Permit III CITY OF TIGARD MASTER PERMIT
s. COMMUNITY DEVELOPMENT Permit#: MST2014-00029
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i t Date Issued: 03/31/2014
T[c�r\R.L� g f / Parcel: 2S109DA18300
ri734 kr ( Jurisdiction:
Site address: 12719 SW WILLOW POINT LN
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 112
Project: Arlington Heights No. 3, Lot 112
Project Description: New SF. 3/30/14: Reprinted permit to include(1)A/C unit. Placement of A/C unit must comply
with manufacturer's clearance requirements.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 1591 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 33 Bathrooms: 3 Second: 1636 sf Garage: 568 sf Front 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3227 sf Value: $374,956.04 Rear 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100
0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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
Fum<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'I 500 sf. 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio 8 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 3227
Owner: Contractor:
STONE BRIDGE HOMES NW LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD ST#100 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 2 Geo tech report required prior
to footing inspection
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $22,814.62
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a cop - - • . or direct questions to OUNC by calling 503.23 .1987 or 1.800.332.2344.
Issued Btl+/ __,i�— �_�� Permittee Ignature: /
0111011710,
by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application //�� FOR OFFICE USE ONLY
City of Tigard , DateBed IQ PemlitNo.: -
pp
13125 SW Hall Blvd.,Tigard,OR 97223 `� Y S t "Isom
Phone: 503.718.2439 Fax: 503.598.196 Plan Review Other Permit:
��" Date/By.
Inspection Line: 503.639.4175 , 0 -1 Date Ready/By: Juris ® See Page 2 for
TIGnR[) t;
Internet: www.tigard-or.gov ��N 30 �� Notified/Method: Supplemental Information
`� t� i
TYPE OF WORK \ V� ++ 11-ex,�`` COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
G rl` Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/rep �I�, lf performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46, 75
Job site address: 4,7 0 5 CVt,(10,A A i R -f LN . Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T' c .LA Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances: _
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
talc (1N) alc- +0 �r'CI WGI itsei, ltt * `'UT7.210/tf ei�:a-fireplace 23.32
J / Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: _ 23.32
— Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater _ _
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: •t i/VN--�T'Jrt 7A MECHANICAL PERMIT FEES*
Address: Subtotal __.. 1{6_ '75-
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee) _
State surcharge(12%of permit fee) •
CCB lic.: TOTAL PERMIT FEE ,, j
This permit application expires if a permit is not obtained within 180
�Z • days after it has been accepted as complete.
Authorized signature: cj' ...,2___ �' �J� .0 • Fee methodology set by Tri-County Building Industry Service Board
Print name: ✓ Date: 6/3d/y
I:\Building\Peneits\EC_PermitApp_0401I3.doc 440-4617r(I1/02/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.
I:\Building\Permits\MEC_PermitApp_040I 13.doc 2
CITY OF TIGARD MASTER PERMIT
II s. COMMUNITY DEVELOPMENT Permit#: MST2014-00029
T r G A R p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2014
Parcel: 2S 109DA18300
Jurisdiction:
Site address: 12719 SW WILLOW POINT LN
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 112
Project: Arlington Heights No.3, Lot 112
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 1591 sf Basement 0 sf Left: 5 Parking Spaces 0
Height: 33 Bathrooms: 3 Second: 1636 sf Garage: 568 sf Front 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors Yes
Total: 3227 sf Value: $374,956.04 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains. 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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 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 add9 500 sf: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener. N All
Other. N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3227
Owner: Contractor:
STONE BRIDGE HOMES NW LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD ST#100 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 2 Geo tech report required prior
to footing inspection
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $22,762.26
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. questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued y: __�— Permittee Signature:
C. . fib? '1It�►0 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.
CITY OF TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT Permit#: SWR2014-00018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2014
Parcel: 2S109DA18300
Jurisdiction:
Site address: 12719 SW WILLOW POINT LN
Project: Arlington Heights No.3,Lot 112 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 112
Project Description: Sewer connection for new SF
Contractor: Owner: STONE BRIDGE HOMES NW LLC
4230 GALEWOOD ST#100
LAKE OSWEGO, OR 97035
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 03/31/2014 $4,800.00
Sewer Inspection-Residential 03/31/2014 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: 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 503.23 987 or 1.800.332.2
Issued By: Permittee Signature:
al :Ft1101°5 by 7:00 a.m.for the next available inspection date.
