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Permit (51) r►, City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 11 41 Request for Permit Action1114 RECEIVED 1", ,;„R I_) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ttgard-or.gov ' . . 2017 TO: CITY OF TIGARD Building Division (1 11 1 £ &k RD 13125 SW Hall Blvd.,Tigard,OR 97223 5 UiT 4D1 G DIVISION 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) -te \---\--ovL i vt Mailing Address: \---PD b--„,....) Wk. CkfcRA Iv 1\N•Q.-.) City/State/Zip: e/ - —' 67n.2(17)----°1 Phone No.: R55_ A D .9- '-L--t\,- --- PLEASE t`- ---PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): Er 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#: S--\•ZDVLQ " 0( J/ 11C';ZDA,'`4lO ' Site Address or Parcel#: 1 5'505 � -' A ! % f1�quk. V 0 Project Name: ' 1C't ' k (__ V-O 35\IA � � ` _ Lot#: Subdivision Name: � '\ t / l cmc--)\kl l qk.L EXPI ANATION: T.envide2-, l S ,-C I S ,1/ .. A .�-� 4-i cjY) Gvy 1 v� -�5 rtU �i -e� ilic �� aR p -b--- - /� L-C- y mss,tax/7 -e7()/, 6-ciAL . ; 7 Z, / 7 7 Signature: I 1 ,-7 e Li/ / S Date: (..,..... ---12.2_ J`22-/ 17 Print Name: (� l� Vvt� �,� G IS 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. SF 7 r- Pf /LS s`.540/-.. S\\ 5:6 'TO Al PF72-'1 ITS FOR OFFICE USE ONLY Route to Sys Admin: Date ,1 e a By :- Route to Records: Date `f /Z /9 B e:°°'''' Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date j///7 By Parcel Tag Added: Date By e I:\Building\Forms\RegPmitAction_0923�j4. oc 111111 . i TIGARD July 26,2017 City of Tigard DR Horton Inc. Attn: Emerald Weeks 4380 SW Macadam Ave. Portland, OR 97239 Re: Permit No. MST2016-00558 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15505 SW Applewood Ln. Project Name: Heritage Crossing,Lot 46 Job No.: N/A Refund Method: ® Check#225390 in the amount of$5,406.58. ❑ Credit card "return"receipt in the amount of$ 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 new plans were submitted under MST2017- 00196. Refund 80% of permit fees. All SDC fees were transferred to new permit. If you have any questions please contact me at 503.718.2430. Sincerely, /<: :k121;11leir-e---- 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 INW = 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: DR Horton Inc. DATE: Attn: Emerald Weeks 7/6/2017 4380 SW Macadam Ave. REQUESTED BY: Dianna Howse Portland, OR 97239 TRANSACTION INFORMATION: Receipt#: 410162 Case#: MST2016-00558 Date: 4/20/2017 Address/Parcel: 15505 SW Applewood Ln Pay Method: CreditCard Project Name: Heritage Crossing,Lot 46 EXPLANATION: Per applicants request as new plans were submitted under MST2017-00196. Refund 80%of permit fees. g .40$111t;;',::;1" rV� dl:�Y i;;;n4 n -il,) -¢€+sV� f �� X�j e��s{irFcRe t �t.?::;:, :::, '> 1ti 4,y¢ c &S " } t_ � ..?,:,,L7-i,,,,,,,!;„,;,: { } } �s $< k14 F3.. . �Bulldulg Permit 230-0000-43104 $1,206.59 ✓ Mechanical Permit 230-0000-43102 Electrical Permit 240.79 `� 220-0000-43103 276.24 ✓ Plumbing Permit 230-0000-43101 ,/ 12%State Surcharge 400.26 100-0000-24001 254.87 ,✓ Metro Construction Excise Tax 230-0000-24010 Tig-Tual School CET 293.63 230-0000-24102 2,422.80 Erosion Control Permit 100-0000-43134 31 / 1.40 ✓ TOTAL REFUND: $5,406.58 ✓ APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff ,, I� If under$12,500 Division Manager i J s), If under$25,500 Department Manager VVV If under$50,000 City Manager If over$50,000 Local Contract Review Board :!:-.4-2N-4-.:'.4;::',:= a t..' IPfP $ ' U Z STR ,TroN xU$ �. a'= '1 :,, a; Case Refund Processed: I Date:' .Y/�/�� I By: � `��}' ' 1 I.