Permit CITY OF TIGARD MASTER PERMIT
.111
COMMUNITY DEVELOPMENT Permit#: MST2020-00137
Date Issued: 05/21/2020
T IC A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S 134DB 13100
Jurisdiction: Tigard
Site address: 11094 SW 114TH PL
Subdivision: BRIGHTWOOD SUBDIVISION Lot: 3
Project: Brightwood, Lot 3
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1492 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1600 sf Garage: 425 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 st Right: 5
Detectors:
Total: 3092 sf Value: $399,356.57 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 0 Storm Sewer: 100
Tubs/Showers: 4 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
Fum>=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
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 3092
Owner: Contractor:
STONE BRIDGE HOMES NW,LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD ST,SUITE 100 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-6394175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-387-7577 PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $39,241.13
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. 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: ,4-74,y ,
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.
tvivi
Building Permit Application
Residential " " t" hc '
FOR OFFICE USE ONLY
City of Tigard APR 23 2020 Dale/By'sAi „,lip Permit Vic 7I,9,24 75to ig 7
114 II 13125 SW Hall Blvd.,Tigard,OR 97223 _ _ y� // G
12 Phone. 503.718.2439 Fax: 503.598.2 0 I Y{J F l r:al�l �?. Dlate Brte W�� Other Pc>�y,(f�Q���D®�O S
TI G A II D Inspection Line: 503.639.4175 D�II Np�G�'+ D 'S -Date Read B : / laic a.See Page 2 for
P 3���LJf{Ve„y UiVIS�°' VotifedMethed: Supplemental Information
Internet: www.tigard-or:gov - - pP
r.*—d
TYPE OF WORK I 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 p fit for the
CATEGORY OF C'ONSTRUC'LION work indicated oil this application. 311 4.2 k
�C
Valuation: S
® I-and 2-amilydwelling []Commerctaliindusttial
0 Accessory building 0 Multi-family Number of bedrooms:. S
0 Master builder 0 Other Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION r Total number of floors: 2 35n �]
'10 UYv II New dwelling arca: '„092 square feet I 60
Job site address; � �� �HI �,. _
City/State/ZIP:Tigard,OR Garage/carport arca: 42'0 Z
nam `
square feet Ie(Ci
Suite/bldg./apt,no.: Project e: Covered porch area: square feel
Cross street/directions to job site'SW North Dakota&SW 114'PI. Deck area: square feet
Other structure arca: Teikr square feel
REQUIRED DATA:CON1NIERCIAL USE CHECKLiS!
Subdivision: Brighti ood T Lot no,: 3 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax nmp/parcel no.t equipment,materials,labor,overhead,and the profit for the
DESCRIP'CION OF WORK work indicated on this application.
new,single family residence V Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Stone Bridge Monies NW,LLC Type of construction;
Address:4230 Galewood St,Suite 100 Occupancy groups:
City/Statei7.IP:Lake Oswego,OR 97035 Existing:
Phone.(503)387.7577 Fax,(503)387.7615 New:
® APPLICANT Cl CONTACT PERSON BUILDING PERMIT FEES*
(Please refer m fee schedule)
Business nunie.Stone Bridge Homes NW, LLC
-- Structural plan review tee(or deposit): 73/, 3
Contact name:Deirdre Britt
FLS plan review fee(if applicable):
Address:same as above -
- - -- - Total fees due upon application:
City/State/ZIP:
Phone:( ) I ( ) Amount received:
Fax::
E-mail.dbritt,estonrbridgchomesnw.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential preset'Wive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Stone Bridge Homes NW,LLC i Submit two(2)sets of roof plan with connection details
---- -- - and fire department access,along with the 2010 Oregon
Address:4230 Galewood St,Suite 100 Solar Installation Specialty Code checklist.
City/State/ZIP: Lake Oswego,OR97035 Permit Fee(includes plan review SI80,00
and administrative Lees):
Phone:(503)387.7577 Fax(503)387.7615 State surcharge(12%of permit fee): $21.60
CCB lie,:173318 Total fee due upon application: S201.60
Authorized signature
'Phis permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
4,�,� *Fee methodology set by Tri-County Building Industry
Print name:Deirdre Britt Date:
4 Service Board.
I:\Building\Permits\BLIP-RESPerntitApp,doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
•
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Permit No.
13125 SW Hall Blvd,Tigard,OR 97223 D 1L,n}
g Associated permits:
Phone. 503.718.2439 Fax: 503.598.1960
TIGARD
24-Hour Inspection Line: 503,639,4I75 ❑ Electrical [I Plumbing ❑ Mechanical
Internet www.tigard-or..gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REViEW YVS Nii N/A.
