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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 3 Request for Permit Action 1 • TIGARD 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 REFUND OR Name: Westland Custom Homes LLC INVOICE TO: (Business or Individual) Attn: Jim Standring Mailing Address: 12670 SW 68th Ave., Ste 400 City/State/Zip: Tigard, OR 97223 Phone No.: 503-780-0626 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ 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 provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: MST2016-00508 Site Address or Parcel #: 15022 SW Corbin St Project Name: Corbin Estates Subdivision Name: Corbin Estates Lot#: 10 EXPLANATION: Resubmitted under MST2017-00055 & SWR2017-00050. Refund 80% of plan review per building official due to street improvements/extension not being completed by city that prevented cars from backing out of the driveway. .- Signature: Date: 3/14/2017 Print Name: Dianna Howse 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. > d' `e 630. d 72-6-77--1-"4-6 Route to Sys Admin: Date By Route to Records: Date „23 By Refund Processed: Date2/y2 /J By Iaj Invoice Processed: Date By Permit Canceled: Date1/7 By f , Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 2314. oc TIGARD City of Tigard May 2,2017 Westland Custom Homes LLC Attn: Jim Standring 12670 SW 68th Ave., Suite 400 Tigard, OR 97223 Re: Permit No. MST2016-00508 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15022 SW Corbin St Project Name: Corbin Estates,Lot 10 Job No.: Refund Method: ® Check#224466 in the amount of$630.28. 0 Credit card"return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account"deposit"receipt in the amount of$ Comment(s): Refund 80% of permit fees plan review fees paid for this permit that was voided and resubmitted under MST2017-00055. If you have any questions please contact me at 503.718.2430. Sincer- , vl Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov a ° City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building ermit application fees. Receipts,documentation and the Request forPermit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator each Wednesday at 5:00 PM. Please allow up to 3 weeks for processingof re uy Payable will route refund checks to Accela System Administrator for distribon n to aap applicantccounts PAYABLE TO: Westland Custom Homes LLC DATE: PP Attn: Jim Standring 4/17/2017 12670 SW 68th Ave., Suite 400 REQUESTED BY: Dianna Howse Tigard, OR 97223 TRANSACTION INFORMATION: Receipt#: 407670&408301 Date: 11/28/2016& 1/10/2017 Case#: MST2016-00508 Pay Method: Check Address/Parcel: 15022 SW Corbin St. Project Name: Corbin Estates,Lot 10 EXPLANATION: Refund 80%of plan review fees per building official as imcomplete street improvements prevented car from backing out of driveway;plans to reverse garage resubmitted+'` under MST2017-00055. LEMT7P F a�� Cae6fix., .. do `# . + " 2';. zaw� ti �aci�!r', e et ,7ttj g rte. a+ x x .`i�-�..,,. 5 tl F aia e7,4f 4d. 3Lk � ?AFA 04114f.': Xt6Plan Review 230-0000-43106 $630.28 11111111111111111111111111111111111111111111 TOTAL REFUND: $630.28 APPROVALS: SIG T DATE: If under$5,000 Professional Staff *Wrir/ If under$12,500 Division �(�� Sion Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board MINISTa ,TIQN:US ONLY Case Refund Processed: Date: r'�2Er/cf- Bick I:\Building\Refunds\RefundRequest.doc s 09/01/2010 CITY OF TIGARD RECEIPT q 1 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Corbin Estates, Lot 10 Site Address: 15022 SW CORBIN ST 12 -Pci Al I Receipt Number: 415776 - 02/23/2018 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00508 $-630.28 Total: $-630.28 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 224466 Payor: Westland Custom Homes LLC DHOWSE 02/23/2018 $-630.28 Total Payments: $-630.28 Balance Due: $630.28 Page 1 of 1 CITY OF TIGARD 111 II 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Receipt Number: 407670 - 11/28/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00508 Plan Review 230-0000-43106 $750.00 4 Total: $750.