Permit t CITY OF TIGARD MASTER PERMIT
Iri 1 COMMUNITY DEVELOPMENT Permit#: MST2022-00219
Date Issued: 10/13/2022
TECAR.T_"s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AC14100
Jurisdiction: Tigard
Site address: 10992 SW 95TH AVE
Subdivision: ASHBROOK VILLAS Lot: 6
Project: Ash Brooke Villas, Lot 6
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
Bcktlw Prevntr: 1
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: 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 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: 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
Other: N Other Description:
Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1979
Owner: Contractor:
ABVOZBP21 LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 169TH PLACE,SUITE 1040 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006 2 Geo Tech Required-
Engineered Fill Present
PHONE: PHONE: 971-221-4597
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 160 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
0G9.nnt.unln fhrn,,h ClAR ocs_nn1-nnon yr ,mar nktaio.o ennv of the n,lae nr riirert n„Petinne in(11 INC.by Tallinn FM 9 1 Ar11T '19 9144
Issued By: .1z—le,...--rer---. .., Permittee Signature:
call 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 USE ONLY
City of Tigard
Permit Na.:
13125 SW Hall Blvd.,Tigard,OR 97223 .o.� �.. .� - ..-A
T ijl,�, f .,,
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 .wIII
'�1
iw .y Date/B -f� Other Permit: / 1
1 I G 4 R n Inspection Line: 503.639.4175Cag2
Date Ready/By. [J/ a See Page 2 for Internet www.tigard-or.gov II 3 0 ''ll 01Z Nodule.•r thod: el /
J:i:� o u LULL / i Supplemental Information
TYPE OF WORT`"(-V Or ,^r", il5
REQ • 'D DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Dergli4iya' Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
D Addition/alteration/replacement ❑ Other:
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION en:c�a tj,on tJti�.application. , . , t�q
® 1-and 2-family dwelling ❑Commercial.industrial va�io((o�:[[����pp (p�j $ i( tr(I '101
D Accessory building "G l� v I'
®Multi-family Number of bedrooms: 4
El Master builder ❑Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 73 n.7
Job site address: 10992 SW 95TH AVE New dwelling area: 1979 square feet 13Q3�3
City/State/ZIP:Tigard Oregon Garage/carport area: 388 square feet U V U
Suite/bldg./apt.no.: I Project name:Ash Brooke Villas CoveredZqb
porch area:`L�TS�square feet
Cross street/directions to job site:
Deck area: ta,C) ysquare feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Ash Brooke Villas I Lot no.:6 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 Residential Construction Valuation: $
Existing building area: square feet
New building area: square feet
',1 PROPERTY OWNER I 0 TENANT
Number of stories:
Name:ABVOZ
Type of construction:
Address: 1815 nw 169'h Place Suite 1040
Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006
Existing:
Phone:(503)533-5167 Fax:(503)533-5164
New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Sage Built Homes LLC (Please refer to fee schedule)
Contact name:Alex Rodriguez Structural plan review fee(or deposit):
Address:Same as above FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application:
Phone:(971)336-6911 I Fax: :( ) Amount received:
E-mail:planning a sagebnilthomcsllccom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
rooftop mounted PhotoVoltaic Solar Panel System.
Business name:Sage Built Homes LLC Submit two(2)sets of roof plan with connection details
Address:Same as Above and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City'State/ZIP: Permit Fee(includes plan review
Phone:( ) Fax:( )
and administrative fees): $180.00
CCB tic.: 189330
State surcharge(12%of permit fee): $21.60
l Total fee due upon application: $201.60
Authorized signature: GJ/- 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;
.f Service Board.
I:/Building`Permits/BUP-RESPermitApp.doc 02/24/201I 440-4613T(11/02/COM/WEB)
A
Building Permit Application Checklist . . . i
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received Permit No.
-ill City of Tigard Receive:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Associated perms,_
Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical ❑ Plumbing ❑ Mechanical
TIGARD 24-Hour Inspection Line: 503.639.4175
Internet: www.tigard-or.gov ❑ Othcr:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes ."so 7;,"
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑❑ 0
3 Verification of approved plat/lot. ❑ ❑ ❑
0
4 Fire district approval required. Name of district: ❑ ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ CI . 0
6 Sewer permit. ❑ 0 0
7 Water district approval. CI ID ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 ❑
basin protection,etc. 0 0 CI
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.
11 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-R.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. El 0 ❑
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 0 El
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. ❑ ❑ D
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels.
