Permit CITY OF TIGARDIN
MASTER PERMIT
Permit#: MST2022-00220
COMMUNITY DEVELOPMENT Date Issued: 10/13/2022
T[taART:.) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AC15700
Jurisdiction: Tigard
Site address: 10986 SW 95TH AVE
Subdivision: ASHBROOK VILLAS Lot: 7
Project: Ash Brooke Villas, Lot 7
Project Description: New attached dwelling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 290 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 32 Bathrooms: 4 Second: 856 sf Garage: 388 sf Front: 10 Smoke
Yes
Dwelling Units:
1 Third: 833 sf Right: 3 Detectors:
Total: 1979 sf Value: $281,006.66 Rear: 12
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckfw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywall-Trench Drain: 0 Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders 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: 3 201-400 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 Y
Ecompasing:
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1979
Owner: Contractor: Required Items and Reports(Conditions)
ABVOZBP21 LLC SAGE BUILT HOMES
1815 NW 169TH PL STE 1040 1815 NW 169TH PLACE,SUITE 1040 1 Geo Tech Required-
BEAVERTON,OR 97006 BEAVERTON,OR 97006 Engineered Fill Present
2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 971-2214597
FAX: 503-533-5164
Total Fees: $28,131.48
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
oc9-nn111(YlA thrnnnh(IAR ac911ni nnan Vnn mw nhtaln a rnnkt of the niloe nr rlirart ni iactinnc in(ll IMft Inn nallinn crr 9'19 1�9 91dd
Issued By: Permittee Signature:
all 503.639.4175 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.
Building Permit Application
Residential FOR OFFICE: 11SI: ONLY
Received
Cityof Tigard / i a?a.— Permit No.: :7-edd.,. 1'S�.
g -'"1 :J Date;ey '7 6� o.J /`�STr/e/t/U (l(J v17r`
i•• 13125 SW Hall Blvd.,Tigard,OR 972 ...0 . . Plan Review
'—' `� ZZ Other Permit:Cr�Q
Phone: 503.718.2439 Fax: 503.598.196CI DatciBy )-„ram/�''
TIGARU Inspection Line: 503.639.4175 , n ;l -.,"; Date Ready/By: / - Juris: El Seel aggc2forC O
Internet: www.tigard-or.gov •f v ',./ L4�� Nolif•. 1 thod�j I Supplemental Information
TYPE OF WORK � REQUIRED DATA:1-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 wor rc ted�o�n�th}'s ap lication. i
® I-and2-familydwelling Va tion C/Vl0_ � !
❑Commercial-industrial
ElAccessory building El Multi-familyNumber of bedrooms: 4
❑Master builder ❑Other Number of bathrooms: 4 1 - '/
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 /Z3W"1
Job site address: 10986 SW 95TH AVE New dwelling area: 1979 square feet
City/State/ZIP:Tigard Oregon Garage carport area: 388 square feet g31.3
Suite/bldg./apt.no.: Project name:Ash Brooke Villas Covered porch areal square feet
Cross street/directions to job site: Deck area: i square feet/Rgp
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Ash Brooke Villas Lot no.:7 Permit fees*are based on the value of the work performed_
Taxmap/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 Residential Construction Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: ABVOZ Type of construction:
Address: 1815 nw 169ts Place Suite 1040 Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006 Existing:
Phone:(503)533-5167 Fax:(503)533-5164 New;
A APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Sage Built Homes LLC
Structural plan review fee(or deposit):
Contact name:Alex Rodriguez
FLS plan review fee(if applicable):
Address:Same as above
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:(971)336-6911 Fax: : ( )
E-mail: planning@sagcbuilthomesllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Sage Built Homes LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same as Above Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees): _
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 189330 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Alex Rodriguez Date:
Service Board.
I:ABuildingVPermitsVBUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
Building Permit Application Checklist r •
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Ill
-
Date/By: Permit No_r
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumping ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THF. FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l'es No vA
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. _ ❑ ❑ 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. 0 0 ❑
4 Fire district approval required. Name of district: . 0 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 El Di
6 Sewer permit. ❑ 0 0
7 Water district approval. 0 ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
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 ❑ ❑ ❑
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 he completed if
copyright violations exist.
