Permit Support Document 1111 - �.
TIGARD
City of Tigard
October 3, 2013
Sage Built Homes LLC
Attn: Katie Patterson
16280 NW Bethany Ct.
Beaverton, OR 97006
Re: Permit No. MST2013-00140
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13571 SW Piper Terr
Project Name: Tindall Partition,Lot 3
Job No.:
Refund Method: ® Check#211627 in the amount of$520.00.
❑ Credit card "return" receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comment(s): Original house plan did not fit on lot;plan review incomplete;refund
80% of plan review fees less development code review fees due. New plans submitted under
MST2013-00184.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,c-pi
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
Accela Refund Request
TIGARD`
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request,for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Sage Built Homes LLC DATE: 9/26/2013
Attn: Katie Patterson
16280 NW Bethany Ct REQUESTED BY: Dianna Howse
Beaverton, OR 97006 Debbie Adamski
TRANSACTION INFORMATION:
Receipt#: 191849 Case#: MST2OI3-00140
Date: 6/18/2013 Address/Parcel: 13571 SW Piper Ter
Pay Method: Check Project Name: Tindall Partition,Lot 3
EXPLANATION: House plan did not fit on lot;new house plan submitted under MST2O13-00184. Plan
review incomplete;refund SO°o of plan review fees,less DCPR fees due.
REFUND INFORMATION:- - • .
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plan Review 230-0000-43106 $520.00
TOTAL REFUND: $520.00
APPROVALS: SIGNA •ES DATE:
If under$5,000 Professional Staff ; i 671C—,
If under$12,500 Division Manager
IE under S25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
• - - FOR TIDEMARK SYSTEM ADMINISTRATION USE O .
Case Refund Processed: Date: /%3`/3 By:
1:\Building\Refunds\RcfundRcqucst.doc x 09/01/21)10
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT C /.Q
lig
" Request Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD VOID
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223 A4f 3
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: El Owner ❑ Applicant ❑ Contractor Ej City Staff
(check one)
REFUND OR Name: 1
INVOICE TO: (Business or Individual) yp
Mailing Address: 1 to a$O N)/A)[-J P,. C4,-.
City/State/Zip: �l J..e4ow C a ei 700(p
Phone No.: 50 - 5oa- L0 a3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El CANCEL/VOID PERMIT APPLICATION.
El REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
El REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: h G j i go i 'J' oo ( 4 U °t otu)e,oho/ 3-60 l-FT
Site Address or Parcel#: ( ? 5 I §u kfil..A LQAAe)-e.2..
Project Name: 4..cQ et—a, 1`' t o.-`
Subdivision Name: Lot#: 3
EXPLANATION: 1\., ,_ o,,.,,`_ .�Q -4 ,4t-
' fTiA:) Atr-f.rn. .J o, Hz5rAot3-a) l g5/
•
Signature: _1,� . % •Ire• Date: 77/ 3
Print Name: —i E./56 j L. A-1j filLt 5i-'\/ _
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date KIMMEISIEM Rte to Bld• Admin: Date/, J5
Refund Processed: Date /a 3 ZZII B Invoice Processed: Date B
Permit Canceled: Date /O/3 /3 By 77—r Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\ReqPermitAction.doc Rev 05/25/2012
Building Permit ApnlicatIEC /e/v/3
Residential FOR OFFICE ICE USE ONLY
City of Tigard JUN 1 2013 RDaecet ea & /� �� )/r', _ao'4/O
LL7 Perm
lig it No.:
C .. 13125 SW Hall Blvd.,Tigard,OR f9RVAi F TIGARD Plan Review Q/l„`3 y
Phone: 503.718.2439 Fax: 503. 1 BUILDING DIVISION Date/By: Other Permit: — RA
I"I G A R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: tuna: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 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 I-
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the -c,
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
® 1-and 2-family dwelling ❑Commercial/industrial
El Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms: -?) l
JOB SITE INFORMATION AND LOCATION Total number of floors: D. Q
Job site address: r New dwelling area: -Z2j - square feet l.)
oi
City/State/ZIP: 7 (11 ta nl i Qfa_ 9 79- Garage/carport area: 6/0 square feet
Suite/bldg./apt.no.: Project nam 1n1 htez P-47777,04 Covered porch area: 'r 75- square feet
Cross street/directions to job site: L_073 Deck area: square feet
Other structure area: square feet (�,
ki
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
�� Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Residential New Construction Valuation: $
Existing building area: square feet
New building area: square feet `1
® PROPERTY OWNER ❑ TENANT Number of stories: (fr7
Name:Sage Built Homes LLC Type of construction: v
Address: 16280 NW Bethany Court Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)502-6623 Fax:(503)533-5164 New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee scheduk)
Business name:Sage Built Homes LLC
Structural plan review fee(or deposit):
Contact name:Katie Patterson
FLS plan review fee(if applicable):
Address: 16280 NW Bethany Court
Total fees due upon application:
City/State/ZIP:Beaverton,OR 97006 a)
Phone:(503)502-6623 Fax::(503)533-5164 Amount received: ?�
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:katie @sagebuilthomesllc.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel Syst- .
