Permit (187) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00416
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2017
Parcel: 2S109AC06500
Jurisdiction: Tigard
Site address: 13275 SW MADDIE LN
Subdivision: MADELINE HEIGHTS Lot: 3
Project: Madeline Heights, Lot 3
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1738 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 4 Second: 1442 sf Garage: 583 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3180 sf Value: $389,052.07 Rear: 15
PLUMBING
Sinks: 2 Water Closets: 4 Washing Mach: 2 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 2
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: 6 201-400 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 3180
Owner: Contractor:
LENNAR NW INC. LENNAR NORTHWEST INC Required Items and Reports(Conditions)
11807 NE 99TH STREET#1170 11807 NE 99TH STREET SUITE 1170 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: 360-258-7900 PHONE: 360-949-9128
FAX: 360-258-7901
Total Fees: $32,734.01
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 9 -001-00 0. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,t//'!� Permittee Signature: �7-G {� ea,./
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
t
Residential ED ( FOR OFFICE USE ONLY
City of Ti114gard E Receive lel/,,, #,P ' �]/y/1 U
q DateB p ermitN�i�/�`� ��
13125 SW Hall Blvd.,Tigard,OR 97223 q 7 Plan Review �L[
Phone: 503.718.2439 Fax: 503. 1�962 4 LO1(
Date/By: 1 1`"p� — ' Other Permit: 2— ^?y
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: rfZI See Page L/" s
Internet: www.tigard-or.gov CITY `t, [) N &ed Method: //
Cr TIGARD / ' 1/7 /, Supplemental Information
Bllli ING DIVISION se
TYPE OF WORK QUIRED DATA:1-AND 2 FAMILY DWELLING
[ New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
.. :CATEGORY OF,CONSTRUCTION work indicated on this application.
gl and 2-family dwelling ❑Commercial/industrial Valuation: $ 3$'� 179.59
❑Accessory building ❑Multi-family Number of bedrooms: 4 3$c3 1 cc a,
❑Master builder ❑Other: Number of bathrooms: q.
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 376 3
Job site address: 13275 SW Maddie Lane New dwelling area: 3180 square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: 583 square feet
Suite/bldg./apt.no.: Project name: Covered porch area: 32 square feet J (,J,.4,,
a.
Cross street/directions to job site: Deck area: square feet J 7 3 Q
Other structure area: square feet v
REQUIRED DATA:COMMERCIAL.-USE CHECKLIST
Subdivision: Madeline Heights Lot no.: 3 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
` . DESCRIPTION OF WORK ti work indicated on this application.
NSFR Valuation: $
Existing building area: square feet
/ New building area: square feet
C' PROPERTY OWNER ID TENANT Number of stories:
Name: Lennar NW Inc. Type of construction:
Address: 11807 NE 99th Street,#1170 Occupancy groups:
City/State/ZIP: Vancouver, WA 98682 Existing:
Phone:(360)258-7900 Fax:(360 ) 258-7901 New:
APPLICANT '' Er CONTACT PERSON BUILDING PERMIT FEES*
(Please refer tofee schedule)
Business name: Lennar NW Inc.
Structural plan review fee(or deposit):
Contact name: Juls Call
FLS plan review fee(if applicable):
Address: SAME AS ABOVE
Total fees due upon application:
City/State/ZIP:
( 360)258-7906 ( ) Amount received:
Phone: Fax:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
juls.call@lennar.com
,,. Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic 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 lic.: 195307 l '°0
^ Total fee due upon application: $201.60
Authorized signature: ( 1/ I This permit application expires if a permit is not obtained
"�A"`rJ within 180 days after it has been accepted as complete.
