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Permit Support Document (8) V ala OJ , RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT FEB 2 5 2016 Request for Permit Action off CITY OF TIGARD SUILDIN(- rl'VISION 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •��`crty i% ;:�rti c7 r�r TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov FROM: ❑x Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE 110: (Business or Individual) Saqe Built Homes Mailing Address: 1815 NW 169th Place, Suite 1040 City/State/Zip: Beaverton, Oregon 97006 Phone No.: 971-221-4597 PLEASE TARE ACTION FOR THE ITEMS) CHECKED (✓): [Q CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑x INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: MST2016-00023 -1t:�w 2 9-014P-OeO lS Site Address or Parcel#: 9926 SW Murdock Street Tigard, Or Project Name: Murdock Subdivision Name: Murdock Lot#: 1 EXPLANATION: Would like to submit new plans for this lot. Signature: Date: �- )�A Print Name: Refund PuUQ 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date R' /(1 BJ_ Route to Records: Date 2/.2 1 B Refund Processed: Date il/,y B Invoice Processed: Date I By Permit Canceled: Date 025 / By Parcel Tag Added: Date 113 1'\Buildinl;\lurms\RcyYennit;leri»i,_,N23i .doe 41 City of Tigard • COMMUNITY DEVELOPMENT Building Division 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov INVOICE TO: Sage Built Homes Customer ID: 189330 1815 NW 169th Pl, Suite 1040 Invoice No.: INV2016-00010 Beaverton, OR 97006 Invoice Date: 2/25/2016 Date Due: 3/25/2016 Case No. Site Address Subdivision-Lot#or Project Name Amount Due MST2016-00023 9926 SW Murdock St Murdock Partition,Lot 1 $927.56 Plan review fees due for plan review completed prior to request to cancel permit. Invoice Total: $927.56 ® Please see attached fee schedule for description of fees due. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (Detach and return this portion with payment.) Case No.: MST2016-00023 Customer ID: 189330 Site Address: 9926 SW Murdock St Invoice No.: INV2016-00010 Project: Murdock Partition,Lot 1 Invoice Date: 2/25/2016 Date Due: 3/25/2016 Invoice Total: $927.56 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse Please mail payment to: City of Tigard, Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 1:\Building\Accounting\Imvoice.doc 01/14/2011 CITY OF TIGARD FEE AND PAYMENT HISTORY a 13125 SW Hall Blvd.,Tigard OR 97223 9 503.639.4171 MST2016-00023 - 9926 SW MURDOCK ST, TIGARD, OR 97224 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Plan Review 230-0000-43106 $751.34 $751.34 $750.00 2/9/16 Check 401956 $1.34 DC Provision Review, SF-Ping 100-0000-43112 $88.00 $88.00 $88.00 Plan Review 230-0000-43106 $838.22 $838.22 $838.22 Totals for Fees $1,677.56 $1,677.56 $750.00 $927.56 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 401956 Check 6019 Sage Built Homes LLC 02/09/2016 $750.00 Total Payments: $750.00 Balance Due: $927.56 Building Permit Application Residential City of Tigard RECEIVED Received Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: PI RAW PA%/B7 Y Phone: 503.718.2439 Fax: 503.598.C9@B 9 20116 Other Permit:C Inspection Line: 503.639.4175 Jufi': 0 See Page 2 for Internet: www.tigard-or.gov Cj_FY OE- 1I A R D Notified/Method:Wjlq1jj, afM— Supplemental Information i i n i�,ir: In t I-K,Ats i 11. 'PAT 0 New construction E]Demolition Permit fees*are based on the value of the work performed. Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all ❑ equipment,materials,labor,overhead,and the profit for the !UTFr"T OF,00MMUel", work indicated on this application. 