Business name:Sage Built Homes Submit two : of roof plan with corm-• on details
and fire department ac -. along wi . . e 2010 Oregon
Address: 16280 NW Bethany Court Solar Installation Specialty .:• ecklist.
City/State/ZIP:Beaverton,OR 97006 Permit Fee(includ : . an revs $180.00
and .:. tnistrative fees):
Phone:(503)502-6623 Fax:(503)533-5164 State s - arge(12%of permit fee): ,. .60
CCB lic.:189330 Total fee due upon application: $201.60
Authorized signature: �p // This permit application expires if a permit is not obtained
` within 180 days after it has been accepted as complete.
Print name:Katie aft on Date: *Fee methodology set by Tn County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 1/02/COM/WEB)
Mechanical Permit Applic ; Ellipil FOR 011.H'II 1ST:O l.1.
City of Tigard • ( E �Da p
III
n 13125 SW Hall Blvd.,Tigard,OR 972211 ∎N 18 2013 PI�, R- •ew D
Phone: 503.718.2439 Fax: 503.598.1 Dat,,: . II Other Permit: cliaOp/5—1001.25
I I G A Iz D Inspection Line: 503.639.4175 8 CITY 1 ®I°TIGARD Date 7radyB''�' MP Juris: ® See Page 2 for
Internet: www.ti d-or. ov I 1 r fl Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For spedal information use checklist
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
2
'' --11 Air conditioning
Job site address: 36'7( W Pt TP�CPrQ� (requires site plan showing placement) 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR '7a�'� Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:Everett Terrace Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: _ 23.32
Tax map/parcel no.: ??c-(+D A -kk Other fuel appliances:
DESCRIPTION OF WORK Water heater j 23.32 a.3.31
Residential New Construction Gas fireplace/insert 1 33.39 ,333 /
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
® PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name:Sage Built Homes LLC Environmental exhaust and ventilation:
Address:16280 NW Bethany Court Range hood/other kitchen
equipment t 33.39 3339
City/State/ZIP:Beaverton,oR 97006 Clothes dryer exhaust ( 33.39 3c'(
Phone: 503 502-6623 Fax: 503 533-5164
Single-duct compartments,rt exhaust(bathrooms,o if e�
( ) ( ) toilet compartments,utility rooms) ` 23.32 �3✓D
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans I 23.32 93.3 .
Other: 23.32
Business name:Sage Built Homes LLC
Fuel piping:
Contact name:Katie Patterson $14.15 for first four,$4.03 for each additional
Address:16280 NW Bethany Court Furnace,etc.
Gas heat pump
City/State/ZIP:Beaverton,OR 97006 Wall/suspended/unit heater
Phone:(503)502-6623 Fax::(503)533-5164 Water heater
Fireplace
E-mail:katie @sagebuilthomesllc.com Range
CONTRACTOR Barbecue -
Clothes dryer(gas)
Business name:The HVAC Team -
Other:
Address:PO Box 854 MECHANICAL PERMIT FEES*
City/State/ZIP:Sherwood,OR 97140 Subtotal
Minimum permit fee($90.00)
(25%Phone:(971)322-5013 Fax:(503)352-9349 permit fee)
Plan review(25 of permit fee
CCB lic.: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: ', This permit application expires if a permit is not obtained within ISO
=� -L /`- ;4 ��_,�L days after it has been accepted as complete.
Print name:Katie fitter son / Date: • Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits EC-7-.App.doe 03/07/12 440-4617T(11/02/COM/WEB)
May 31 2013 8: 50RM ROSS ELECTRIC INC 5036425815 p. 2
• Electrical Permit Applic:`71.+, �a
....4.� rl:nt t 11'f lt'I:I'ti l{t by 1,T
Received f,,
City 0 Tigard 2013 Da1dB : loQ� r Permit No.. S ,, �/3••00/ dl
el 13123 SW Hell Blvd.,Tigard,OR 97 N
PhDIIO: 503.639.4171 Fox: 503,59lf1'60 1
Plan view Outer Petmit:&Dg7 i 3 ex,/.2
I I C:A i t i> Inspection Line: 503.639.4175 r
Internet: www.tlger4•or.gov CITY OFTIGARD i ;}!t ,4 1'. % Supplemental lnformedon
1'' •' ,1� . � t al r!III ',1.1 , it .',..•,.i,.ly{I t �JI((,y(�f1 11 1'r �''� G{ I/'r1, I I t f, I It:{I� ',1.,:.,:;!-,I '4-,i11/, i:r. I�I i.. ,,.i'I, ; , , ,, ,q;� .i I
I i fy )
�tilA�Aul ,:,.,:'. ,.114', ._.h.{�t✓1�11,9�.1. 'fin" .:',IN ,IL ,,w.�VS .1 :zq,.,Ya-, _ . .i;'..,.v�. ,:,...'t .,,s.tf 'iii: ,.. �IYdlu;,∎e,-?
.,i,... emu_:,
❑New construction Addition/alteration/replacement Please cheek all that apply(submit a seta ofp Ina writs,*chocked bvlvw);
❑Service or feeder 400 amps or more 0 Building over three'loeiea,
❑Demolition 0 Other: where the visitable halt enfant ❑Mariam and boalyords.
