Loading...
Permit Support Document (160) ttir' City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT p 'v 144 = N1,,,,,40!/.4),i, R equest for Permit Action , goy .0) T I G A R f) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • ww8 ' it' ov(0/ 41, , ,, ' TO: CITY OF TIGAD �01 4.iiti r, R Building Division "` 4 13125 SW Hall Blvd.,Tigard, OR 97223 //?//7 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner EIVA-pplicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) ,3 2 t% 1 e,n ' 1 y, • 3 I Mailing Address: "1. M) M6'_;,1.,-AA iej Sul /co City/State/Zip: ( 1-H( -\ . De y7,1-39 Phone No.: SC)S- ( ?-c-9.-_ LI,S, PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): `=. CANCEL/VOID PERMIT APPLICATION. ►J REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). II INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: P `)-/--c9-‘)//,lQ -0d 3� f lU ai 2 Site Address or Parcel#: RS9Z0 &A../ Am.,'" Ci-1' Project Name: 1-6.f1(1.,, C C 3S Subdivision Name: Lot#: L 1 EXPLANATION: (.1,tt-�n , ,ei tx� _S r i-1. )&, e2077Ae___ "fi. '/ .,-620 3 2 3 Signature: A . Date: 11/hc/c 1 Aa Print Name: J el l ciII Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date i1 /s- /(p By Route to Records: Date % 4 /2 B Refund Processed: Date /2/2V./ By 407 Invoice Processed: Date By Permit Canceled: Date /2/2 VA By4' - Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_092314.doc ; -,' " TIGARD City of Tigard December 29, 2016 DR Horton, Inc. Attn: Emerald Weeks 4380 SW Macadam Ave., Suite 100 Portland, OR 97239 Re: Permit No. MST2016-00377 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8596 SW Schmidt Lp Project Name: Heritage Crossing,Lot 11 Job No.: N/A Refund Method: ® Check#223392 in the amount of$28,789.64. ❑ Credit card "return"receipt in the amount of$ . 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 to void permit and resubmit revised plans for this lot. Refund 100% of permit fees and SDC fees paid. Retain all plan review fees for plan review completed prior to request to void permit. If you have any questions please contact me at 503.718.2430. Sincerely, OF...NJ i` / ' 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 IN q 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 RequestforPermit 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: DR Horton, Inc. DATE: 12/21/2016 Attn: Emerald Weeks 4380 SW Macadam Ave., Suite 100 REQUESTED BY: Dianna Howse Portland, OR 97239 TRANSACTION INFORMATION: Receipt#: 407693 Case#: Date: 11/29/2016 MST2016-00377 Address/Parcel: 8596 SW Schmidt Lp Pay Method: CreditCard Project Name: Heritage Crossing,Lot 11 EXPLANATION: Per applicant's request to void permit and resubmit revised plans. Refund 100%of permit fees paid,and retain all plan review fees for review performed prior to request. UNDINFbIFM OL pp2 . . y r - s ca . , �� �4 ,,aim ' ` g� ' ,Deptionrom Recipt . .Y , ; R`.1 x3 f0Y t -" :.m ' 7�'yplel3gP 4it"tr-4r ' ld. ;3 1 r � jirt: 34 ��; E GBuilding Permit 230-0000-43104 $1,875.30Mechanical Permit Electrical Permit 230-0000-43102 300.99 Plumbing Permit 220-0000-43103 413.14 12%State Surcharge. 