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. ❑ CI ID
prescriptiveWall 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. CI 0 CI
Floor/roof framing. Provide plans for all tloors/roof assemblies,indicating member sizing,spacing,and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 0 0 0
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
for four or more appliances. ❑ 0 0
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
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". ❑❑ 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ 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. and Cityof Ti and El 0 ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable), g
Street Tree List.29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ 0 CI
and protection measures must be drawn to scale and must include the project arborist's signature of approval. ❑ ❑ 0
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.
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
i
,Electrical Permit Application IOR OI I I(,: I ,I. tl'\l )
City Of Tigard Received Permit a
' ,,�w Date/BY /,i! e2r. — 4t Jf I��
.�_— 13125 SW Hall Blvd.,Tigard,OR 97223 _ ri x"" : Plan Review
g Phone: 503 718.2439 Fax. 503 598 1960 & ,C L I '9r�k,,,. Date/By
Related Permit a:
f I L 1(t O Inspection Line: 503.639 4175 Ready Date/By. rdtis I RI See Page 2 for
Internet: www.tigard-or.gov Notified/Method j 1 Supplemental Information
•
TYPE OF WORK PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
' ❑Service or feeder 400 amps or more ❑Building over three stories,
I ❑ Demolition ❑ Other:
where the available fault current ❑Marinas and boatyards
_ CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 1000 ❑Commercial-use agricultural
ngs.
❑Multi-family ❑ Master builder 0 Other: ampsirefor all other installations builallati
0Fire pump 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: ' 10992 SW 95TH AVE 0 Add180H on of nee or morere motor toad of system.
100H ❑"A","E","I-2","I-3",
City/State/ZIP: Tigard Oregon ❑Six or more residential units. occupancy
0 Health-care facilities 0 Recreational vehicle parks
Suite/bldg./apt.#: Project name: Ash Brooke Villas 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: FEE SCHEDULE
ne,cription I Qty. i Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Ash Brooke Villas Lot#: 6 Includes attached garage.
1,000 sq ft or less 168.54 4
Tax map/parcel#: Ea add'I 500 sq ft or portion 33 92 1
DESCRIPTION OF WORK Limited energy,residential 75 00 2 I
New Residential Construction (with above so.ft)
Limited energy,multi-family 75.00 2
residential(with above sa ft,)
Renewable Energy 0 See Page 2
ElPROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: ABVOZ 200 amps or less t I 100 70 I 100 70 12
Address: 1815 nw 169TH Place Suite 1040 201 amps to 400 amps I 133.56 I 12
401 amps to 600 amps 200 34 12
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 1 2
Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts 552.26 2
1 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 5936 I
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 1 168 54 2
El APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension, er 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
Address: branch circuit 56.18 2
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@sagebuilthamesllc.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2 1
Business name:Ross Electric Sign or outline lighting I I 67 84 I 12
Address: 2870 SE 75th Ave 203 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel alteration or extension
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: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.001 hr
CCB Lic.: 157891 Electrical Lie.: 34-436C I Suprv.Lic._ specifically listed('%hr min)
— ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: te./e, 1, I U11/l L3 Subtotal:
—
Print name: Stephen Ross ST- PIte \ kos f f Date: (I2 S / ❑Plan Review Required(25%ofpermit fee):
9 / State surcharge(12%of permit fee):
Authorized signature: r' '' � TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within l80
Print name: Alex Rodriguez I Date: 2/1/2018 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1\Bdilding'Penniti,ELC_PennirApp F,LR ERE doe Rev 06/17/2015 440-4615T(1 l/O5/COM/WEB
1
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
• 13125 SW Hall Blvd.,Tigard,OR 97223 r� r Date/ByRe Pemrit No-M 7 „ode?
111 _ Phone: 503.718.2439 Fax: 503.598.1960 C� . / .. ` Plan Review , I`�`'4"� ��l/
TIGARD Inspection Line: 503.639.4175 ham- .W �-m.`DateRea Other Permit
Internet: wtsW,ligard-or.gov l r Date Rd,M tho: 7uris: See Page 2 for
Notified/Mcthod: Supplemental information
TYPE OF WORK L,i v1f O}-•. 1 j(j/ iLs COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
"' fit' Mechanical permit fees*are based on the value attic work
®New constrrtction ❑Addition/alteration/replacement�' '
performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:S
RESIDENTIAL.EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special inJnrnration use checklist.
