Permit (180) II CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2019-00293
II Date Issued: 08/12/2019
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t '' Parcel: 1S134BD12200
to ♦ Jurisdiction: Tigard
Site address: 10889 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 5
Project: Summerbrook, Lot 5
Project Description: New SF.with 273sf attic storage. 9/18/2019: REPRINT to add backflow device. 10/21/19:
REPRINTED permit to add A/C.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1469 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height 25 Bathrooms: 3 Second: 1658 sf Garage: 868 sf Front: 20 Smoke Yes
Dwelling Units: 1
Third: 0 sf Right: 5 Detectors:
Total: 3127 sf Value: $438,533.35 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
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: Y 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: 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 Y
Ecompasing:
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3127
Owner: Contractor:
Required Items and Reports(Conditions)
WEEKLEY HOMES LLC WEEKLEY HOMES
1905 NW 169TH PL STE 102 1905 NW 169TH PLACE SUITE 102 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $35,891.35
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r-:
- v.__ �� 47,e-"Co7:-e-,Y1.-----
.-
Call
-� �� -~�_ Permittee Signature:Issued By: `'" -�f s`503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
CIt of TI and Received }}i
Yg Date/By: /I,/tai//e' 'P.,,,, _.._ PermitNo.: / {./� f .t I �". d
le 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
:IN I Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: I ® See Page 2 for
Internet: www.tigard-or.gov . Notified/Method: Supplemental Information
TYPE OF WORKOCTs 1 .-U
t , Print name:Hannah Scharer
®New construction ❑Addition/alteration/replacement TK 3A D COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑Demolition ❑Other: "VISION Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead,and profit.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Ac ; ,*-1•'-:',; . Value:$
El Multi-family ❑Master builder IDOt ' RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
JOB SITE INFORMATION AND LOCATI ISkit / i-, , For special information use checklist.
4- t c.-�. i
Description Qty. Ea. Total
Job site address:10889 SW �timnmer'$rook Ln Heating/cooling:
City/State/ZIP:Tigard/OR/97223 Air conditioning 1 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
Suite/bldg./apt.no.: Project name:Summerbrook Furnace 100,000+BTU(ducts/vents) 54.91
Cross street/directions to job site:SW 121°t Ave and Summerbrook Lane Heat pump 61.06
Duct work 23.32
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
Subdivision:Summerbrook Lot no.:05 Flue/vent for any of above 23.32
Tax map/parcel no.:TBD Other: 23.32
DESCRIPTION OF WORK Other fuel appliances:
Water heater 23.32
New single family home to be built-3127 sqft,5 bedroom 3 bath home with Gas fireplace/insert 33.39
868 sqft 5 car garage Flue vent for water heater or gas
fireplace 23.32
J Ad� / ` Log lighter(gas) 23.32
t Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Name:Weekley Homes LLC Other: 23.32
Environmental exhaust and ventilation:
Address:1111 N Post Oak Road Range hood/other kitchen
City/State/ZIP:Houston,TX 77055 equipment _ 33.39
Clothes dryer exhausti 33.39
Phone:(503)213-4415 Fax:( ) Single-duct exhaust(bathrooms,
® APPLICANT : ® CONTACT PERSON toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
Business name:David Weekley Homes Other: 23.32
Contact name:Michele Schiedler Fuel piping:
$14.15 for first four;$4.03 for each additional
Address:1905 NW 169th Place,Suite 102
Furnace,etc.
City/State/ZIP:Beaverton/OR/97006 Gas heat pump
Phone:(503)213-4415 Fax::( ) Wall/suspended/unit heater
Water heater
E-mail:mschiedler@dwhomes.com Fireplace
CONTRACTOR Range
Barbecue
Business name:David Weekley Homes
Clothes dryer(gas)
Address:1905 NW 169th Place Suite 102 Other:
MECHANICAL PERMIT FEES*
City/State/ZIP:Beaverton/OR/97006
Subtotal
Phone:(503)213-4415 Fax:( ) Minimum permit fee($90.00)
CCB lic.:213653 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
TOTAL PERMIT FEE S1 f St.
