Permit FOR OFFICE USE ONLY-SITE ADDRESS: Q3$A 1.011paR A
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11 ' Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: AN 121022
COMPANY: Jt ei& &ALI -tOinS LW CITY o r((ai sil 0�
PHONE: q- ( -- 2.5-G($`L() BUILDING DIVISION BY:
EMAIL: \ilASpA l OJ S I E 1171- 4'0Mea I\l._1-- ` ( C7�rLD
157-
RE: ��(� Q�10(Pj g391 mg/ cMJ u ivisktr7zo22 oosr8 <i-orr7
(Sire Address) (Permit Number) 572p2 2-cO 7 �o(-ig;
Kirk. 12' Ut(- (7- 2(� I►'1ST2oZ2—c S2a �lotl4�
(Project name or subdivisionn n name and lot number)
M s-rZoza—Oo52.I Cla-If 2A
ATTACHED ARE THE FOLLOWING ITEMS:
, l
Copies: Description: Copies: Description:
Additional set(s) of plans. x Revisions:Slit ?(.A I;JS
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FO FF E USE ONLY
Routed to Permit Technici : Date: .5 f S Z� Initials:
Fees Due: ❑ Yes No Fee Desc 'ptio . Amount ue:
r) 06-
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No ❑ Done
Applicant Notified: •./ Date: \ .1% Initials: P '
I:\Building\Forms\Transmittal Letter-Revisions_073120.doc
CITY OF TIGARD MASTER PERMIT
;. �- COMMUNITY DEVELOPMENT Permit#: MST2022-00521
T I G A r r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2023
Parcel: 1 S 135AC 15300
Jurisdiction: Tigard
Site address: 9384 SW LONGSTAFF ST
Subdivision: ASHBROOK VILLAS Lot: 20
Project: Ashbrook Villas, Lot 20
Project Description: New attached dwelling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 609 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 30 Bathrooms: 3 Second: 891 sf Garage: 216 sf Front: 15 Smoke Yes
Dwelling Units: 1 Third: 321 sf Right: 3 Detectors:
Total: 1821 sf Value: $289,954.67 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: Storm Sewer: 100
0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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: 1
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 4 201-400 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
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 1821
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
PHONE: PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $29,704.78
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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
0F9An1_nn1n than iinnh nIA QF9-nm-Mlgnu'Yni n htnin P.-nnv of fha r,lae nr,1irant ni,uefinnc to(II INC by na Ilion sM 919 10A7 nr 1 Ann 1a9 9%14
/^
Issued By: � 1LZ/ii 1 l Y/ Permittee Signature. 9):r.cr'1CN�,
(it
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date. 1
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 i N
Residential DEC 21 lid FOu UII 1( I: 1 SI:ONI.I
Cityof Tigard i Pear. .
111 ° 131SW Hall Blvd.,Tigard,OR 97223 ��� OF C 1t�A Le1��,(::'view ( � ����
: Phone: 503.718.2439 Fax. 503.598.1960 .`Yt 111 r�,NCi1M�� �pji -oa'a -ooa-s7
T I GA R D Inspection Line: 503.639 4175 /lt�lf ' Date Ready/By furls: PI See Page 2 for
Internet: www.tigard-or.go Ntotititieeit!Metthod`t�'1U • RP' I Supplemental Information
- \P Lii() 011lt .
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fix;s*are based on the value of the work performed_
Indicate the value(rounded to the nearest dollar)of all
El Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. kil
Valuation: �' eer-
'
0 1-and 2-family dwelling 0 Commercial/industrial "�"
❑Accessory building 0 Multi-family Number of bedrooms:2
❑Master builder ID Other:
Number of bathrooms
JOB SITE INFORMATION AND LOCATION Total number of floors:3 siAl
Job site address:9384 SW Longstaff Street New dwelling area: 1821 square feet 321
City/State/ZIP:Tigard, OR 97223 Garage/carport area: 216 square feet igc,
Suite/bldg./apt.no.: Project name:Ashbrook Villas Covered porch area:28 square feet t g OCi
Cross streetldirections to job site: Deck area:48 square feet
Greenburg Road and 95th Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:AShbr00k Villa's Lot no.: 20 Permit tees*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.
Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name ABVOZBP21 LLC Type of construction:
Address:1815 NW 169TH PLACE, SUITE 1040 Occupancy groups:
City/State/ZIP:Beaverton, OR 97006 Existing:
Phone: 603-5026623 Fax:( ) New:
0 APPLICANT ❑CONTACT PERSON BUILDING PERMIT FEES*
Business name:Same as above (Please refer tofu schedule)
-- — - - Structural plan review fee(or deposit):
Contact name:Katie Patterson
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax: :( )
E-mail:katie@sagebuilthomeslIc.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:1815 NW 169TH PLACE, SUITE 1040 Solar Installation Spec tally Code checklist.