I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 0 ❑
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, ❑ ❑ ❑
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
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. 0 ❑ 0
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- ❑ ❑ ❑
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 ❑ 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 0
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 0 0 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 ❑ ❑ 0
architect licensed in Ore:on and shall be shown to be applicable 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. ❑ ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 ❑
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, ❑ ❑ ❑
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.doe 02/2412011 440-4613T(I I!02/COM/WEB)
,Electrical Permit Application
City of Tigard I Received permit a.
. • 13125 SW Hall Blvd.,Tigard,OR 9722311111
• Ptaan Review M 7r95Ui9 of".t 3G7
Phone: 503 718.2439 Fax: 503598.1960 Date/By. Related Permit a:
Inspection Line: 503.639.4175 1 Ready Date/tny , luis- I ® See Page 2 for
F I Lr 1 ft I7 Internet: www.tigard-or.gov { Notified/Method j Supplemental Information
TYPE OF WORK , PLAN REVIEW
®New construction ❑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 ❑ Other: where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
less to ground,or exceeds 14,000 0 Commercial-use agricultural
CZ1-and 2-family dwelling ❑Commercial/industrial [:1Accessory building amps for all other installations buildings.
❑Multi-family ❑ Master builder 0 Other: ['Fire pump 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: 1 Job site address: . I09S6 S\V 95 D I AV'I• 100HP or more ❑"A""E" "I-2" "1-3"
1 ❑Six or more residential units occupancy
City/State/ZIP: Tigard Oregon 0 Recreational vehicle parks
❑Health-care facilities
Suite/bldg./apt.#: l Project name: Ash Brooke Villas ❑Hazardous locations 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Delrriatlan 1 Qty. I Each I Total I •
_ New residential single-or multi-family dwelling unit.
Subdivision: Ash Brooke Villas Lot#: 7 Includes attached garage.
1,000 sq II or less 168.54 4
Tax map/parcel#: Ea.add'1 500 sq ft or portion 33 92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft) 75 00 2
New Residential Construction Limited energy,multi-family 75.00 2
... residential(with above sq ft.)
Renewable Energy ❑ See Page 2
® PROPERTY OWNER 0 TENANT , Services or feeders installation,alteration.and/or relocation
Name: ABVOZ 200 amps or less I I 100 70 I 100.70 12
Address: 1815 nw 169TH Place Suite 1040 201 amps to 400 amps { 133.56 C C 2
401 amps to 600 amps 200 34 2
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 2
Phone:(971)221-4597 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 1 own which is not 200 amps or less 59 36
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
® APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A Fee for branch circuits with
Business name:Same As Above above service or feeder fee, 7 42 2
each branch circuit
Contact name: Alex Rodriguez B. Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (971)336-6911 Fax: :( ) Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Email: Planning@sagebuilthomeslle.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 12
Business name:Ross Electric Sign or outline lighting I I 67 84 I 12
Signal circuit(s)or limited-energy IPageI
Address:2870 SE 75th Ave 203 panel alteration or extension. 0 See 2 12
City/State/ZIP: Hillsboro Oregon 97123 _Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(I hr min) 90.00/hr
Email: CoI//2- Industrial plant(1 hr min) 78.18/hr
LL 6 J Inspections for which no fee is 90 00/hr
CCB I.ic.: 157891 Electrical Lic.: 34-436C I Suprv. Lic.: y)32_S specifcally listed(55 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: /I 44'1t. I�)�` e--�2 Subtotal:
Print name: Stephen Ross sir Fit•\ post f I Date: ❑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: Alex Rodriguez Date: 2/1/2018 days after it has been accepted an complete.
• Number of inspections allowed per permit.
1.\Building\PennitAELE PermiiApp ELR,ERE dot Rev OMl1712015 440-4015T(IItt15ICOM/WRB
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received
- Dates Permit No. cfur.p0�_ 2 O
• 13125 SW Hall Blvd.,Tigard,OR 97223 c view
Phone: 503.718.2439 Fax 503.598.I960 '"` o^a Other Permit:
I - Date/Ely:
T I G A R D Inspection Line: 503.639.4175 „.-...,'.,../.......( C. t,Bate-ReadyBy: tuns: ® See Page 2 for
Internet: www.tigard-or.gov Netificd/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fee,*are based on the value of the work
®New construction D Addition/alteration/replacement:r: ', l . ; performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special infornmtinn use checklist.
E Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. Total _
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address. 10986 SW 95TH AVE Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Ash Brooke Villas 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:Ash Brooke Villas Lot no.:7 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
- Flue vent for water heater or gas
New Residential Construction fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY,OWNER 0 TENANT Other: 23.32
` Environmental exhaust and ventilation:
Name:A BV OZ Range hood/other kitchen
equipment I 33.39 33.39
Address:1815 NW 169th Place Suite 1040 Clothes dryer exhaust I 33.39 33.39
City State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
- - toilet compartments,utility rooms) 4 23.32 93.28
Phone:1503)533-5156 Fax.( ) Attic/crawlspace fans I 23.32 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Same as Above 1
$14.15 for first four;$4.03 for each additional
Contact name:Alex Rodriguez Furnace,etc.
Address:Same As Above Gas heat pump
Wallisuspended/unit heater
City%State/ZIP: Water heater
Phone:( ) Fax:: ( ) Fireplace
Range
E-mail: Plannnig@sagebuilthomeslle.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating&Cooling Other.
MECHANICAL PERMIT FEES*
Address:PO BOX 1341 Subtotal
City/State/Z1P:Lake Oswego,Oregon 97035 Minimum permit fee($90.00)
-- - Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 184575‘ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized signature: \---C / * Fee methodology set by Tri-County Building Industry Service Board
Print name:Alex Rodriguez Date:6/27/2022
I:\Bullding\Permits`MEC PermrtApp 0401 I3-doc 440-4617T(I 1d12s('OM/WFB)
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 fcc$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
$2.8 I 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.
1:\Building,Permits\MEC_PermitApp_040113.doc 2
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLI
Cit of Ti and "'` Received
Y g `•� Permit Ni..: }�
13125 SW Hall Blvd.,Tigard,OR 97223 ""' Date/By: �rf/�?�
,� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 awlDate/By: Other Permit No.:
Inspection Line: 503.639.4175 '� ` " Date Read B fens: ® See Page 2 for
IICARD Ready,By: g
Internet: www.tigard-or.gov Notified/Mcthod- Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 DemolitionFor special information use checklist
- -- Description I Qty. Ea. 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 0 Commercial-industrial SFR(2)bath 437.78
❑Accessory building El Multi-family
SFR(3)bath x 500.32 500.32
Each additional bath/kitchen 25.02
E Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9406 SW Longstaff Stt Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard Oregon
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Ash Brooke Villas 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:Ash Brooke Villas Lot no.:7 Fixture or item:
Tar map/parcel no.: Backflow preventer I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
New Residential Construction
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:ABVOZ Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169"'Place Suite 1040
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton Oregon 97006 Hose bib 2 25.02 25.02
Phone:(503)533-5156 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Sage Built Homes LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Alex Rodriguez
Roof drain(commercial) 12.51
Address:1815 NW 169'h Place Suite 1040 Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP:Beaverton oregon 97006 Solar units(potable water) 62.54
Phone:(971)336-6911 Fax: :1 ) Tub/shower/shower pan 3 12.51 37.53
E-mail:planning`a_.sagebuilthomesllc.com Urinal 25.02
Water closet 4 25.02 100.08
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Edward Mullen Water Pip g t m ;DWV 56.29
Address:1601A SE River Road Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)572-4586 Fax:( ) l/(S-/L Minimum permit fee: $72.50
���� Plan review (25%of permit fee)
CCB Lic.:92689 Plumbing Lic.no
State surcharge(12%of permit fee)
Authorized signature: applicationTOTAL PERMIT FEE
- This permit expires if a permit is not obtained within 180 days
Print name:Alex Rodriguez Date:6/27/2022after it has been accepted as complete.
*Fce methodology set by Tri-County Building Industry Service Board.
I:ABui4linguPermits PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 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 S5,000.00 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) Total each additional 5100.00 or fraction thereof,to
and including S 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 S25,000.00.
Inspections outside of normal business 90.00/hr $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 S742.00 for the first$50,000.00 and S1.20 for
(minimum charge-1i2 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*.
