Permit (123) 741 ,� CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00328
Date Issued: 09/05/2019
T + AR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Y `
Parcel: 1 S 134 B D 12300
to , j Jurisdiction: Tigard
Site address: 10869 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 6
Project: Summerbrook, Lot 6
Project Description: New SF. 9/18/2019: REPRINT to add backflow device. 10/21/19: REPRINTED permit to add A/C.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 2066 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 3 Second: 0 sf Garage: 581 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2066 sf Value: $281,314.49 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
Drains. 0
Tubs/Showers: 2 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: 4 201-400 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+a m p/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2066
Owner: Contractor:
WEEKLEY HOMES LLC WEEKLEY HOMES 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: $32,797.47
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c••y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Vic- 1'J �
'�. 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: ! Permit No.: . j �;
114 13125 SW Hall Blvd.,Tigard,OR 97223 ' / �z'
9 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit:
RECEIVE
TI G A R D Inspection Line: 503.639.4175 '
��Date Ready/By: 7uris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
1Z0' 19 Print name:Hannah Scharer
TYPE OF W I ''.
®New construction ❑Addition/alteratio hgiN
GAPt�
tDIVISION COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑Demolition El Other: Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION -. ' loan t -amechanical materials,equipment,labor,overhead,and profit.
® 1-and 2-family dwelling CICommercial/industrial ❑A,cess 1/4;
S _ Value:$
1=I Multi-family El Master builder ❑Other: RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
For special information use checklist.
JOB SITE INFORMATION AND LOCATION Description Qty. Ea. Total
Job site address:10869 SW Teal Crest Place 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'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.:06 Flue/vent for any of above 23.32
Tax map/parcel no.:TBD Other: 23.32
Other fuel appliances:
DESCRIPTION OF WORK PP
Water heater 23.32
New single family home to be built-2066 sqft,3 bedroom 2.5 bath home with Gas fireplace/insert 33.39
581 sqft 3 car garage Flue vent for water heater or gas
fireplace 23.32
f j j f Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER 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 33.39
Clothes dryer exhaust 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:
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 Gas heat pump
Wall/suspended/unit heater
Phone:(503)213-4415 Fax::( )
Water heater
E-mail:mschiedler@dwhomes.com Fireplace
CONTRACTOR Range
Business name:David Weekley Homes Barbecue
Clothes dryer(gas)
Address:1905 NW 169th Place Suite 102 Other:
City/State/ZIP:Beaverton/OR/97006 MECHANICAL`PERMIT FEES*
Subtotal
Phone:(503)213-4415 Fax:( ) Minimum permit fee($90.00)
CCB lic.:213653Plan review(25%of permit fee)
State surcharge(12%of permit fee)
TOTAL PERMIT FEE '<4 r
Authorized signature: 4
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_04011r3.doc 11 .1a I()/-440-16 ,(11/02/COM/WEB)
CITY OF TIGARD71 MASTER PERMIT
.x Permit#: MST2019-00328
.- COMMUNITY DEVELOPMENT10 1
' . Date Issued: 09/05/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 x '
Parcel: 1 S134BD12300
Jurisdiction: Tigard
Site address: 10869 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 6
Project: Summerbrook, Lot 6
Project Description: New SF.9/18/2019: REPRINT to add backflow device.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 2066 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 3 Second: 0 sf Garage: 581 sf Front 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 2066 sf Value: $281,314.49 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
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 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'500 sf: 4 201-400 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 2066
Owner: Contractor:
WEEKLEY HOMES LLC WEEKLEY HOMES Required Items and Reports(Conditions)
1905-NW 413.27t4151 STE 102 #905'NW¶ 9TH-PLACE SUITE 482 1 Ersn Gntr1503-639-417`
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $32,745.11
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 OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: A`^ ‘C
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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Cityli of Tigard Received
�, `S Date/By: �� Ct �-c Permit No.:V\S\ i�Ct'-(12 -;
13125 SW Hall Blvd.,Tigard,OR 97223 b ' ,��\
Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Date/By:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: lune: 0 See Page 2 for
Internet: www.tigard-or.gov Notitied/btethod: Supplemental Information
,„. ,,,,, TYPE OF WORK i.1 ,.
