08-August (2) CITY OF TIGARD MASTER PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: MST2019-00294
Date Issued: 08/01/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BD12100
Jurisdiction: Tigard
Site address: 11959 SW SUMMERBROOK LN
Subdivision: SUMMERBROOK SUBDIVISION Lot: 4
Project: Summerbrook, Lot 4
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1469 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 22 Bathrooms: 3 Second: 1312 sf Garage: 674 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2781 sf Value: $373,405.28 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 3 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2781
Owner: Contractor:
_ WEE KLEY IOMES-ILC ---- --- -- WEVI ---- --- --------- Required Items and Reports(Conditions)
1905 NW 169TH PL STE 102 1905 NW 169TH PLACE SUITE 102 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 503-213-4415 PHONE: 503-213-4415
FAX:
Total Fees: $34,622.70
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. .1987 1.800.332.2344.
Issued By: 0 s_� •er- -- ',nature:
z./
ell ��
-. 13.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Build ng Permit Application
Residential 1 15, FOR OFFICE USE ONLY
ri� City of Tigard Date/BY 7 /7 7, / /
te47"�jpi_��S
■ 13125 SW Hall Blvd.,Tigard,OR 97223 n Pl �) --1/,?_s_ I Phone: 503.718.2439 Fax: 503.598.1960JUL Date/By:
► Seett_a_:).0/1......,06,,t......,06......,06,,t2.ti
I I G A K D Inspection Line: 503.639.4175 i , , Date Ready/By: / oris: 0 See Page 2 for
Internet: www.tigard-or.gov ell'I q.`C 1 it +r if I Noti d/Metliod: j �j'' Supplemental Information
131.J1LD NG 1 iV Sat
S Ui �. ,{t '<<.. .' . ,, . ,. v ,tib-, ,. t.. ... --.*yr t,�•_ #,,;.�vt
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION ' work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: „$3S+A;8btJ 373/4 b f""
❑Accessory building 0 Multi-family Number of bedrooms: 4 1
❑Master builder 0 Other: Number of bathrooms: 3
,�.;;. JOB SITE'INFORMATION AND LOCATIONy;, " Total number of floors: 1 34 Sc
Job site address:11959 SW Summerbrook Ln New dwelling area: 2781 square feet `3 1.
City/State/ZIP:Tigard/OR/97223 Garage/carport area: (g7l square feet‘14 l
Suite/bldg./apt.no.: Project name:Summerbrook Covered porch area: >WC square feet
Cross street/directions to job site:SW 121'Ave and SW Summerbrook Lane Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
,
Subdivision:Summerbrook I Lot no.:04 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 Home to be built-2781 SQFT 4 Bedroom,3 bath with 674 SQ Valuation: $
FT 3 car garage, Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑.TENAN ,",., Number of stories:
Name:Weekley Homes LLC Type of construction:
Address: 1111 N Post Oak Road Occupancy groups:
City/State/ZIP:Houston,TX 77055 Existing:
Phone:(503)213-4415 Fax:( ) New:
1 ❑ APPLICANT -'.CONTACT PER$( E ``.." BUILDING PERMIT FEES* 4
Business name:David Weekley Homes
`e . . (Please referto feeschedute) -_ . ',
Structural plan review fee(or deposit):
Contact name:Michele Schiedler
Address: 1905 NW 169th Place,Suite 102 FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP:Beaverton/OR/97006
Phone:(503)213-4415 Fax::( )
LAS'- ,,FE -S
E-mail:mschiedler@dwhomes.com OTOV0 QR P NET, . ,. - °y
a , 4 ;�, , c - ,,--,Ave ; Commercial and residential prescriptive installation of
it ,,, y4 7, CONTRA C OR + > V z
�.. .. ret,.-.7,--; �:�� .,°� _ � �...r. lift;. .:, roof-top mounted Photovoltaic Solar Panel System.
Business name:David Weekley Homes Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:1905 NW 169th Place,Suite 102 Solar Installation Specialty Code checklist.
City/State/ZIP:Bea erto OR/97006 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)213-4.15 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.:213653
/
Total fee due upon application: $201.60
Authorized signatu e: P0/ l_________) This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Michel, c d Date:7/16/19 *Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling .,m 1 FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.:
III13125 SW Hall Blvd.,Tigard,OR 97223 �U L ?019
Phone: 503.718.24 39 Fax: 503.598.1960 Associated permits:
1.l t,n{t 1) 24-Hour Inspection Line: 503.639.4175 'G1 i E,a�"` 1 t+ a •
® Electrical ® Plumbing El Mechanical
Internet: www.tigard-or.gov t l l!L;„`)iN( r iVI S1(;\i 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW YeS No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ® ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ® 0 0
3 Verification of approved plat/lot. ® 0 El
4 Fire district approval required. Name of district: . ❑ ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El
6 Sewer permit. ❑ 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ® El 0
9 Erosion control ®plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state Z ❑ ❑
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 ® El 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 ® El p
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- ® ❑ ❑
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. ® El ❑
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- ® p ❑
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 /1 ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ p
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 ® ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required Z ❑ ❑
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 ® El ❑
architect licensed in Ore.on and shall be shown to be a..licable to the .ro'ect under review.