Authorized signature: �� This permit application expires if a permit is not obtained within 180
1r
r) days after it has been accepted as complete.
I:\Building\Permits\MEC_PermitApp_040113.docL'int 6/ ' .1t,; - I !. (440-4617T(I 1/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
c 'r " ' Permit#: MST2019-00293
COMMUNITY DEVELOPMENT ,,§`.t .s
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 z Date Issued: 08/12/2019
�tCa: FRL? ,\ _ Parcel: 1S134BD12200
40 Jurisdiction: Tigard
Site address: 10889 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 5
Project: Summerbrook, Lot 5
Project Description: New SF.with 273sf attic storage.9/18/2019: REPRINT to add backflow device.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1469 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1658 sf Garage: 868 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 3127 sf Value: $438,533.35 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF RainStorm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 1
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: 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: 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 Y
Other. N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3127
Owner: Contractor:
WEEKLEY HOMES LLC WEEKLEY HOMES Required Items and Reports(Conditions)
1905 NW 169TH PL STE 102 19855 f1w te9T#4 PLACE 8UfTf 102 1 Erso Grad 543-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $35,838.99
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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling
g5 (
503.2322.19877 oorr 1.800.332.2344.
Issued By: ,`k( ..1\--)."----- Permittee Signature: :)--- '�t�i' ,L,t��(
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.
, 4
Plumbing Permit Application
Building Fixtures h x FOR OFFICE USE ONLY
City of Tigard Received
g t? Permit No.: C
q 13125 SW Hall Blvd..Tigard,OR 97223 Date/By: ��\�� �ij �Yl��z y\�-Li y (�
Plan Review
I 0 Phone: 503.718.2439 Fax: 503.581960Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: pais: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK " FEE xuSCHEDULE , ,:.
®New construction Demolition For special infor,nation use checklist.
❑ 4 fat - -• Description I Qty. I Ea. 1 Total
O Addition/alteration/replacement ❑Other: + New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION s. SFR(1)bath 312.70
® i-and 2-family dwelling ❑Commercial/indu' SFR(2)bath 437.78
0 Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION y'p .t r Site utilities:
Job site address: 10889 SW Teal Crest Lane Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Summerbrook Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
SW 121'1 Avenue 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:Summerbrook I Lot no.:5 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
' Clothes washer 25.02
Irrigation and backflow for lot 5 landscaping Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER �- ❑ TENANT Expansion tank 12.51
Name:Weekley Homes,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1905 NW 169'Place,102
Garbage disposal 25.02
City/State/ZIP:Beaverton,OR 97006 Hose bib 25.02
Phone:(503)213-4415 Fax:( ) Ice maker 12.51
APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:David Weekley Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Hannah Scharer
Roof drain(commercial) 12.51
Address: 1905 NW 169'Place,102 Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton,OR 97006 Solar units(potable water) 62.54
Phone:(503)7181477-42 718-474 2_. _ s Fax::( 1 TtibTShuwerViuwcint 1 1
E-mail:hscharer@.dwhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Gro Outdoor Living Water piping/DWV 56.29
Address:5800 NE 88th Street Other: 25.02
City/State/ZIP:Vancouver,WA Subtotal
Phone:(360)727-5974 Fax:( ) Uk Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:193268 Plumbing Lic.no.: Ckci-
i t State surcharge(12%of permit fee)
Authorized signature: .7Z �?1 4 `,� TOTAL PERMIT FEE
V *�- � /f6 fi This permit application expires if a permit is not obtained within 180 days
Print name: �,, Date: / after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
1:\Building\Permits\PLMU-PermitApp.d°c 10/01/09 440-4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su pression Systems:
t .^��ti a,u r.S ',i ' ,� i `, g -}+�r +a -:.,�c: P tS r'� x 7tA1 2 ' ,4 ;s 'fiik1.5,t1 nyy #v'Y
•
IS_fe td t es .i.,�a�,r�Zi ; , lx Y , ' , �.r Te.,u - ,Sgaare Footagee . t P :•I ii, Fee ,.i :
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 � s �Aluation ;'3 ` ",w r, ,
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
R,-,.. A !`., t �, s, each additional$100.00 or fraction thereof,to
°IheiIl, pections•orwF � QGI� �t` t' 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
- --accur-ately4eportfixtures could-result hvincreased-sewer-fees
�: a , Quantity by Flzture Type J ,,Plan Re4Re tl Qr�. blh p , : tI.,, i '
FLrti T `�for i i # -0,k' A'�f r+ ,ti l :.;*01,*,;:,
Plan review is required for any of the following.