FEE"•;SGIiEDIJLE
Z New construction. 0 Demolition
For special information use checklist.
ille,kDescription I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: ,1,1 m "'� x ; New 1-2-family dwellings(includes 100 ft.for each utility connection)
r. CATEGORY OF CONSTRUCTION `i* SFR(1)bath 312.70
Z 1-and 2-family dwelling 0 Commercial/indu triQ�\kAN SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10869 SW Teal Crest Lane Catch basin or area dram 18.76
Dtywell,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 12151 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.:6 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Irrigation and backflow for lot 6 landscaping Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' ® PROPERTY OWNER 0 TENANT Expansion tank 1/.51
Name:Weekley Homes,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1905 NW 169°i 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
0 APPLICANT ® CONTACT PERSON - interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: David Weekley Homes
Primer 12.51
Contact name:Hannah Scharer
Roof drain(commercial) 12.51
Address:1905 NW 169°i Place,102 Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97006 Solar units(potable water) 62.54
i -Flione r63)71g-4`742 - __ Fax::.t Tu is x. ,-,5ti,,, ptttr
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:( ) oc "-'(r� Minimum permit fee: $72.50
CCB Lic.:193268 Plumbing Lic,no.: Plan review (25%of permit fee)
� �" State surcharge(12%ofpetmit fee)
Authorized signatur doe, 1.- -N\kS, TOTAL PERMIT FEE
n This permit application expires if a permit is not obtained within 180 days
Print name: /. ��� Date: /r(�! VrjJ/n after it has been accepted as complete.
/ "' *Fee methodology set by Tri-County Building Industry Service Board.
Ii\Building\Permits\PLbfU-PermiiApp.doc 10/01/09 440-616T(I 0102/COM/WEB)
� a
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
atResidential Fire Suppression Sy..,stems:
f e. .yprl ,., ' o itm Fee'(ea) \2'P
� tiFP »;skb i� , �in• Nfi44
t,l1 ' r ? W . giarmnpfag �
N71
Footing drain-1"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 & its4+ ' � i• 't gte
Stonn&Rain Drain 1st 100' 62,54 °°i1a '+� el Mat •, ., ',
$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
t a P a o°" i° ", Fee(ea) d+;o- otal each additional$100.00 or fraction thereof,to
IQ }lIIROI 0Y'1!'CC �yrr.+ 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) Parh_additinnal$100 00.oc&action.therrn f 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*.
by Fixture Type ax& .• Y�"I"C.abvt llttvn
4A1�
_.
Future Type for r� ` r P w1 Replace/
Work'PIrformed x,„' .wa'` ' _ apped `: Added Relocate Plan review is required for any of the following,
Baptistry/Font Please check all that apply.
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 Thm 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" v y` ,,e x4 a+. ��: .uw 4C r J ..tri%RI#a�cwm,
#fi M t ,), list I 1 I I..a4 !}r a„iagrariam ''+'%' ,�,. _w.•.
Car Wash Drain
Garbage Domestic—non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic—food related that meet the qualifications above.
-Commercial—food related
- ttifibnitredated
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
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\hbrecken\Downloads\PLMF—PermitApp(1).doc 2
CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2019-00328
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2019
T t[_;;t g D 9 Parcel: 1 S134BD12300
Jurisdiction: Tigard
Site address: 10869 SW TEAL CREST PL
Subdivision: SUMMERBROOK SUBDIVISION Lot: 6
Project: Summerbrook, Lot 6
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 2066 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 3 Second: 0 sf Garage: 581 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2066 sf Value: $281,314.49 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
Drains: 0
Tubs/Showers: 2 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
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: 4 201-400 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 2066
Owner: Contractor:
WEEKLEY HOMES LLC WEEKLEY HOMES Required Items and Reports(Conditions)
1905 NW 169TH PL STE 102 1905 NW 169TH PLACE SUITE 102 1 Ertn Cntrt 503-639"-475
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $32,710.09
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 •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95,E11-00.5. Yo I ay obtain,copy of j-a rules or direct questions to OUNC by calling 503.2, .1987 or 1.800.332.2344.