This permit c. • 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 FOR OI I i( I. I "1. O\l \
Received
ilill _ City of Tigard A A/t DateB o fit{ � ll Permit No.: 4,1, /1_15043-9
a 13125 SW Hall Blvd.,Tigard,OR 97223 MAR Plan Review ,� �!
Phone: 503.639.4171 Fax: 503.598.1960 DateB : �" Other Permit
�� ■ so i-410
TIGARD Inspection Line: 503.639.4175 CITY VC 1 i`_ Date Ready:y: tuns ® See Page 2 for
Internet: www.tigard-or.gov r.l,t���n�_ M�� Notified/Method: eQ �O // Supplemental Information
C5)Q .-244gC- - C �,�L.
TYPE OF WORK REQUIRED DATA I-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 applic ion.
® I-and 2-family dwelling ❑Commercial/industrial
Valuation:374j %r
❑Accessory building 12 Multi-family
Number of bedrooms: 3
0 Master builder ❑Other: Number of bathrooms: -2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: 7/q SW WI 1,40W POINT (Al. New dwelling area: y1. ,� i?"� a feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 5611,• square feet _
Suite/bldg./apt.no.: Project name:Arlington Heights Covered porch area: J43u ii5quare feet I b
Cross street/directions to job site: Deck area: • square feet
Other structure area:. square feet ''2;
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Arlington Heights Lot no.: I l'f,. 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
New building area: square feet
® PROPERTY OWNER 0 TENANAIIIM' 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:
° ❑ 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
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@stonehridgehomesnw.com
CONTRACTOR
Business name:SEE ABOVE BUILDING PERMIT FEES*
Address:
(Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP:
FLS plan review fee(if applicable):
Phone:( ) Ilay:( )
Total fees due upon application:
CCB lie.:173318 oG
Amount received: 75
Authorized signature. permit application expires if a permit is not obtained
���11L���///��` within 180 days after it has been accepted as complete.
Print name: DEI1 DRE e,Ftrrr Date: 3/0/144 * Fee methodology set by Tri-County Building Industry
Service Board.
1.\Building\Permits\BUP-RES PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures '/ FOR OFFICE USE ONLY
City of Tigard
Date/By: p�)io Iy PermitNo.: �d�_! -€ c9
13125 SW Hall Blvd.,Tigard,OR 97223 y' ICJ
Plan Review !,f COIT Received
r1FP
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: �f'CJt-i.r
T I GARD Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK tQfl tr-nr(M ?$!!£ FEE* SCHEDULE
®New conslrUCtion ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath ( 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
.1 11,S1 E INFORMATION AND LOCATION Site utilities:
Job site address:
SW WL.0 VW 1'H 01 Nrr UN Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Arlington Heights Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Arlington Heights I Lot no.: l ,,, Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New,Single Family Residential Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Stone Bridge Homes
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65th Avenue#505
Garbage disposal 25.02
City/State/ZIP:Lake Oswego,OR 97035 Hose bib 25.02
Phone:(503)387-7577 Fax:(503)387-7615 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:SEE ABOVE Medical gas(value:$ ) 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: dbrittr)stonebridgehomesnw.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Jardine Plumbing Water piping/DWV 56.29
Address: PO Box 186 Other: 25.02
City/State/ZIP: Subtotal
Estacada,OR 97023
Phone:(503)351-8532 Fax:(503)6302882 Minimum permit fee: $72.50
CCB Lic.: 108747 Plumbing Lic.no.: 93-1185347 Plan review (25%of pt permit fee)
State surcharge(12%of permit fee)
Authorized signature: �..;(/i TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: lay Jardine Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
]?.Building'Permits..PLMU-PermitApp.doe 10/01/09 440-4616 r(10/02iCOM/WEB)
•
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received 1
Uate/BY: O) {'(�//(� ��, 9 Penni[Nn.: �T �, �UGQa
• 13125 SW Hall Blvd.,Tigard,O Y� V
0 Plan Review .5wu0 ,/D^�'g
Phone: SU3.639.4171 Pax: 50writ, Date/By: Other Permit: �7 C�V/
TIGARD Inspection Line: 503.639.4175 MAR 1 0 2014 DateReady/By: )°.;s: ® see Pugel for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
II
TYPE 1 ' ts ) COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
®New construction ❑Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special ity`ormation trsc chcckh.,1.