230-0000-43101 500.32 Info Process/Archiving Fee 100-0000-24001 370.78 230-0000-43135 72.50 Metro Construction Excise Tax 230-0000-24010 Tig-Tual School Construction Excise Tax 316.01 230-0000-24110202 Erosion Control Permit 100-0000-43134 Washington County Trans Dev Tax 100-0000-43134 386.40 405-0000-43320 8,278.00 Tigard Trans SDC-Improvement 415-0000-43300 Tigard Trans SDC-Reimbursement 5 317.00 415-0000-433011 9 Parks SDC Improvement/Neighborhood 71.00 Parks SDC Reimbursement 425-0000-43300 5,971.00 425-0000-43301 1,207.00 TOTAL REFUND: $28,789.64 \\ APPROVALS: SIGNATURES/DATE: /10 N If under$5,000 Professional Staff ti(�'v0 If under$12,500 Division Manager P'pIv -0,If under$25,500 Department Manager 9 • —=� If under$50,000 Ci Mana If �� (� �fy�'L� r ty g If over$50,000 Local Contract Review Board ,:I?OR TTISEI IARK SYST'E Am 5`ITRATION-VsE.,O LY I Case Refund Processed. I Date: I /7 B I:\Buildin. R �\ efunds\RefundRequest.doc x 12/21/2016 IICITY OF TIGARD RECEIPT 2 13125 SW HaII Blvd.,Tigard OR 97223 503.639.4171 Ti GARD Receipt Number: 408245 - 01/06/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00377 5�I D,!6-(A/et.-- P r $-28,789.64 7 V ,e-ed-7- C_O.6 65 Total: $-28,789.64 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 223392 DHOWSE 01/06/2017 $-28,789.64 Payor: DR Horton Total Payments: $-28,789.64 Balance Due: $28,789.64 Page 1 of 1 CITY OF TIGARD RECEIPT ;! 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD ""C: 4 N,6 197-1-- 1 .--&--S ESO T /1 —icl /2-E?4Eu} / -bZ-3 ri-e—T-}/Nth IReceipt Number: 407693 - 11/29/2016 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00377 Building Permit-New Construction 230-0000-43104 MST2016-00377 12%State Surcharge-Building $1,225.04 100 MST2016-00377 Wash Co -0000-24001 $225.04 Trans Dev Tax-SF Detached 405-0000-43320 $8,278.00 MST2016-00377 Tigard Trans SDC Improvement-SF 415-0000-43300 Detached $5,488.00 MST2016-00377 Tigard Trans SDC Reimbursement-SF 415-0000-43301 Detached $317.00 MST2016-00377 Parks SDC Improvement-SF Dwelling 425-0000-43300 (detached/attached) $4,356.00 MST2016-00377 Parks SDC Reimbursement-SF 425-0000-43301 Dwelling(detached/attached) $1,207.00 MST2016-00377 Parks SDC Neighborhood-SF Dwelling 425-0000-43300 (detached/attached) $1,615.00 MST2016-00377 DC Provision Review, SF-Ping 100-0000-43112 2e7-15MST2016-00377 Info Process/ArchivingL $2.00 �"� $90.00 " g (over230-0000-43135 $40.00 11x17) MST2016-00377 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 11x17) $32.50 MST2016-00377 Metro Const. Excise Tax 230-0000-24010 MST2016-00377 Tig-Tual School CET-Residential $316.01 MST2016-00377 230-0000-24102 $3,216.00 Permit Fee-Elect(per dwelling unit) 220-0000-43103 $338.14 MST2016-00377 Limited Energy 220-0000-43103 MST2016-00377 12%State Surcharge-Electrical $79. MST2016-00377 100-0000-24001 $49.58 Furnaces< 100K BTU 230-0000-43102 $46.75 MST2016-00377 Water Heater 230-0000-43102 MST2016-00377 Gas Fireplace $33.39 230-0000-43102 $33.39 MST2016-00377 Range Hood/Other Kitchen 230-0000-43102 $33.39 MST2016-00377 Clothes Dryer Exhaust 230-0000-43102 