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Check CASHIER ID RECEIPT DATE RECEIPT AMT 1272 Payor: Westland Custom Homes LLC DADAMSKI 11/28/2016 $750.00 Total Payments: $750.00 Balance Due: $0.00 1 1 Page 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT REFR„E IN q . 0,_L_I Re uest for Permit Action � 13125 Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard- ov8 20'7 TIGARD On tai` lili#«1 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 r Contractor 0 City Staff Check(✓)one REFUND OR Name: Wye r �^- ,�, � �� INVOICE TO: (Business or Individual) //�"j 1 '�JY f^ ni- 9.tio Mailing Address: ..;t0'?0 vgy City/State/Zip: 17(jl "4, O e • ae7)23 Phone No.: 3 IN CI PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): /`_'6°" 50 3 -`' 7 -Q 7Y;L ❑ 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 provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: H -r ,16 -6,056 gr(-0IK. /6 -°°0-14 Address or Parcel#: 6'4.0-212 *. (Q-"� , r 1 C7 r Site � ¶l&- v- O(2-- c 7 ? Lot#: Subdivision Name: I HP 1, EXPLANATION: .IV..,, _. AiL . r ---- I ► /.- t"' P / s Ji i7-000ss" ' 2got7-eicO5 ) Signature: Date: 2. 2117 —ow Print Name: ��1�ailni ' P Refund Policy ',S w e-S+.l C. -C(,a ( i CO rv. 1. The city's Community Developmetir ,birector,Building Official or City Engineer may authorize the refund of: • Any 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. FOR OFFICE USE ONLY Route to Sys Admin: Date ,8 17 :, A TO Route to Records: Date 3 21" /7 B Refund Processed: Date :/Z,,/i7 By $( Invoice Processed: Date y Permit Canceled: Date j/ //7 By. Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_09 314.doc 1111 . . . M TIGARD City of Tigard March 15,2017 Westland Custom Homes Attn: Jim Standring 12670 SW 68th Ave., Suite 400 Tigard, OR 97223 Re: Permit No. MST2016-00508& SWR2016-00424 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15022 SW Corbin St. Project Name: Corbin Estates,Lot 10 Job No.: N/A Refund Method: ® Check#224152 in the amount of$35,964.77. 0 Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account"deposit"receipt in the amount of$ Comment(s): Per applicant's request as house plans were changed and submitted under a new permit. Refund 100% of permit fees and SDC fees. If you have any questions please contact me at 503.718.2430. Sincerely, /605:2)4" 2— Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts,documentation and the Request for Permit Action form (if applicable)must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Westland Custom Homes DATE: 3/10/2017 Attn: Jim Standring 12670 SW 68th Ave, Ste. 400 REQUESTED BY: Dianna Howse Tigard, OR 97223 DA TRANSACTION INFORMATION: Receipt#: 408301/408302 Case#: MST2016-00508/SWR2016-00424 Date: 1/10/2017 Address/Parcel: 15022 SW Corbin St. Pay Method: Credit Card Project Name: Corbin Estates,Lot 10 EXPLANATION: Per applications request as they changed house plans.Refund 100%of permit fees. aV MA {rte' gl a J 1 ® o1 a d ,3 V Building Permit 230-0000-43104 $2,365.92 Mechanical Permit 230-0000-43102 324.31 Electrical Permit 220-0000-43103 480.98 Plumbing Permit 230-0000-43101 550.36 12%State Surcharge 100-0000-24001 446.59 Metro Construction Excise Tax 230-0000-24010 526.01 Tig-Tual School CET—Residential 230-0000-24102 4,213.20 Erosion Control w/Development 100-0000-43134 461.40 Tigard Trans SDC Improvement—SF 415-0000-43300 5,488.00 Tigard Trans SDC Reimbursement—SF 415-0000-43301 317.00 Washington County Trans Dev Tax—SF 405-0000-43320 8,278.00 Parks SDC Improvement 425-0000-43300 4,356.00 Parks SDC Reimbursement 425-0000-43301 1,207.00 Parks SDC Neighborhood 425-0000-43300 1,615.00 Sewer Connection Fee 500-0000-25500 5,300.00 Sewer Inspection Fee 230-0000-43118 35.00 TOTAL REFUND: $35,964.77 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board A1/4/ FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: 3/2. 0/j 7 By: I:\Building\Refunds\RefundRequest.doc x 12/21/2016 1114CITY OF TIGARD MASTER PERMIT 31 ' COMMUNITY DEVELOPMENT Permit#: MST2016 00508 T[ AR. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/10/2017 Parcel: 2S112CB19300 Jurisdiction: Tigard Site address: 15022 SW CORBIN ST Subdivision: CORBIN ESTATES Lot: 10 Project: Corbin Estates, Lot 10 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1289 sf Basement: 818 sf Left: 3 Parking Spaces: 0 Height: 26 Bathrooms: 4 Second: 1404 sf Garage: 730 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 3511 sf Value: $438,338.93 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add.'500 sf: 7 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3511 Owner: Contractor: ANDERSON HOMES&CONSULTING LL(WESTLAND INDUSTRIES Required Items and Reports(Conditions) 12600 SW 72ND AVE,STE 200 12670 SW 68TH AVE STE#400 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-245-9715 FAX: 503-598-9081 Total Fees: $32,343.62 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C-• - Those rules are set forth in OAR 952-00 010 through R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .:11.332.2344. CIssue Permittee Signature: X Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until corn of the proj ct. Approved plans are required on the job site at the time of each inspection. T EIlectcrrilkzJ PenniIt A�1 Ift, :,l 1l_t' ,..;,a ® ® , t '° '' City of Tigard1 Received Permit#: (a 5 01(�—Gb J ) D 1c Date/By: w 13125 SW Hall Blvd.,Tigard, ��iU Plan Review Related Permit#: m Phone: 503.7182439 Fax 50`.598 1960 Date/By: kris: ( Q See Page 2 for Inspection Line: 503.639.41,75; , Ready Date/By: t'S7 G.A,RD : 3\�, Notified/Method: Supplemental Information :< Internet: www.tigard-or.god '. i TYPE OF WORK PLAN REVIEW P" Please check all that apply(submit 2 sets of plans w/items checked): New construction ❑Other:on/a]teration/replacement D Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural 1-and 2-family ❑ dwelling 0 Commercial/industrial 0 Accessory building amps for all other instillations. buildings. Master builder ❑Other: less pump. buildings. of 150 KVA or Multi-family 0 separately se JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger P Y derived system. ❑Addition of new motor load of • r-' 100HP or more. ❑"A""E","1-2" "1-3„ Job#: Job site address: SO 2,7„,, b11� /,'1 occupancy. 0 Six or more residential units. City/State/ZIP: rp �( �>�y`� ❑Health-care facilities. 0 Recreational vehicle parks. p 1(0 r> 0 Supply voltage for more than 0oHazardous locations. 600 vlnominal. Suite/bldg./apt.#: Project name: 0 Service or feeder 600 amps or more. Cross street/directions to job site: CbG ? L 4i\,ti")N FEE SCHEDULE Description I Qty. I Each E Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: ' Includes attached garage. pfi �� 1,000 sq.ft.or less i 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 7 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 g-PROPERTY OWNER 0 TENANT i 1 Services or feeders installation,alteration,and/or relocation /� \ 200 amps or less 100.70 2 Name: g Q \ y a P3�DfC�e3�" Pe� p 133.56 2 tD rte ; 201 amps to 400 amps Address: r�J4tir 045 el 401 amps to 600 amps 200.34 2 City/State/ZIP: M ( j ' 0 q 2�� 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 Phone: �m7-4 � Fax:( � ��2,%4 "®G Temporary services or ffeeders installation,alteration,and/or Email: relocation 59.36 1 Owner installation:This installation is being made on property that I own which is not 200 amps or less 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 2 Owner signature:�� Date: 401 amps to 599 amps 168.54 25-APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel F } A.Fee for branch circuits with Business name: W e .i u. t+ above service or feeder fee, 7.42 2 each branch circuit Contact name: �0 C 'i < B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: 2-1..o70 9u , 6 a ` ,�a_ branch circuit Each add'I branch circuit 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) Phone:( r P Fax: ( g Each manufactured or modular 67.84 2 // S '(�' /� I "® dwelling,service and/or feeder �. 