;k -W,. .,',:: +,?,Capped;i: Added i ,yR,.,,,.e
Wo`r&Performed: Please check all that apply.
Baptistry/.Font
Bath -Tub/Shower ❑ 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040,
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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"
-4" 4y ,,.1 if iiw t , 1rt ., `s..¢�a+.ds3F,; ii .rz;,.
Car Wash Drain
Garbage Domestic-non-food El Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
aristna1-Teod related
Ice Mach,/Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec,Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal .plumbing permit can be issued.
Other Fixtures: . ' '
C:\Users\hbrecken\Downloads\PLMF_PermitApp(1).doc 2
1111 CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00293
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2019
T I(_ ,ti It.n9 Parcel: 1S134BD12200
Jurisdiction: Tigard
Site address: 10889 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 5
Project: Summerbrook, Lot 5
Project Description: New SF.with 273sf attic storage
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1469 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1658 sf Garage: 868 sf Front: 20 Smoke
Third: 0 sf Right: Yes
5 Detectors.
Dwelling Units: 1
Total: 3127 sf Value: $438,533.35 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
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: 2 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!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 3127
Owner: Contractor:
WEEKLEY- ONIES-L.0 Required Items and Reports(Conditions)
1905 NW 169TH PL STE 102 1905 NW 169TH PLACE SUITE 102 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $35,803.97
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 I w requires you to ollow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 - 01-009 You may o sin a copy of the rul or direct questions to OUNC by calling 503.. 322.11199 7 or 1.800.332.2344.
Issued By: Permittee Signature: ay% / �� -,6fir--- 7 .
Call 503.639.4175 by 7:00 a.m.fe 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.
I
Building Permit Application
Residential 7+ `
� �� � �,..Aj �`. � �.� �Gr� FOR OFFiC:F.. USE ONLY
City of Tigard "9 ,)n [l Received 7P /7
:1 Ill 13125 SW Hall Blvd.,Tigard,OR 97223 I Lill- i !l) J
Date/By: .',--��e�+�
Plan Review a
Phone: 503.718.2439 Fax: 503.598.1964 I v . 4 ,'.t Date;By: / 1 -� ?; r'. Ili; G,7...66 5
Inspection Line: 503.639.4175 lit , c s r,a I r•to Ready By: H See Pae 2 for
1 I(�A K t7 _I E 6 ,k..."1 .otified/Meth / ii Supplemental Internet: www.tigard-or.gov / pp emental information
I.
/ / ,d,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 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.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: ,000 L(3% 33
❑Accessory building 0 Multi-family Number of bedrooms: 5
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 231
‘71'S
Job site address:10889 SW 're.,/ Cres-4 p/. New dwelling area: 3127 square feet (i5/3
City/State/ZIP:Tigard/OR/97223 Garage/carport area: 868 square feet 1& ( i
1
Suite/bldg./apt.no.: Project name:Summerbrook Covered porch reams_( square feet 1
Cross street/directions to job site:SW 121S`Ave and SW Summerbrook Lane l arei C S�-1` .$ square feet
Other structure area: ��� square feet
-REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Summerbrook I Lot no.:05 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 work indicated on this application.