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 El
2 Zoning.:Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑ ❑
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district ❑ 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.
8 Soils report. Must carry original applicable stamp and signature on file or with application..
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 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 ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate lull-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist::
I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if /3 ❑ ❑
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
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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- to 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. ❑
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
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 hearing El 0 ❑
locations. Show attic ventilation.
IS 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 /S 0 ❑
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 ® 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.on and shall be shown to ben islicable to the .re ectunder review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item I I above. Site plans must be 8-1/2"x 11"or 11"x l7 0 0_. ❑
24 Two(2)sets each are required for Items 16,19,20 and 22 above. ❑ L 0
25 Building plans shall not contain red lines or tape-ors. "Mirrored'building plans will not be accepted. El 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 r 27 "Drawn to scale"indicates standard architect or engineer scale. 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 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
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\Perrnits\B UP-RESPennit App.doe 02/24/2011 440-4613T(I 1/02/COMIWRB)
Mechanical Permit Application FOR OFFICE USF.ONLY
a} q3' i r— Received .(,J( 'A^,,,
City of Tigard 1 14 s,..,. Date7By: Permit Nor/,/7;P Po 'W�3 7..
, y 13125 SW Hall Blvd.,Tigard,OR 97223- - 'a' plan Review
_ Phone: 503.718.2439 Fax: 503.598.1960 IN
Other Permit'
:
T IGARD Inspection Line: 503.639,4175 APR 2j3 2020 DatelBy
Date Ready/By. Aids: - ® See Page 2 ror
Internet: www.tigard-or,gov Notified/Method. Supplemental Information
CITY OF 'GAP
"a 4 d�9 '_' ' M COMERCIAL FEE* SCHEDULE— USE CHECKLIST. :'.
Mechanical permit fees*are based on the value of the work
®New conslniction ❑Addition/alteratioiilreplacetnenl performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment.labor,overhead,and profit,
Value:$
CATEGORY- F L'IDI!tSTRUGTION RESIDENTIAL EQUIPMENT/:SYSTEMS FEES•
® I-mid 2-family dwelling ❑ Commercial/Mdustrial U Accessory building For special information use eheckli5t
❑ Multi-family ❑ Master builder ❑ Other: Description Qty._ Ea. Total
JOB SITE INFORMATION AND LOCATION Heatinglcoolingt
q .. Air conditioning 46.75
.lob site address: 1 l V i"II 3te'V e r of i f'-- Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR Furnace100,000+BTU(ductsventx) 54.91
---- Heat pump 61.06
Suite/bldg.apt.no:: Project name:
- -_. Duct work 23.32
Cross street/directions to job site:SW North Dakota&SW 114th PI Hydronic lint water system 23,32
-- - - - --- -- - Residential boiler(radiator or
hydronic) 23.32
----- -- - - Unit heaters(filel-type,not electric), --
-.-. -- --- in-wall;in-duct,suspended;etc,. 46,75
P1uen'cnt for any of above I 23.32
Subdivision.Brightwood Lot no.:3 Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
.,,
DESCRIPTION OF WORK Gas fireplace/insert I 3339
Flue vent for water healer or gals
new,single family residence 'fireplace 2 23,32
Log lighter(gas) 23,32
Wood/pellet stove _.. 33.39
Wood fireplace/insert 23.32
Chinmev'liner/Bue/vonl 23.32
r —.. -- Other 23.32
Rd PROPERTY. OWNER ❑ TENANT - - - -
Environmental exhaust and ventilation:
Name:Stone Bridge Homes NW,LLC Range hood/other kitchen
equipment 1 , 33_39
Address:4230 Calewood St,Suite 100 Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms, r
toilet compartments,utility rooms) J 23,32
Phone:(503)387.7577 Fax:(503)387.7615 Attie./crawlspace fans 23,32
® APPLICANT. 2 ,`1]'''6ON'TAC1 ii ' ,. . -' Other 23,32
Business name:same as above Fuel piping: ._ - --
$14.15 for first four;$4.03 for each additional
Contact name:Deirdre Britt Furnace,etc.,. 1
Address:: Gas heal pump...