MST2016-00377 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $1$33.3916.60 Utility Rooms) MST2016-00377 Fuel Piping 230-0000-43102 MST2016-00377 12%State Surcharge-Mechanical $16.12 MST2016-00377 100-0000-24001 $36.12 SFR-Baths 230-0000-43101 $500.32 MST2016-00377 12%State Surcharge-Plumbing 100-0000-24001 $60.04 MST2016-00377 Erosion Control w/Development 100-0000-43134 $386.40 MST2016-00377 Plan Review 230-0000-43106 4ETft/A/' $467.61 4—— Total: $29,347.25 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 071063 PUBLICUSERO 11/29/2016 Payor: dr horton inc $29,347.25 Total Payments: $29,347.25 Balance Due: $0.00 Page 1 of 1 Building Permit ApplicationJ/�� )(915_,5--- AL, ,; 0 1 0 /Z 2//le, Residential !OR 111 I It I I ,I ()NI i ', City of Tigard Received ,�r� -� llr 13t2S SW Hall Blvd.,Tigard,OR 97223VIN Datr'0�` y 6 '1 f Permit No.'..it* -- Liar �'Y)3-7 7 Phone: 503:718.2439 Fax: 503.!598.1960 ' 1 ,y !'tan Ftrt it q r i Inspection Line: 503.639.4175 Date(ty: ~ J l .../C Other Permit:5( aar 2 -a )atr Ready R\" Jur%s '�, Internet: www.ti and-or.goo '�,rv�p.+ BI See Page i far g b C,j 3 4//l Matified•`Mettmd: 8uppkmentat Information TYPE OF WORK / t. li O ' 1'!•.- REQUIRED DATA:I-.AND 2-FAMILY DWELLING New construction 0 Dem SS 0„..sivc D' v„.,t,,t Permit fees*are based on the value of the work performed. 0 Otig�31 Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Q I-and 2-family dwellingValuation ) 0Commercial/industrial �, tf (� LyC _ - - 0 Accessory building 0 Multi-family Number of b s: S �r 1 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors;3 11`)-4.1 Job site address: 5. cS[� t � et �� ssw t C�� New da elling area: a�� square fret City/State/ZIP:Tigard, OR 97223 Garage/carport area:}'Std( j r square feet L Suite/bldg./apt.no.: Project name ' t� - „..e. // Iporch area: "`r`33� square feet J3 -Covered / c„,tri p Cross street/directions to job site: ',.1 Deck area, square feet g$S Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: L I Permit fees*are based on the value of the work performed, 0 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 SFR valuation: $ Existing building area: square feet New building area: square feet PROPERTY OWNER 0 TENANT Number of stories: Name: DR Horton Inc, Type of construction: Address: 4380 SW Macadam Ave Suite 100 Occupancy groups: • City/State/ZlP:Portland, OR 97239 Existing: Phone:( 503) 222-4151 Fax:( ) APPLICANT 0New: $ CONTACT PERSON BUILDING PERMIT FEES* Business name: DR Horton Inc. (Please refer to eeaeheduI) Contact name:Emerald Weeks Structural plan reviewfee(or deposit): Address: 4380 SW Macadam Ave Suite 100 FLS plan revie++ fee Of applicable): City/State/ZIP:Portland, OR 97239 Total fees due upon application: Phone:(503 )222-4151 X1107 Fax: :t ) Amount received; E-mail: esweeks@drhorton.com PHOTOA'OL'1 AIc SOLAR PANEL S'Y STEM FEES° CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: DR Horton Inc Submit two(2)sets of roof plan with connection details and fire department access,along with the 2011)Oregon Address:43$0 SW Macadam Ave Suite 100 Solar Installation Specialty Code checklist. Permit Fre(includes plan revie City/State/ZIP: Portland, OR 97239 review Phone: l 60.00 Phone:(503 )222-4151 Fax:( ) and administrative fees): State surcharge 112%of permit fee): 521.60 CCB tic.: 130859 , ter, Total fee due upon application: 3201.60 Authorized signature: # l ° ! ' This applicationexpires (. i t �, ,�� � � ,1, � .