New Single Family Home to be built-3127 SQFT 5 Bedroom,3 bath with 868 SQ Valuation: $
FT 5 car garage, -k- tt 4L- 21 sf Existing building area: square feet
New building area: square feet
®`PROPERTYlOWNER �
0 TENANT Number of stories:
Name:Weekley Homes LLC Type of construction:
Address: 1111 N Post Oak Road Occupancy groups:
City/State/ZIP:Houston,TX 77055 Existing:
Phone:(503)213-4415 Fax:( ) New:
'El-APPLICANT - _,:..x ® CONTACT PERSON `' BUIEDING PERMIT FEES*.
Business name:David Weekley Homes (Pieaserelertofeeschedute} '.
Structural plan review fee(or deposit):
Contact name:Michele Schiedler
FLS plan review fee(if applicable):
Address: 1905 NW 169"'Place,Suite 102
Total fees due upon application:
City/State/ZIP:Beaverton/OR/97006
Phone:(503)213-4415 Fax::( ) Amount received.
PHOTOVOLTA OLAR PANEL SYSTEM FEES*
E-mail:mschiedler@dwhomes.com .: �
, :-::',---4,,,,r-'.-4.'.,,,,:,--, ,,,. COR Commercial and residential prescriptive installation of
, .. Y 1 u' roof-top mounted PhotoVoltaic Solar Panel System.
Business name:David Weekley Homes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1905 NW 169th Place,Suite 102 Solar Installation Specialty Code checklist.
City/State/ZIP:Bea,erton ,R/97006 Permit Fee(includes plan review $180.00
i and administrative fees):
Phone:(503)213-4415 F. :( ) State surcharge(12%of permit fee): $21.60
CCB lie.:213653
I 1 / Total fee due upon application: $201.60
Authorized signator-: /, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Michele chied r Date:7/16/19 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-• SPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Buildirn' Permit A• s lication Checklis _ ,r
One- and Two-Famil Dllin p ,',° `
Yweg FOR OFFICE USE ONLY
f r�
City of Tigard �i (� Received
III13125 SW Hall Blvd.,Tigard,OR 97223 Date'By:
Permit No.:
Phone: 503.718.2439 Fax 50 3.598.1960 Y r 1 ,t=r - Associated permits:
I 1 G A R f) 24-flour Inspection Line: 503.639.4175 i ,..qL a t-,�'i i`i ,ai _ ® Electrical ® Plumbing ® Mechanical
Internet: www.tigard-or.gov I -
❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Fes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ® ❑ 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ® ❑ 0
3 Verification of approved plat/lot. ® 0 ❑
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ El 0
6 Sewer permit. — 0 0 0
7 Water district approval. 0 ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® 0 ❑
9 Erosion control ®plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® El ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® El ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ® El El
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® El El
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- /1 ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ® ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- Z ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ® ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ® ❑ El
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ® ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ® ❑ El
architect licensed in Oregon and shall be shown to be a.'licable to •- • •.- ••-
J U RISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". Z ❑ El
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ® El ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ® ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ® ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard Z ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑
El
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\Building\Perniits\BLIP-RESPermitApp.doe 02/24/2011 440-46131(11/02/COM/WEB)
IN
Mechanical Permit Applicatio
FOR OFFICE USE ONLY
City of Tigard Received
J3125 SW Hall Blvd.,Tigard,OR 97223 JULn °i G Date/By: Permit No.:
III Phone: 503.718.2439 Fax: 503.598.1960 (V Plan Review
1.I t j A R I) Inspection Line: 503.639.4175
Date By: Other Permit:
Internet: www.tigard-or.gov a Date Ready By: Ju„s:
0 See Page 2 for
0 4{ "'Notitiied/Method: Supplemental Information
TYPE OF,WORK > Print name:Ken Pittman
®New construction ❑Addition/alteration/replacement
❑ Demolition 'i 1 i — USE'CfiECKLIST
❑Other: Mechanical permit fees*are based on the value of the work
CATEGORY OF CONSTRUCTION performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Value:$
❑Multi-family 0 Master builder ❑Other. RESIDENTIAL EQUIPMENT/SYSTEMS'FEES*
JOB"SITE INFORMATION AND LOCATION
For special infora:ationuse checklist
Description I Qty. I Ea. I Total
Job site address: 10889 SW Teal Co,c4 / l.