Wall/suspended/unit healer
City/State/ZIP: Water heater l ---
Phone:( ) Fax: :( ) Fireplace-.. , 1
-. ,- Range 1
E-mail:dbritt@stonebridgehomesnw.com Barbecue
_ -_ CONTRACTOR:_ - '"�. '" = Clothes.dryer(gas)
Business name:Comfort Zone Other'
-.-. MECILANICAL PERMIT FEES" - ?tip)U1E, <
Address:1032 NW Corporate D Subtotal
ubtotal
City/State/ZIP:Troutdale,OR 97060 --- Minimum permit fee(S90 00).
Plan review
Phone:(503)667.5595 mm Fax:(503)491.8252 State surchargeharage(12%of permit fee)
(25%of permit fec)
CCB lie.:110091 (..�f3 / L)_. TOTAL PERMIT FEE
t This permit application expires if a permit is not obtained within 180
` days after it has been accepted as complete.
Authorized signature: l '-- ------ ...s __ " Fee methodology set by Tri-County Building Industry Service Board
Print name:David Heldstab Date: 4.2.20
I:/BuadstgiPemtilstMBC Pem,aApp 01a113aloe 140-46171{11102/CGM/NEi3)
Electrical Permit Applica FOR OFFICE USE ONLY
• Received iT2 2i- , O/.n7
IICity of Tigard (� 2 3 202� Reeve Permit1111 dfJ (/f/ J
4. 13125 S W Hall Blvd.,Tigard,OR 971.FR Plan Review
I` Phone: 503.718.2439 Fax: 503.598.1960Related Permit 4.
Line: 503.639.4175 `';-�i;J r.1 i c',,,...-,--
Inspection ' Red Be: y (nos
g 2
✓ ._.._.... n
Ready llaleB : 0 Scc Page-far
TIGARD Internet. www.tigard-or.gov e v yl,(-. I N ti!,.d/"dcthnd. Suppleniental Information
TYPE be SVORR a _ PLAN REVIEW ,
®New construction ❑Addition/alteration/replacement Piea.r,heck al rice.,Pply(submit 2 sets of plans iv/items checked).
❑Service OF feeder 400 amps or mote 0 Building over three stories
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards,
CATEGORY.OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® I-and 2-family dwelling ❑CemmerciaVindustrial ❑Accessory building iess
mps for all otherinstallations,groud,or exceeds00 ❑buildings.
0 Immgs sal-use agricultural
❑ Multi-family ❑Master builder ❑ Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND:LOCATION 0 Emergency system, larger separately derived
2Z57 IIO94 SW Ii4�'i R• ❑Addition of new motor load of system
Job# lob site address: i./� IootlParmore. ❑..A. ..E" "t-z" ..t-3..,
Cit'/State/ZIP:Tigard,OR occupancy.
❑Six or more residential units, P Y
} g , ❑Recreational vehicle parks.
_ - '.❑Health-care facilities,
Suite/bldg./apt.# Project name: ❑Hazardous locations, ❑Supply voltage for more than
❑Sery ice or feeder 600 amps or more 610 volt'noram.al.
Cross street/directions to job site:SW North Dakota&SW I14rh PI. x ' SCHEDULE
Deserlpnon I Qty.1 Each I Total I `
New residential single-or multi-fancily dwelling unit.
Subdivision:Brighhvood Lot#: 3 includes attached garage.
- - 1,000 sy.ft.or less T3 168.54 4
Pax ntaprpareel#7 Ea,add'I 500 sq..ft,or portion % 33.92 1
DSCITINFWRK. , ERPO O O Limited energy,residential
(with above sq.ft.) 75.00 2
new,single family residence
___-,_ Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
19 PROPERTY OWNER r!( ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Stone Bridge Homes NW,LLC 200 amps or less 100.70 2
Address:-1230 Galewood St,Suite 100 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Lake Oswego,OR 97035 601 amps to 1,000 amps 301.04 2
Phone:(503)387.7577 Fax:(503)387.7615 Over 1,000 amps or volts 552,26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation: This installation is being made on property that[owl)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
® APPLICANT ❑ CONTACT*ER8ON '� Branch circuits—new,alteration,or extension'der panel
A Fee for branch circuits with
Business name'. same as above above service or feeder Fee, 7.42 2
-- - each branch circuit
Contact name:Deirdre Britt B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
CityfState%GIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: dbrittAstonebridgehomesnw.com Reconnect only 67.84 '2
CONTRACTOR Pump or irrigation circle 67.84- 2
Business name:City Electric S lighting 67.84 2
sign outline
V
Signal circuits)or limited-cncrg}• ❑ See Page 2 2
Address:55568 SW Schaltenbrand Lll. panel.alteration,.or extension..
