Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2013-00212
Date Issued: 01/22/2014
TIGARD 13125 SW Hall Blvd . Tigard OR 97223 503 718 2439 Parcel: 2S110CB10600
Jurisdiction: Tigard
Site address: 15492 SW SUMMERVIEW DR
Project: Arlington Heights No 3. Lot 94 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 94
Project Description: Sewer connection for new SF
Contractor: Owner; STONE BRIDGE HOMES NW LLC
4230 GALEWOOD ST#100
LAKE OSWEGO, OR 97035
PHONE: PHONE: 503-387-7577
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/22/2014 $4.800 00
Sewer Inspection-Residential 01/22/2014 $35 00
Type of Use: SF
Class of Work: NEW
Install Typo: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4.835.00
•
Required Items and Reports(Conditions)
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: rmfttee-S+gnature:
Call 5E} . .4 by 7:D0 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
Residential cE'JE
CFOR OFFICE USE ONL1
City of Tigard 2013 e /A /e //4 Cy Gj Permit No.:NSro?e�13-o0,�,.49
13125 SW Hall Blvd.,Tigard,OR 9722�C C 1 Q Plan Revi ��
I Phone: 503.718.2439 Fax: 503.598.1960 DateBy. 1� Other Permit: " u;2,A0J7,r-ccr;it _
l I •‘K t) Inspection Line: 503.639.4175 CITY OF 1IGi- _ Date Ready / : , turps B See Page 2 for
Internet: www.tigard-or.gov CITY . -ti,- • • otified/Meth�d:,O /��/// Supplemental Information
4:1 4r TYPE OF WORK REQUIRED DATA:I- D 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 indica =.. this •plication.
® I-and 2-family dwelling ❑Commercial/industrial Valuation: �l �iAB;222"OlP � �,
❑Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address:15492 SW Summerview Dr. New dwelling area: 2,075 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 440 square feet
Suite/bldg./apt.no.: Project name:Arlington Heights Covered porch area: 58 square feet 415-
Cross street/directions to job site: Deck area: 150 square feet [S30
Other structure area: 2.5-1.3 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKi i
Subdivision:Arlinnton Heights Lot no.:94 Permit fees'are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment.materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New,Single Family Residential Valuation: $
Existing building area: square feet
7 New building area: square feet
Z PROPERTY OWNER ❑ TENANT 1 Number of stories:
1.
Name:Stone Bridge homes Type of construction:
Address:4230 Gale%ood 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 BUILDING PERMIT FEES*
Business name:SEE ABOVE (Please refer tn fee schedule)
Structural plan review tee(or deposit):
Contact name:Gayland Forsberg -
—
FLS plan review fee(if applicable):
Address: - - - -
Total fees due upon application:
City/State/ZIP: �f t
Phone:( ) Fax::( )
Amount received: I -�5z
E-mail:gayland(afstonehridgehomesnw.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted P otoVoltaic Solar Panel System.
Business name:SEE:tBOVE Submit two(2)sets o •of plan with conn- details
and fire department ace- s.along w' • . e 2010 Oregon
Address: Solar Installation Specia , C c ecklist.
City/State/ZIP: Permit Fee(inclu• : .n review
$180.00
and ... tnistra e fees):
Phone:( ) Fax:( ) State sure,-. •e(12%of• it fee): $21.60
CCB lie.: 173318 oti al tee due upon application: $201.60
Authorized signature- This permit application expires if a permit is not obtained
C within 180 days after it has been accepted as complete.
Print name:Gayland Forsberg ✓?Date: 12/5/13 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Plumbing Permit Application
Building Fixtures - < FOR OFFICE USE ONLY
City of Tigard Received Penni:Nn. '/
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �a'1 /C f/.3( A, {9j /--ii j /j/3.6-C) er
II Plan Review
C �,
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:mow, ' f 3--65,_ 2
TIGARD Inspection Line: 503.639.4175 Date Ready/By: huts ® See Page 2 for
Internet: www.tigard-or.gov 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 I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑CommerciaUindustrial
SFR(2)bath 437.78
❑Accessory building ID 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: `4 Z t,It y �..NG
Catch basin or area drain 18.76
City/State/Z1P:Tigard,OR 97223 Dnnvell,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 R.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Arlington Heights I Lot no.:q 4. 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 Dishwasher 25.02
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
Address: 16869 SW 65th Avenue#505 Floor drain/floor sink/hub 25.02
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: dbritt(a)stonehridgehomesnw.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Jardine Plumbing Water !/n m DWV 56.29
P P
Address: PO Box 186 Other: 25.02
City/State/ZIP: Estacada,OR 97023 Subtotal
Phone:(503)351-8532 Fax:(503)6302882 Minimum permit fee: $72.50
CCB Lie.: 108747 Plumbing Lic.no.: 93-1185347 Plan review (25%of permit fee)
Y.,_
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE.
Print name: Jay Jardine Date: i
iZG ja This permit application expires If a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology'set by"I ri•County Building Industry Service Board.
1:\Building\l ennas\PI.MU-I'ertnilApp.doc IO/Oi/IM 440.4616r(I0/02ICOM/W1i11)
'Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received /¢4� Permit No.: �r raw 3-t ge/
e 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Chher Penmit ( L 9. ,s-A).7, .
T I G A tt 1 r Inspection Line: 503.639.4175 Dace Ready/By: loos:
Internet: www.ti -or. ov Supplemental Sec Pent l for
b Notified/Methud: Supplemental infurntatian
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
® New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION - Value:$
® 1- 2-Tamil} dwelling RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
g ❑Commercial/industrial ❑Accessory building
❑ Multi-family ❑ Master builder ❑Other: For special information use checklist.