• ''1111(1:' . .c.1 ;. oO N, +a' !,.il'1,`„}�ni•htinhli:i�,i,,t1,.=i-%;+thultd,r'�.:i9V.1;,.•.•••"{1^li, i
• Plumbing Permit Applicati EC IVED
Building Fixtures rOIZ order. I s[: 0w1.,
City of Tigard JUN 18 2013 Received 2 Permit No.: / /r ()
I� q 13125 SW Hall Blvd.,Tigard,OR 97223 y /�/i �lL
a: Phone: 503.718.2439 Fax: 503.59°P1 OF TIGARD Dat e" Other Permit No.�yO�`ot3��1
Inspection Line: 503.639.4175 BUILDING DIVISION e R yBy:0 1 tom+ ® See Page 2 for
1ICi/\RU
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 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(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath I 500.32 5c0 7D,-
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
-T Catch basin or area drain 18.76
Job site address: s57 ) Pt )24' leJ('0P a,_1 Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 9'9-a 3
It Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 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: - Lot no.: Fixture or item:
Tax map/parcel no.: pex-co \ iA Backflow preventer 31.27 3 ,�-7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer k 25.02 a5,pa
Residential New Construction
Dishwasher 1 25.02 a,s.0
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:16280 NW Bethany Court
Garbage disposal I 25.02
City/State/ZIP:Beaverton,OR 97006 Hose bib 0 25.02 50.01{
Phone:(503)502-6623 Fax:(503)533-5164 Ice maker ( 12.51 ip .S l
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Sage Built Homes LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Katie Patterson
Roof drain(commercial) 12.51
Address:16280 NW Bethany Court Sink/basin/lavatory �0 25.02 DSO
City/State/ZIP:Beaverton,OR 97006 Solar units(potable water) 62.54
Phone:(503)502-6623 Fax::(503)533-5164 Tub/shower/shower pan 3 12.51 7.53
E-mail:katie@sagebuilthomesllc.com Urinal 25.02
CONTRACTOR Water closet 3 25.02 75,(:)(o
Water heater 1 37.52 3.7.s D.._
Business name:Malmedal Plumbing Water piping/DWV 56.29
Address:PO Box 207 Other: 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)502-6623 Fax:(503)533-5164 Minimum permit fee: $72.50
CCB Lic.: -
Plumbing Lic.no.:
�► Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:I /,��I'��/ TOTAL PERMIT FEE
/_ aa►..1 fLr••
Print name:Katie •atterson / Date: I 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 Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
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SITE PLAN - PARCEL 3 71, •/' 41,..................4240.. . -so r.
Scale 1"=20'-0' �. ;
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iPlairl' SAGE BUILT HOMES PIPER COURT PARCEL 3
C J�^ BU l L 18820 NW Bethany Court#200 Job No. 156-1211-12 Date 6/06/13 Sheet
�7^V m � Beaverton,Oregon
Client Sage Built Homes By MEB
Building Division
Development Code Provision Review
T c A a Residential'Projects
Building Permit No.: M`a-c90 13- OC) 1 LI O
Project/Subdivision Name: 1 .S b u Pf}2Ti TivI • , Lot #:
Site Address: 1 3571 a1t1 P� Pte.. e2 e€
CWS Service Provider Letter:
Required:Yes ❑ No
Received:Yes ❑ No cg-
Plans Routed:
Original Plan Submittal Date: tot 1S1 Routed B •
1St Revision Submittal Date: ❑ Site Plan Only Routed By: •
2nd Revision Submittal Date: ❑ Site Plan Only Routed By:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (1) items are approved. Items not approved and those listed in the notes must be
revised prior to re-submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review(contact klaeS Vz- w
oa( - at(503) 718- -1-1"
21 or Gnes @tigard-
or.gov) 1�
Land Use Case No. mLP 20C10°COCOS
Zoning \ y.
0'Setbacks:
GI
1
Front Rear , Side 4b Street Side 1\1 IA' Garage
0/Maximum Building Height: 3D' Actual Building Height ±2-tO
EKVisual Clearance OJWA -
❑ Easements
EVSensitive Lands Type: 1\10ME
❑ Street Trees
❑ Protected Trees
Notes: OiSLIS I^(101-4- cone'rht v IS *(U
,Sh nIW I c-J r o_rd' c t I
• � 4ror N'tr�
U .
1 \t�rd_S°4-Se O I Y.
Original Plan: Approved ❑ Not Approved)3( Date: (ill
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13
Engineering Review(contact Mike White at 503-718-2464 or MikeW @tigard-or.gov)
Actual Slope: 49
Notes:
Original Plan: Approved 4Er Not Approved ❑ Date: 6 et/a
Revision 1: Approved ❑ Not Approved ❑ Date: t
Revision 2: Approved ❑ Not Approved ❑ Date:
•
Permit Coordinator Review(contact Albert Shields at(503) 718-2426 or albeit @ tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No e �/// / 3
Date Routed to Building:
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc Rev.01/16/13