❑ Multi-family ❑Master builder ❑Other:
Description Qty. I Ea. Total
JO ITE INFORMATION AND LOCATION Heating/cooling
(2' ' PONT . Air conditioning
Job site address:
SW (requires site plan showing placement) 46.75
City/State/ZIP:Tigard,OR Furnace 100,000 BTU(ducts/vents) t 46.75
Furnace 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
Flue/vent for any of above 23.32
Subdivision:Arlington Heights Lot no.: 112- Other: 23.32
Tax map/parcel no.: Other fuel appliances
� -, DESCRIPTION OF WORK Water heater ( 2332
Gas fireplace k 33.39
New,Single Family Residential 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
® PROPERTY OWNER Chimney/liner/flue/vent 23.32
❑ TENANT Other: 23.32
Name:Stone Bridge Homes NW,LLC Environmental exhaust and ventilation
Range hood/other kitchen
Address:16869 SW 65th Avenue#505 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 El CONTACT PERSON Attic/crawlspace fans 23.32
Business name:same as above Other: 23.32
Fuel piping
Contact name: Deirdre Britt S14.15 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 l
Fireplace
E-mail: dbrittnstonebridgehontesnw.com Range 1
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
Minimum permit fee($90.00)
Phone:(503)667-5595 Fax:(503)491-8252 Plan review(25%of permit fee)
CCB lie.: 110091 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
�� — This permit application expires if a permit is not obtained within 188
Authorized signature: days after it has been accepted as complete.
Print name:David Heldstab Date: 1 * Fee methodology set by Tri-County Building Industry Service Board
1:`,.Building'Permits\MEC-Pcrmiulpp_doe 10/01/09 440-0617f(I1/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
p�_P
Cl of Tigard - i I Received Permit No.: C1
IIIg Date/By: ►4 .-S 1ISTai,<<l-0aaa 7
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
a Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:��K liif_ j/g
T 1 GA R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notitied/Method: Supplemental Information
•
TYPE l 11i ' i.)ik � !):4 . sp� s : : ,s 4
`6:.:'
®New construction ❑ Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other: where Service or feeder 400 amps or more ❑Building over three stories,
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION 7.I!,MWO 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
a ❑Emergency system.
"r .,, SI ,' A . e - . � larger separately derived system.
a� , : �`°; ,. :�,� w > ) ,. � . : 0"A","E","I-2" "1-3",
Job no.: libb Job site address: ctA)WI'WW POINT L,N, 100HP or more. occupancy.
❑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/bldgJapt.no.: Project name:Arlington Heights ❑Service or feeder 600 amps or more.
Cross street/directions to job site: Description
Qty Fee Total ••
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision:Arlington Heights Lot no.: ((Z 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK -_ (with above sq.ft.) - ( 75,60 2
Limited energy,multi-family `
residential(with above sq.ft.)
67.84 I 2
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
tattinglgil*#,COW4it,,:iVigPFM:fatfiii0A4**1120111.D above service or feeder fee,
7.42 2
Business name:SEE ABOVE Fee branch branch circuit
B.Fee for branch circuits
Contact name: Deirdre Britt without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: dbritt @stonebridgehomesnw.com Pump or irrigation circle 67.84 2
, , CONTRACTOR Sign or outline lighting 67.84 2
Business name:City 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
Phone:(971)404-1714 Fax:(503)625-3052 inspection 66.25
investtigattion ion 66. 5
ga 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 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1a 1luilding\Permits`.IELC-PemtitApp.doc 10/01/09 440-7615-(11/05,COM/Wl/l3
Building Permit Number: it ora i CI—6669-9
_ " Building Permit Review
Residential Projects
TIGARD
ia-7 11
Site Address: S W ii0; f f v P4 . C e, -
.Verify site address is valid.
Project Name & Lot #: P r 1'i n cl --0 - -eLq v - S L o4 I ) a
Clean Water Services—Service Provider Letter: (lot platted prior to 9/10/1995)
Required: Yes ❑ No l Received: Yes ❑ No ❑
Site Plan Elements:
Site plan must be on 8-1/2"x 11"or 11"x 17"paper DiThree(3)copies of site plan
Drawn to scale(standard architect or engineer scale) WNorth arrow
Sap and tax lot number,site address,project or subdivision lkFootprint of new structure(including decks)with finished
name,lot number,and zoning floor CV/Applicant information(name and phone number) PLot and building setback dimensions
❑Property corner elevations(2 foot contour lines if more than ❑Lot area,building coverage area,percentage of coverage and
4 foot differential) impervious area.