Print name: *Fee methodology set by Tri-County Building Industry
Juls Call Date: 10/23/17 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit,7Appl r'4r' -l:ny FIN/ED FOR OFFICE US ONLv
City of Tigard Received ,
. • 13125 SW Hall Blvd.,Tigard,OR 9Q63-1 2 d 2017 Date/By: /
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960DateBy: Other Permit:
TIt1AItD Inspection Line: 503.639.4175 CiY`/'C' ' TIGARD Date Read B Inns:
See Pent 2nr
Internet: www.tigard-or.govBUIL�I�� DIVISION Notified/Method: Supplemental Information ormation
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CHECKLIST
Mechanical permit fees*are based on the value of the work
[N/New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF,CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
R 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION: AND: LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address: 13275 SW Maddie Lane Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Madeline Heights Lot no.: 1
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF.WORK Gas fireplace/insert 1 33.39 23.32
Flue vent for water heater or gas
NSFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
%PROPERTY OWNER ❑ TENANT Other: 23.32
' Environmental exhaust and ventilation:
Name: Lennar NW Inc. Range hood/other kitchen
equipment 1 33.39 33.39
Address: 11807 NE 99th St.#1170 Clothes dryer exhaust a 33.39
City/State/ZIP: Vnacouver, WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) \ 23.32 93.28
Phone:(360) 258-7900 Fax:(360) 258-7901 Attic/crawlspace fans 23.32
APPLICANT Nal CONTACT'PERSON Other: 23.32
Fuel piping:
Business name: SAME AS ABOVE
$14.15 for first four;$4.03 for each additional
Contact name: J u is Call Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(360)258-7906 Fax::( ) Fireplace
Range
E-mail: juls.call@lennar.com Barbecue
-' ' 'CONTRACTOR. Clothes dryer(gas)
Other:
Business name: Development Northwest Inc. dba Wolcott Plumbing MECHANICAL,PERMIT FEES*
Address: 1075 W Historic Columbia River Hwy Subtotal $220.06
City/State/ZIP: Minimum permit fee($90.00)
y Troutdale, OR 97060 Plan review(25%of permit fee)
Phone:( 503) 667-1781 Ext. 3007 Fax:(503 ) 667-9891 State surcharge(12%of permit fee)
CCB lic.: 112220 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Td-County Building Industry Service Board
Print name: Dennis L. Dunning Date: 10/23/17
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard OCT 2 4 2017 Received
Plan R
!Al ql 13125 SW Hall Blvd.,Tigard,OR 97223 res 1st_" ICAI�� .N
I; CI z i t Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 h�l( �( DlVtSI l�ateB : Related Permit#:
T[GA R D Inspection Line: 503.639.4175 Ready Date/By: Suns: ®' See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
B�
---, '-., TYPE OF WORK PLAN REVIEW
Ez New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Service or Feeder 400 amps or more ❑Building over three stories.
❑Other: where the available fault current
0 Marinas and boatyards.
' ' ` CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑commercial-nse agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
. JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
J ❑Addition of new motor load of system.
Ob#: Job site address:
13275 SW Maddie Lane l00HP or more. ❑"A "E°,°°1-z "1-s'
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential un ts. occupancy.
❑Health-care facilities. ❑Recreational veh cle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more, 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Madeline Heights Lot#: 3 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
` ` DESCRIPTION OF WORK
Limited energy,residential
NSFR (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
f.'1„=„ ' ` _ PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Lennar NW Inc. 200 amps or less 100.70 2
Address: 11807 NE 99th St. #1170 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Vancouver, WA 98682 601 amps to 1,000 amps 301.04 2
Phone:(360 )258-7900 Fax:(360 ) 258-7901 Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
t' If APPLICANT ''... V CONTACT,PERSON Branch circuits—new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: Same as above above service or feeder fee,
each branch circuit 7'42 2
Contact name: Juls Call B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: juls.call@lennar.com
Reconnect only 67.84 2
r CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Lantil LLC dba Three Phase Electric Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
11490 SE Jennifer St. panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Clackamas, OR 97015 Additional inspection(1 hr min) 66.25/hr
Phone:( 503) 908-8058 Fax:(503 )726-1823 Investigation(1 hr min) 90.00/hr
Email: rlane@threephaseelectric.com Industrial plant(1hrmin) 78.18/hr
Inspections for which no fee is
CCB Lic.: 162368 Electrical Lic.: 3-332C Suprv.Lic.: 3398S specifically listed('/hr min) 90.00/hr
Suprv.Electrician signature,required: , , '
.,, , -tl�It��,.