IIssued By: �/, ./. ,' iAid Permittee Signature: 41".i.i/./ � A `,
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
ResidentialRrr' r "C,;,'1 FOR OFFICE USE ONLY
City of Tigard Reeelv� Date/Bed (�, 7 /, 0' / ��
13125 S50 Hall Blvd.,Tigard,OR 98.1 3 AUG C'l;I1111 Plan Review : / ii /�,e ......4f t/C/// ✓eac�
� Phone: 503.718.2439 Fax: 503.598.1960 Date!By: l/ ��" �
T'I. A K D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ,� / I hu is. H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Not +/Method: /� , 1 L' /#' Supplemental Information
II A lird'ithaal .
TYPE OF WORK x_ "„'' REQUIRED 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 0 Other: equipment,materials,labor,overhead,and the profit for the
` CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: __,S.1141;0110 Zg 11 3 t1
❑Accessory building ❑Multi-family Number of bedrooms: 3
ID builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: c?W til 7
Job site address:10869 SW Teal Crest Place New dwelling area: square feet
City/State/ZIP:Tigard/OR/97223 Garage/carport area: 311M square feet
Suite/bldg./apt.no.: Project name:Summerbrook Covered porch area: square feet
Cross street/directions to job site:SW 121"Ave and SW Summerbrook Lane Deck area: square feet
Other structure area: X square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Summerbrook I Lot no.:06 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 Single Family Home to be built-2066 SQFT 3 Bedroom,2.5 bath with 581 SQ Valuation: $
FT 3 car garage, Existing building area: square feet
New building area: square feet
121 PROPERTY OWNER ❑ 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:
D APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:David Weekley Homes (Pteoserijer#olte.cckedute}
Structural plan review fee(or deposit):
Contact name:Michele Schiedler
FLS plan review fee(if applicable):
Address:1905 NW 169th Place,Suite 102
Total fees due upon application:
City/State/ZIP:Beaverton/OR/97006
Phone:(503)213-4415 Fax: :( )
'PHOTOVOLT IC SO i PAEL SYSTEM FEES*
E-mail:mschiedler adwhomes.com
,; Commercial and residential prescriptive installation of
,.., '4: a<
CONTRACTOR,-,X -,,,--*.i, 1-7- roof-top mounted Photo Voltaic 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 169`h Place,Suite 102 Solar Installation Specialty Code checklist.
City/State/ZIP:Beaverton/OR/97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)213-441. Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:213653 / Total fee due upon application: $201.60
Authorized signature: // 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 htdustry
Print name:Michele 'chi.,ler Date:8/3/19 Service Board.
1:A Building\Permits 1BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COMIWEB)
I
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
al 13125 SW Hall Blvd.,Tigard,OR 97223
AssociatedDate,
permits:
U Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 El Electrical 0 Plumbing El Mechanical
TIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAIN REVIEW Yes 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 0
3 Verification of approved plat/lot. ® 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® 0 0
9 Erosion control ®plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 0 0
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 ® 0 0
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 ® 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® 0 0
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- ® 0 0
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. ® 0 0
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- ® 0 0
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 Z 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 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 ® 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. Z 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required Z 0 0
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 ® 0 0
architect licensed in Ore g on and shall be shown to be .r'licable to the •ro'ect under review.
JURISDICTIONAL 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". ® 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ® 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ® 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ® 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ® 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0
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, 0 0
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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application-4',- (� FOR OFFICE USE ONLY
Received
city of TigardIN
Date/By: PetmitNo.:
13125 SW Hall Blvd.,Tigard,OR 97223 AU CUIR
II r 1 Plan Review Other Permit:
Phone: 503.718._439 Fax: 503.5)8.1960 Date By:
TI G A R D Inspection Line: 503.639.4175 Date Ready By: fans: ® See Page 2 for
Internet: www.tigard-or.gov iI NotifiedlMethod: Supplemental Information
TYPE OF WORK Print name:Ken Puttman
®New construction 0 Addition/alteration/replacement MMERCIAL-FEE'►~SC 'SE USE CHECKLIST-=
0 Demolition 0 Other: 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.
® I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building Value:$
0 Multi-family 0 Master builder 0 Other: RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
For special information use checklist.
