Permit CITY OF TIGARD MASTER PERMIT
II ' • COMMUNITY DEVELOPMENT Permit#: MST2019-00432
T I GAR p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2020
Parcel: 1S134DB12900
Jurisdiction: Tigard
Site address: 11349 SW ELLSON LN
Subdivision: BRIGHTWOOD SUBDIVISION Lot: 1
Project: Brightwood, Lot 1
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1193 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1758 sf Garage: 1319 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2951 sf Value: $425,654.33 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains. 0
Tubs/Showers: 2 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
Other Fixtures: 0
Drywell-Trench Drain: 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
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'I 500 sf: 7 201-400 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 2951
Owner: Contractor:
STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $35,487.07
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 requir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 2-00 90. ou may obtai of rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: R Permittee Signature: .
/>-"
Call 503.639.4175 by 7:00 a.m.for the next available inspectiofi 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.
#r21 5w'
Building Permit Applieatio ECEIVEC
Residential FOR OFFICE USE ONLY
Cityof Tigard DEC 0 3 2019
Received
Date/Bv J�/-3 /9 Pumit N t,i 7 /9 e Oii q .
II 44, 13125 SW Hall Blvd.,Tigard,OR 9720ITY OF TIGARDli Plan Review ,, // ii %J
Phone: 503.718.2439 Fax: 503.59 •then P �
bit DING DIVISION Date/By: l y e) aof?_ 03ro
t'I Ci A it t) Inspection Line: 503.639A175 Date Ready By: y? /ins: El See Page 2 for
Internet: www.tigard-or,gov Votifie eth / / J/ Supplomental Information
i,f OF.=WORK w REQUIRED DATA 1 A 2;FAA 4ILYDWELL1NG "
®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 roft fo the
CATEGOR'1 OF CONS IP,F.1ION'i ,6,._. '' ork indicated on this application.
® I and 2-family dwelling ❑Commercial/industrial V .a1Os.�G�� S.
❑Accessory building CI Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:, j "3
Total number of floors: L V f o
.IOB BYTJ INFOR114A TI®N AND LOCATION 1
Job site address: 1049 S'W eusoN 1,14. New dwelling area: 2g5-0 square feet I 715
City/State/ZIP:Tigard,OR Garage/carport area: 13/9 square feet _{3
I\
Suite/bldg.lapt,no.: Project name: Covered porch area: —.15 . square feet
Cross street/directions to job site:SW North Dakota&SW 114th P1. Deck area: ... square feet
Other structure area: square feet
ItA, A C3NIMER+C'AI'USE C73E V
Subdivision:Brightwood Lot no.: I 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 residence Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER L. 't WANT Number of stories:
Name:Stone Bridge Homes NW,LLC 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)387.7615 New:
( is APPLICANT ❑ CONTACT PERSON . BUILDING PERMIT FEES,""-,-.: /a
Business name:Stone Bridge Homes NW,LLC lP �ereJerrnfreschrdule} „ -.,mm-
Structural plan review fee(or deposit):
Contact name:Deirdre Britt
FLS plan review fee(if applicable):
Address:same as above
City/State/ZIP:
Total fees due upon application:
Phone:( ) Fax::( )
Amount received:
E-mail:dbritt@stonebridgehomesnw.com rehomesmv.com ,IIUTOVOLTAIC SOLAR PANE)(.,.BYS'I'EMPf 1
Commercial and residential prescriptive installation of
CONTRACTOR • roof-top mounted Photovoltaic Solar Panel System_
Business name:Stone Bridge Homes NW,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:4230 Galewood St,Suite 100 Solarinstallalion Specialty Code checklist.
City/State/ZIP. Lake Oswego,OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)387.7577 ( Fax:(503)387.7615 State surcharge(1240 of permit fee): $21.60
CCB lic.:173318 `is\l(/ Total fee due upon application: $201.60
Authorized signature ai This permit application expires if a permit is not obtained
within 180(lays after it has been accepted as complete.
`�f� *Fee methodology set by Tri-County Building Industry
Print name:Deirdre Britt Date: "�'�
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
,
, Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit Na:
,it 13125 SW Hall Blvd.;Tigard,OR 97223 Date:By.
t as Phone: 503.718,2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503,639.4175 12 Electrical El Plumbing 0 Mechanical
TIGARL3
Internet: www;tigardd-or,gov ❑ Otther.