� ,� permit if a permit is not obtained within ISO days after it has been accepted as complete. Print name:It ? U{` 1 , ; t i /_..R_ i Date:2016 ”Fee methodology set by Tri-County Building Industry !�` , Service Board: I.BuildingPermits BLIP-RESPermitApp,doc 02.242011 440.4613Tt1 i 02:COM'WEB, Mechanical Permit Application 1 44.4 : ii 4 t ,i ii4.4A 4, tResshstst ,h,, F. - IC .1 City of Tigard 11115 SCV tiAii fticd, ittextd.(* 97221 SI -e`k 1 ,, t li,«F . ''' ' Ali. 11'1574'I --t4 , 7,, - ir rt.vw, 5t)1-1*244:” lawportion t roe: $0,1 09 417d VIk*:T'.1 a rust itstsits Iti '.1 )'\'1 ssh le %ist Pito 2 ftsr i s .1 irtititsrlI si ww.tipirti-to pri sksiiihist Melts sd Soffittrostitsi Ititstams-thos , , %, fret, /.-:///tIllertott • .:*art have•ti tut dre vallte ui the ottri / til0 New crwertrution 0 AddIttoo"alterurron'rePlatntri)%. r‘:.‘14)L : ‘13/ t1' p„..ri , ...Insitfttie the vsittv tits:tided iti Ow fteltICS14.10iLit nrechntical totornab,twpft100.labot,#,VrtfillItil, 0 Ok/rtooltrictu Doht'l CI- .4.1,kc v* , .,,:::::* 4:04'!.4444.4. AI/ I-and 2-1analy tilatiling 0 CormwallitalintrIal 0 Acetswrey butklInu . fir Vtet id"“ifonsitstion*nu nnettlen o.sluiti.tranily 0 Moter budder 0 Other - Intow 'T tde; 1 1L . . tort condiment/ nth Noe*fittest, g-L5,qc,, ot„„ 4 0, ,., ., ,, ! iI Ftlf11.443" IX),,(160 liTi...!into,/tn/// : harnICC t'"‘ S141v LIP Tigard,OR 97223 100.„009"Olt ., ,,.. uJ- Motebideprd " .r,0 ....f,leas h i AM; cro,,fit dnolp,la ji,th rme liwhook:to Irk/total Neter tratinho ht / i I 1 1 t o 1 1: lot beaten 1 nor ttne.not elons:t 1 -t; ottwak.tonnen.eh, . , --- ; Flionetni fur any or altho +.' .......* "-1 Other sortrin ES#44-11 I I-1 i -- „ - , . „,_, ; I flitter tort appliance " - 1 AN,rihippwrcel rol ---T-147471- 1 oas fireplace New SFR - ! iimaaee 1 21.12 lotion 4.441 '1 In . — A turd'pellet hove : It to 1 / Wood fireplacenor,/en : //1 r" f ---- - - — 4 honnewlent-iltur en 4 --/-- I- , ----- '. -- 4 s-- I fIn-strottatstistid t'Sbattst and veottlaritro: DR Horton Inc ___, NZWW' . K,„,,,t,,,ht...ci(iso.im,.t„,,,, 1 — — Add""4380 SW Macadam Ave Suite 100 ,..... / Stone duo crinust thothrhoors, / OirSI-tic lir:Portland,OR 97239 , ___.4 talk;rormwriottors,hoist)thorn/ ,,,,,,,23 1," ~ 1 Phone '503 1 222-4151 ray( , 1., , Athc vtassistris-tt Ism . -8 . 4 I2-• '- , '''., fir•o/f**0.11 romc DR Horton Inc. I i— $1,14/5 tor first lout.SA Al tor tact sidttitiurtsi , .... — 1 Gtoitteci ti 4: Emerald Weeks 1 , Vtitlil,i,ICC CIC t —-,_ 4 Adtkrss: 4380 SW Maca I , . Ave Suite 100 1 -,_. , _ ,. ... _ ,' (i40 iu,,airumt. 1 1. f_tri aii sitspersitsi row trettet / / , 7 -/- (£I1'S101'ill' Portland,OR 97239 :A''.''sr :''re — 4 i //r----4 Ib''''' 1503 ' 222- 4151 x110/ I.,,, r t i r ork,„trec ' '-- 'T I 443'4 4 I man 4.44sweeks€44drhorton,com ,. 