\Budding\Refunds\RefundRequest.doc x 12/21/2016 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 46 Site Address: 15505 SW APPLEWOOD LN �"ZC1CJ Receipt Number: 415913 - 03/02/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00558 $-5,406.58 Total: $-5,406.58 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 225390 DHOWSE 03/02/2018 $-5,406.58 Payor: D R Horton Inc Total Payments: $-5,406.58 Balance Due: $5,406.58 Page 1 of 1 11111 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 46 Site Address: 15505 SW APPLEWOOD LN 0 X / (A/4"-4-- Receipt (_- Receipt Number: 410162 - 04/20/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00558 Building Permit-New Construction 230-0000-43104 /yet.4'$1,508.24 E-- MST2016-00558 Plan Review 230-0000-43106 $751.34 MST2016-00558 12%State Surcharge-Building 100-0000-24001 /2 q $180.99 4.- MST2016-00558 DC Provision Review, SF-Ping 100-0000-43112 $90.00 MST2016-00558 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $34.00 11x17) MST2016-00558 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $29.50 11x17) MST2016-00558 Metro Const. Excise Tax 230-0000-24010 ✓ $293.63 4-- MST2016-00558 Tig-Tual School CET-Residential 230-0000-24102 V.$2,422.80 E- MST2016-00558 Permit Fee-Elect(per dwelling unit) 220-0000-43103 E $270.30 E- MST2016-00558 Limited Energy 220-0000-43103 E $75.00 F-- MST2016-00558 12%State Surcharge-Electrical 100-0000-24001 /y,9, $41.44 E-- MST2016-00558 Furnaces< 100K BTU 230-0000-43102 ,' $46.75 4-- MST2016-00558 Water Heater 230-0000-43102 M $23.32 E- MST2016-00558 Gas Fireplace 230-0000-43102 ry $33.39 0- M5T2016-00558 Range Hood/Other Kitchen 230-0000-43102 /y $33.39 F-- MST2016-00558 Clothes Dryer Exhaust 230-0000-43102 /1 $33.394- MST2016-00558 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 /7 $116.60 +- Utility Rooms) MST2016-00558 Fuel Piping 230-0000-43102 /1 $14.15 F MST2016-00558 12%State Surcharge-Mechanical 100-0000-24001 124 $36.12. -- MST2016-00558 SFR-Baths 230-0000-43101 P $500.32 F- MST2016-00558 12%State Surcharge-Plumbing 100-0000-24001 /Z'Po $60.04 t- MST2016-00558 Erosion Control w/Development 100-0000-43134 V✓ $311.40 E- MST2016-00558 Plan Review 230-0000-43106 $229.02 Total: $7,135.13 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 054600 PUBLICUSERO 04/20/2017 $28,396.13 Payor: dr horton Total Payments: $28,396.13 ti Balance Due: $0.00 l G96- E/-- ---c-�/a e4-z-- I2 EC 9NiCq L--0014P LK/r10/Al G-- py4 ff. 2.1Z ru fiv26-E- So6,yy 0270, 30 1,15 / , 7.5 1,yo Z-oo . 3ez. ✓e,,g9 tw, /y 1 ,/..5 7,--(pa* .7s, 1 fr .23. 3�. ii,c+ ✓ 7, 2 - 36 /i-2- , yv c�' 70 /,e, 03 ��o� , s9 3N5, 30 �. �� 37, 35' a�1/ ✓ �//�. of Go .&V / ✓ hoz, .w- .33. 39 ,4,7/ _ y�" Y 3c ao ,,,co:9� �yy 19 30 /.Iso = 0276, ay 4r 3 3, ? 9 ;4'7/ 2 Id ✓ 4 3 2_ i�,s7 Aellr a3,3-// 4 , i o f /46 ,o 0 2s y,�� 70 ,30 9s, r0 fiti S /1, 12- jFe �o N1> ,2 iG, ,., y 66'°I) 30 0 , g9 ✓ �e?Sy.