Heating/cooling:
City/State/ZIP:Tigard/OR/97223 Air conditioning 46.75
Suite/bldg./apt.no.: I Project name:Summerbrook Furnace 100,000 BTU(ducts/vents) 1 46.75
Furnace 100,000+BTU(ducts/vents) 54.91
Cross street/directions to job site:SW 121'Ave and Summerbrook Lane Heat pump 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
Subdivision:Summerbrook in-wall,in-duct,suspended,etc. 46.75
Lot no.:05 Flue/vent for any of above 23.32
Tax map/parcel no.:TBD Other:
23.32
DESCRIPTION OF WORK Other fuel appliances:
New single family home to be built-3127 sqft,5 bedroom 3 bath home with Water heater I 23.32
Gas fireplace/insert l 33.39
868 sqft 5 car garage Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
PROPERTY OWNERWood fireplace/insert 23.32
P s 0 TENANT Chimney/liner/flue/vent 23.32
Name:Weekley Homes LLC Other:
23.32
Address:1111 N Post Oak Road Environmental exhaust and ventilation:
Range hood/other kitchen
City/State/ZIP:Houston,TX 77055 equipment 1 33.39
Phone:(503)213-4415 Clothes dryer exhaust 1 33.39
Fax ( ) Single-duct exhaust(bathrooms,
APPI>tCA CONTACT PERSON toilet compartments,utility rooms) 3 23.32
Business name:David Weekley Homes Attic/crawispace fans 23.32
Other: 23.32
Contact name:Michele Schiedler Fuel piping:
Address:1905 NW 169th Place,Suite 102 $14.15 for first four;$4.03 for each additional
Furnace,etc.
City/State/ZIP:Beaverton/OR/97006
Ppu11
Phone:(503)213-4415 Fax::( ) Wall/suspended/unit heater
Water heater
E-mail:mschiedler@dwhomes.com
`�• � � �; � � Fireplace
._, i . .. Range
Business name:David Weekley Homes Barbecue
Clothes dryer(gas)
Address:1905 NW 169'Place Suite 102 Other:
City/State/ZIP:Beaverton/OR/97006
Phone:(503)213-4415 Subtotal
I Fax:( ) Minimum permit fee($90.00)
CCB lic.:213653 Plan review(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
days after it has been accepted as complete.
I:\Building\Permits\MEC_PermitApp_0401l 3.doe 440-4617T(11,02iCOM/RBB)
Electrical Permit Application 4
1 {r' FOR OFFICE LSE ONLY
City of Tigard JUL 7 1.O 9 Received
Pr 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: Permit it:
Phone: 503 718.2439 Fax: 503.598 1960 %..e]r ld <„); 1 t I-:!'`� ,n Review Related Permit 14,
'�a�e/By:
7 i(,ARb Inspection Line: 503.639.4175 #il} ltd;(' )t 1X16 *Date/By: 153 See Page 2 for
k _,;� ,�., r Rea ' kris.
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
''.TYPE OF :WORK' . t.. ,s , LAN RE W „.
®New construction 0 Addition/alterationlreplacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition Other:
0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY.OF),CONSTRUCTION .ti'' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps0 for all other installationsbuildings.Multi-family 0 Master builder 0 Other
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION,AND''LOCATION , , •,'' 0 Emergency system larger separately derived
Job#:68020005 Job site address: 10889 SW 'red/ a/"1` pi, ❑Addition mOf new motor load of system.
100HP or more. ❑"A” "E" "i-2""I-3"
City/State/ZIP:Tigard/OR/97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
0hazardous locations. 0Supply voltage for more than
Suite/bldg./apt.#: Project name:Summerbrook
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 121st Ave and Summerbrook Lane - Va.E SCHEDULE
Description 1 Qty. i Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision:Summerbrook Lot#:05 Includes attached garage.
Tax map/parcel#:TBD 1,000 sq.ft.or less I 168.54 168.54 4
Ea.add'I 500 sq.ft.or portion 3 33.92 107.76 1
DESCRIPTION OF WORK - ', • ,,; Limited energy,residential
New single family home to be built-3127 sqft,5 bedroom 3 bath home with
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
868 sqft 5 car garage residential(with above sq ft.)