44.44444-04e 4 I • ' — Otter fitortes,11,1411V i ;"'" 4 _ ,,,, . 6iiiri7;74)7-,7)7 4- AA0 iiiitiniA ji 41- . 4.„ .,.. ! , .. Subtotal / t / i of; Starr:711' Ag -.:01,i' 1Air, iv4 ci; ' 21 _ , j 2, -',„.. vh,wtrItum Pvinn ft.<(94003) [ --1/1411 rer:ICA t:',"-Of rerrou Inn I /, .. / . ; nk/ 7.74-S'--/ w i _____Cf:/ /) /*q.?fr''i 7C2,1"/ : ' Sole sn I'24/4 0 penult rho / I '''' _ ..ur I Pt-4) , . TOTAI pi:KNOTT FF1 i t li It4 :.? 4 , — -- 1144 permit-owls,sus*tArifrt it*sorra*is)104 uhtstara oft/oh orf/ 41**.*fin.**ltstwit attspiss4 Itft itaapit It nothorrien. • o oten. 1 J ' f..- ,,,r1f4,4,4 4100 ,3133Ft= 30 ,_,--4 ..-. T - r• _ 1 , -.,),./.-"^-.. iPrint rtetwo---- , 2 14,rh. . J 3 4.33$ ii,,,e,/ .VI .4,--- - ---------------0 t Electrical Permit A lication City©fTigardi '>ii ''' ' i' 1 , r3\i IN rk1 13125 SW Hatt Blvd,T igaM'5°0'13(598.1960 OR 97223 • `: 7(t� ; 303.718.2439 Fax: 303598.1960vi,,,vicisi,-To'' �; ,, Pe No.:/S a t,'Lt 3/ 7 i •r Inspection Line:503.639.4175 "A 7. `�r t T o` Permit Intern www.tigatd.orgov P G 0 gee 2In Supplemental Information ID®New construction 0 Additionfaitentritsgrepi. # Please cheek all that 1 PLAN REYIEw Demolition 0 Other: �r �1 ' apply is tit sets ofpla,s wltems checked below ❑Setviee ar feeder 400 amps or more } CATEGORY OF CONSIST }i' when the available fault meat ❑Minio s over ihra storios. ❑1-and 2-family dwellingexceeds 10,000 amps et 150 volts or ❑Minions and boatyards. 0 Commercial/industrial- 0 Accessory building less to d Or meds 14,000 "S buildings. ❑Muni-family amps for sll other installations.14, 0 Cornm -use ginculturat 0 Master builder --'JOB SITE INFORMATION ❑Other: oPuep,aop '"i1 8 AND LOCATION q rB Y system. larger Installation of 75 KVA or Job no.: Job site address: ,S--(S-L ❑Addition ofnew motor load of separately derived Ci /Stat 1 10013p or occupancy."1-2">"1-3 h' e/27Pi ❑Six or more residential units. ion 0Iie -we ❑Soppy Recreational than Suite/bldg./apt.no.: fana7i600. a for more Project Warne: ; s OHaatdouslocations 1�Serviex or leader 600 amps or more. nominal. Cross.street/directions to job site: t FEE SCHEDULE Dared,:;; K,,,II New resldeatial sm -single-or multi-family,dw®nit Subdivision: Includes attached e. Tax m 1 Lot no.: ' 1,00014 R°doss .r1� aP parcel no. i �� D En.add'/500 sq.$,or portion 19 OF wonx Limited withenergy,residential above ft. ill 7,00 IIIIIII/ Limited energy,mn16-family residential with above .,ft. ■ 75.00 Ell® Services or feeders installation alteration,and/or relocation 200 or lessna 0PROPER7y OWNER ' 0 TENANT201 amps inPs to 400 amps iiitimiam 100.70 _ 401 amps to 600 amps =® Address: 601 amps to 1,000 amps 3°1 ,,„. _® Adds tate/ZIP: Over 1,000 amps or volts--'tw Phone:( Tempore ices or feeders installation,alteration,and/or® ) pax:( ) Owner installation:This installation is 200 amps or kiss intendederssale,lease,This or made on property that I own which is not 201 amps to 400 amps exchange,according to ORS 447,449,670,and 701. `01 amps to 599 amps • 25°8 ®� Owner signature: ���® Date: Branch circuits—br new alteration or extension . ❑APPLICANT A.Fee for breach circlets with Wel ! 