,JOB SITE INFORMATION AND LOCATION Description Qty. Ea. Total
Job site address: 10869 SW Teal Crest Place Heating/cooling:
City/State/ZIP:Tigard/OR/97223 Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75
Suite/bldg./apt.no.: Project name:Summerbrook Furnace 100,000+BTU(ducts,vents) 54.91
Cross street/directions to job site:SW 121st 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.:06 Flue/vent for any of above 23.32
Tax map/parcel no.:TBD Other: 23.32
DESCRIPTION OF WORK
Other fuel appliances:
Water heater I 23.32
New single family home to be built-2066 sqft,3 bedroom 2.5 bath home with Gas fireplace/insert I 33.39
581 sqft 3 car garage Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTYOWNER 0 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 1 33.39
Clothes dryer exhaust 1 33.39
Phone:(503)213-4415 Fax:( ) Single-duct exhaust(bathrooms,
N APPLICANT :I CONTACT PERSON toilet compartments,utility rooms) 3 23.32
Attic/crawlspace fans 23.32
Business name:David Weekley Homes Other: 23.32
Contact name:Michele Schiedler Fuel piping:
Address:1905 NW 169'Place,Suite 102 $14.15 for first four;$4.03 for each additional
Furnace,etc.
—CityatatsZL i&v€rtoo/OR/97006 -__.-- Gas heat pump _--__ ,
Phone:(503)213-4415 Fax: :( ) WalUsuspended/unithgater
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 lie.:213653 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: 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_0401 I3.doc 440-4617T(I 1/02;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.
1::\Building\Permits\MEC_PermitApp_040113.doc 3
ri 7 H O
Electrical Permit Application FOR OFFICE USE ONLY
• t"�V L� it 2019 Received
City of Tigard Date/B : Permit 8.
w 13125 SW Hall Blvd.,Tigard,OR 972(23 1 Plan Review
Phone: 503.718.2439 Fax: 503.59-1,54%0:., pate/B : Related Permit 8:
:aUfa ., t .Ft P V a i-
TIGARD Inspection Line: 503.6394175 Ready Date/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
: TYPE,OF:WORK .
: PI,A1�1`REVIEW
®New construction ❑Addition/alteration/replacement Please cheek all that apply(submit z sets of plans w/items checked).
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards
CATEGORY'OF CONSTRUCTION( 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
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 installation of 150 KVA or
'JOB SITE INFORMATION AND LOCATION':. 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job 4:68020006 Job site address: 10869 SW Teal Crest PI 1001-ll'or more. ❑`A"."E","t-2","I-3",
❑Six or snore residential traits. occupancy.
0 Health-care facilities. 0
City/State/ZiP:Tigard/OR/97223Recreational vehicle parks.
0 Supply voltage for more than
0 Hazardous locations.
Suite-bldg,i'apt.4: Project name:Summerbrook
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 121st Ave and Summerbrook Lane „
;, 'FEE SCHEDULE , ,
Description I 771 Each I Total = I'
New residential single-or multi-family dwelling unit.
Subdivision: Summerbrook Lot#:06 Includes attached garage.
1,000 sq.ft.or less 1 16854 168.54 4
Tax map/parcel 4:TBD
Ea.add'1 500 sq.ft.or portion 3 33.92 107.76 I
.DESCRIPTION OF sWORK ` Limited energy,residential 75.00 2
New single family home to be built-2066 sqft,3 bedroom 2.5 bath home with (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
581 sqft 3 car garage - Renewable Energy 0 See Page 2
® PROPERTY OWNER . `..d.'TENANT' ..- Services or feeders installation,alteration,and/or relocation
Name:WEEKLY HOMES LLC 200 amps or less 100.70 , 2
Address: 111 i 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
-- — Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:"Phis installation is being made on property that I own which is not 200 amps or less 59.36 I
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
® APPLICANT ,® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: David Weekley Homes above service or feeder fee, 7.42 2
each branch circuit
Contact name: Michele Schiedler B.Fee for branch circuits without
servicAddress: 1905 NW 169th Place Suite 102e rueder fee,first
circcuit
56 18 2
branch
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 67.84 2
dwelling,serviceand/or feeder
Email: mschiedler@dwhomes.com Reconnect only
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
'-=---_ ssrramtrrner T _ _ __ 4244-. _ -- 2. —_ __
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:2920 SE Brookwood Ave. panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State!""/.IP: Hillsboro,OR 97123 Additional inspection(I hr min) 66251 hr
Phone:(503)523-9060 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 90.00/hr
CCB Lie.: 121159 Electrical Lic.: 34-305 / S .rv”ic.: 3707S specifically listed(14 hr min)
7/
E-(;EeTi;tCA *ERMIT 4EES' .
