off: Toff for Planning(include notes from planning review) Route Application Documents: L FT g-ineering: (1) copy of permit application, (1) site plan, (1) building plan and ori al plan review routing form. uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: .. Date: *a.W.A.r.. Engineering Review • Slope at building pad: 344 Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes No e. LIDA Facility on lot: ❑ Ycs 111No ❑ NOT Approved by Engi eering: Date: Notes: 4.dip � �► 41° s�"�'� /a Approved by Engineering: i4G U Date: age,/5 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ 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: SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: ❑ Yes WN/A Parks SDC: Yes ❑ N/A POK to Issue Permit Approved by Permit Coordinator: 4Zr.----Date: / 73A-' ;D I:\Building\Forms\BldgPennit Rvw_RES_070915.docx