THE FOLLOWING ITEMS iRE REQUIRED FOR PLAN REVIEW 'yes No N/A
......
I Land use actions completed. See jurisdiction criteria for concurrent reviews. I 0 ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. a ❑ El
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: le 0 0
5 Septic system permit or authorization for remodel. Existing system capacity - in 0 0 '
6 Sewer permit. ❑ 0 0
7 Water district approval. Q ❑
8 Soils report.Must carry original applicable stamp and signature on file or with application, ❑ 0
9 Erosion control ❑plan ❑permit required Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state i. 0 0
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 0' 0
W'
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
and location:
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 0
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- ® 0 ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
constriction. 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. ` 0 l
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- ® 0 0
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 irl El El
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered •
El 0 kr
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 ® El ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load,
20 Manufactured floor/roof truss design details. ►ia 0 CI
21 Energy Code compliance. Identity the prescriptive path or provide calculations. A gas-piping schematic is required ® ❑' " 0
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 in. ❑ ❑
architect licensed in Oreton and shall be shown to be a wlible to the Ero'ect under review.
3URISDI ';"l`IC)NA1.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". 0 El CI24 Two(2)sets each are required for Items 16,19,20 and 22 above.. ❑ _ ❑ ❑
25 Building plans shall not contain red lines or tape-ors, "Mirrored"building plans will not be accepted. 0 ❑ 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document.. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard El El El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval, Tree locations,driplines, 0 ❑ ❑
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 Cl
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:1Building\Permits\BUP-RESPertnitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit AnnlicatinL FOR OFFICE USE ONLY
City of Tigard CEIVE® Received
Dale/By: Permit No,..;
'K 13125 SW Hall Blvd.,Tigard,OR 97223 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598,196CD1111
EC 0 3 Date/By. Other Permit,
Inspection Line: 503.639.4175
T1GAItD Date Ready/By. tuffs: BJ See Page 2 for
Internet: www.tigard-orgov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK GO1tMEI2CIAL„FEE, SCHEDULE. - 4E CHECKLIST x
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
mechanical materials,equipment.labor,overhead,and profit,
Demolition ❑Other:
.. .
Value:S
CATEGORY.OE CONSTRUCTION . ,
RESIDENTIAL I SYSTEMS'F'EES*' ;r `
® 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description I Qty. J Ea. Total
JOB SITE INFORMATION"AND'LOCATION -, st Ai dit 46.75
r con t toning
Job site address: 113443 � e SQ1J �. Furnace 100,000 BTU(duets/vents) ^ 1 46.75
City/State/ZIP:Tigard,OR Furitacc 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name, Duct work 23.32
Cross streetidirections to job site:SW North Dakota&SW 114ta PI 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 1 23.32
Other 23.32
Subdivision:Brightwood Lot no.: Other fuel appliances:
Tax map/parcel no,; Water heater 1 ,. 23.32
:" DEScnnTIOPI OF WOEX' a Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
new,single family residence fireplace 2 23,32
Loge lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chinntev/liner/thteivent 23.32
Other: 23.32
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name:Stone Bridge Homes NW,LLC Range hood/other kitchen
equipment 1 33,39
Address:4230 Galewood St,Suite 100 Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego,OR 97035 Single-duct exhaust(bathrooms,
T toilet compartments,utility rooms) 23,32
Phone:(503)387.7577 Fax:(503)387.7615 Attic/crawlspace fans 23.32
tea - -
® APPLICANT 1 " i d: . Other: 23,32
Fuel piping:
Business name:same as above
$14.15 for first four:$4.03 for each additional
Contact name:Deirdre Britt Furnace,etc. I
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater 1
Phone( ) Fax :( ) Fireplace 1
Range I
E-mail:dbritt( stonebridgehomesnw.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Comfort Zone Other:
MECHANICAL PERI4T FEES*
Address:1032 NW Corporate Dr. Subtotal
City/State/ZIP:Troutdale,OR 97060 Minimum permit fee(S90.00)
Phone:(503)667.5595 Fax:(503)491.8252 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:110091 TOTAL PERMIT FEE
This permit application expires ira permit is not obtained within 180
t,,_ f-� days after it has been accepted as complete.