❑Multi-family ❑ Master builder 0 Other: Description P I Qty" I La. I Total
JOB SITE INFORMATION AND LOCATION Heating cooling:
Job site address: 10992 SW 95TH AVE Air conditioning 1 46.75 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Suite bldg.iapt.no.: I Project name:Ash Brooke Villas Heat pump 61.06
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.:6 Other: 23.32
Tax map/parcel nrr.: Other fuel appliances:
Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
New Residential Construction Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chintney/liner/clue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Name:ABVOZ Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 1815 NW 169th Place Suite 1040 equipment I 33.39 33.39
Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
Phone:(503)533-5156 toilet compartments,utility rooms) 4 23.32 93.28
Pax:( ) Attic/crawls ace fans P I 23.32 23.32
0 APPLICANT 0 CONTACT PERSON Other:
23.32
Business name:Same as Above Fuel piping:
Contact name:Alex Rodriguez S14.15 for first four;$4.03 for each additional
Furnace,etc.
Address:Same As Above Gas heat pump
City/State/ZIP: Wall/suspendedlunit heater
Water heater
Phone:( ) I Fax: ( I Fireplace
E-mail:PlannnigCsagehuilthomesilc.com Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating&Cooling Other:
Address:PO BOX 1341 MECHANICAL PERMIT FEES*
Subtotal
City/State/Z1P:Lake Oswego,Oregon 97035 Minimum permit fee(S90.00)
Plan review(25%ofpermit fee)
Phone:(503)208-2276 I Fax:(
CCB lie.: 1845757
State surcharge(12%of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
Authorized signature: days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:Alex Rodriguez Date:6/27/2022
I a nnildingTermits‘MF.C_PermnApp_040I I3.doe
440-4617T tl 1,02/COMIVEM
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to S500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first S50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Plumbing Permit Application
•
Building Fixtures
FOR OFFICE USE ONLY
IIIICity of Tigard Received
�'•� Permit No.: F 13125 SW Hall Blvd.,Tigard,OR 97223 -ka r /i� "�atcBy: sr t l
_ Phone: 503.718.2439 Fax: 503.598.1960 "' �'i ti' k...Date/By:
Review 1
Inspection Line: 503.639.4175 Date/By: Other Permit Ner:
TI GARD P !!??� 3 0 i'22 Date Ready/By. Ions:r.gov ! See Page 2 for
Internet: www.tigard-o
NoGficd/Method. Supplemental Information
TYPE OF WORK L`T` r rIC_'r`f
. �: FEE* SCHEDULE
®New construction ❑Demolitions For special infarnit tint use checklist
❑Addition/alteration/replacement - Description I Qty. I Ea. j Total
0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ElI-and 2-family dwelling ❑Commercial,industrial SFR(2)bath 437.78
-
❑Accessory building ❑Multi-family SFR(3)bath x 500.32 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other.
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10992 SW 95TH AVE Catch basin or area drain 18.76
City/State/ZIP:Tigard Oregon Drywell,leach line,or trench drain 18.76
Suite/bld g% Pa t,no.: Project name:Ash Brooke Villas Footing drain(no.linear ft.: ) Page 2
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
Subdivision:Ash Brooke Villas Water service(no.linear ft.:_) Page 2
Lot no.:6 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New Residential Construction Clothes washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:ABVOZ Fixture/sewer cap 25.02
Address: 1815 NW 169th Place Suite 1040 Floor drain/floor sink/hub 25.02
City/State/ZIP:Beaverton Oregon 97006 Garbage disposal 1 25.02 25.02
Hose bib 2 25.02 25.02
Phone:(503)533-5156 Fax:( )
Ice maker 12.51
Ca APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Sage Built Homes LLC Medical gas(value:$ ) Page 2
Contact name:Alex Rodriguez Primer 12.51
Address:1815 NW 169`°Place Suite 1040 Roof drain(commercial) 12.51
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: :( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:planningEdsagcbuilthomesllc.com Urinal 25.02
CONTRACTOR Water closet 4 25.02 100.08
Business name:Edward Mullen Water heater t 37.52 37.52
Water piping/DWV 56.29
Address:1601A SE River Road
Other: 25.02
City/State/ZIP: Hillsboro Oregon 97123
Subtotal
Phone:(503)572-4586 Fax:( ) Ls- Minimum permit fee: $72.50
CCB Lie.:92689 Plumbing Lic,no.: 11100Plan review (25 of permit fee)
Authorized signature: State surcharge( 2%ofpermit fee)
-��� TOTAL PERMIT FEE
This permit application expires If a permit is not obtained within 180 days
Print name:Alex Rodriguez Date:6/27/2022
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
CUsuilding\Permits PLMU-PermitApp.dx I0/01/09 440-4616T(10/02/COMAVEB)
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:
50.03 0 to 2,000 $12190
Footing drain-1" 100' 2,001 to 3,600 S 169.69
Footing drain-each additional 100' 37.52 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand 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.
