Permit Support Document T I CARD-
City of Tigard
August 1, 2013
Stone Bridge Homes NW LLC
4230 Galewood St., Ste. 100
Lake Oswego, OR 97035
Re: Permit No. MST2012 -00280
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15352 SW Oakmont P1
Project Name: Arlington Heights No. 3, Lot 83
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $523.00.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as new plans submitted under MST2013- 00176.
Refund 80% of plan review deposit, less development code revision review completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
•
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Stone Bridge Homes NW LLC DATE: 8/1/2013
4230 Galewood St., Ste 100
Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse
DA
TRANSACTION INFORMATION:
Receipt #: 189123 Case #: MST2012 -00280
Date: 11/8/2012 Address /Parcel: 15352 SW Oakmont Pl
Pay Method: CreditCard Project Name: Arlington Heights No. 3, Lot 83
EXPLANATION: Per applicant's request as different building plan was submitted under MST2013- 00172.
Refund 80% of plan review fee.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Plan Review 230- 0000 -43106 $523.00
TOTAL REFUND: $523.00
APPROVALS: SIGNAT RES /DATE:
If under $5,000 Professional Staff t / ? p -
If under $12,500 Division Manager
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM USE O_NL
Case Refund Processed: I Date: I "1//_3 By:
1: \ Building\ Refunds \RefundRequest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT rJP
III _ Request Permit Action C
q ` � ov i
TIG 13125 SW Flail Blvd. • Tigard, Oregon 97223 •503.71 vww. i ar -or.
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TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 11 City Staff
(check one)
REFUND OR Name: ' 1
INVOICE TO: (Business or Individual) &t...2. 1C�E1 N (� G ! 1 ,..) 0 3 L
Mailing Address: 4 a , 3U �oF}Ltiwo b , ° i- � ,-+. t re_ /
City/State /Zip: L.tl o t.ota,0 - 9 703 S
Phone No.: 17 5 0 3 - a j�S 7 - 7577
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: NST o 12 - DO a$O °L W e-0 /P-- eO 3
Site Address or Parcel #: 153Sa 0#1. MG+JT- \1 Pt-
Project Name: / � 2 L, hl 67-0/3 /-41.1 roftrs ND. 3 4-or 3
I
Subdivision Name: P - R L i ijr .) I#Co; 5 4 Zj Lot #: e 3
EXPLANATION: C.r,.ITQ ftc_I-ol2 -re, u 6 H 1 i "1:), FFE L*&)T /4.
D l,o, (1.)0 PLAV 4
Hs r - a 0/ 7. .e.)--tv 3 "'00 6
Signature: 0 ' A 0 • ■ ' Date: /g.`7 / 3
Print Name: -- 1 - >_66 14. (7 D ft l,-.4 5(r ! t
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date / 3 B • Rte to Bldg Admin: Date , / "3 By 4►'� 1.
Refund Processed: Date ,P 7 3 By . 'I. Invoice Processed: Date By
Permit Canceled: Date (///3 By . Parcel Tag Added: Date By
Receipt # Date Method Amount $
l: \ Building \Forms \RegPemutAction.doc Rev 05/25/2012
Building Permit ApPlic tion n. EIVED
Residential p , 0 $ 2012 FOR OFFICE USE ONLY ,
\ad
' . City of Tigard TIGARD Dat /By / / / h Permit No ./1 Q ST��a �C
OO,
13125 SW Hall Blvd Tigard, OR 97223 CITY OF Plan Revie
' 2 . Phone: 503.639.4171 Fax: 503 . 598 . 1 B4IILDING DIVISION Date /By: Other Perm y2a9 / —eaa4.3
TI G A RD Inspection Line: • 503.639.4175 Date Ready /By: Juris: HI See Page 2 for
Internet: www.tigard- or.gov Notified /Method: re - Supplemental Information
TYPE OF WORK 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
p.� r _
® I- and 2- family dwelling ❑ Commercial /industrial
Valuation: $ 4 Vto q(*
❑ Accessory building ❑ Multi- family Number of bedrooms: S
❑ Master builder ❑Other: Number of bathrooms: 3.5
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 5352 ft,W O F ie-M O t1T pt.. New dwelling area: 4i Vr square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: , 01 square feet
Suite/bldg. /apt. no.: Project name: Arlington Heights Covered porch area: 144 square feet
Cross street/directions to job site: Deck area: 2'11 square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Arlington Heights Lot no.: 9J 3 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 Residential Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes Type of construction:
Address: 4230 Galewood St, Suite 100 Occupancy groups:
City /State /ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)387-7577 Fax: (503)387 -7616 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
`.business name: SEE ABOVE All contractors and subcontractors are required to be
Contact name: Deirdre Britt licensed with the Oregon Construction Contractors Board
L under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail: dbritt@stonebridgehomesnw.com
CONTRACTOR
Business name: SEE ABOVE BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee.(or deposit):
! FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lie.: 173318 Total fees due upon application:
Amount received:
Authorized signatur This permit application expires if a permit is not obtained
within ISO days after it has been accepted as complete.