® PROPERTY OWNER Renewable Energy 0 See Page 2
0:TENANT Services or feeders installation,alteration,and/or relocation
Name:WEEKLY HOMES LLC 200 amps or less 100.70 2
Address: 1111 N POST OAK ROAD 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:HOUSTON TX 77055 601 amps to 1,000 amps 301.04 2
Phone:(503)213-4415 Fax:( ) 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
® APPLICANT18:1 CONTi4BranchFeefor circuitsbranch—circuits new,alterationwith ,or extension,per panel
CT;-PERSOtY A.
Business name:David Weekley Homes above service or feeder fee,
each branch circuit 7.42 2
Contact name: Michele Schiedler B.Fee for branch circuits without
Address: 1905 NW 169th Place Suite 102 service or feeder fee,first 56 18 2
branch circuit
City/State/ZIP:Beaverton/OR/97006 Each add']branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)213-4415 Fax: :( ) Each manufactured or modular
Email: mschiedler@dwhomes.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric — <2
Address:2920 SE Brookwood Ave. Signal circuit(s)or limited energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:permits@garnerelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 121159 Electrical Lie.: 34-30 C up''.Lic.: 3707S ,specifically listed(ia hr mm) 90.00/hr
Suprv.Electrician signature,required:
iq:i:1 .. tLLC1RIC'AL'PERMIT FEit;S' ,,
Subtotal:
Print name: Charles Garn Date: 7/16/2019 0 Plan Review Required(25%of permit fee):
' / State surcharge(12%of permit fee):
Authorized signature: e /, J!!!! TOTAL PERMIT FEE:
•('-(��4 This permit application expires if a permit is not obtained within 180
Print name: Andrea Phillips Dat : 7/16/2019 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I]Building.Permits\hLC PermitApp_ELR_ERE.doc Res 06/17/2015 440-4615T(I 1/05/COM/WEB
Plumbing Permit Application '4r fi Ire
Building Fixtures hOu mil( 1 I sI O'\I.i
IUt. i 7 1019
City of Tigard Received
• 13125 SW HaII Blvd.,Tigard,OR 97223Ur 1 t �, DatelBy: Permit No.:
3 a "Plan Review
• Phone: 503.718.2439 Fax: 503.590,611L.,-,!6,: x Other Permit No.:
Inspection Line: 503.639.4175 ° �( '�i "t I t atwBy.
I I s i ARI) p Date Ready/By: loris. el See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
.... ............... ......._ . ....�-YPE-OF WORK.,..
Supplemental Information
a
For special information use checklist
®New construction 0 Demolition
Description I Qty. I Ea. I Total
/
❑Addition/alteration/replacement 0 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 0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10889 SW -red/ lfp 04. pi. Catch basin or area drain I I 18.76
City/State/ZIP:Tigard/OR/97223 Drywell,leach line,or trench drain 18,76
Footing drain(no.linear ft.:230) Page 2 87.55
Suite/bldg./apt.no.: I Project name:Summerbrook
Manufactured home utilities 50.03
Cross street/directions to job site:SW 121"Ave and SW Summerbrook Lane 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:Summerbrook I Lot no.:OS
Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New Single Family Home 3127 sqft 5 bedroom,3 bath with 868 sqft 5 car garage Clothes washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank
12.51
Name:Weekley Homes LLC Fixture/sewer cap 25.02
Address:1111 N Post Oak Road Floor drain/floor sink/hub 25.02
Garbage disposal 1 25.02 25.02
City/State/ZIP:Houston TX 77055
Hose bib 2 25.02 50.04
Phone:(503)213-4415 Fax:( ) I Ice maker 1 12.51 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:David Weekley Homes Medical gas(value:$ ) Page 2
Contact name:Michele Schiedler Primer 12.51
Address:1905 NW 169th Place,Suite 102 Roof drain(commercial) 12.51
_ Sink/basin/lavatory 4 25.02 100.08
City/State/Z1P:Beaverton/OR/97006 Solar units(potable water) 62.54
Phone:(503)213-4415 Fax::( ) Tub/shower/shower pan 2 12.51 25.02
P-.gall:
oM th ftfal 25.02
CONTRACTOR Water closet 2 25.02 75.06
Business name:Malmedal Plumbing Water heater 1 37.52 37.52
Water piping/DWV 56.29
Address:PO Box 207 Other:
25.02
City/State/ZIP:Banks/OR/97106 Subtotal
Phone:(503)324-0759 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:102535 Plumbing Lic.no.:34-276PB Plan review (25%of permit fee)
signature:
/Q�____„ State surcharge(12%of permit fee)
�`�rt I 1 _ 1 !ln,s ( „ -Ht.,"
� t., TOTAL PERMIT FEE
Print name:car Y��l 1,�1� Date: g 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.