ELECTRICAL`PERMIT,FEES `'
i
Subtotal:
Print name: Dennis Welch Date: 10/23/17 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: ` �, TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Robert Lane Date: 10/23/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
... Description Qty. I Each..., I Total I *:
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
E Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
COMMERCIAL WORK ONLY: ,r'iELECTRICAL PERMIT FEES :::
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
I Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
I I Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC PermitApp_ELR ERE.doc Rev 06/17/2015
Plumbing Permit ApplAtt
Building Fixtures FOR OFFICE USE ONLY'
City of Tigard OCT 2 d 2017 EEeiew
PermitNo.;,J 57Lc/2,r /// _13125 SW Hall Blvd.,Tigard,OR 97223 �//I '7l�(
�` Phone: 503.718.2439 Fax:1111
q�}966 Other Permit No.:
'C:1 F Iq. ARD Date/By:
TIGARD Inspection Line: 503.639.t�IL I NG DIVISION DateReadyBy: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
, ,, TYPE OF WORK FEE* SCHEDULE
pprte �.
New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen l 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13275 SW Maddie Lane Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
y Tigard, OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Madeline Heights I Lot no.:3 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
:JanI' `
DESCRIPTION OF.WORK Backwater valve 12.51
NSFR Clothes washer "1/4 25.02 25.02
Dishwasher 325.02 25.02
Drinking fountain UUU 25.02
Ejectors/sump 25.02
-e-'21.4V PROPERTY OWNER I ! ❑ TENANT Expansion tank 12.51
Name: Lennar NW Inc.
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11807 NE 99th St.#1170 Garbage disposal 1 25.02 25.02
City/State/ZIP: Vancouver, WA 98682 Hose bib 2 25.02 50.04
Phone:(360)258-7900 Fax:( 360) 258-7901 Ice maker 12.51
i. APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: SAME AS ABOVE Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Juls Call
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory O 25.02 150.12
City/State/ZIP: Solar units(potable water) 62.54
Phone:(360)258-7906 Fax::( ) Tub/shower/shower pan \ 12.51 37.50
Urinal 25.02
E-mail: Juls.call@lennar.com
Water closet 3 25.02 75.06
i - -, CONTRACTOR `:4 '
Water heater 1 37.52 37.52
Business name: Development Northwest Inc., dba Wolcott Plumbing Water piping/DWV 56.29
Address: 1075 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP: Troutdale, OR 97060 Subtotal 956.89
Phone:(503) 667-1781 Fax:( 503)667-9891 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 112220 Plumbing Lic.no.: 26-824PB
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Dennis L. Dunning Date: 10/19/17 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
1
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-l'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 greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
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
Other Inspections or Fees Qty., " Fee(ea) Total 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*.
Quantity by Fixture Type Plan Review'for Plumbing Installations
Fixture Type for Replace/ Plan review requiredis for anyof the following.
Work Performed: Capped Added Relocate own g•
Baptistry/Font Please check all that apply.
Bath Tub/Shower C] Any new commercial building with water service 2"and
-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 Isometric or Riser Diagram
Garbage Domestic-non-food GI Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work underthis permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\JuCall\Downloads\PLMF_PermitApp(1).doc 2
City of Tigard
n COMMUNITY DEVELOPMENT DEPARTMENT
T I c A R D Building Permit Review — Residential
Building Permit #: vA's7;,pfl-'. 7 W..
Site Address: 1 3 2'7 S S w M at 4 oU -e., Ln •
Project Name: M olcle lint. H-er1-3 .SV 6 Lot #: 3
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: NOW SE (4-
Verify site address/suite#exists and active in permit system.