__ _� JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ® ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® ❑ El
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. /1 ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ® El ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ® El ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑
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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicatiev t-=a, i V �.. FOR OFFICE ESE ONLY
City of Tigard + s.,? - Received Permit No.:
Date By:
111 ill
13125 SW Hall Blvd.,Tigard,OR 97223 1 y E�+ PlaReview
Phone: 503.718.2439 Fax: 503.598.1960 ,JUL 2 u 1 C
Datue.'By: Other Permit:
i c A I:t) Inspection Line: 503.639.4175 Date ReadyBy:` loris:
Internet: www.tigard-or.gov al ti l See Page 2 for
k Notitied/Method: Supplemental Information
Print name:Ken Puttman
", TYPE OF,WORK c '`
®New construction 0 Addition/alteration/replacementY
C`IAL"rrE"15t ttrLL11 L° 115E Ll ,
0 Demolition 0 Other: Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead,and profit.
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building Value:$
❑Multi family ❑Master builder ❑Other: RESIDENTIAL EQUIPMENT t SYSTEMS FEES*. ;.
For special information use checklist.
,JOB SITE ,'INFORMATION AND LOCATION Description p Qty. Ea. Total
Job site address: 11959 SW Summerbrook Ln Heating/cooling:
City/State/ZIP:Tigard/OR/97223 Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75
Suite/bldg./apt.no.: Project name:Summerbrook
Furnace 100,000+BTU(ducts vents) 54.91
Cross street/directions to job site:SW 121st Ave and Summerbrook Lane Heat pump 61.06
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:Summerbrook Lot no.:04
Flue/vent for any of above 23.32
Tax map/parcel no.:TBD Other: 23.32
DESCRIPTION OF WORK Other fuel appliances:
Water heater 1 23.32
New single family home to be built-2781 sqft,4 bedroom 3 bath home with Gas fireplace/insert I 33.39
674 sqft 3 car garage Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
® PRCIPERTI Wood fireplace/insert 23.32
` _.� WNER ❑;TENANT , ", Chimney/liner/flue/vent 23.32
Name:Weekley Homes LLC Other: 23.32
Address: 1111 N Post Oak Road Environmental exhaust and ventilation:
Range hood/other kitchen
City/State/ZIP:Houston,TX 77055 equipment 1 33.39
Clothes dryer exhaust 1 33.39
Phone:(503)213-4415 Fax ( )
Single-duct exhaust(bathrooms, 5
x ®''APPIICANT ';�� toilet compartments,utility rooms) \ 23.32
:'CONTA I�'>R O+i ° Auic/crawispace fans 23.32
Business name:David Weekley Homes Other: 23.32
Contact name:Michele Schiedler Fuel piping:
Address: 1905 NW 169th Place,Suite 102 $14.15 for first four;$4.03 for each additional
Furnace,etc.
City/State/Z1P:Beaverton/OR/97006 Gas heat puma
Phone:(503)213-4415 Fax::( ) Walllsuspended/unitbeater
Water heater
E-mail:mschiedler@dwhomes.com Fireplace '
- :` TINA b n; !Al Ran e Barbecue
Business name:David Weekley Homes
Clothes dryer(gas)
Address: 1905 NW 169th Place Suite 102 Other:
City/State/ZIP:Beaverton/OR/97006AttSkt::'
Subtotal
Phone:(503)213-4415 Fax:( ) Minimum permit fee($90.00)
CCB lic.:213653 Plan review(25%of permit fee)
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.
1:Building'.PermitslMEC_Perm tApp_040113.doe 440-4617T(IL 02,COM/WEB)
Electrical Permit Application . r-/ � t_' FOR OFFICE USE ONLY
City of Ti and i. r. Received
g I l i l_ l tZ ?Dig Date/13 : Permit#:
14 11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503 598.mot Date•B Related Permit 6.
,,,,,, Inspection Line: 503.639.4175 -g t t tx Ready Date/By. Juris. Fa See Page 2 for
Internet: www.tigard-or,gov '—ti,-....'!7.,_„,,,, ' ° Notified/Method: Supplemental Information
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current
• • 0 Marinas and boatyards.
CATEGORY:OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.1 I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fireum .