0 CONTACT PERSON dee for for rviceorfeederfee, each branch circuit Business name: DR Horton Inc IIIIIIIIIIIIIIII Contact name: Emery Wee S B.Fee branch circuits without service orfeeder fex.lFr=st Address: 4380 SW macs.am Ave branch circuit Each add/branch circuit ���© City/S t jp: Portland OR 97239 Miscellaneous IEach mauni service or feeder not included Phone:( ) - fachned or modular Iliminie dwaell smvice atM/or feeder E-mail: Reconnect only - Pump or irrigation circle � �® CONTRACTOR i • sign or oust lighting - Business Warne:: 4' (� l f G'� a Signal circuit(s)or limited-energy ■ Address: /, t „ ot'eXtens on 7 / �' ` Each additional ins, Won overallowable in an of ® 11111111111 City/State/ZIP: 4' <?- t�. Additional inspection(11>t mays ���: Phone:(3‘a iv 01Investigation(1 hr rain) f _ T-,5-;."....9 P�^ Industrial �� Fax:f C /+ plant(]which no ��f3 t� Inspections far w�h' 78.1$/hr �■ ' Electrical Lic.:. �7 s, ciffcal teh no fee is �L j/ Suprv.Lic.: hated %hrmin a 90.00/hr -. Suprv.Electrician signature,required: •Alk ECIRICAL now p� ----••� SnbJo Ar 4111111 totai: Date: Plan review(25%of lea) Authorized signature: //� State : 2111.11111111 IIIMIIIMIIIII surge(12%of permit fee): f,/ lIllMnill. This TOTAL PERMIT FEE r Date: penult app000tron expires if a permit is not obtained within 180 1 iBufldnall'ermne / * days after it has been accepted as cod �1-GPamitApp' Number of inspections allowed per permit. complete. aw-ac t set t 1ro5iconvtve8 ' Electrical Permit Application—City of Tigard Page 2—Supplemental Information ,Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: Fee for all residential systems combined: $�+75 n FEE SCHEDULEI Qty. 1 Each .D/J.v4 nescr3ptinn Renewable electrical energy systems: J Total µ 5a or 1esG Check Type of Work Involved: 100.70El 2 2 Audio and Stereo Systems* s.ctl to la kra 13 .sh 15.01 to_2.5 kva 200.34 ❑ Burglar Alarm Wind generation;systems in excess of 25 kva: + 25.01 to 50 kva 301.04 1 MC Garage Door Opener* 50.01 to 100 k,a 55_,226 ® stOtl kra(fee in accordance 2 Heating, Ventilation and Air Conditioning with OAR 1h-309-0040)tjtiatj> 552.26 System* Solar generation systems in excess of ZS kva: Each additional kva over 25 �' �3 _.....4__ on Vacuum Systems* ,,100„100kiu—no additional charge Other Solar additional inspection over allowable in any of the above Each additional inspection is charged at an hourly(1 hr min) nb-25?hr i Inspections for which no ice is COMMERCIAL WORK ONLY: ELECTRICAL hated t'.hr min) p(t.00 hr Fee for each commercial system: ELECTRICAL PERMIT FEES (SEE OAR 918-309-0000) $75.00 Subtotal(Enteron Pagel). ” Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n C• lock Systems ❑ D• ata Telecommunication Installation 0 Fire Alarm Installation n HVAC ri Instrumentation ❑ Intercom and Paging Systems ri Landscape Irrigation Control* E Medical O Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling C Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I_:8uildin}Peirrn f?LCPrumnApp LLR ERE,u<>c Fte uti 1'aal PlumbinE Permit Application Building Fixtures ' I