zrRiver Terrace Neighborhood: fe No El Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan ❑I✓..:Alu,g t.uttures on site
/Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow gUtility locations&easements (required for new and additions)
)2Site address,project or subdivision name and lot number /Sidewalk/driveway approach
/Applicant information(name and phone number) 'fia on"of wells/septic systems
J of dimensions and building setback dimensions Axisting trees to be retained with drip line,and tree
iliA Square footage of buildings to be demolished protection measures
/Lot area,building coverage area,percentage of coverage and fZStreet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) 'Street names
/Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? I;Vfes ❑No
4 foot differential) If yes,is a storm water quality facility shown? 'es ENO
Sv6
XClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified #.No Received: ❑ es El No
Iyr Public Facilities Improvement(PFI) Permit: Pr �1 (o -. 00 I1q
Required: $ Yes,applicant was notified Z.No Applied For: Yes ❑ No,stop intake
/ Land Use Case#: S V B ZO I IO — 0 000 3
Zoning: i` 1
Required Setbacks: Front 1 S Rear f S Side 5 Street Side / 0 Garage Z�
Landscape Requirement: 2.0
71 Lot Coverage Maximum:
0 Building Height: Maximum Height Actual Height ZO
Visual Clearance
--323rsirh e Lands: ❑ Yes %No Type
7 Urban Forestry Plan
7 Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: /.‘,\, ON-v—: �./a\- Date: (6/24 / 11
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: El Approved El Not Approved
I:\Building\Forms\BldgPermitRvw REs 061417.docx
Building Permit Submittal
Original Submittal Date: (Q/'
Site Plans: #
Building Plans: #
3
Building Permit#: •► nter building permit#above.
Workflow Routing: P' Planning CP'Engineering C Permit Coordinator 1 Building
Workflow Sign-off: P3 Sign-off for Planning(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.
7 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ��"l�rMi /rrV Date: ,
f
Engineering Review
Slope at building pad: Li g
[Conditions "Met"prior to issuance of building permit
2 -Easements (encroachments)per engineering conditions of approval and plat
2-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ YesTo
Assess Water Quantity Fee in-lieu: ❑ Yes [ o
LIDA Facility on lot: ❑ Yes 1:2-"No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 12,E.4) A SCJ Date: /0'2,-7—i'7
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 N/A
Parks SDC: ❑ Yes N/A
LIDA ❑ Yes N/A
OK to Issue Permit
Approvedby Permit Coordinator: Vte: 101/
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
FOR OFFICE USE ONLY-SITE ADDRESS: C 2 7 $4)
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
INCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
ai
Transmittal Letter
T l G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigald-or.gov
TO: DATA 1,
DEPT: BUILDING DIVISION i
r DEC 1 1 2017
FROM: Juls Call // '..;1:V OF AR
/ 7.31:!:::',1-N,, ....:t;.„,;j,,,,
COMPANY: Lennar NW Inc.
PHONE: 360-258-7906 I By:
RE: LOT 16, 15, 14, 13, 4 3,►2, 1 MST2017- 00448, -00447, -00446,
(Site Address) -00417 00n-00415. -00419
(PermiYl� �
Madeline Heights
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEM
Copies Descriptions n
# , opes. =` `Description:
Additional set(s) of plans. ' 0. 3 Revisions: Edit the bathroom OPTION
Cross section(s) and details. lJ Wall bracing and/or lateral analysis.
Floor/roof framing. t 1 Basement and retaining walls.
Beam calculations. • V ` Engineer's calculations.
s.
Other(explain):
REMARKS: We are using the opti► on plans,so we X out teh originally had on plan and circled the option.
FOR OFFICE USE ONLY
Routed to Permit Tech•ician: Date: I _ -��2-' ) Initials:
Fees Due: ❑ Yes No Fee Description: Amount Due:
• S. )Y' P) 4,h y'.\,: .... $ y, --e-
Special
Instruct''ins:
Repri' Permit(per PE): ❑ Yes /.No ❑Done
Ap. icant Notified: p, Date: (,Z. [/ O `7 - Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13275 SW MADDIE LN, TIGARD, OR, 97224 April 11 , 2018 at 9:52:17 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00416
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
No hot water.
No dishwasher installed.
Not ready for final inspection, no inspection done.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13275 SW MADDIE LN, TIGARD, OR, 97224 April 24, 2018 at 11 :13:06 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00416
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13275 SW MADDIE LN, TIGARD, OR, 97224 April 24, 2018 at 11 :11 :35 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00416
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13275 SW MADDIE LN, TIGARD, OR, 97224 April 27, 2018 at 10:09:06 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00416
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13275 SW MADDIE LN, TIGARD, OR, 97224 May 2, 2018 at 11 :48:49 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00416
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Corrections complete from previous inspection.
Final erosion control approved.
Street tree certification received.
Moisture content form received.
High efficiency lighting form received.
Blower door test report checked.
Insulation certification checked.
C of 0 left on site with approved plans.
Violation Summary:
Inspector Contractor