�7 �O Flo y, ab i5,� �a ' 02 �yO.rl Page 1 oft 444 0!o ,✓ rya, 79 7.07-#1,z z72_6-7;9/4 = s9y/69 IIU CITY OF TIGARD MASTER PERMIT 2:" COMMUNITY DEVELOPMENT Permit#: MST2016-00558 1 f G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2017 Parcel: 2S 111 DA22700 Jurisdiction: Tigard Site address: 15505 SW APPLEWOOD LN Subdivision: HERITAGE CROSSING Lot: 46 Project: Heritage Crossing, Lot 46 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 701 sf Basement: 0 sf Left: 4 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 991 sf Garage: 340 sf Front: 15 Smoke Dwelling Units: 1 Third: 327 sf Right: 4 Detectors: Yes Total: 2019 sf Value: $244,690.31 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 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'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 HVAC: N 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 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 2019 Owner: Contractor: DR HORTON INC. Required Items and Reports(Conditions) 4380 SW MACADAM AVE STE 100 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97239 PHONE: 503-222-4151 PHONE: FAX: Total Fees: $28,396.13 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952- 01-0090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: z(G Permittee Signature: 19 r,-- 0 .4..V 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 completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application 7 4 Residential i -� (,1 ,� t."., I Oft 0111(1. 1 ,l 0VI 1 City of Tigard Received 11 y 13 i25 5 W Hall Blvd..Tigard,012 97223 i 1\;` Date,t3): a//'7//� / Peen-NA) -j�// s-s7 Phone: 503.718 2439 Fax. 503.598.191,0 1 ! Plan itet,cu /'' /��<</ Inspection Line. 503.639 41/5 Date tiv. L� - Other Permie . E=t, pp @� S�i�-�cY��y� Internet: aww.tigardttr.gov R a��i lYatr Rrad�H. n 1 Ea See Pap.2 fur Nari�ed-Mert nd: y f i l �TU1 Il uvula.-lXn Supplemental Information 1Ji,�Il�� DIVISION Ei4c.Qrai TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DN ELLING 11 New construction 0 Demolition Permit fees*arc based on the value of the work performed. 0 Addition/alteration/replacement 0 Other: - Indicate the value(rounded to the nearest dollar)of all _ equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Q I-and 2-family dwelling valuation: u i ❑Commercial/industrial $at}et 69 0 - i ❑Accessory building // 11 ❑Multi-familyNumber of bedrooms: 3 ❑ Master builder 0 Other: Number of bathroom i..,3 JOB SITE INFORMATION AND LOCATION Total number of floors'..3 Job site address: I(53.-0 , <7 i.. _a New dwelling area:A.)01 square feet City/State/ZIP:Tigard,OR 97223 Garage.carport arca: square feet Suitebidg.lapt.no.: Project name ' P,e, L/`/Y U,�, i Caterer porch area: ts square feet 9 9 ' Cross street/directions to job site: ,J Deck area: square feet 7 O ' Other structure area: square feet Subdivision: u REQUIRED DATA:(OMMERC IAL-USE CHECKLIST I Lot no.: Woo Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. New SFR valuation: S Existing building area: square feet New building area: square feet e PROPERTY OWNER 1 0 TENANT Number of stories: Name: DR Horton Inc. Type of construction: Address: 4380 SW Macadam Ave Suite 100 Occupancy groups: City/State/ZIP:Portland,OR 97239 