'oFl 2 Email: �® �� e„,7-1-0- P . Reconnect only 67.84 CONTRACTOR Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 Business name: D��--h �, _ ^e Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: _ j- ® anel,alteration or extension. Each additional inspection over allowable in any of the above City/State/ZIP: �� Ira(� Additional inspection(1 hr min) 66.25/hr ( ) Fax:0"a) �y� V II Investigation(1 hr min) 90.00/hr Phone: y s Ab' , 78.18/hr Industrial plant(1 hr min) Email: a�� Imo•.6��,1D t ik OL,. /��° g p Inspections for which no fee is 90.00/hr l specifically listed(''1 hr min) CCB Lie.: Q �� Electrical Lic.: > a rv.Lio. ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: £?Ake Oei- J. 64 ( Date: 0 Plan Review Required(25%of permit fee): F„�/ , State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 &" Date: days after it has been accepted as complete. Print name: * Number of inspections allowed per permit. Ann n<,<TmmvrnnnnuPR Mechz>mIlcall Pe milt;AID laced*d, - .., ,U ti os 1 OC UM ORILLA w 't " s % Received ��f��vo5-0 g r City of T1 Ilgaird 1-4,0- .' Permit No.: Date/By: �. e,r, 13125 SW Hall Blvd.,Tigard,OR 97223 4 Plan Review (IA Other Permit: �� ° Phone: 503.718.2439 Fax: 503.595�I 4 Date/By: �' Inspection Line: 503.639.4175 ‘3,4`, Date Ready/By: Juris: d See Pagel for ,6 . o a , Supplemental Information Internet: www.tigard-or.gov I Notified/Method: t G 'x�� + COMMERCIAL FEE* SCHEDULE— USE CHECKLIST TYPE OF WORK Mechanical permit fees are based on the value of the work &-New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead,and profit. ❑Demolition ❑Other: Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* kfl-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 Bleating/cooling: JOB SITE INFORMATION AND LOCATION Air conditioning 46.75 Job site address: t QV-A., ' (yi49 I n 5A-- ' Furnace 100,000 BTU(ducts/vents) Q 46.75 ��-��"�� Furnace 100,000+BTU(ducts/vents) 54.91 City/State/ZIP: rn ,1 P �� Heat pump 61.06 Suite/bldg./apt.no.: I Project name: Duct work I. 23.32 �q� Hydronic hot water system 23.32 Cross street/directions to job site: l - k � l�� Il U Residential boiler(radiator or 23.32 hydronic) Unit heaters(fuel-type,not electric), 46.75 in-wall,in-duct,suspended,etc. - Flue/vent for any of above 23.32 Other. 23.32 Subdivision: &- mid ] Lot no.: 1 Other fuel appliances: Water heater 23.32 Tax map/parcel no.: 33.39 Gas fireplace/insert DESCRIPTION OF WORKGas vent for water heater or gas Pi W_ Q 1� fireplace 23.32 ( fl., /� 3'e Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other. 23.32 PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name: 4/0-D t/LSd/...) Range hood/other kitchen 33.39 equipment Address: ---- ,..3 '''' Clothes dryer exhaust k 33.39 Single-duct exhaust(bathrooms, f City/State/ZIP: CTI�! ��3 toilet compartments,utility rooms) c Y 23.32 Phone:c-33, // Attic/crawlspace fans 23.32 —A]PPLIICANT 0 CONTACT PERSON Other: 23.32 p Fuel piping: Business name: j, r 1 .4-J/ ° $14.15 for first four;$4.03 for each additional Contact name: tib` Ii (Z___T-- Furnace,etc. Q - +� p Gas heat pump Address: o70 (00e 6 ��` Wall/suspended/unit heater City/State/ZIP: T Q cA . 6?-0- --2,7 Water heater � Q Phone:( ® 0624, IFax::(Q0, 6?0V Fireplace Range �4 E-mail: a 5e D e rikv.,,,, e6vt,NBarbecue CONTRACTOR Clothes dryer(gas) Other: Business name: !� ; i/ noe MECHANICAL PERMIT FEES* Address: V b'q , I'D9a .6' pieSubtotal Minimum permit fee($90.00) City/State/ZIP: Plan review(25%of permit fee) Phone:(�0o e -0 04 f) I Fax:( ) State surcharge(12%of permit fee) TOTAL PERMIT FIRE CCB lic.: � 0� q This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. t * Fee methodology set by Tri-County Building Industry Service Board Authorized signature: ` h Print name: A4 ?— � �r G'�s�Bate: V if COL i �'llual nbing Perrirdtt Agj the I Ti m 2 1 :.a X ' :I", ." ORME, U5C QOlj i.l� I�uAIlIldhr>�g �'ll�Y�SUATfeS� i tt�)�1 2 _1 ,C Received �� 4(� //_ ,i Permit No.: 045�� ,.D I�q a�. , City of Tigard Dateive V/ v 13125 SW Hall Blvd.,Tigard,OR"9?--23 t Plan Review Other PennitNo.: Phone: 503.718.2439 Fax 503;5'9$1960 4''' Date/By: �.