Permit Support Document 0 I
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
g
. •
• ///7`/ i1,1Request for PermitAction
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www. •PIT r i m
TO: CITY OF TIGARD
OCT
Building Division 2016
13125 SW Hall Blvd.,Tigard, OR 97223 CITY OF OFTIGARb
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingP a '.s gr. ov
tt tor/ .I
FROM: ❑ Owner Applicant ❑ Contractor ❑ CityStf
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) IDEt-t�V \ ( Y P
Mailing Address: q��' b SN0 Ot,O,AiatAxY1 av--b Ito
City/State/Zip: çXL-
Phone No.: � ��_ a(,9 -`-1 t s l X L(31
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
A CANCEL OID PERMIT APPLICATION.
'. "e "D 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#: M 57-0WICP_'00 3Y4rn _ oo o
Site Address or Parcel#: 5.11 JL �C k yvv l( Le,op
Project Name:
Subdivision Name: U 55\(X, Lot#:
EXPLANATION: \t C/InetA I Ill ► • I
Sr '9-s-7-,Pe/ - t530)/7.57 .434-, /k ed3( /
Signature: cANA.Q6tici wto, Date: ,, � /)
Print Name: \ivp'{t, S
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date/L'is if By • 4 Route to Records: Date By
Refund Processed: Date /✓41- By - Invoice Processed: Date /'//2l/� BY4Rfr
Permit Canceled: Date //7//4 By Parcel Tag Added: Date / By
I:\Building\Forms\RegPermitAction_0 2314.doc
City of Tigard • COMMUNITY DEVELOPMENT
1111
•
Building Division
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TIGARD
INVOICE
TO: DR Horton, Inc. Customer ID: 130859
Attn: Emerald Weeks Invoice No.: INV2016-00015
4380 SW Macadam Ave., #100 Invoice Date: 11/7/2016
Portland, OR 97239 Date Due: 12/7/2016
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
MST2016-00384 8511 SW Schmidt Lp Heritage Crossing,Lot 18 $255.24
Fees due for plan review completed
prior to request to cancel permit.
Invoice Total: $255.24
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2016-00384 Customer ID: 130859
Site Address: 8511 SW Schmidt Lp Invoice No.: INV2016-00015
Project: Heritage Crossing,Lot 18 Invoice Date: 11/7/2016
Date Due: 12/7/2016
Invoice Total: $255.24
Amount Paid: $
Office Note:
Please mailPaY ment to:
City of Tigard,Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
L\Building\Accounting\Invoice.doc 01/14/2011
CITY OF TIGARD FEE AND PAYMENT HISTORY
_ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
MST2016-00384 - 8511 SW SCHMIDT LP, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Plan Review 230-0000-43106 $751.34 $751.34 $751.34 10/3/16 Credit Card 406526 $0.00
DC Provision Review, SF-Ping 100-0000-43112 $90.00 $90.00 $90.00
Plan Review 230-0000-43106 $165.24 $165.24 $165.24
Totals for Fees $1,006.58 $1,006.58 $751.34 $255.24
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
406526 Credit Card dr horton inc 10/03/2016 $751.34
Total Payments: $751.34
Balance Due: $255.24
l
1
ir
' Building Permit Applica .i � 7lb 4/,Kidlntiai 9 /4U
es � /�
r 10k (11 1 1( 1 1 41 (Os! 1
5 F- 7
p 2 2016 i:ccrtved
City of Tigard 9 p'!.Q I to A t Pemnt No:11615)6-(x)3
1 615) -( 3'3'11
13125 SW Hall Blvd.,Tigard OR $7,221 '' ' g 1) Qatr e u
Phone: 503.718.2439 Fax: 503".548.1.960 : i n ," Ptah Kevira
", Uatc By: IQ"a �/ Other Pern�iI: FOICJiIO g 0
, ,, inspection Line: 503.639 4175 i t . _,'� j:,!,0' ' tate ReadyRy: saris
la Ser Page 2 fur
Internet: www.tigard-or.gov Notified`Method: supplemental information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
New construction 0 Demolition Permit fees*are based on the sloe of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑ Addition/alteration/replacement 0 Other: equipment,materials:labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Q 1-and 2-family dwelling 0 Commercial/industrial Valuation; _{) g 1
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other. Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: a, re1 1 6
8-151Job site address: 'S"I S�/ �hMtr� f, 6,-C New dwelling area: 1 VC squarecfeetl
City/State/ZIP:Tigard, OR 97223 l� Garage/carport area: >L f , square feet
Suite/bldg./apt.no.: Project namt vitvi-kyle, f ,,r t 0 Covered porch area: q9 square feet 14 91
Cross street/directions to job site: "+' Deck area: square feet 7
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: ! 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.
Valuation: S
New SPR ..