OR 01 I It E (SI: 0\1_1 of Tigard Phone: 503.718.2439 Fax; 503.598.1960 111;1 ' a 13125 SW Hall Blvd.,Tigard,OR 97223 Revised pwmit No.: SS�- 1 7, r 10:�It a Inspection Line: 503.639.4175 ' • '� tither Permit No.. Internet: www.tigard-or.gov gov '=ate Resdy/By: aai.: R Sac 3 for e Notified/Method: Sappk mllarirna8oa ,.' :I, TYPE OF WORK. c6 ❑New construction j]Demolition (9 For spade/Information useehaealistt ❑Addition/alteration/replacement 0 Other. .tit:V1.3 ert n j Q.X. ( Ea j Total CATEGORY�C s{,�p�,i! ,j LL aatily dwellings(includes 100 ft.for each utility connection) Ol!1S7RUIC1tON c i AC reek(1)bath 312.70 Ttil0 ' SFR(21 ID 1-and 2-familydwellmg ommercalindus t‘� a437.78 0 Accessory building 0 Multi-family SFR(3)beth 50032 Each additional bath/kitchen 1 23.02 0 Master builder 0 steer; Fire sprinkler(_,_sq.ft.) Page 2 • JOB'SPII361FQR6U!AVON:AND LOCATION : Site utilities Job site address: Eckcefiv ,5l././ ,,1_b tA1 1, Catch basin or area drain 18.76 City/State/Z1P: ICCr f piyv ell,leach line or trendy drain 18.76 J Suite/bldg./apt.J Footing drain(no.linear R:,_,_ Page 2 dB apt.no.: ' Project name: v* (.�V6 t 11 f Manufactured home utilities ' Cross Ansel/directions to job site: 50.03 Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no linear R.:_J Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: Water service(no.linear ft.:_,J Page 2 Lot no.: i t Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 r: DESCRIPTION OF-WORK Backwater valve 12.51 .. Clothes washer 25.02 1 Dishwasher 25.02 ' Drinking fountain 25.02 Ejectors/sump 25.02 ❑�PROPER ! OW,I�ER '`1 [� 7TownExpansion tank 12.51 Name: \.--)Z.,Vri Fixture/sewer cap 25.02 Address: c61/4.-) Floor drain/floor sank/hub 25.02 . wt.�t./Y+ " Garbage disposal 25.02 City/StatJLi P: �Q„r��- 1 tn_nO' C ( L' �L Hose bib Phone `~ ! 2S,OI a -41 , j Fax:( ) Ice maker 12.51 0 APPLICANT 0 CON'1'AC? PERSON Interceptor/grease trap 25:02. Business name: \-kuo- _ 1 Medical gas(value:$ .) Page 2 Contact name: V..yl, 1 >1 ' 1��� � r Primer 12.51 Address: '/ ' ''t Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State2lP: Solar units(potable water) 62.54 Phone:( ) Fax: ( �r), Tub/shower/shower pan 12.51 I E-mail: Sl��;r 46 . Ikv V1. aL/1l 'i ) ,cowl Urinal 25.02 -CONTRACTOR r Water closet 25.02 Business name:EDWARD MULLEN PLUMBING Water heater 37.52 Address:1601 SE RIVER ROAD Water piping/DWV 56,29 Other: 25.02 City/State/ZIP:HILLSBORO,OREGON 97123 Subtotal Phone:(503)640-0113 Fax:(503)640.4483 Minimum permit fee: $72.30 CCB Lic.:94689 Plumbing Lia no.:34-260PB Plan review (25%of permit fee) State surcharge(12%of permit fee) , Authorizedsignature: , 41111P�I� TOTAL PERMIT FEE - Print name:RAY MULLEN f Date: . This permit sweeties expires ifs permit is act obtained within t110 days after it hu area accepted as ample*. 