Utility locations ZLocation of wells/septic systems. 1.J/?
xisting structures on site 1--J/A )Surface drainage
Street names WStreet tree size,type and location
'Erosion control(including drainage-way protection,silt fence grExisting trees to be retained with drip line,and tree J\J/�
design,location of catch basin,etc.) protection measures
Planning Review
cS1 Land Use Case Number: 5 L,LB a o)to - 0 0 0 0 i
I l
Zoning: R- 7
lxj Setbacks:
Front I5 Rear _ I S Side 5 Street Side I 0 Garage ,A. u
I41 Landscape Requirement: 07 0
rA Lot Coverage Maximum: 8 %V �o - J 5$ riS m
0 Building Height: Maximum Height 3S Actual Height 33
W Visual Clearance
• Easements
Igi Sensitive Lands: ❑ Yes Type t• ' fk
NUrban Forestry Plan
❑ Conditions Satisfied
Approved by: C4 , a . c,..- ,_ Date: 3 - 0 - t f-
Notes:
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
I:\Building\Forms\BldgPerm itRvw_RES_123013.docx
Building Permit Submittal
Original Plan Submittal: Date: ZIICI1il By:
Site Plans: # 3
Building Plans: #
Create Case Record#: Enter`case#above for Building Permit Number.
Workflow Routing: 01/tanning Engineering 8J
Permit Coordinator 'Building
Workflow Sign-off: 0214.n-off� for Planning staff,including notes from planning review(page 1)
Route Application Documents: [ Engineering. (1)copy of permit application,(1) site plan,(1) building plan and
,tiginal plan review routing form.
LJ Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: Date:
Notes:
/
Engineering Review—reviewed by: h•,.; rt y i-1i 2
Actual Slope: QUO,
❑ Conditions Satisfied
Notes:
Approved by: IL,_ Date: n> -- r c - ii
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
P it Coordinator Review
onditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Appli
Okay to Issue Permit- Date: /�//�
I:\Building\Forms\BI dg Perm itRvw_RES_123013.docx
toDi STONE BRIDGE OBE : 1483
`J HOMES NW Iri LOT: 1220
4230 GALEWOOD ST. SUITE 100 REcEil f / /14
LAKE OSWEGO,OR 97035 . PROPERTY: ARLINGTON
.
(503)387-7577 ;,;;AR 1 0 2014 HEIGHTS
CITY: TIGARD
CITU. SCALE: 1"=20'
PLAN No.: 304A
I STANDARD ELEVATION
.h
s s. ,m
�
y TRACT N
8, C• RED
-ATIO
3 �� 9 e,
\f, 2,1 8Q.FT. N�9.
\
y Am
\ \( EEATH
e'9\R v� A
1 \ t
s
�ue !! \ m l#6": ..
" e
C`I''V k\ , ,
.'tr 11,,.o
J
3 /
\*...\\\ i ojt0, :`//5 i
LOT 113 . :-.--. •� • ::.
\ A \ 3 .yy GPI;..:.j- �.
÷.
4?()
` O
�\ CITY OF TIGARD
Approved,�\ PP d by Planning
\z , Date: 3 -, u -, `1
Initials: c c c -COVERAGE LEGEND
LOT AREA 5,241 SQ. FT. II
BUILDING AREA 2014 SQ. FT. —STREET TREES
PERCENTAGE 35% r,as4-e.Y n Red bt,tcl
CcrG, s Cc_nader,s,s
NOTES:
ALL GRADE AND PROPERTY LINE< ARE ESTIMATES OF CURRENT LOCATIONS.
ALL DIMENSIONS AND SQUARE FO:°:STAGE ARE APPROXIMATE FIGURES.
ALL RETAINING WALL HEIGHTS ANb LOCATIONS ARE ESTIMATES.
THEY MAY VARY AND BE SUBJECT TO CHANGE. LOT 0112
DRIVEWAY
SS REET IGHTS, AND FOT ER SITE CONDITIONS. UTILITY BOXES, 5,241 8q. ft.
1.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12719 SW WILLOW POINT LN, TIGARD, OR,
97224
Residential - Master Permit
199 Electrical final
FAIL
MST2014-00029
Herb Stabenow
Back outlet on deck not covered by proper cover--garage space above the garage not
GFCI protected -several liters upst.not AFCI protected
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12719 SW WILLOW POINT LN, TIGARD, OR,
97224
Residential - Master Permit
199 Electrical final
FAIL
MST2014-00029
Herb Stabenow
Upstairs lites not excerpted from AFCI protection see OESC amendment from jan 2013
Violation Summary:
Inspector Contractor