P P ❑Installation of 150 KVA or
' JOB SITE'''INFORMATION,AND'LOCATION.' ! 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job 4:6802004 Job site address: 11959 SW Summerbrook Lane I00HP or more. ❑"A","E "t-2","l-3",
City/State/ZIP:Tigard/OR/97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name:Summerbrook 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site:SW 121st Ave and Summerbrook Lane • FEE.SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:Summerbrook Lot 4:04 Includes attached garage.
1,000 sq.ft or less I 168.54 168,54 4
Tax map/parcel# TBD Ea.add'1500 sq.ft.or portion 3 33.92 107.76 I
' '. , ':liESCRIIrfjON OF WORK' , . Limited energy,residential
New single family home to be build-2781 sqft,4 bedroom 3 bath home with
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00
674 sqft 4 car tandem garage residential(with above sq.ft.) 2
Renewable Energy 0 Sec Page 2
® PROPERTY OWNER ', 0 TENANT' ' Services or feeders installation,alteration,and/or relocation
Name:WEEKLY HOMES LLC 200 amps or less 100.70 2
Address: 1111 N POST OAK ROAD 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: HOUSTON TX 77055 601 amps to 1,000 amps 301.04 2
Phone:(503)213-4415 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
El APPLICANT •': ' CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
' ; A
Fee far branch circuits with
Business name:David Weekley Homes above service or feeder fee,
7.42 2
each branch circuit
Contact name: Michele Schiedler B.Fee for branch circuits without
Address: 1905 NW 169th Place Suite 102 branch circuit
City/State/ZIP:Beaverton/OR/97006 Each add']branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)213-4415 Fax: :( ) Each manufactured or modular
67.84
dwelling,service and/or feeder
Email:mschiedler@dwhomes.com Reconnect only 67,84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Signor outline lighting 67.84 2
Address:2920 SE Brookwood Ave. panel,of a ationt(s)or limited-energyxeni0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)523-9060 Fax:(503)642-7925 Investigation(I hr min) 90.00/hr
Email:andreap@garnerelectric.coro Industrial plant(I hr min) 78.18;hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical L. .. 3 05 Suprv,Lic.: 3707S specificaily,listed('h hr min)
' ,EI.ECTRICAI::•PCRMIT.,FEES .
Suprv.Electrician signature,required: Subtotal:
Print name: Charles Garner Date: 6/4/2019 0 Plan Review Required(25%of permit fee):
o / I State surcharge(12%of permit fee):
Authorized signature: /7(` i TOTAL PERMIT FEE:
/ Thisermit application app tcafion expires if a permit is not obtained within 180
Print name: Andrea Phillips Da : 6/4/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I`,Building\Permits1ELC Per.miApp OLE ERE.doe Rev 06/17/2015 440-46 IST(II/05/COM,WEB
Plumbing Permit Applicat r •, � iy F
Building Fixtures2019 I:0li 011I( e t !,l 0\1.1
City of Tigard U L Received
ll 13125 S W Hall Blvd.,Tigard OR L‘11- l�f ��x ti v) Date/By
Permit No.:
: I Phone: 503.718.2439 Fax 50 § 1`{ ° Plan Review Other Penult No.:
Inspection Line: 503.639.4175 1e,i ."i" ' ).` ` DatelBy:
Y-
1 1 c;h.R D Date Ready/By: furls: Si See Page 2 for
Internet: www.ttgard-or,gov Notified/Method: Supplemental Information
. - TYPE OF WORK I FEE* SCHEDULE
.4 New construction ❑Demolition For special information use checklist
Description I Qty. 1 Ea. 1 Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
I CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
j C 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
1 ❑Accessory building 0 Multi-family SFR(3)bath 1 500.32 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) 1 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11959 SW Summerbrook Lane Catch basin or area drain 18.76
City/State/ZIP:Tigard/OR97223 Drytivell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: Page 2 87.55
Suite/bldgfapt.no.: Project name:Summerbrook Manufactured home utilities 50.03
Cross street/directions to job site:SW 121"Ave and SW Summerbrook Lane Manholes 18.76
Rain drain connector 18.76
j Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Summerbrook Lot no.:04 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
I DESCRIPTION OF WORK Backwater valve 12.51
New Single Family Home 2781 sqft 4 bedroom,3 bath with 674 sqft 4 car garage Clothes washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 1 25.02
181 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Weekley Homes LLC Fixture/sewer cap 25.02
Address:1111 N.Post Oak Road
Floor drain/floor sink/hub 25.02
Garbage disposal 1 25.02 25.02
City/State/ZIP:Houston TX 77055 Hose bib 2 25.02 50.04
Phone:(503)213.4415 ! Fax:( ) Ice maker 1 12.51 12.51
® APPLICANT 121 CONTACT PERSON Interceptor/grease trap 25.02
Business name:David Weekley Homes Medical gas(value:$ ) Page 2
Contact name:Michele Schiedler Primer 12.51
Roof drain(commercial) 12.51
Address:1905 NW 169th Place,Suite 102 Sink/basin/lavatory 4 25.02 100.08
City/State/ZIP:Beaverton/OR/97006 Solar units(potable water) 62.54
Phone:(503)213-4415 I Fax::( ) Tub/shower/shower pan 2 I 12.51 25.02
_ -._ UnnaI
..-,.