Existing building area: square feet
New building area: square feet
IIII PROPERTY OWNER 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 _ Existing:
g
Phone:( 503) 222-4151 Fax:(
New:
0 APPLICANT $ CONTACT PERSON
BUILDING PERMIT FEES*
Business name: DR Horton Inc.
(Please refer wire schedule,
Structural plan review fee(or deposit):
Contact name:Emerald Weeks
FLS plan review fee Of applicable):
Address: 4380 SW Macadam Ave Suite 100
City/State/ZIP: Total fees due upon application:
Portland, OR 97239
Phone:(503 )222-4151 x1107 Fax: :( 1 Amount received:
E-mail: esweeks@drhorton.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: DR Horton Inc. Submit two(2)sets of roof plan with connection details
Address:4380 SW Macadam Ave Suite 100 and fire department access,along with the 2010 Oregon
Solar Insrullafion Specialty{:ode checklist.
City/State/ZlP: Portland, DR 97239 Permit Fee(includes plan review
and administrative fees): 5180:00
Phone:(5{13)222-41 51 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 130859
Total fee due upon application: 5201.60
Authorized signature / { , This permit application expires if a permit is not obtained
t within ISO days after it has been accepted as complete.
Print name ; - 1 Date:2016 *Fee methodology set by Tri-County Building Industry
i 3 j `7 1 v' ( a Service Board.
I:,Building Permits'•BUP-RES PcnnitApp.doc 0124,2011 440-4613T(11,02'COM'WEB 1
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Mechanical Permit Application
City of Tigard
13125 SW flail titral. t oxford,(11f naty.„
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0 Detnolittori 0 Other f 1/ nt/a113ari.hal nonertata,caparanna,litt..ki"ovrtficiod 04 ptortit_
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Electrical Permit Application 1 c>>, c i 1 t I c 1 I ‘,1 r h\i
City of Tigard SEP 2 7 ?01,6 Received
11114
Date/By: 9 A9 /(o Parnit Ne•:1 6recv6-W 3P5i
13125 SW Ball Blvd Tigard,OR 97223 , ,, , plan Review,
Phone: 503.718.2439 Fax: 503.* 10f t s'=
Plumbing Permit Apptinc tl l 'ak -' ''
Building Fixtures 7 2(,11 , i OR 01 1 I(I. I.SI: O.LI
City of Tigard !1 Rowyett 9a2/ CPT/ Permit No.W5r /�60385/
14 a 13125 SW Hall Blvd.,Tigard,OR 97223..7 ;1 , t .` 1 plan Review r L ! .
I a ' Phone: 503.718.2439 Fax 503.5 $;46 i0 '' ,,, Other Permit No.:
1 G:1 Et t) Inspection Line: 503.639.4175 ` i.R�T,,4- €'>-'I ,p:.k j�^pPer Re /By. aria See Pare 1 for
Internet: www.tigatd•or.gov t, No4iF.edll kthmd:
Swimmeret meeret lsferoatlos
i,' TYPE OP WORK. • ,PEliia $Cf!)6D41I**.,;', 'h .
❑New construction 0 Demolition For spedal lnformialon use checklist
Description I Qtk. I Ea. I Total
0 Additionlaftl•rstittn/repleeement ) ❑Otber. New l-2-family dwellings(includes 100 ft.for each utility connection)
t.ATWORY OF CONSL'R i nON SFR(1)bath 312.70
❑1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 50032
$ach additional bath/kitthen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
• '' .10E'5 . 7ORMA N:AND LOCATION She utilities:
lob site address: r` r Catch basin or area drain 18.76
City/State ZIP: o ki 0� `7 7j '' Drywall,leach line,Or trench drain 18.76
l ? Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.:(-1Project name: VIA' CA/4bb'la 11 if Manufactured home utilities 50.03
Cross street/directions to job site: t Manholes _ 18.76
Rain drain connector 18.76
Sanitary sewer(no linear ft.: ) Page 2
Storm sewer(no.linear ft.:.-J Page 2
Water service(no.linear ft.:_„,J Page 2
Subdivision: Lot no.: 1,&-- Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
,;: ••f- ,. DESCRIPTION•OP-WORK .