Quandy 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 ❑ 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 Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
S:\Sage Built\Subdivisions\Ash Brook Villas\Lot 7\Applications\PLMF_PlirmitApp.doc
t.Y 1-.•v-(/'- ' aJv v V
City of Tigard
OoOOZ
IN
y�L l -0o l—f
COMMUNITY DEVELOPMENT DEPARTMENT
T i G A R D Building Permit Review — Residential
Building Permit #: MST-aZa'-_IICg2�-
Site Address: _ (01.6 SWG " P\Jt
Project Name: Ask:. $caoA4-c J‘A aS f u.0 C& kiwi( Lot #: _±
Planning Review
Proposal: \2 oy,/VIOUlie KOCt&4 kkO'5
Verify address/suite# active in Accela. ❑ In River Terrace: 17C,No ❑ Yes,River Terrace Review Addendum
*p..,
Site Plan Elements: g,rosion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper yaetained trees with drip line and tree protection measures
?Brawn to scale(standard architect or engineer scale) %Footprint of new structure(including decks) and FFE
Worth arrow ,Utility locations&easements(required for new and additions)
ite address,project or subdivision name and lot number 'Sidewalk/driveway approach
4tpplicant information(name and phone number) terns
T,SLot dimensions and building setback dimensions 'treet tree size,type and location
o VIStreet names
omer elevations(2'contours if more than 4'diff ntial)
of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Yes
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes o
Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
>R>�e�quired: ❑ Yes,applicant was notified ',.,No Received: ❑ Yes , 1Vo
_T'tVater Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
r. Required: ❑ Yes,applicant was notified -No Received: ❑ Yes )6.,No
191.1 SDC Exemption for ADU applied for: ❑ Yes &No Received: ❑ Yes 7S-No
Public Facilities Improvement(PFI) Permit:
equired: fX.,Yes,applicant was notified ❑ No Applied For: Yes 0 No,stop intake
Land Use Case#: 'bo Rear: Z0Z7 00002 `,Zoning. ��\t-
Required Setbacks: Front l0 Rear: Y� Side: I�I Street Side: I C Garage: Z.D
Building Height: Max. Height: '3`S Actual Height: 3
Landscape Area:_ - % lig,Lot Coverage M :_ VA _%
Entrance Set back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows Minimum 12%of area of all street-facie facades
oor is e d widest street-facing wall ❑ Yes ❑ No,one of the following is met:
xtends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no an 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
❑ Garage door width is 0 12'or less ° or less of facade 0 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ D a ❑ 1'Roof eave 0 Roof offset
❑ Fire shingles ❑ Lap Siding 0 Roof pitch 0 G l or.g brelroof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Wmdow proje ' ❑ Balcony
tsuare.i ti=a trace an'Fvres ytt fan
1 I Sensitive Lands: 0 Yes 14,No Type:
❑ Conditions met prior to issuance of building permit
Notes: /
'Approved By Planning: S\ Date: co(30re'l
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\FomvslBldgPemvtRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: (/?d/e.
Site Plans: # 3
Building Plans: # 3
Building Permit#: 111- i ter building permit#above.
Workflow Routing: ['Planning [ .ngineering gl--irermit Coordinator Building
Workflow Sign-off: 12i--giign-off for Planning(include notes from planning review)
Route Application Documents: (engineering: (1) copy of permit application, (1) site plan, (1) building plan and
oriffiinal plan review routing form.
0'Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: A,.,,,,./..--, —7-G'J — Date: 7iai/
En eering Review
Slope at building pad: „
Conditions "Met"prior to issuance of building permit
�,/Easements (encroachments)per engineering conditions of approval and plat
am l ' Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes �T,/No
Assess Water Quantity Fee in-lieu: 0 Yes LTNo
Er/No/LIDA Facility on lot: ❑ Yes Add Fee: 0 Yes ❑ No
Final Plat Recorded:
NOT Approved by Engineering: r Date: "
Notes: _ _ ,_ , , T, ,
0"Approved by Engineering: ({ . Ii s J-1 .Date: 3-2G2
Revisions (after Building Submittal only)/ Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
El Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant
Revision Notice 2: Date Sent to Applicant:
❑ SDC Exemption: 0 Received 4 Does not apply
1 SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 0 N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: 0 Yes 0 N/A
LIDA 0 Yes EICiN/A
pOK to Issue Permit
Approved by Permit Coordinator: k\ %\kRYck Date: •- -12.
i:\Building\Fonns\BldgPemutRvw_RES_1208021.d ocx