City/State/ZIP:Beaverton, OR 97006 Permit Fee(includes plan review $I80.00
and administrative fees):
Phone:( )503-5026623 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: ]$993Q Iv l O \.1.1.IA Total fee due upon application: $201.60
Authorized signature: ,. /9ezteztetzfriv This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Katie Patterson Date:12/15/22 *Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPcrmitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
A
. r
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLI
F -. City of Tigard Pe mit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960 aeceived
TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ID Mechanical
Internet: www.tigard-orgov ❑ Other.
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1,es No N/.t
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ 0 ❑ ,
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 ❑
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
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 be completed if
copyright violations exist.
1 I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 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 ❑ ❑ 0
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- ❑ ❑ ❑
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 ❑ ❑
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 ❑ ❑ ❑
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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon 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
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 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 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, ❑ ❑ ❑
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, 0 0 0
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-RESPeermitApp.doc 02/242011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Paget -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$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.
I:\Building\Peunits\MEC_PermitApp 040113.doe 2
Electrical Permit Application RECEIV
. City of Tigard DEC 21 202 Rcce red
PeRnit N:
n I3125 SW Hall Blvd.,Tigard,OR 97223 °° MSS1a12 04521
Phone: 503.7182439 Fax: 503.598.1960 CITY OF TIGARZ,By, Related�W Related Permit#
FIGARI) Inspection Line: 503.639.4175 BUILDING DIVISI °a y' mi. ! ® See Page 2for _�
Internet: www.tigard-or.gov etlod: 1 Supplemental information
TYPE OF WORK PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of pima w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories
Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
FA 1-and 2-family dwelling Q Commercial/industrial ❑Accessory building l,,,.to grwwl,or exceeds 44,000 0 Commercial-,use agricultural
❑Multi-family ❑Master builder ID Other: ❑ampsoeall other installations. buildings.
m
pump_ 0 Installation of 150ICVA or
JOB SITE INFORMATION AND
(�LOCATION
� /� Q ❑Emergency system larger separately derived
I 138y s�o Lusr C"7STfi l�T ❑l00HP no of new. motor load of system.
Job#: Job site address: !pulp or more. ❑"A:`E^.`t-z�,`1-3^.
City/State/ZIP:Tigard, OR 97223 ❑Six or more residenMr units. occupancy_
Health-cam facilities. 0 Recreational vehicleparks.
Suite/bldgJapt#: Project name:Ash Brook Villas 0 Hamrdoes locations. 0 Supply voltage for more than
El service or feeder 600 amps or more_ 600 volts nominal.
Cross street/directions to job site: FEE SCIIEDIJLE
nemlpaas I our. 1 Foal I TOW I
New residential single-or multi-family dwelling unit.
Subdivision:Ashbrook Villa's Lot rt: EC) Includes attached garage.
1,000 sq.ft.or less 168.54 a 4
Tax map/parcel Ea.add'I 500 sq.R.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.) _
-- Limited eulogy,multi-fondly 75.00 2
residential(with above sq.ft.)
Fa PROPERTY OWNER ❑ TgNANC Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:ABVOZBP21 LLC 200anlpsorless 1 100.70 i100.70 2
Address:1815 NW 169TH PLACE, SUITE 1040 201 amps to 400 amps 133.56 2
401 amps to 600 amps 20034 2
City/State/ZIP:Beaverton, OR 97006 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 55226 , 2
Temporary services or feeders installation,alteration,and/or
Email:katie@sagebuilthomesllc.com relocation
Owner installation_This installation is being made on property that I own which is not 200 amps or less 5936 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
® APPLICANT ❑ CONTACT PERSON Branch circuits-new,attention or extension,per panel
A.Fee for branch circuits with
Business name:ABVOZBP21 LLC above service or feeder fee, 7 A2 2
each branch circuit
Contact name:Katie Patterson B.Fee for branch circuits without
- service or feeder fee,itrst 56.18 2
Address:Same as above branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not hu ceded)
Phone:603-5)2fi623 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service anal/or feeer d
Email:katie@sagebuilthomesllc.com -
Rec>onetxtmly 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Grizzly Electric Inc Sign or outline lighting 67.84 2
Address: 2414 mom �&` sit- foe„ i J 7 Signal circuit(s) orr exiension. 0 See Page 2 2
r.1 L l s / panel,alteration,or extension.