litClothes washer
Dishwasher 25.02
�n(1^R.. 25.02
b. ,,. Drinking fountain 25.02
Ejectors/sump 25.02
0 racially. OWWER • ' 0 TENANT Expansion tank 12.51
Name: C7 > y 4 \ -
Fixture/sewer cap 25.02
� U
`, � Floor drain/floor sink/hub 25.02
Address: -'lr,SSI) cCS \ 1ILG&.. * Garbage disposal 25.02
City/State/ZIP: . Q'. °1'Lr7 ' Hose bib 25,02
'� - � 1
Phone: Fax:( ) ice maker 12.51
0 APPLICANT O CONTACT PERSON Interceptor/grease trap 25.02
Business name: )::)V__ N AVO- I (n {,,i Medical gas(value:S-„o) Page 2
i ,�.,, �/ Primer 12.51
Contact me: \ ��� `CX�C Raofdrain(commercial) 12.51 ,
naL �l �
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) J�r ii Fax::( ) Tub/shower/shower pan 12.51
E-mail: eS�66 _ 62\yVl Ovtvin .CuvV 1 Urinal 25.02
Water closet 25.02
•CONTRACTOR Water heater 37.52
Business name:EDWARD MULLEN PLUMBING Water piping/DWV 56,29
Address:1601 SE RIVER ROAD Ott; 25.02 _
City/State/ZIP:HILLSBORO,OREGON 97123 Subtotal
Phone:(503)640-0113 Fax:(503)640-4483 Minimum permit fee: 572.30
- Plan review (25%of permit fee)
CCB Lic.:94689 Plumbing Lic.no.:34-260PB State surcharge(12%of permit fee)
Authorized signature: Allef�'kl,P./ITOTAL PERMIT FEE
Print name:RAY MULLEN l Date:
-This permit applicants expires Be permit is ear Misdeed within ISO days
miter it has beam accepted as complete.
*Fee methods/My set by Tri.Counry Building Industry Service Board.
I'muddirtternitOLMU•hra*Asp.doc 10/01/09 440.4616TII0/07KOMAYESI
City of Tigard
11111 d COMMUNITY DEVELOPMENT DEPARTMENT
111
T I G A R D Building Permit Review — Residential
N
BuildingPermit #: i'(ST9-o i(,o -on 3 q`1
Site Address: g 511 Svv SC h m i d1- boo p
Project Name: Reritc3 e CESS on ciLot #: IY
(New dwelling=subdivision name;Additio or Alteration=last name of owner)
Planning Review
Proposal: N Lw S'-
I Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: K No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan fisting structures 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
W.brawn to scale(standard architect or engineer scale) floor elevations
North arrow /Utility locations (required for new,may apply for additions)
Site address,project or subdivision name and lot number ntUrztion of wells/septic systems
,Applicant information(name and phone number) isting trees to be retained with drip line,and tree
Lot dimensions and building setback dimensions protection measures
Lot area,building coverage area,percentage of coverage and ,g treet tree size,type and location
impervious area(applicable if R-7„R-25&R-40) 1 Street names
/Property corner elevations 6(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
L' Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Wr Land Use Case#: SU e2-01c- 0 001 S 1 ?.alit 201C- 00000
Vi Zoning: R- 12,
Vi Required Setbacks: Front [S Rear /`; Side 1 Street Side ® Garage 7_,.„V
Landscape Requirement: 60 %
0 Lot Coverage Maximum: 2 %
0/Building Height: Maximum Height 55 Actual Height 1-
Visual Clearance
❑ Easements
-Sensitive Lands: ❑ Yes ❑ No Type
Z Urban Forestry Plan
VConditions "Met"prior to issuance of building permit
Notes: ( 0 rttiiio n . tr' be. nr)e - pcii)r r-o i s1 LI c4 pi La 0 t- la,,,,L> ,-,y
p.ev t fi3
Approved By Planning: 44 0- v�` e. 1 o cL2...ot.-t Date: f/ Z V) ,f,,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: ❑ Enter building permit#above.
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
El 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: jg
/ El Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes (V No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved b Engineering: Date:
Notes: �_ ' b� ss se i A. tri MI A.�U
Approved by Engineering: I421) Date: e?_____,01,—,g
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
Ppproved,NOT Released: �yyrrate: 6'
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:
BDC Fees Entered: Wash Co Trans Dev Tax: les ❑ N/A
Tigard Trans SDC: , Yes ❑ N/A
Parks SDC: � {es CI N/A
111 OK to Issue Permit /
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
Albert Shields
From: Albert Shields
Sent: Thursday, September 29, 201.6 11:14 AM
To: esweeks@drhorton.com
Cc: Kim McMillan;Al Dickman; Gary Pagenstecher
Subject: Heritage Crossing, MST2016-00383, -00384, & -00367
Attachments: Conditions - 09-29--2016.pdf
Emerald, on review of the applications for these building permits we note that there are multiple Conditions of Approval
for the underlying land use case, SUB2015-00015,that have not been met. Please see the attached list of
conditions. Accordingly, I am putting these applications on Hold as Approved but Not Released. Plan Review will
proceed but not issuance.
Regarding MST2016-00367 for the model home,this can be released once Condition #34 is met—all public
improvements are substantially complete.
Please let me know if you have any questions.
Albert Shields.
1