Authorized signature; ,.,-.--... `'.• * Fee methodology set by Tn-County Building Industry Service Board
Lrint name:David Heklstab Date: ko 2,0.11
1:\Bandung\Pemits\MttC_PemtsIApp_04G113,doe 440-1617I 0 1102 CUWWEB1
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard �EGEI ViI ED Received Permitttt-
Date/By
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Keview
" I Phone: 503.718.2439 Fax: 503,598,1960®EC, Q 3 2019 Related Permit#:
TIGARD Inspection Line: 503.639.4175 Ready Date/By. 1w s El SeePage 2 for
Internet: www,ligaid-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
P�tI) �V+®< PLAN'REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stones..
❑Demolition El Other: where the available fault current ❑Marinas and boatyards;
--CAT,,, N ' 6 1* ., ��F, �„_ r „ exceeds 10,000 amps at 150 volts or 0 Floating buildings-
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 1$OU0 ❑Commercial-use agricultural
amps for all other installations, buildings.
❑ Multi-family ❑Master builder ❑Other: 0 Fire pump, 0 Installation of 150 KVA or
,,,;JOB SITE INFO .14.17 pl. . 1-01!t' 0 Emergency system, larger separately derived
c,,, El Addition of new motor load of system,
Job#: 2�% Job site address: I IY,C1 SW _ SON La'$4• 1001IP or more, ❑"A","E","1.2" "I 3"
City/State/ZIP:Tigard,OR ❑Six or more residential units, occupancy.
-- -- ❑Health-care facilities„ ❑Recreational vehicle parks,
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
-- - � ❑Service or Seeder 600 amps�r morn
6U0vnhs nominal,
Cross street/directions to job site:SW North Dakota&SW 114'h Pl. FEE SCHEDULE
Descrlp0on � Qty. ,� Each � Total
New residential single-or multi-family dwelling unit.
Subdivision:Brightwood Lot#: IIncludes attached garage.
1,000 sq,ft.or less 2 168.54 4
Tax map/parcel#: Ea.add'l 500 sq,ft,or portion 2. 33.92 1
DESCRIPTION IF-WORK Limited energy,residential
new,single family residence (with above sq.ft.) 75.00 2
Limited energy,multi-family 75;00 2
residential(with above sq.ft.)
p Renewable Energy 0 See Page 2
1
.,•,PROPERTY OWNER >�,, #t t x E wz` Services or feeders installation,altetntion,and/orrelocation
Name:Stone Bridge Homes NW,LLC 200 amps or less 100,70 2
Address:4230 Galewood St,Suite 100 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Lake Oswego,OR 97035 601 amps to 1,000 amps 301.04 2
Phone:(503)387.7577 Fax:(503)387.7615 Over 1,000 amps or volts 55226 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
) �PPL ICAIV h Branch circuits alteration,or extension,per panel
O CONTACT ri* rEt
' "-^ A,Fee for branch`circuits with
Business name:same as above above service or feeder fee, 7,12 2
each branch circuit .
Contact name:Deirdre Britt B.Fee for branch circuits without
service or feeder fee,first
Address: 56.18 2
.branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)"
Phone:( ) Fax: :( ) Each manufactured or modular 1
dwelling,service and/or feeder 67.84 2
Email: dbrittgstonebridgehomesnw.com Reconnect only 67.84 2
CONTRACTt3R ...-. Pump or irrigation circle 67.84 2
Business Hanle:City Electric Signor outline lighting 67,84 2
Address:55568 SW Schaltenbrand Ln. Spanel, ltera ion or limited-energy 0 See Page 2 2
..panel,alteration„or extension.
City/State/ZIP:Sherwood,OR 97140 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/!v
Phone:(971)404.1714 Fax:(503)625.3052 Investigation(1 hr min) 90,00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
listed('/hr min) 90.00/Iv
CC13 Lic. 42422 Electrical Lic,: 26-289C Suprv,Lic.: 35925specifically
ELECTRICAL PERMIT FEES '1'
Suprv.Electrician signature,required: Subtotal:
Print name: Chuck Friesen Date: 1 l,'Zlo,`q 0 Plan Review Required(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: Dale: days aner it has been accepted ns complete.