City/State/ZIP: Sherwood,OR 97140 Each additional inspection over allowable in any of the above
- - Additional inspection(I hr min) 66,251 1u
Phone:(971)404.1714 Fax:(503)625.3052 Investigation(1 hr min) 90.00/In
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/Iv
CCB Lie:: 42422 Electrical Lie,: 26-289C Stiprv,Lie.: 35925 specifically listed fFi hr mm) t
-.. 4D111l' .= rcTRYCAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Chuck Friesen Dale'- 1,2,10 ❑Plait Review Required(25%of permit tee):
- - ' State surcharge(12%of permit fee):
'41 r M TOTAL PERMIT FEE:
Authorized signature: '- e.
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit.
I iBu:ldn,glPcnn:t0ELC_Perroitipp_ELR_ERG.doc Rev 06,17/2015 1d0-4615T(r!.DX,TOMVWEB
Electrical Permit Application— City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE sC:EEDut E
Description I Qt)'. 1 LacL ( 7nta1 "
Fee for all residential systems combined: S75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 00a0 2
5„01 to 15 kva 133,56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems utt excess of 25 kva:
Ell B• urglar Alarm 25,01 to 50 kva 301,04 2
® Garage Door Opener* 50,01 to 100 kva ss226 2
>100 kva(fee in accordance 552,26 2
with OAR 918309-0040)::.
® 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 an of the above:
ri Other Each additional inspection is. 66.25�hr 1
- - charged at an hourly(1 hr min)
Inspections for which no fee is 90.00,hr
xpecifically listed('Y it min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FFFS
Fee for each commercial system: $75.00 Subtotal(Enter on Pa e 1.).
Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ A• udio and Stereo Systems
❑ Boiler Controls
• Clock Systems
n D• ata Telecommunication Installation
, F• ire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
M• edical
• Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1''0w51aig\P.nnils'ELC_PenidiApp.ELR ERE,dec Rauh/122015
+ 4�zg,�� yN'
Plumbing Permit Applications ti \/
Building Fixtures APR 23 2020 FOR OFFICE USE ONLY
City of Tigard Received �`1.ST�a -QD/3 7
P�aie/B `'rat '°
It 13125 SW Hall Blvd.,Tigard,OR 97223�1�Y�jF �fi"1t'�.+�Y..� 7'
ill I` Phone: 503.718.2439 Fax: 503.59 t s h,. A y I r�yplao Review Other Permit No.
Inspection Luce 503.639,4175 � ' ��'`:� b13�x6Rdlate ea
T I GARD m Date Readvdty all,. el See Page 2 for
Internet: www.tigerd-or,gov Nolifiedthdethed- Suppinnenlal Informnlion
TYPE OF WORK` ,_; � =_ .Pr�,li FEE' SCHEDULE
❑Demolition For special information use checklist
®New construction -
----- - _ Description I Qiv. I Ea. I Total
❑Add ition/alteratiolerept ieement -0 Other: New 1-.2-fufuily dwellings(includes 100 R,for each utility connection)
CATEGORY OF CONSTRUCTION s , )1j1-_ _. = SFR(I)bath 312.70
® 1-and 2-family dwelling m ❑ Commercial/industrial SFR(2)bath 437,78
. . SFR(3)bath I 500,32
0 Accessory building ❑Multi-family -
.. -. Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sy...ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address. 1 I Q54 SW 1144.41 pc. Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76 ,
Footing drain(no.linear ft,: ) Page 2
Suite/bldgJapt,no.: Project name: Manufactured home utilities 50.03
a Cross street/directions to job site:SW North Dakota&S W 114"'PI Manholes 18.76 t
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
" - Storni sewer(no.linear tl.: ) Page 2
- - Water service(no.linear if;; ) r Page 2
Subdivision:Brightwood 1 Lot no.;. . FYxturooeitem: l
r
Tax map/parcelno.. Backflow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
-- - - - Clothes washer I 25,02
new,single fancily residence
_.. Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors suncp ... 25.02
El PROPERTY OWNER 0TENANT _ Expansion tank 12.51
Name:Stone Bridge Monies NW, LTC Fixture/sewer cap 25.02
- - _ Floor drain/floor sink/huh 25.02
Address.4230 Galewood St,Suite 1011
., Garbage disposal I 25.02
City/State/ZIP: Lake Oswego,OR 97035 Hose bib 2 25.02
Phone:(503)387.7577 Fax:(503)387.7615 Ice soaker I2.51
® APPLICANT -❑..CONTACT.PERSON Interceptor/grease trap 25.02
Business name same as above Medical;gas(value:$ ). ' Page 2
Primer 12.51
Contact name:Deirdre Britt
--... --- Roof drain(connnercial) 1251
Address: _ Sink'basirillavatory 1 25,02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail:d britt(res tone bridgchantesnw.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR
- Water heater 1 37.52