Print name: '73P41 T' Date: I 0 4 I' 12 * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building \Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(I 1 /02 /COM /WEB)
re
■
Building Permit Application Checklist . . , , One- and Two - Family DWelhn I „FOR OFFICI USE O \'t 1
Received
City of Tigard Date /By: Permit No.:
I I I n 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 44-- Associated permits:
-.:41- 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Ti1G.
:.. ,:-,:.f,,,,,w: Internet: www.tigard - or.gov ❑ Other:
THEFOLLOWINGITEMS A RE REQUIRED FOR PLAN REVIEW ; : Yes" .'No 'N/Ai.
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ El ❑
3 Verification of approved plat /lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ El
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ El
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state g ❑ ❑
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 zr ❑ 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 e ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 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- Et ❑ ❑
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. J ❑ ❑
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 0 ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered g ❑ El
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 Z ❑ ❑
over 10 feet long and /or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. Er El ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required I ❑ ❑
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 LI ❑ El
architect licensed in Oregon and shall be shown to be applicable to the .ro'ect under review.
..' SPECIFICS - A .. - 4 `. , ! 1 II , ",:4;;
23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x I I" or 11" x 17 ". ❑ ❑ ❑
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. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ El
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 ❑ ❑ ❑
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, ❑ ❑ El
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 \Permits \BUP -RES- PermitApp doc 03/21/06 440- 4613T(I 1/02 /COM/WEB)
Mechanical Permit Application ! -
Received FOR OFFICE USE ONLY
City of Tigard 4 t Permit No &J"rc �/d /)n q go
13125 SW Flail Blvd., Tigard, OR 972_ NOV q Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I i Q V 08 2 012 Date/By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 Date Ready /By: luris:
• Internet: www.ti ard -or. ov CITY OF Supplemental see Pen
g g Notitied/Method: Stlln formation
BUILDING DNIS1O
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® New construction ❑ Addition /alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT! SYSTEMS FEES*
I - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heatingleooling
Job site address: 1 5 ? j 1 j SW O0 `r' DNT PL. Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard, OR Furnace 100,000 BTU (ducts /vents) 46.75
Fumace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Arlington Heights Heat pump 61.06
Cross street/directions to job site: 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: Arlington Heights Lot no.: $ 3 Flue vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
New, Single Family Residential Flue vent for water heater or gas
fireplace 23.32
I.og lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32 _
Name: Stone Bridge Homes NW, LLC Environmental exhaust and ventilation
Address: 16869 SW 65 Avenue #505 Range hood /other kitchen
equipment 33.39
City/State /ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms.