1:1Building1PermitslPLMU-PermitApp.doe 10/01/09 440-4616T(t0/02/COM/WEB)
City of Tigard
C r COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: 57-3/.0` 5 -c9 9 LS 7
Site Address: /Oge9 Q&) �a/ 0:44 /),l
Project Name: a/MI/Jr- 6,_ Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pro�sal: 10
-?,lt) Qp/2-.
V Verify address/suite# active in Accela. ❑ In River Terrace: Ly' No El Yes,River Terrace Review Addendum
Siy Plan Elements: tld> rosion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper twined trees with drip line and tree protection measures.rawn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE
,orth arrow VU ' 'ty locations&easements(required for new and additions)
175 to address,project or subdivision name and lot number Sidewalk/driveway approach
plicant information(name and phone number) ,Is,1 cation of wells/septic systems
1!J'•t dimensions and building setback dimensions Mreet tree size,type and location
II;snare footage of buildings to be demolishedeet names
1.4° ting structures on site VJ Comer elevations(2'contours if more than 4'diffe ntial)
II 0k area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replac ? N1Yes ❑�
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown Yes IMNo
►)' Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
lZ Public Facili ' s Improvement (PFI) Permit:
quired: t] Yes,applicant was notified ❑ No Applie For: /Yes ❑ No,stop intake
1a and Use Case#: f"-240/ — DODO [ Zoning: �— 2/
04 RequiL�tred Setbacks: Front: -20 Rear: /S-- Side: c— Street Side: A Garage: ?
❑ Building Height: Max.Height: Actual Height: e.9S
Landscape Area: % 1V b.1 of Coverage M,ay 0/0
Entrance V et back no more than 8'from street-facing wall 0� Parallel to street or offset 45 degrees or less
Windows '' um 12%of area of all street-facing facades
Garage V Gara a door is behind widest street-facing wall ❑ Yes No,one of the following is met:
Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
/❑ Door extends no more than 5'from w and there is a 12 sq ft.window above garage on 2nd floor.
Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch CI Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ! Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance 7 Urban Forestry an
11&.ensitive Lands: ❑ Yes No Type:
a Conditions met prior to issuance of building permit
No s: J
ItOi Approved By Planning: t Date: //-4//7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_022819.docx
Building Permit Submittal
Original Submittal Date: 7
Site Plans: #
Building Plans: #
Building Permit#: ►: nter building permit#above.
Workflow Routing: P Planning engineering Omit Coordinator �8'uilding
Workflow Sign-off: Ti Sign-off for Alarming(include notes from planning review) /
Route Application Documents: e Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
1original plan review routing form.
0 Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician: p4- plicable74 7/
En veering Review
L S pe at building pad: Z1
[ 'Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility: 1/
Assess Water Quality Fee in-lieu: ❑ Yes L�'No
Assess Water Quantity Fee in-lieu: ❑ Yes [ /No
�� LIDA Facility on lot: ❑ Yes �No
0 Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
[I Approved by Engineering: ,f . Date: 7 Sc, /f
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:
V,SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: ' Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes 9n N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 1
ID I iq
I:\Building\Forms\BldgPermitRvw_RES_022819.docx