Description I Qty. I Ea- I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
r Air conditioning
Job site address:
1 SarlyintYle0 1 YG (requires site plan showinit placement) 46.75 ,
City/State/ZIP:Tigard,OR Furnace 100,000 BTU(ducts/vents) , 46.75
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: [ Project name:Arlington Heights Heat pump 6L06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hvdronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended.etc. 46.75
Flue/vent for any of above 23.32
Subdivision:Arlington Heights Lot no.:qtr.. 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
Log lighter(gas) 2332
Wood/pellet stove 33.39
Wood fireplace/insert 2332
® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 2332
Other: 23.32
Name:Stone Bridge Homes NW,LLC Environmental exhaust and ventilation
Address:16869 SW 65"Avenue#505
Range hood/other kitchen
equipment I 33.39
City/State/ZIP:Lake Oswego,OR 97035 Clothes dryer exhaust i 33.39
Single-duct exhaust(bathrooms,
Phone:(503)387-7577 Fax:(503)387-7616 toilet compartments,utility moms) 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;54.03 for each additional
Address:
Furnace,etc.
Gas heat pump
City/Suite/ZIP: Wall/suspended/unit heater
I
Phone:( ) Fax: : ( .) Water heater
Fireplace
E-mail' dhritt(2wstoneb rid gehomesnw.com .Ramie
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 fee)
CCB lie.:110091 State surcharge(12%of permit fee)
` TOTAL PERMIT FEE
_`
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name:David Heldstab Date: f Z,/5113 ' Fee methodology set by Tri-Count Building Industry Service Board
t:l HuildingiaennitntMHC-Nermithpp.doc 10/01/09 440.46171(11rV2/COMM/wha)
Electrical Permit Application FOR OFFICE USE ONLY
Received
- City of Tigard /p/3 ( .`j ' Penn No.. ,•-/5 rX%7-C'C�a-419
1101 • 13125 SW flall Blvd.,Ti ard.OR 97223 Plan Review
('� /
g� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/Hy: Other Permit: 3ev+ / ,�3-GLn��
T I G A K D Inspection Line: 503.639.4175 Date Ready/By: ions: lii See Page 2 for
Internet: www'.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Z New construction ❑ Additionialteration/replacement
Please check all that apply(submit 2 sets of plans w/items checked below):
❑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 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® 1-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.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: Q ` �+ I OOHP or more. occupancy.
`�� ✓ 1 1 e iA/ �4W►�lfQ��lrlw7 ❑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.: l Project name:Arlington Heights — ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ur.rripi ion I tic,. I Fee. I 1 0110 I k
New residential single-or multi-family dwelling unit.
Includes attached garage_
Subdivision:Arlington Heights 1 Lot no.: CM, 1,0(10 sq.ft.or less k 168.54 4
Ea.add'I 500 sq. ft.or portion ' 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft) I 7-5,(r.,
Limited energy,multi-family 67.84
residential(with above sq.ft.)
Services or feeders installation.alteration,and/or relocation
200 amps or less 1(10.70 2
Z 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 I 59.36 1
Owner installation:This installation is being made on property that 1 own which is not 201 amps to 400 amps I 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
Z APPLICANT ❑ 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
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
dwelling,service and/or feeder
Phone:( ) Fax: : ( ) Reconnect only 67.84 2
E-mail dbritt(a)stonebridgehontesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s)or limited-
Business name:City Electric energy panel,alteration,or
Address: 55568 SW Schaltenbrand Lane extension.Describe: Page 2 2
City/State/Z1P: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 Dale: Plan review(25%of permit fee):
«!J rJ 1143 State surcharge(12%of permit fee):
Authorized signature: __ .. 'l'OTA1. PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within Hie
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I aOuiWmg■Permas\U.('-PemmApp.doc 10/01/09 441W61 Sill t/05/COM/WEB
III Building Division
Development Code Provision Review
T I CARD Residential Projects
Building Permit No.: H 6--r-e9 )/5 c 9
Project/Subdivision Name: � f r_.4. -6-7 • D , Lot #: (/`�
Site Address: /6.i(9a 6 �d J i�u�-- -
CWS Service Provider Letter:
Required:Yes ❑ No ,
Received:Yes ❑ No
Plans Routed:
Original Plan Submittal Date: /A/e)/3 Routed By:
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2°c' Revision Submittal Date: ❑ Site Plan Only Routed By:
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 Wjnes GL at(503) 718-2421 or aeyes @tigard-
or.gov)
Land Use C se No. AP2UC7(D_CM I
Zoning k—i
Setbacks: i ,
u/front i Rear �� Side .. Street Side ,U) Garage 2.0
[Maximum Building Height Actual Building Height f 30
l.1 Visual Clearance N/Pr
Er Easements
❑ Sensitive Lands Type: CANS Vet •CoYl dDf f rncei vt4 k1.1 e, haw ,
["Street Trees
"Protected Trees ti I Pr
Notes:
Original Plan: Approved Not Approved ❑ Date: 121 i l l t
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR RES.doc Rev.01/16/13
Engineering Review(contact Mike White at 503-718-2464 or MikeW @tigard-or.gov)
2 Actual Slope: ?—') %
Notes:
Original Plan: Approved,H- Not Approved ❑ Date: (C7
Z
Revision 1: Approved ❑ Not Approved ❑ Date: < <
Revision 2: Approved ❑ Not Approved ❑ Date:
d
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 Applicant
Okay to Issue Permit: Yes No ❑
Date Routed to Building
G°,/ 3 Mit
Page 2 of 2
1:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13