Phone: (503)387 - 7577 Fax: (503)387 -7616 toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: same as above
Fuel piping
Contact name: Deirdre Britt $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: dbritt @stonebridgehomesnw.com Range
CONTRACTOR Barbecue
Business name: Comfort Zone
Clothes dryer (gas)
Other:
Address: 1032 NW Corporate Drive MECHANICAL PERMIT FEES*
City /State /ZIP: Troutdale, OR 97060 Subtotal
Phone: (503) 667 -5595 Fax: (503) 491 -8252 Minimum permit fee ($90.00)
Plan review (25% of permit tee)
CCB tic.: 110091 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.
Print name: David Heldstab Date: • Fee methodology set by Tri- County Building Industry Service Board
t:l nuitding1 PermiislMEC- PennitApp.doc 10!01109 440 -4617r (11:02,COMAVlitt)
Electrical Permit Application RECEIVE I FOR OFFICE USE ONLY
• City of Tigard NOV 0 8 2012 Re dyed
• 13125 SW Hall Blvd., Tigard, OR 97223 � M. 14
C Phone: 503.639.417 Fax: 503.598.19613, O FTIGARD - J Other Permit:
T I G A RD Inspection Line: 503.639.4175 1. Date R' dy /By: N - . inns: Ed See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISIOI Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans wlitems checked below):
® New construction ❑ Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to around, or exceeds 14,000 ❑ Commercial -use agricultural
® l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
A `' i ❑Addition of new motor load of ❑ "A" "E "l -2" ' l -3
Job no.: d Job site address: � 5352 SW AW10 NT . 1 OOHP or more. R :c re
IT O ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Arlington Heights ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I Qtv. � Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Arlington Heights Lot no.: 63 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Stone Bridge Homes 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 16869 SW 65th Avenue #505 Over 1,000 amps or volts 552.26 2
City /State /ZIP: Lake Oswego, OR 97035 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)387 - 7577 Fax: (503)387 7615 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
1/ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: SEE ABOVE B. Fee for branch circuits
without service or feeder fee,
Contact name: Deirdre Britt first branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
67.84 2
Phone: dwelling, service and/or feeder
( ) Fax: ( ) Reconnect only 67.84 2
E -mail: dbritt (Ostonebridgehomesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Cite Electric Signal circuits) or limited-
energy panel, alteration, or
Address: 55568 SW Schaltenbrand Lane extension. Describe: Page 2 2
City /State /ZIP: Sherwood, OR 97140 Each additional inspection over allowable in any of the above -
per inspection 66.25
Phone: (971) 404 - 1714 Fax: (503) 625 - 3052 Investigation per hour (I hr min) 66.25
CCB Lic.: 42422 Electrical Lie.: 26 -289C Suprv. Lie.: 35925 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Chuck Friesen Date:
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 ISO
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
11Building\I Permits 1F.l.C- PemitApp.doc 10101/09 4451 - 46151( I I /05 /COM.'w'EB
Plumbing Permit Application RECEIVED
•Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard NOV 08 2012 Received
Date /By: , Perm it - 0 2 .4 0,o -Oo a e ed
Y 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• 1111 17 Phone: 503.639.4171 Fax: 503.598.19 0 Other Permit No.:
OF
T i G A R ll Inspection Line: 503.639.4 175 va l T A Date/By:
pD tV+A1W Date Ready /By: Juris: ei See Page 2 for
Internet: www. tigard -ongov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 312.70
® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5352 SW OAF/1 x i NT il • 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.: _ ) Page 2