Phone:( Existing: S03) 222-4151 Fax:( ) 0 APPLICANT Nev.:. CONTACT PERSON _ BUILDING PERMIT FEES* Business name: DR Horton Inc. (Please refer false schedule Contact name:Emerald Weeks Structural plan review fee(or deposit): Address: 4380 SW Macadam Ave Suite 100 RS plan review fee(if applicable): City/State/ZIP:Portland, OR 97239 Total fees due upon application: Phone:(503 )222-4151 x1107 I Fax. :( ) Amount received: PHOTOYOLrAIC SOLAR PANEL S)STEM FEES* E-mail: e$,IVee1CS@ill17UrtOn.CGm CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: DR Horton Inc. Submit two ( )sets of roof plan with connection details and fire department access.along with the 2010 Oregon Address:4380 SW Macadam Ave Suite 100' City;State?ZIP: I Solar Installation Specialty Code checklist. Portland, OR 97239 Permit Fee(includes plan review and administrative fees: 5 180.00 Phone:(503 )222-4151 I Fax:( ) CCB lie.: 130859 State surcharge(12%of permit fee): S21.60 Authorized signature: , Total fee due upon application: Sgt)I.60 if a a , ? { f This permit application expires permit is not obtained within 180 days after it has been accepted as complete. Print name: , • I "Fee methodologyset b Tri-County Building Industn t i 1 t ' v .' i.• __ , I Date!2016 y Service Board. I.Building,Permits BUP-RESPennitApp.doc (12 24-2011 440-4o In(1 I 02('OM WEB, , Mec`hanical Pernait Applica44*; ltE Iiii4r,j f(4ft(4 f f f( f f 4,‘f ()\1 N (it) of ligard :'':, ;,''' '' 'El '://,(570toic,-D ,cr ..., 1h04. 'io-1. :.‘"r" /tot '''4''''' '1N[1V i D 2016 ,44', , -,—P, 440441 taw CO;4 lq 414 '-'1"),,, k.t,. h -*- — - : 13 N.,rotxr:13-44 ft0crtict t4 4%kk tir.,t,1'''1,,,, AO ITN/1:''‘.,i,;;'4;T.j('Ai 0,li.) , ,;;,-,%.!, ;;..- 1.43oppl,m4141346 104,4 444411,m - '4 0.. ` Al rypE ',-illtitift IA'G 1...9.4W4S2 It)IN :,_ COMMERCIAL FEE* SCIVEDI ILE USE EllECKLIst *,, „,, ti‘4.*.3% l'",1^..."ti,,'4 tt, N.d'It't•t St't..'It-,,7- ' 4:4"Is411441444" 0 ‘,1.1404trt-1141,07t,t; rVit1,1 ,t)....,,' U44.'11.,14-41 1,01...,11,•4 Ow 3,Ii43.-3 3,y4,1,,t31 4,3 31-tt 33,-,,33,-.3 i0 1)0140111101 ED t ttItcr 1 , ''1'4),':WI',..Lt1.1_2211,L,":21:-.,L1IT'..1 .1,;4'" L-------- — CATEGORY COIQITRV-CTION 1 3.13tir 14 OF RESIDENTIAL EQUIPMENT i SYSTEWS EELS* , 1 ig ; old 1 ;3int1,, ,itts 44114.1gt 0& 0411111.03,,1.44 ilthfu‘t3t.,1 0 ‘‘,,,,,,,,,..,,,,,, !Ikjid•pt„ i 4,4.p3r,i3.ii roolormtaixon.....,.het iit‘t. Dmult.•!4,44,,i, U ,41..„,,14.-4644ild,, I 33343.3. 11,.044,,t3,,, — JOIISIT EINFOTLMATION AND LOCATION — -, ,. fical_143%titxt_ITit 3, 3,1331k.-4.4. 1,tr,50,5- c_5(4, /Appitt4440L01., 1,14A/Ntt, 1.,344,,,,,140,01. It j I . „ . , 4 „ „- fo, :IP "'iv,d, OR 97-113 12L,,,.... ,...,ix.“ si i 1 ,,,,_, „; 4 t'Itt t 3 - ii. irtikt 1 ............, . , , .01'NO,' N. .........._... ....-._ __ 1 4144 ,-'41‘.'-',t t,.it 4 tu p' tt.,,^4,•,, t"„ • , N\,t4i, UI tits...I '4 t,,,t33,1,3,4 3.tt, 4, t . . 4 , 1 •••,,It4d.‘ •.,,qt i,t I.• ' ''.- ^ - ---- ' , _ _ — ,-.. t. . , other W 1 ueltwillti44,51343,e J4 . .. 1 fiIn ,t ,,,;1,11+,0 44.4 11, ,t,t,ite,,34c3 ! :4 „ DESCRIMON OF WORK i .."..."222111"1±5.}27•(21 _. _ — - — — ' — 104 40144!,47 y..11-.1 i;,',1,:' Nc14.-SI'R ,;:1,1.;.4 4- . , 2 .1.,t 'Jr:titer tps.1 ,+0 th'14,1 t..;,,,,,.