�, ]oris: @1 See Page 2 for ; Inspection Line: 503.639.4175 ' a , Date Ready/By: El See mental Information ,, Internet: www.tigard-or.gov NotiSed/Method: FEE* SCI-IEDULE TYPEOFWORK For special information use checklistgr- Total New construction ❑Demolition Description Qty. Ea ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(include- 00 ft.for each utility connection) SFR(1)bath 312.70 CATEGORY OF CONSTRUCTIION SFR(2)bath 437.78 -and 2-family dwelling 0 Commercial/industrial SFR(3)bath {J 500.32 lti-famil 0 Multi-family 25.02 ❑Accessory building Each additional bath/kitchen Other. Page 2 ❑Master builder 0 OtheFire sprinkler�_s4•ft) Site utilities: 18.76 JOB SITE INFORMATION LOCATIONP1//S''ID,,�� ,j, Catch basin or area drain Job site address: ' 60 74." C_ c bt ✓ 18.76 Datch ba leach line,or trench drain �_ � Page 2 City/State/ZIP: 111 6�`(/( Oi�� rte` Footing drain(no.linear ft.:_� Suite/bldg./apt no.: I Project name: Manufactured home utilities 50.03 18.76 Cross street/directions to job site: Manholes 18.76 ¶ 4 73 EPA„ UYIN Rain drain connector N f(�/ Page 2 Sanitary sewer(no.linear ft.:_) Storm sewer(no linear ft.: ) Page 2 Water service(no.linear ft.:_) 1 Page 2 t �� Lot no.: 0 Fixture or item: 31.27 Subdivision: a 60 1 ` Bacldlow preventer Tax map/parcel no.: 12.51 Backwater valve DESCRIPTION OF WORK 25.02 Clothes washer Dishwasher 25.02 � !'i f� - -' 25.02 - Drinking fountain Ejectors/sump 25.02 0 TENANT 1 Expansion tank 12.51 ‘L..6.PROPERTY OWNER I25.02 t � .\ i.,r6,4 Fixture/sewer cap Jame: �, (SCA Ui De6N Floor drain/floor sink/hub 25.02 25.02 kddress: �ycO Garbage disposal 25.02 �' Hose bib :ity/State/ZIPt�('i,-.",+�`V �� X �/�_ 12.51 e C n- c� �-� ( t t,.@� Ice maker 'hone:�,�'%'� --, 14� --�1� Fax: � ��9 25.02 Interceptor/grease trap 0 APPLICANT CONTACT PERSON Page 2 nn� Medical gas(value:$ ) lusiness name: NT PDa,, S C_--° 12.51 Primer R� ` 12.51 :ontact name U I U IA., /m� Roof drain(commercial) c� 25.02 Lddress: Q ,0c, 5,Q- ' P.O `sem 1,04....4, ®6 Sink/basin/lavatory :ity/State/ZIP: friCip O el e Z-, Solar units(potable water) 62.54 (9 �8 e eb g� Tub/shower/shower pan 12.51 hone:(5 � �� I Fax:: Urinal 25.02 -mail: Water closet 25.02 CONTRACTOR1 37.52 Water heater Water piping/DWV 56.29 usiness name: i 1- g . ', l cm-, Q 25.02 ddress: II / qS egvi ,t) Other. Subtotal ity/State/ZIP: ,Ro t 0 q7))p,U Minimum pennit fee: $72.50 hone:( ) Fax:( ) Plan review (25%of permit fee) CB Lic.: C16 S. Plumbing Lic.no.: MIP 2-0�j eR State surcharge(12%of permit fee) TOTAL PERMIT FEE uthorized signature:_�,ll�„a This permit application expires if a permit is not obtained within 180 days ant name: h 9 p j r.� ` Njj I Date: 't►q ► * after it has been accepted as complete. Fee methodology set by Tri-County Building Industry Service Board. I_�llln��l b'in2 Pe ric ln'� r iwIliccatt ilon - (C�t' r;r'`I ngarrd Page 2 e Supplemental Information Fee Schedule: Residenntiaull It] Suppression Systemms: Qty. Fee(ea) Total Squna re Footauge: Perm it IFr se tee: Site Utilities oto 2,000 $121.90 Footing drain-In 100' ` 50.03 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 edica l Ga s Systems: Water Service-each additional 100' 37.52 �VaIlLn2tti®IIIl' �emIIffiIlt)F'ee' 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 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,to Other Inspections or Fees Qty. Fee(ea) Total 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 and including$25,000.00. (minimum charge-1/2 hour) 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 or each additional$100.00 or fraction thereof,to hours(minimum charge-2 hours) and including$50,000.00. Reinspection Fees 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Replace/ Please check all that apply. Wrk Fixture eryor a Capped Added Relocate ❑ Any new commercial building with water service 2"and Work Performed: Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thin 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher. -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" Isometric or Riser Diagram 4•> 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer IEIDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 7 City of Tigard IN m a COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Residential Building Permit #: M/7ra6tce —oo 50� s �w Site Address: Project Name: Cor I s (New dwelling=subdivision name;Addition or Alteration=last name of Lot #: I Planning Review —+-- owner) Proposal: t't.6 ciloCif.