Business name:Jardine Plumbing -, Water piping/DW V 56.29
Address:PO Box 186 _.. Other: t 25.02
City/StatetZIP: Estacada,OR 97023 7/j Subtotal
Phone:(503)351.8532 Fax:(503)630.2882 3 tz.?v Minimum permit fee: S72.50
CCB Lie.:108747 Plumbing Lw,no,:13 1197,347 Plan review (259�of permit fcc)
- --- . �:.- - State surcharge(12°zo off permit fee)
Authorized signature ,'`� r F(`> ,- TOTAL PERMIT FEE
Print name:Jay Jardine Date: 4,Z• This permit application expires if a permit is not obtained within 180 days
_. . .._.. 4(.t_....... after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i:.L ldug:Pertnits PLSll1-rirnebtop foe 1b'ol:W .140.1616Ti 10bstCOM/Wr.o)
City of Tigard
■ 1" COMMUNITY DEVELOPMENT DEPARTMENT
!PI
T I G A R D Building Permit Review — Residential
Building Permit #: N/,1"i.2d20 -OO/3 7
Site Address: l`(rt4 SVJ i l 4- '- P CP✓
Project Name: one vll V\16od Lot #: S
Planning Review
Proposal: t\1CW •Rpice.,
Igs Verify address/suite #active in Accela. In River Terrace: .i®- No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: 0 rosion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper F"- -tained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) -I ootprint of new structure(including decks)and Nbh
%North arrow *Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number Sidewalk/driveway approach
,Applicant information(name and phone number) NAALocation of wells/septic systems
,ot dimensions and building setback dimensions Street tree size,type and location
ILL..uare footage of buildings to be demolished E.r. treet names
7 - :.sting structures on site .Corner elevations(2'contours if more than 4'differential)
El .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Me ( , o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? OPT s '10
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified izt,No Received: 0 Yes ❑ No
-E1 Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Requited: ,t9--Yes,applicant was notified ❑ No Received: ,Yes ❑ No
.79, SDC 2)CFE24/9-1.— applied for: ❑ Yes No Received: 0 Yes 0 No
--Public Facilities Improvement(PFI) Permit
Required: 0 Yes,applicant was notified No Applied For: 0 Yes ❑ No,stop intake
12(Land Use Case#: 3' B2D g. Ra`18-000O 4 0,Zoning
.Required Setbacks: Front: 2.—() Rear:5 Side: S Street Side: \S Garage: 2-O
Building Height: Max. Height: 3O Actual Height t 2-
/VI andscape Area: % /)Lot Coverage Max: °/u
Entrance Set back no more than 8'from street-facing wall X Parallel to street or offset 45 degrees or less
Windows l ' ' urn 12%of area of all street-facing facades
Garage r. Garage door is behind widest street-facing wall 0 Yes No,one of the following is met:
oor extends no more than 5'from wall and there is a covered porch extending beyond garage.
O Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
,1 Garage door width is 0 12'or less >C50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave 0 Roof offset
O Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer
O Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance .Urban Forestry Plan
�,/ Sensitive Lands: ❑ Yes TNo Type:
�t Conditions met prior to issuance of building permit
Notes: /�
'Approved By Planning: 4P/4—`-- Date: If i27 I�'t'
Revisions (after Building Submittal only Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:Suilding1Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: `I/2:3/Zl
Site Plans: #
Building Plans: # _�
Building Permit#: .1=1-Enter building permit#above.
Workflow Routing: C� 1�Planning Engineering Permit Coordinator Et-frailding
Workflow Sign-off r Sign-off for Planning(include notes from planning review)
Route Application Documents: Q-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
2/Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician: LiA � '4-a— Date: .sh/Zo
Engineering Review o
Pr Slope at building pad: i9
Conditions "Met"prior to issuance of building permit
,asements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes
Assess Water Quantity Fee in-lieu: 0 Yes 17:Y: o
it1 / LIDA Facility on lot: 0 Yes 0 No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: /
l YApproved by Engineering: Date: G/4/2Z'3
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
A, SDC Exemption: ❑ Received g Does not apply
XSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes N/A
.ig-OK to Issue Permit
Approved by Permit Coordinator: Val- Date: 615120
I:\Building'Forms\BldgPemiltRvw_RES_122419.docx