CitylState/ZIP:Vancouver, WA 98660 Each additional inspection over allowable in any of toe above
Additional inspection(1 hr oar) 6625/hr
Phone:( 9 7/ S"P— �'/p l Fax:( ) Investigation(1 hr min) 90.013/br
Email:grizZlyeieCtriC@msn.COm Q Industrial plant(I hrmm) 78.18/In
/ l�t•J Inspections for which no fee is 90.00/hr
CCB Lic.:186218 Electrical Lic.: 1-446C Suprv.Lic_: 373 specifically IistedCAhrtata)
y� ELECTRICAL PERMIT FEES
Suprv_Electrician signature,required:
Subtotal•
Print name: A ,tt t,/ /jqc,,!,,�y .J f 2` t 40 /�rL 0 Plan Review Required(25%of permit feel:
% State surcharge(12%of permit fee): •
Authorized signature: /�/f7424. P � TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
Print name:Katie Patterson Date:12/1/22 days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:Wuildi g\Pa-mts\E1C_PvmsApp EIR_EHEdoe Rev 06/172015 44046/3T(11/t15/COM/WEIr
1
e
t
Plumbing Permit Applicatiol
Building Fixtures DEC 2 1 ZOZZ FOR OFFICE LSE ONLY
Cityof Tigard Received toll l) M St
ll Permit\o.'.MST 4O L{.-W
13125 SW Hall Blvd.,Tigard,OR 97223�/I�� �F r IUHHLF Dim Rev
Phone: 503,718.2439 Fax: 503.598.i0.1 PlanRevrew
LDING DIVISION DateBy: Other Permit No.:
T I G Ali r) Inspection Line: 503 639 4175 Date Ready/By: luris. la See Page 2 for
Internet www.tigard-or.gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ['Other- New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
lj I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 50032 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft,) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
9384 SW Longstaff Street Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223 Footing drain(no.linear tt:_) Page 2
Suite/bldg./apt.no.: I Project name:Ashbrook Villa's 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:Ashbrook Villa's I Lot no.:120 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 2.51
Clothes washer 1 2502 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 1251
Name:ABVOZBP21 LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169TH PLACE, SUITE 1040 Garbage disposal 1 2502 25.02
City/State/ZIP:Beaverton, OR 97006 Hose bib 2 25 02 50.04
Phone:( n4-�i(19RR94 Fax:( ) Ice maker 1 12.51 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Businessname:ABVOZBP21 LLC Medical gas(value:$_) Paget
Primer 12.51
Contact name:Katie Patterson Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory 5 25.02 125.10
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:katie@sagebuilthomeslIc.com Urinal zs oz
Water closet 3 25.02 75.06
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Ed Mullen Plumbing Water pg/
rp m DWV 56,29
Address:1601A SE River Road Other: 25.02
City/State/ZIP:Hillsboro, OR 97123 Subtotal
Phone:(503 )572-4586 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:92689 Plumbing Lic.no.: •11a0 Plan review (25%ofpe permit fee)
K & /2��g� State surcharge T (1OTAL
PERMf T FEE
ee)
Authorized signature: G�c�. 1 •1•23 TOTAL PERMIT FEE
Print name:Katie Patterson Date: 12/1/22 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-Cormiy Building Industry Service Board.
I.\Building\Permits\PLMU-PermitApp.dor 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:
Foofing drain-I' 100' •,003 0to2,000 S 12190
Footing drain-each additional 100' 37.52 2,00I 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
WaterService- 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' 3752 $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$100.00 or fraction thereof,to
P 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.
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 $742 00 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
ElCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure
-Drive Thm as defined in OAR918-780-0040.
ElCuspidor/water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El 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"
3" Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
• Urinal
Other Fixtures:
I:\Buildingspermits\PLMFPermitApp.doc 08/04/2011 2
City of Tigard
114 " COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
6,
Building Permit #: M 51 )x."34" " 00 4 Y\
Site Address: q3$ l (-Aw tiNtOtt rTE- 1Verified in Accela
Project Name: A-9,p4,96,K. VALks 1.o'1- as Co /Unit #: 2t7:).