Suprv. Electrician signature,required: j / Subtotal: I
Print name: Charles Garn-r sate: 8/5/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature' r S TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Andrea Phillips te: 8/5/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I.BuildmePerinits'd:LC PeoniiApp_ELR_ERE.doc Rev 06'17/200 440-4615T(tt/0SICOMIWEB
Elecgrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY • • :,' =FFE
•
Fee for all residential systems stems combined: $75.00 Renews I Qty. I Each I Total I Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 2S kva:
❑ B• urglar Alarm 25.01 to 50 kva 30104 2
® Garage Door Opener* 50 01 to loo kva 552 26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
® Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 6625/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(!h hr min)
COMMERCIAL WORK ONLY: ELEctRicAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n A• udio and Stereo Systems
❑ Boiler Controls
n C• lock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
ri Instrumentation
C Intercom and Paging Systems
C Landscape Irrigation Control*
O Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.:Btu lding`Permits`ELC_PermitApp_ELR_ORE.doe Rev 06'172015
Plumbing Permit Application
'Building Fixtures 10R 011 1( E l SI. 0\1 1
City of Tigard Received
Date/By: Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97225'"' '`'
Plan Review Other Permit No.:
1 Phone: 503.718.2439 Fax: 503.598.1%0 Date/By:
I 1 i;;�it l Inspection Line: 503.639.4175 i'i Date Ready/By. luris ta See Page 2 for
Internet: www.tigard-or.gov Di1: ' ' Notified/Method: Supplemental Information
TYPE OF WORK FEEa ISCHEDULE_.
®New construction ❑Demolition For special Information use checklist
Description I Qty. I Ea. I Total
0 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 0 Commercial/industrial SFR(2)bath 1 437.78 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10869 SW Teal Crest Place Catch basin or area drain 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.: 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 Lot no.:06 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
New Single Family Home 2066 sqft 3 bedroom,2.5 bath with 582 sqft 3 car garage Dishwasher 1 25.02 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:1111 N Post Oak Road
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:( ) 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
Primer 12.51
Contact name:Michele Sebiedler
Roof drain(commercial) 12.51
Address: 1905 NW 169th Place,Suite 102 Sink/basin/lavatory 4 25.02 100.08
City/State/ZIP:Beaverton/OR/97006 Solar units(potable water) 62.54
Phon'(503)213-4415 Fax:;( ) _ ___LLTub/shower/shower pan 2 12.51 25.02
J
E-mail:mschiedler@dwhomes.com Urinal 25.02
Water closet 2 25.02 75.06
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Malmedal Plumbing 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
Plan review (25%of permit fee)
CCB Lic.:102535P Ing Lic.no.:34-276PB
State surcharge(12%of permit fee)
Authorized signature: C a _ L:.__ ,_.._ • TOTAL PERMIT FEE
1�1 P� (� 1 y7'2 Q i 1�Cate: This permit application expires if a permit is not obtained within 180 days
Print name: Gl r� 1 O �(� after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
11Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616r(10/02ICOM/WEB)
Building Permit Submittal
Original Submittal Date: W7/7
Site Plans: #
Building Plans: #
Building Permit#: EY-Enter building permit#above.
Workflow Routing: IZ .Planning 9-Engineering C Permit Coordinator Building
Workflow Sign-off: )Z Sign-off for Planning(include notes from planning review)
Route Application Documents: A 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
EiSlope at building pad: .2.1
❑ 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 [No
Assess Water Quantity Fee in-lieu: ❑ Yes [1 No
LIDA Facility on lot: ❑ Yes Er-No
EFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
C'Approved by Engineering: Date: efg/59
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
El 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: /
VSDC Fees Entered: Wash Co Trans Dev Tax: [�' es ❑ N/A
Tigard Trans SDC: LY Ye CI N/A
Parks SDC: es ❑ N/A
LIDA CI Yes [YN/A
OK to Issue Permit )
Approved by Permit Coordinator: 44/Date:
�/
I:\Building\Forms\BldgPermitRvw_RES 022819.docx