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 S100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Ad
(minimum
char review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 anyof the following.
Please check all that apply.
Baptistry;Font ❑ Any new commercial building with water service 2"and
Bath -TubiShower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive Aspirator as defined in OAR918-780-0040.
Cuspidor/Water i wherCore ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial
-Domestic El Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2"
4 Isometric or Riser Diagram
Car Wash Drain El Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestic-food related
-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/Lay -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 fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
S:\Sage Built\Subdivisions\Ash Brook Villas\Lot 6\Applications\PLMF_P2rmitApp.doc
Yyy--tz,z, , - (AAA./v
City of Tigarde2bi2 00�0 2
100113
1 Ill II
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
Building Permit #: P1ST At*-6 t1_ _
Site Address: _ \091/5Q3 or AVl;
Project Name: rill‘ X31(120‘4‹. OW J ,&OctA k{Wr't Lot #: t(1`
Planning Review
Proposal: V_Dt lkapub-C MOCtIA kko"1t-S
Verify address/suite #active in Accela. ❑ In River Terrace: No 0 Yes,River Terrace Review Addendum
Site Plan Elements: K.rosion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper `[Retained trees with drip line and tree protection measures
, rawn to scale (standard architect or engineer scale) Footprint of new structure(including decks)and FEE,
Torth arrow , Utility locations&easements(required for new and additions)
'site address,project or subdivision name and lot number ,Sidewalk/driveway approach
iilpplicant information(name and phone number) eptic Systems
Scot dimensions and building setback dimensions 'treet tree size,type and location
( fovea. o rigs w In.tienavkahcil Street names
2omer elevations (2'contours if more than 4'diffe ntia])
littot 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? 12Yes o
Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
>Required: I: Yes,applicant was notified )l .No Received: 0 Yes To
2T"CVater Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified p `.No Received: 0 Yes No
AlSDC Exemption for ADU applied for: 0 Yes I&No Received: 0 Yes ,5-No
Public Facilities Improvement (PH) Permit:
equired: ( ,Yes,applicant was notified 0 No Applied For: -Yes 0 No,stop intake
Land Use Case#: "�eL/ QZo22 Ob0o2 `,Zoning. ��Z
Required Setbacks: Front: 10 Reat �Z' Side: I�J Street Side: j C Garage: 2 D
y3 Building Height: n Max. Height: D Actual Height: Sri"'
', X Landscape Area:_'L.- _% IA Lot Coverage M :_ ljA _
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 ' d widest street-facing wall ❑ Yes 0 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.
0 Garage door width is 0 12'or12' less '$-5 ° or less of facade 0 60%or less and includes 7 of following:
0 Covered porch 0 Recessed entrance 0 V a 0 1'Roof eave 0 Roof offset
❑ Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable, p, brel roof 0 Dormer
❑ Accent siding 0 Window trim 0 Window recess ❑ Window projec ' 0 Balcony
Isua?i°t ice 1113"tl-rbarrFvrrstry Plan _
131 Sensitive Lands: 0 Yes BNo Type:
❑ Conditions met prior to issuance of building permit
Notes:
Approved By Planning: &V Date: ((30Pl
(Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
I:\Building\Forms\BIdgPennitRvw_RES_1224I 9.docx
Building Permit Submittal
Original Submittal Date: (P`t )711-
Site Plans: # /
Building Plans: # 3
Building Permit#: `L— niter building permit#above.
Workflow Routing. 5nning gineering �]s -P€mit Coordinator 8-f ti Whig
Workflow Sign-off: JJ8ign-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.
ding. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: 7
Engineering Review
Slope at building pad: p
Conditions "Met"prior to issuance of building permit
l, Easements (encroachments)per engineering conditions of approval and plat
2 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes FrVNo
Assess Water Quantity Fee in-lieu: ❑ Yes 0
LIDA Facility on lot: 0 Yes IQ No Add Fee: ❑ Yes 0 No
Ld Final Plat Recorded:
-'SNOT Approved by Engineering: ,_ Date:Notes:
liL Approved by Engineering: V V . 6 Date: S zvz2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved 0 Not°Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
0 SDC Exemption: 0 Received 50 Does not apply
91 SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: Yes 0 N/A
LIDA ❑ Yes 151 N/A
KOK to Issue Permit
Approved by Permit Coordinator: - �(1\1,\Y Date:
I:IBuildinglFor ns\BldgPemutRvw_RES_1208021.docx