_...._.. . ._ ._, • Number of inspections allowed per permit.:
f'Ba I linglPennils\E LC._PemiitApp_ELR_ER E.doc Rev Oo'17/2U li :I<10-46 15T(1 t/051COKVNE
•
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
1 RESIDENTIAL;WORK ONLY: IEEE SCHEDULE
Description { QI, l Each I Total I.*
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 2
5,01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of25 kva:
Et Burglar Alarm 25,01 to 50 kva 301,04 2
50.01 to 100 kva 552,26 2
® Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040)_ 552 z6 2
►1 Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
• Vacuum Systems* >100 kva no additional charge 0,0 3
Each additional inspection over allowable in any of the above:
• Other: Each additional inspection is
charged at an hourly(1 hr mitt) 66,25J hr 1
Inspections for which no fee is
specifically listedl'h hr min) 90.00 hr
COMMERCIAL"WORK ONLY: , ,"', .'ELECTRICAL PERMIT FEES,,;
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 + Number of inspections allotted r permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
U Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Ell Fire Alarm Installation
❑; HVAC
❑ Instrumentation
El Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
• Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Buildu:b:Pemuts\E LC_PenttitApp ELR ERE:.dee Rev Oto17/2015
Plumbing Permit Application
RECEIVED
Building Fixtures DEC 0 3 201Q FOR OFFICE USE ONLY
City of Tigard CITY OF HGARC Reeeivzd
' ateB'v' Permit No
114 •f 13125 SW Hall Blvd,Tigard,OR 97223 BUILDING DIVISIO
g Phone: 503.718.2439 Fax: 503.598,1960 an Review Other Petmit No,
DatelBy:
Inspection Line: 503.639.4175
TIGARD Internet: tvww.ti and-or, ov DateReady/By: Juris: 121See Page2 for
g g Notified/Method: Supplemental Information
TYPE OF WQ :yV, t._ ' ;. `` .. FEE* SCHEDULE
®New construction El Demolition For weird htfurtttation use checklist. - ...
"Description I Qty. ';I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ti,for each utility connection)
a CATEGORY':OF'G`O STRUCfION SFR(1)bath __. 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437,78
❑Accessory buildingSFR(3)bath 1 500.32
0 Multi-family - - -
Each additional bath/kitchen 25.02
❑Master builder ❑Other: -
Fire sprinkler( sq,ft.) Page 2
JOB SITE INFORMATION AND LOCATION c Site utilities:
Job site address: ,) Catch basin or area drain 18,76
� Leo. ,
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR .'
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.: I Project name:
Manufactured home utilities 50.03
Cross streetidirections to job site:SW North Dakota&SW 114n'PI 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:Brightwood Lot no.:
Fixture at•9tem:
Tax map/parcel no.: Backflow preventer 1 31.27
. :, Backwater valve 12.51
rt DSCRIPTI+IIN OF WORT;' r
Clothes washer I 25.02
new,single family residence Dishwasher 1 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
PROPERTY OWNER fl TENANi Expansion tank 12.51
Name:Stone Bridge Homes NW,LL.0 Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:4230 Galewood St,Suite 100
Garbage disposal ( 25.02
City/State/ZIP: Lake Oswego,OR 97035 Hose bib Z 25.02
( ) (503)387.7615Ice maker 12.51
Phone: SU3 387.7577 Fax:
-
® APPLICANT .. ❑ CONTACT'PERSON ,,,, Interceptor/grease trap 25.02
Business name:same as above Medical gas(value:$ -) Page 2
Primer 12.51
Contact name:Deirdre Britt
Roof drain(commercial) 12.51
Address: Sink basin/lavatory • 7 25,02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 2, 12.51
E-mail:dbritt@stonehridgehomesnw.com Urinal 25,02
Water closet 3 25,02
CONTRACTOR -
Water heater I 37.52
Business name:Jardine Plumbing Water piping DWG' 56.29,
Address:PO Box 186 Other: 25.02
City/State/ZIP: Estacada,OR 97023 -7 4 40 Subtotal
Phone:(503)351.8532 Fax:(503)630.2882 3 3 oV�rJ Minimum permit fee: $72.50
/ + Plan review (25%of permit fee)
CCB Etc.:108747 ,�A > �// Plumbing Lic,no,:
F P� State surcharge(12%of permit fee)
Authorized signature: _. ,„:,. TOTAL PERMIT FEE
w
Print name:Jay Jardine Date:t'.2e.1 1 This permit application expires if a permit is not obtained within 180 days
�e after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board
I.Bnileiae`t'ennits‘PLAIU-Pemiu\ppdoc 10,F0U09 -1.10.461 oT(10i02/CO\tIW'E0)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . Fee( g- Tom i Square Footage: Permit Fee: J�,
Footing drain-I"100' 50.03 0 to 2,000 $12190
Footing drain-each additional 100' 3.7.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1,00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001,00 to$10,000.00 $72,50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Toiah
each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000,00 $148.50 for the first$10,000,00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge—1/2 hour) _ and including$25,000.00„
hspections outside of normal business 90,00lhr $25,001.00 to$50,000,00 $379,50 for the first$25,000.00 and$1,45 for
hours(minimum charge 2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr
and including$50,000.00.