.___ .. . 25.02
E-mail:mschedkrgdwhoroes.com
CONTRACTOR Water closet 2 25.02 75.06
Water heater 1 37,52 37.52
Business name:Malmedal Plumbing
Water pipingDWV 56.29
Address:PO Box 207 Other: 25.02
City/State/ZIP:Banks/OR/97106 Subtotal
Phone:(503)324-0759 Fax:( ) Minimum permit fee: $72.50 f
•CCB Lic.:102535 /� --) I Plumbing Lic.no.:34-276PB Plan review (25%ofpermit fee)
1 State surcharge(12%of permit fee)
Authorized signature: 1�.✓� TOTAL PERMIT FEE
Print name:Cl. .bYil t<t� tk*--- M
6 Date: ty (� Thin permit application expiresif a pmit1a nottained withto ISO days
11 after it bas been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:tBuilding\PertnitsiPLMU-PermitApp.doc 10/01109 940-4616T(10,1021Co.WWEB)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
likig
T l a lz o Building Permit Review — Residential
Building Permit #: m S % p-0/ -- QD2`14
Site Address: i i q Sq S INf 6i1. e,r-bv--rs Lt _
Project Name: JrArvv br,k Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review ( q �j
Pr osal: U S�g. : e t J 78(9i
lla Verify address/suite#active in Accela. V In River Terrace: No ❑ Yes,River Terrace Review Addendum
Site lan Elements: [Gat sion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper L��, p aired trees with drip line and tree protection measures
yawn to scale(standard architect or engineer scale) E 'F tprint of new structure(including decks)and FFE
rth arrow 'ty locations&easements(required for new and additions)
LAS address,project or subdivision name and lot number idewalk/driveway approach
L plicant information(name and phone number) ation of wells/septic systems
lot dimensions and building setback dimensions d.t -et tree size,type and location
�are footage of buildings to be demolished reet names
',Lld,[E�xisting structures on site Ii orner elevations(2'contours if more than 4'diffe tial)
I` of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? lir es�ENo
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑4ANo
Ly' Clean Water Services-Service Provider Letter of platted prior to 9/10/1995):
R ed: ❑ Yes,applicant was notified L'7 No Received: ❑ Yes ❑ No
Public Faciliti mprovement (PFI) Permit:
Required: V Yes,applicant was notified ❑ Nod App_lie For: ❑ (Yes ❑ No,stop intake
�LCA and Use Case#: �-l1'� 11-° lj "' �l -�� 1 �` Zoning: 1 "J
equired Setbacks: Front: 2-0 Rear: 1.b Side: S Street Side: `S Garage: ZO
Building Height: Max.Height: S 0 Actual Height:
?Z
Wr Landscape A�r a: % tiNi Lot Coverage Max:
Entrance [Vt back no more than 8'from street-facing wall lid" Parallel to street or offset 45 degrees or less
Windows um 12%of area of all street-facing facades 11,5 4 1�/`
Garage at Garage door is behind widest street-facing wall V Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than 5'from�wallind there is a 12 sq ft.window above garage on 2nd floor.
[
Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
LJ Fire shingles -®—Q ZapSc t�ng-17- oR�ol'p chi _Gaffe;dip;ok"gam rrre of Do r —
iVisual
❑ Accent siding Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Clearance II Urban Forestry pan
[Diansitive Lands: ❑ YesIJd No Type:
LTJ'Conditions mel priorto issuance of builclin permit
No s: �i +-..u� ,p
y� ,.j 1 +s�SVO.tw
L Approved By Planning: _ Date: 7-IC-(if
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\BldgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: 77(c 7(7
Site Plans: #
Building Plans: #
Building Permit#: \'- nter buildingermit#above.
Workflow Routing: r�'lanning [ngineering Permit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
I
By Permit Technician: _ Date:
Engineering Review
L Slope at building pad: 14
Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes [No
�/ LIDA Facility on lot: CI Yes lfr o
LJ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
C Approved by Engineering: Date: &.5"--
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Re ' 'on Notice 3: Date Sent to Applicant: //
C Fees Entered: Wash Co Trans Dev Tax: LYYes ❑ N/A
Tigard Trans SDC: C�� CI N/A
Parks SDC: IWYes ❑ N/A
LIDA ❑ Yes 2'N/A
I <OK to Issue Permit
Approved by Permit Coordinator: %e Date: 2 V)
I
I:\Building\Forms\B1dgPermitRvw_RES_022819.docx