Suite /bldg. /apt. no.: I Project name: Arlington Heights Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: Arlington Heights I Lot no.: cb 3 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New, Single Family Residential �� 02
Dishwasher
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65' Avenue #505
Garbage disposal 25.02
City/State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: (503)387 -7577 Fax: (503)387 -7615 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: SEE ABOVE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Deirdre Britt Roof drain (commercial) 12.51
Address: Sink/basin /lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: dhritt @stonebridgehomesnw.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Jardine Plumbing Water piping/DWV 56.29
Address: PO Box 186 Other: 25.02
City /State /ZIP: Estacada, OR 97023 Subtotal
Phone: (503)351 -8532 Fax: (503) 6302882 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 108747 Plumbing Lic. no.: 93- 1185347
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Jay Jardine Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I^•. ttuildint :Pem,it+1PLMIi- PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEn)
° Building Division
Development Code Provision Review
T l G A R D Residential Projects
Building Permit No.: /7S4 .. — '400e &
Site Address: / S3 Sot , J QA-, _Aie
Project Name & Lot No.: f/1L /A/G-70A/ 09 No . 3 � SOT :`3
CWS Service Provider Letter
Required: Yes ❑ No la
Received: Yes ❑ No ❑
Routed Plans:
Original Plan Submittal Date: ///1//4
1st Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked ( items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact ' at 503 - 718 - Lc(3F or @tigard- or.gov)
Land Use Case No. ,add 200 - rAnt)
Zoning R. -'7
0 Setbacks:
Front I Rear (S Side f Street Side (O Garage ZC)
Maximum Building Height: 3 Actual Building Height
8 Visual Clearance
S' Easements ,/
JO Sensitive Lands Type: /`
H' Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved .@' Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
Engineering Review (contact Mike White at 503 -718 -2464 or MikeW @tigard - or.gov)
Afr Actual Slope:
Notes:
Original Plan: Approved Not Approved ❑ Date:, tic � f " i Z
Revision 1: Approved ❑ Not. Approved ❑ Date:
Revision 2:: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert, Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit •
Notes : _
•
•
Original Plan: Date Sent to Applicant:
• Revision 1: Date Sent to Applicant
• Revision 2: Date Sent to Appli t
Okay to Issue Permit: Yes o ❑
Date Routed to Building:
•
•
•
•
Page 2 of 2
y,
' STONE BRIDGE pEIVED OBE: 1454
HOMES NW NOV 0 2012 D TE: 83
4230 GALEWOOD ST. SUITE 100 PROPERTY: ARLINGTON
LAKE OSWEGO, OR 97035 CITYOFTIGARD HEIGHTS
(5 387-7577 V O I BUILDING DIVISION CITY: TIGARD
SCALE: 1"=20'
S ITE PLAN PLAN No.: 244
PRAIRIE ELEVATION
20'.0' w
0
3 0 u!
N
ILI ilk
9 9
in
n ., 4-
1 „ "7 ^7 e 1
f!t : ! !! ; 31' 7 9'8' �. � - , I —
--
I- I ,
gr 4 . sl.:'..ub— i • .
u W F' : ; : 0 j a 0 ( ..0;--)
BOTTOM OF WALL
1 ,15'
i AT BACK OF WALK ' :��� ;.I I 1 _a EL =2893'
I
.� : a VE - LI i ► 3.05 S .: 331 ..7. 29 . ' . ". C II 1 : 331 ' _. 1 r� 1. I kS .:.I .'6. r I.0 98 - - 1 2'- • g
O I 4 r I _ ��R
. h , I 3'6' -0 �
a . 0 I ili � v1 r m L'
ti) ! � ' i • r • 6' 16' 20'2 _ SEWER
328 -�----�I■® _ _ STORM
in
l Nr" I / ...,a1
WATER �
I Ili
0 0
1 -�D� An � Q �f SILT 1 • Lt INING
W
2V -6' 0
t r ) 2d' -6'
0
U1
LOT COVERAGE STREET TREES
LOT AREA: 6,062 SQ. FT.
BUILDING AREA: 2,155 SQ. FT.
PERCENTAGE: 46.2% — PYRU5 EALLERYANA
ORNAMENTAL PEAR
NOTES:
ALL GRADE AND PROPERTY LINES ARE ESTIMATES OF CURRENT LOCATIONS.
ALL DIMENSIONS AND SQUARE FOOTAGE ARE APPROXIMATE FIGURES.
ALL RETAINING WALL 4— (EIGHTS AND LOCATIONS ARE ESTIMATES.
THEY MAY VARY AND BE SUBJECT TO CHANGE. LOT 0 53
STREET IGN S, AND OTTHER SITE CONDI I O OF UTILITY BOXES, 6,062 e . ft.
N