Additional plan review for revisions 90.00/hr'- $50,001,00 and up $74400 for the first$50,000.00 and$1.20 for
(minimum charge—1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan'Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive 71ui, ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040,
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic El Any multipurpose rim sprinkler system.
Drinking,Fountain El Any complex stntctufe as defined in 0AR918-780-0040.
Eye Wash
Floor Drain/sink 2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food Cl Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related -
Ice Mach,/Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lae -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal, plumbing permit can be issued.
Other Fixtures:
P:\City Permit Applications\Brightwood\BW PLMF_PennitApp-Jardine Plitmbing.doc
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
■
TtGARD Building Permit Review — Residential
Building Permit #: /"f-S'T.Ao /9 —OO 113,;)--
Site Address: ( I3Z Cj 3 W€1 (so n L .
Project Name: 13 rt o, hi-woo 04 Lot #: (
(New dwellilig=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N , s F R
Verify address/suite#active in Accela. jzrIn River Terrace: 1"No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: Erosion Control
/3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper iiRctauicd goes with drip line and tree protection measures
/Drawn to scale(standard architect or engineer scale) /eFootprint of new structure(including decks)and FFE
/North arrow ,ZUtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number /Sidewalk/driveway approach
/Applicant information(name and phone number) 'SLoua�ini,,fwells/septic systems
Lot dimensions and building setback dimensions /Street tree size,type and location
- gtrare-fatstage-e€ tidings to be demolished /Street names
lExisting structures on site Corner elevations(2'contours if more than 4'diff ential)
C crt-sxea,..building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Yes ❑No1,,
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Ye ❑NS &
615
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified *No Received: / Yes ❑ No
pPublic Facilities Improvement(PFI) Permit:
Required: ,zr Yes,applicant was notified 0 No Applied For: y�, Yes ❑ No,stop intake
A and Use Case#: s ua W ( v -Qd 0 9 ❑ Zoning: 1 , S
pi Required Setbacks: Front: 2-0 Rear: ( 5 Side: S Street Side: I S Garage: .7A0
gf Building Height: Max. Height: .30 Actual Height:
IZ Landscape Area: N I Pt- % /f\
Entrance X Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows 7 Minimum 12%of area of all street-facing facades
Garage 0 Garage door is behind widest street-facing wall 0 Yes la No,one of the following is met:
0 Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
Z Door extends no more than 5'from w ll and there is a 12 sq ft.window above garage on 2nd floor.
,ie Garage door width is ❑ 12'or less 50%or less of facade 0 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
.0--Visual Clearance ❑ Urban Forestry Plan
aitive Lands: ❑ Yes te No P—Caditions met prior to issuance of building permit
Notes:
j2" Approved By Planning: /in "- iti� Date: i 2/ 3 / ( a
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES 022819.docx
Building Permit Submittal
Original Submittal Date: za/. /i 9
Site Plans: # 3
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 2-Tngineering 1... ----Permit Coordinator -a uilding
Workflow Sign-off: ,..II-Sign-off for Planning(include notes from planning review)
Route Application Documents: E''Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
iirBuilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ^` Date: % 3:3// `1.
Engineering Review
L.ld' S ope at building pad: 7L
[ ' onditions "Met"prior to issuance of building permit
131�Easements (encroachments)per engineering conditions of approval and plat
IZ/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 52No
Assess Water Quantity Fee in-lieu: ❑ Yes L!d/No
FLIDA Facility on lot: DI Yes L"No
inal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
VApproved by Engineering: Date: /2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved 0 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:
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: , Yes CI N/A
Tigard Trans SDC: I� es 0 N/A
Parks SDC: L Yes ❑ ND /A
LIDA CI Yes Ld'N/A
l0 OK to Issue Permit
Date: / 7.���/
Approved by Permit Coordinator:
I:\Building\Fonns\BldgPermitRvw_RES_022819.docx