• . t 1 1,3,44,3!1,1-4.4,,,,,- , •. ' ' ' • - — -- - 'I 1,,,,,4..,.:: !,,„.,.1',„:-,14 I t— ra—RoTorry owNER "1.-- 0'TENAN-i------1 ; _ I.__ _,......... 44 ' 1,.. onmental e%hallo and*rotiltatoont "1.:14,414: 1)R Horton Inc. : itt 34.4:34 43,31 3344134 k ti,1101, 1 ,..,, _AL:111 fIt'll' .Z , .4380 SAN' Macadam Ave Suite 100 414,444-444,44,444., ‘ 44, stmv ill' Portland,OR 97234 ,,,,i4 d.....,-., ,..;. lit t.,"0 , . 1,,,it•!,ot:2.1:ft't t,t ',",t1.,‘. r t.,tt..t 1 2 t • 3 112.4151 , 1.1k ' ' '',;,t. t t po.,ti...,t 1,,t,. L ' — .....„, ‘, ,..„ ' 0 AFFEKANT ip corAct km" ,cl,,,, ............-- — . 1.44(1 pippg:,,:14,,,,4,11111.4 DR Horton Inc, t _..... . _ . _ . Ito 44411.3.1331411.3341A1, I,,nIJ(I 4141114: Emerald 'Weeks t 4 343 3,s slt. 1 ‘tldic1, 4380 SW,- Macadam Ave Suite 100 i . 4 ( if. ‘,,0L iii° Portland,OR 9139 'A 4t4 33,3y i ' I , , . f ,, -.4),1 222- -1151 x1107, ; ' " ' . . ,-1, t.-Nweekso'clrhotton A.om ,, 4. 4.4..,, 44_ 4 . L - , CONTRACTORk h,th....1. ,.... ., . —— , - ;lf R ft.. t„. Li.ft.jAi i A • Mt 1. __________ IL_AMIt, 1 ',Lily/SP '41,-1 1"IL/I 7 v;f, , ' !I A . .1 ,,,, f),1 . • ••••:::.4""44‘-"..2P'''''''`'''''''Th- ..., , ..c4........,!,44_ .1., '-'„- - ...,. .1 ../. ; ---1- ' -,- ., „:„ .• 1 .4 11,.., I i . •4' 4 • 4 'it. ' '' ....e ,4 ' `, ,-,".t •,4.','' ' .1,..,-,-•.' ',•.,•i , . i t H .,. , _ ,j 101 %1 PI R\111 1/I i it,/.....421.0...h...r,,,w,...,.a writ-Id IS 4. l 3444034.3“1 4.334b33,I%4 Ali 4.1 likt It..ts/tt t plett*"(4334441414 4, it!iti.,"f•.,, .I..4r....!...k.; Pr•Pt 14•114.4.;.. • Electrical Permit Apolicaay I Hi: (>1 1 it I t -.1 (>\I l City of Tigard Received 13125 SW Ha11 B1vd.,Tigard,OR 97 1 V _ `01 Date/ByPermit 1Vo.%�c J/(C 7�?.K3 Phone: 503.7182439 Fax: 503.598.1960 Pima" Inspection Linin: 503.639.4I75 s" '° '3._I r s,< 1 Date Re Jud,OthPermit Internet www.tigard-or-gov " f °r ( �. Nom RC metho lurk S See Pagetal for NotiSed/Metbod TYPE , i a,.'7‘.).1. SuPPlemeq in[ormatiou PIAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submitg sets of plans w/ltens checked below): O Service or 400 amps or more O Building ova three stories. ❑Demolition ❑Other: I./bereft available fault curlew Cl Marinas and boatyards, CATEGORY OF L' CT1ON • exceeds 10,000 amps at 150 volts or O Floating buildings. ❑I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000• 13 Commercial-user avicuttural ElMuIti-family El Master builder > for all Diner installations. buildings. Other: OFin pump' 0 Installation of 75 KVA or JOB SITE INFORMATION LOCATIONO Emergency system. larger separately derived system. ❑Addition ofnew motor load of 0"A","g","1-2","1-3", Job no,: ( Job site address: I� �U 1 loot>P amore. icy. ./* tu�r.� O six a more esidentiai units. a Recreational vehicle parks. City/State/ZIP: 1[o,fi(y 0 D i7�'n 3 ❑Health-care facilities. ❑Hazardous locations. ❑supply voltage for more that G( 600 volts nominal, Suite/bldg./apt.no. --) Cv lProject name: 0- CA,-0,3, p O Service or feeder 600 amps a more. Cross street/directions to job site: 1 FEE SCHEDULE �„/ Dereriethe I Qtr. I Nee. 1 Tag I . New residenfaisingle:or multi-family dwelling unit. Includes attached garage. Subdivision: I Lot no.: y� 1,000 sq.ft or less I 168.54 4 Tax map/parcel no.: Ea.add'I 500 sq.R.or portion ,3 33.92 1 DESCRIPTION OF WORK • Limited(withenergy,stial 75.00 2 ) Limited energy,ntuki-family 75.00 I 2 residential(with above sq.ft.) Services or feeders installsdon,alteration,and/or relocation 200 Iamps less 100.70 2 I 0 TENANT 201 0 PROPERTY OWNER � amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 60I amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or relocation Phone:( ) F`ax:(: ) 200 amps or less 59.36 I 1 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 strops to 599 amps 168.54 2 Owner signature' Branch circuits-new,alteration,or extension, r panel Date: t✓ A.Fee for branch circuits with 0 APPLICANT I I ❑ CONTACT PERSON above service or feeder fee, Business name: DR Horton Inc each branch circuit 7.42 2 B.Fee for branch circuits without ' Contact name: Emerald Weeks service or feeder fee,Rist branch circuit 56.18 2 Address: 4380 SW macadam Ave Each dela']bnancb circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP: Portland OR 97239 Each manufactured or modular 503 ZLZ-4151 dwetistg,serviceand/or feeder 67.84 I2 Phone:( ) I Fax::( ) ./ Reconnect only ,.. . 67.84 E-mailPump or irrigation circle 67.84 I22 • ) fC�ONLTRACCTJOR , i' - Sign or outline lighting 67.84 2 Business name: �(A 141 t,# iE" 1�4 g(Q�G, ' Sandal circuit(s)or extension. -� G �`/__ panel,alteration, Paget 1z allowable in any of the shoveAddress: 2 go z/ es- a tt t0 Additional inspection City/State/ZIP: �G�Y)C t�(i1 l/ t. . ,�� Inv�gation( min)hr ) 6251 hr Phone: (3‘,a5/f— .�,� ,9 Fax: Industrial plant(1 hr min) 78.18/hr 2�= 966 6:7 Inspections for wl*h no fee i4 CCB Lic.:J�ZZ.6V._91 Electrical Lic.:.CZ 30 ( Suprv.Lic.: / specifically listed/1i hr mut) 90.00/hr �f Z v T el y S ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: }1• - Subtotal: Print name:Ch L S ti�. <� a�— rl Date: Plan review(25%of permit fee): State surcharge(12%of pewit fee) Authorized signature: TOTAL PERMIT FEE: This permit applicationaferexpires Ia permit is not obtained within 180 Print name: • N- I Date: days artier it has been accepted as completer * Number of inspections allowed per permit. L1ButlainalPermitslfit f PumRApy 440-4615T0 ties/co,ej 'Electrical Permit Application-City of Tigard .�',so i - ' ,A t *-4 T1 Page 2—Supplemental Information NOV 5 L116 /Pt S 7)-0/(i "00 c-S6- Limited Energy Permit Fees: 1 Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: �1� iii Fiy y I)t.V;SIOJ, FEE SCHEDULE Fee for all residential systems combined: S75.00 Dccription Qty. Fath Total • Renewable electrical energy systems: Check Type of Work Involved: 5 kva or Icsti IIII l,(l,u S.01 w IS kva 133.56 , ElAudio and Stereo Systems* — 15 n to 25 kva 21)1.34 n Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 ' , I X� Garage Door Opener* SIJ.f11 In IOU k,l 552.26 'llp to (fee in accordance XIwith OAR 91s-309-0oau) Heating, Ventilation and Air Conditioning System* I Solar generation systems in excess of 25 kva: Each additional kva 'Nei- 5 2 Vacuum Systems* - '- IUlrk�a—nuadduionalchargc Uri } Each additional inspection over allowable in any of the above: Other: Each additional inspection is charged at an hourly(1 hr min) hb-25,hr Inspections lhr which no Ice is specifrcall) listed(':hr min) 90.00,hr COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): I (SEE OAR 918-309-0000) ' Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls n C• lock Systems ❑ Data Telecommunication Installation n F• ire Alarm Installation • HVAC • Instrumentation n Intercom and Paging Systems • Landscape Irrigation Control* n M• edical n N• urse Calls E Outdoor Landscape Lighting* n Protective Signaling E Other: Total number of commercial systems: _ 1 *No licenses are required. Licenses are required for all other installations I Building Pe,:n it'1 LC PomitApp LLR ERE dtr t:cs u';1'"'r!t5 Pl Building tt Application4,10 t_ 1eill fil i :1 Tr gFixtures FOR 01 1 1( 11 t SE O\., City of Tigard Received la 13125 SW Hall Blvd.,Tigard,OR 97223 0 NOV 1 Ntilh j;�, D Permit V /4o/vs Phone: 503.718.2439 Fax: 503.598.1960 DatdBy: Other /Permit No.: r t c>>it u inspection Line: 503.639.4175 x, / Internet: www.tigafd.or.gov C ' "-`' 11.4.1,'j,I P Rem/By: rte: RI See Page 2 kr lied/Method: Supplemental lafermatba . *, . TYPE OF WOJ t l ,DI1 $ r 8'r; z i', ❑New construction 0 Demolition For spedallrforrrtat/oa use checklist• , Addition/alteration/replacement }0Other: Description r Qty, 1 Ea. I Total New i-2-family dwellings(includes 100 R.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70_ ❑I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath l 500 32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: , Fire sprinkler( sq.ft.) Page 2 JOB.07B i1FORM0OJl1:'AND LOCATION She utilities: Job site address: I Yh). .C, _ . A^p iL Catch basin ch Pact drrn 18.76 City/State/ZIP: ';A__ 4 ��12 9^''a✓ - Drywall leach line,linear french drain 18.76 /.�" J�,� Footing drain(no.linear ft.: ) Page 2 Suite/bidgJapt.no.: Project name: V*ii 11/7 1 Manufactured home utilities 50.03 Cross street/directions to job site: 6Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_J Page 2 Storm sewer(no.linear ft.:_, ) Page 2 Water service(no.linear ft.:,_-,J 1 Page 2 Subdivision: ` Lot no.: Ifto Fixture or Item: Tax map/parcel no.: Backflow preventer 31.27 . .. DESCRiP.fON•OF:WORiK J Backwater valve 12 51 .. Clothes washer _ 25.02 Dishwasher 25.02 q VF Drinking fountain 25.02 Ejectors/sump 25.02 •;0 minim( O'WIVER . ' ..1 (] TENANT . Expansion tank 12.51 Name: ->� Vim,L. Fixture/sewer cap 25.02 Floor drain/floor sinklhub 25.02 Address krY c -) \ ODvG 61/1 -ku- Garbage disposal 25.02 City/State/ZiP: (O'L 10- Hose bib _ 25.02 i Phone:0)3 1'a4-'` -. I Fax:( ) Ice maker 12.51 0 APPLICANT I 0 CONTACT PERSON interceptor/grease trap 25.02 Business name: V fv4- 1kilC Medical gas(value:S ) Page 2 Primer 12.51 Contact name: V-5\NAQ_,1/Gt101 .\aj ,, Ro Roof dein(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/StatetZlP: Solar units(potable water) 62.54 Phone:( )) y / ,� Fax::( ) Tub/shower/shower pan 12.51 E-mail: e 1��TtX/t`/js (7,V VI CT/ .Co VV Urinal 25.02 Water closet 25.02 CONTRACTOR . i Water heater 37.52 Business name:EDWARD MULLEN PLUMBING Water piping/DWV 56.29 Address:1601 SE RiVER ROAD Other: 25.02 City/State/ZiP:HiLLSBORO,OREGON 97123 Subtotal Phone:(503)640-0113 Fax:(503)640-4483 Minkrutm permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.:94689 Plumbing Lie.no.:34-260PB / f�J/ State surcharge(129'e of pexmit fee) Authorized signature: _ TOTAL PERMIT FEE / This permit applications expires if a permit Is use obtained within 150 days Print name:RAY MULLEN Date: after it has baa accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. I:muddig5fawipVtM.PevwsApp.doc 10/01/09 440.4416T(10/02/COMAVE9) IIIICity of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT T 1 c A R D Building Permit Review — Residential ire�.