--eci SM, XVerify site address/suite#exists and active in permit system. River Terrace Neighborhood: No El Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan ,,Site plan must be on 8-1/2"x 11"or 11 x 17"paper �E o�g structures on site Drawn to scale(standard architect or engineer scale) � tpnnt of new structure(including decks)with finished C�1�Iorth arrow floor elevations �� ite address,project or subdivision name and lot numbertY locations(required for new,may apply for additions) ki Applicant information(name and phone number) �ocation of wells/septic systems xing trees to be retained with drip line,and tree tot dimensions and building setback dimensions NfLot area,building coverage area,percentage of coverage and , protectione measures rl impervious area(applicable if R-7,R-12,R-25&R-40) ✓Street tree size,type and location AiProperty corner elevations (2 foot contour lines if more thantifiStreet names foot differential Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No Ac Public Facilities Improvement(PFI) Permit: Required: ❑ yes,applicant was notified No Applied For: ❑ Yes ❑ 'Land Use Case#: No,stop intake 1 Zoning: II Required Setbacks: +Front ,;20 Rear 1Jii Landscape Requirement: N �o �S Side 5 Street Side (S Garage I. Lot Coverage Maximum: II kr Z Building Height: Maximum Height '30Visual Clearance Actual Height o�-o if Easements Xr Sensitive Lands: ❑ Yes Urban Forestry Plan NO Type ,'Conditions "Met"prior to issuance of building permit Notes: i n i _ i;r.tzi z ii 1A.S o-v.Q4 Approved By Planning: Date: if- �, Revisions (after Building Submittal only) Ce � Revision 1: ❑ Approved ❑ Not Approved Reviewer Date Revision 2: El Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw REg_091216.docx Building Permit Submittal Original Submittal Date: #44 Site Plans: -- Building Plans: # a5(/16 —1 Building Permit#: ['-Enter building permit#above. Building Workflow Sign-off: ❑' Sign-off for Planningcopy(of ludnotes y arionna(1�ge plan, (1)building plan and Route Application Documents: [�'Engineering: ( ) pY permit 7original plan review routing form. building plans,engineer and Building: original permit application,site plans, beam calculations and trust details,`if applicable,etc. �J>�-t�to-�--o �!._ lir r a� / . Notes: �� nn Date: // / . �-d�� v ByPermit Technician: - n Engineering Review B'Slope at building pad: C Conditions"Met"prior to issuance of building permit 2—Easements (encroachments)per engineering conditions of approval and plat Er-Water Quality/Quantity Facility: a--No Water Quality Fee in-lieu: ❑ Yes �No Assess Water Quantity Fee in-lieu: 0 Yes N LIDA Facility on lot: 0 Yes o Date: 0 NOT Approved by Engineering: Notes: GoL+04rii"'s t t.. L at, bwi-c rt,aaii • t SS,%A.0.466- .fsSN�C Date: j�- Z -J4 Approved by Engineering: Reviewer Date Revisions (after Building Submittal only) Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review 0 Conditions"Met"prior to issuance of building permit 2� IC.'jt Date: pproved,NOT Released: otes: 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: 'p7Yes 0 N/A Tigard Trans SDC: es 0 N/A Parks SDC: es 0 N/A OK to Issue Permit rDate./""? /4*Approved by Permit Coordinator: I:1BuildingWorms\BldgPermitRvw_RES_091216.docx Albert Shields From: Albert Shields Sent: Tuesday, November 29, 2016 6:19 PM To: jswestland@aol.com' Subject: MST2016 00508 Attachments: Conditions - 11-29-2016.pdf Jim, in reviewing the application for MST2016-00508 we realized that Condition of Approval No. 2 for bimonthly arborist inspections has not been met. See the attached list. Accordingly, I am classifying this application as "Approved but Not Released." Plan Review with proceed but we'll need to have Condition No. 2 signed off before we can issue the permit. Please let me know if you have any questions. Albert Shields. 1