'Fee methodology set by Tri-County Building industry Service Board. I_teadirsPamit►VLMthpmaaApedoe to'oIe9 440.4alatooro2KOMlweB) City of Tigard 111 m III COMMUNITY DEVELOPMENT DEPARTMENT V C) / t:''''', BuildingPermit Review _ ResidentialTIGARD Building Permit #: �► Site Address: SC7 �, SW h/r►i sc � d-r- LOoe Project Name: ci4ft 3 CfrOast name of owner) Lot #: / Planning Review Proposal: N' i F A RI Verify site address/suite#exists and active in permit system. jt River Terrace Neighborhood: x No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan Site plan must be on 8-1/2"x 11"or 11 x 17"paper ��stmg structures on site /Drawn to scale(standard architect or engineer s pe) �flf or�elevations of w structure(including decks)with finishedNorth arrow ['Utility locations (required for new,may apply for additions) /Site address,project or subdivision name and lot number Applicant information(name and phone number) f�'dcation of wells/septic systems XLot dimensions and building setback dimensions B£of ction measures ees to be retained with drip line,and tree VLot area,building coverage area,peejge of coverage and %Street tree size,type and location impervious area(applicable if R-7, y� R-25& �{ R-40) Street names Property corner elevations(2 foot contour lines if more than 4 foot differential XClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ yeS ❑ No Public Facilities Improvement(PFI) Permit: Required: %Yes,appli t as notified ❑ No SApplied For: ❑ yeS ❑ No,stop intake 6 X Land Use Case#: 1/„S —000 /J ' T ry ao,6 .- 0000k iel Zoning: _ Z gr Required Setbacks: Front , Landscape Requirement: p � o Rear � is Side Street Side Garage 4111 0 Lot Coverage Maximum: 2.49 Building Height: Maximum Height `� Visual Clearance g Actual Height Easements -5"Sensitive Lands: ❑ Yes ❑ No Type Urban Forestry Plan 0 Conditions "Met"prior to issuance of building permit Notes: CO h dA fiQ n jbe m�.•- �f. Prl 0 ` I f Ili i /- Approved By Planning: MO ''',w:%- le:/10,t17 Cru-4 Date: ` /Z G i / 4:::7 Revisions (after Building Submittal only) Revision 1: ❑ A roved Reviewer Date pp ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES_091216.docx Building Permit Submittal Original Submittal Date: # 7 6 Site Plans: Building Plans: # Building Permit#: nter building permit#above.g Workflow Routing: � ul Tannin engineering [�, Permit Coordinator ding Workflow Sign-off: L � -- (^ _ ..� include notes from planning review) off for Planning Route Application Documents: L�'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: ,g" Date I By Permit Technician: ri .49 Engineering Review Slope at building pad: 4,9 Conditions "Met"prior to issuance of building permit Easements (encroachments)per engineering conditions of approval and plat Z.Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No Date: 0 NOT Approv-• b Engineering: p 413/Mrarifirifligeo. „4./..A„,, Notes: :,- �� ��_, - �./�� dill Date: 9,- /J , Approved by Engineering: Date Revisions (after Building Submittal only) Reviewer Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review 0 Conditions"Met"prior to issuance of building permit `?E) G����(/ .7 1 p / - ) / Date: Approved,NOT Released: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Taxes 0 N/A Tigard Trans SDC: Yes 0 N/A Parks SDC: Yes 0 N/A OK to Issue Permit Approved by Permit Coordinator: / Date: l I I:13uilding\Forms\BldgPermitRvw_RES_091216.docx