§Ls; ,wfty.. ...'.1St .,%.,^t ,_ ,,*,,,z_tt.:'5 3—Z.. 54,E -V.100t...*'..3xue 4.,,i. ?t:Yy d.-L,, ..n�vl.H,"$Ytb&&,a.3ti,i ..:n.LEAu` i�v5� .,�.1J*P k....', Building Permit #: AtS LA0%_ D0S-75 Site Address: ISS 05 cSw Ai'pt�vvooc. Ln. Project Name: j-E r-'-1- 19 e C ross i r)cc S Lot #: 16 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: t eAN 'F R 71 Verify site address/suite# exists and active in permit system. gel River Terrace Neighborhood: /I No 1:1 Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan wig structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper ,J Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations ,.,{North arrow Utility locations (required for new,may apply for additions) XJ Site address,project or subdivision name and lot number —ration of wells/septic systems .Applicant information(name and phone number) ®13xisting trees to be retained with drip line,and tree Plot dimensions and building setback dimensions protection measures PLot area,building coverage area,percentage of coverage and /Street tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) ,treet names Property corner elevations(2 foot contour lines if more than 4 foot differential) Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No gr Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake Land Use Case#: ZQN2o1S- 0000(o , E jt37o)5- QOO 1 S c? Zoning: (Z_ 1 2 XZl Required Setbacks: Front 15 Rear (...g Side 9 Street Side I p Garage 2,c,Landscape Requirement: O% r Lot Coverage Maximum: SO Z Building Height: Maximum Height 3s Actual Height ?2. 1 Visual Clearance )Z] Easements pt Sensitive Lands: ❑ Yes ❑ No Type VUrban Forestry Plan e7Conditions "Met"prior to issuance of building permit Notes: Eon dIvon ire lot41 � k & - Prior �1SSUG‘nQ:L Q C. butt m5 p r rtif-s Approved By Planning: 7/419'c••--.. _. Date: I 1/ I to / 1 co Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\BuildingWorms\BldgpennitRvw RES 091216.docx Building Permit Submittal Original Submittal Date: /1l5//k Site Plans: # Building Plans: # Building Permit#: ►: Enter building permit#above. Workflow Routing: I - lanning Engineering f'Permit Coordinator ,uilding Workflow Sign-off: n Sign-off for Planningla (include notes from planning review) Route Application Documents: I 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: , ,, Date: Engineering Review Slope at building pad: �t� 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: 0 Yes No Assess Water Quantity Fee in-lieu: ❑ YesNo LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: ilz. ]7 Date: 4 1Z Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review Er-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: 2- Yes ❑ N/A Tigard Trans SDC: C Yes ❑ N/A / Parks SDC: CfYes ❑ N/A [N OK to Issue Permit Approved by Permit Coordinator: Ccw,..v.. Date: I a - a-. — ) 10 I:\Building\Forms\BldgPermitRvw_RES_091216.docx