Proposal (include housing type): N4W Rot' AU—. Zone: Re5 - Q
Required Site Plan Elements: Ke vt3 j vi•.. 2 ; 'vi•S- - S yik 10/41.7
i3 cgpies of site plan on max 11x17"
Drawn to standard scale • , rcteetiom },9o-0000D.
orth arrow 1 set and site trees shown labeled _ ?DR G.1-„Jr j
4 Site address, project name, lot # able calculating tree canopy at maturity -k4-2
lEf/Street names (N/A for SFR) Alt 52t Qr°ni-00}
P1,Applicant name
Id Lot and setback dimensions Vision clearance triangle
tility locations &easements
Footprint of new structure and FFE A'roperty corner elevations
dl idewalk/driveway dimensioned i tan.a-{_>_1, O(jsf ViLot area and lot coverage percentage Erosion control
Required Elevation Plan Elements:
(ForR: calcs needed only on street-facing) Garage doors dimensioned
NI aw n e S mart' table with calculations for:
i" `tom} Building height dimensions total facade area
.r
viik eoi facade imensione Total window and door area
Windows and doors dimensioned iTotal garage area
Required Floor Plan Elements: llSummary table that includes
VEach story dimensioned g otal floor area
ach story floor area calculated �"Floor area per story
Planning Review
The following standards have been met: f
Setbacks Front: IS Rear: IS Side: ✓ Min/Max Street Side: N/A Garage:
_eoMcri- bv,ildk Ie` - -t cc# t/.
Height ❑ Max. Height: 3 S Proposed Height:
301 & 4 ,
ilYes ❑ N/A Landscape -IA lect,. S �JS#� ki `144-
. Yes1 N/A Scieening (Q'adnnly) _ I¢( �;..eu1w./
ICJ/Yes N/A % Window Coverage + le.ri Cyst Y kS �y,,, -eadh )GCS•
Ye N/A Ga aye oly /fit % D µ �°r id
V Parking (Other Res;)/ (SFR Q
Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
V Yes ❑ N/A Other building design standards (Rowhouse only)
O Yes aN/A Accessory Structure Standards
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
Yes ❑ N/A Unit Count:Col
'Yes C/N/A Lot Width and Size
0 Yes N/A Pathway
itional standards for Courtyard Units and Cottage Clusters only:
❑ Yes /A U • rea:
❑ Yes ❑ N Floor Area (per story)
❑ Ye /A Co and
es 0 N/A Fence
0/Yes ❑ No eN/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Ed Yes ❑ No ON/A Public Facilities Improvement (PFI) Permit:
Required: /Yes ❑ No
Applied For: P,Yes ❑ No, stop intake
I6ensitive Lands: la Yes ❑ No /
O Land Use Case #: P DP..10 a.t) - 00 /Conditions met prior
permit is su7ance
Approved By Planning: _ Date: / 2/ 7/�G Z
Notes
Revision 1: yffApproved ❑ Not Approved Date: / I /21 v3
Revision 2: 'Approved ❑ Not Approved v Date: 3 f? 12!3
Building Permit Submittal
Original Submittal Date: * 1?-41 I
Site Plans #:
Building Plans #: 4
Building Permit #: " Building permit # entered on page 1
Workflow Routing: PS Planning V Engineering '.Permit Coordinator `Building
Workflow Sign-off: &Sign-off for Planning (include notes from planning review)
Route Documents: Iik Engineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
N Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.Permit Technician: Date: p--/ r-7
/3,..
Notes:
Engineering Review
lope at building pad: pZ°.ri %
@'Conditions met prior to issuance of permit
asements (encroachments) per engineering conditions of approval and plat
i 1kiater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes dNo
Assess Water Quantity Fee in-lieu: 0 Yes 1 o
LIDA Facility on lot: ❑ Yes ErNo Add Fee: ❑ Yes 0 No
al Plat Recorded
La-NOT Approved: IL : F 9 y4-r- Date:
Notes: 4i.1a1/4..3 U/an.ta.-T 5.4+4<r.+ 1 (Arit441.. C.411 hs� 5'1140-... 1.1k7ter41r(
Approved By Engineering: Date:
Revision 1: Approved 0 Not Approved i4 .1Wel&
isp0c2 Date: 1.- (1- 2_o 2�
Revision 2: e�pproved ❑ Not Approved 1{. Date: 3- 13.2o2,5
Permit Coordinator Review
'Conditions met prior to permit issuance
0 Approved, NOT Released: Date notified applicant:
1.ENG Revisions Required: %\`pY(:\ Date notified applicant: 1-G -"7-'5-
'‘,121'lSDC Exemption: ❑Applied for ❑ Received ❑ Does not apply
*SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A ❑ Deferred
Parks SDC: Yes ❑ N/A ❑ Deferred
LIDA ❑ Yes � M N/A
fd'6K to Issue/Approved by Permit Coordinator: k 1' 7 Date: t 118 12,02.,5
Revision 1: f2'/Cpproved ❑ Not Approved Date:
Revision 2: /Approved 0 Not Approved Date: ..* f 20't-3