1-and 2-family dwelling ❑ Valuation: $ Commercial/industrial El Accessory building ❑Multi-family Number of bedrooms: 4 El Master builder ❑Other. Number of bathrooms: 3 VMQMWTM A",LWAMN Total number of floors: 2 Job site address:9926 SW MURDOCK STREET New dwelling area: 3760 square feet City/State/ZIP:PORTLAND,OR 97224 Garage/carport area: 658 square feet Suite/bldg./apt.no.: Project name:MURDOCK V-441r/ot-), Covered porch area: 191 square feet Cross street/directions to job site:SW 100'AVENUE Deck area: square feet Other structure area: square feet Subdivision:MURDOCK Lot no.:I 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 work indicated on this application. NEW RESIDENTIAL CONSTRUCTION Valuation: $ Existing building area: square fed New building area: square feet OWW '[7 C, Number of stories: Name:SAGE BUILT HOMES LLC Type of construction: Address:1815 NW 169""PL.SUM 1040 Occupancy groups: City/State/ZIP:BEAVERTON,OR 97006 Existing: Phone:(503)533-5167 Fax:(503)533-5164 New: 0 COWACT ""WN Business name:SAGE BUILT HOMES LLC Contact name:KYLIE HOFENBREDL Structural plan review fee(or deposit): Address:SAME AS ABOVE FLS plan review fee(if applicable): City/State/ZIP: Total fees due upon application: Ll Phone:(971)2214597 Fax: Amount received: E-mail:KYLIE*SAGEBUILTHOMESLLC.COM Commercial and residential prescriptive installation of roof-top mount da Photovoltaic Solar Panel System. un Business name:SAGE BUILT HOMES LLC Submit two(2) is of roof plan with co ion details 0 g g;� the 0 and fire departme% ccess,along e 20 10 Oregon e checklist Address:SAME AS ABOVE Solar Installation Spkialty C echecklist. City/State/ZIP: Permit Fee(incl plan review $180.00 ini five fees): Phone:( Fax:I State arge(12%of $21.60 CCB lic.:189330 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained Lif within 180 days after it has been accepted as complete. Print name:KYLIE HOFENBEDL Date: Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\PermitsBUP-RESPennitApp.doc 02/24/2011 4404613T(I 1/02/COMfWEB) Electrical Permit Application City of Tigard ReB Permit#: te _ 13125 SW Hall Blvd.,Tigard OR 97223 r. Plan Review >4 Phone: 503.718.2439 Fax: 503.598.1960 Date/g : Related Permit#: Inspection Line: 503.639.4175 F E_B 9 20116 Ready nate/By: huts —OSee Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE MMl PLAN REVE9W Al ®New construction ❑Addition/aIGV *fit r—I t Please check all that apply(submit 2 sets of plans w/item,checked): ❑New construction C1 Other. [3 Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUMON exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or eras 14,000 ❑Commercial-use agricultural ❑ amps for all other installations. buildings. Multi-family E]Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address:9926 SW Murdock Street ❑Addition of new motor load of system. I OOHP or more. ❑"A","E","1-2",`1-3-. City/State/ZIP:Portland,Oregon 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:SW 100"avenue FEE SCHEDULE Description I Q1Y, I Eari I TOW New residential single-or multi-family dwelling unit. Subdivision:Murdock Lot#: 1 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 DESCRIPTION OF WORK Ea.add 1500 sq.ft.or portion 33.92 1 Limited energy,residential with above .ft. j 75.00 2 Limited energy,multi-family 75.00 2 New Residential Construction residential with above .R PROPERTY OWNER ❑ TENANT Renewable Ea ❑ Sec P e 2 Services or feeders installation,alteration,and/or relocation Name:Sage Built Homes,LLC 200 amps or less 1 100.70 100.70 2 Address:1815 NW 169"Place Suite 1040 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Beaverton,Or 97006 601 amps to 1,000 amps 301.04 2 Phone:(503)533-5167 Fax:(503)533-5164 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 I own which is not 200 amps or less 59.361 11 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 1 2 ® APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, rpanel A.Fee for branch circuits with Business name:Sage Built Homes LLC above service or feeder fee, each branch circuit 7'42 2 Contact name:Kylie Hofenbredl B.Fee for branch circuits without Address:Same as above service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch cincttit 7.42 2 Miscellaneous service or feeder not included Phone:(971)2214597 Fax::( ) Each manufactured or modular 6784 2 Email:kylie@sagebuilthomeslic.com dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Ross Electric Sign or outline lighting 67.84 2 Address:2870 SE 75th Avenue,#203 Signal circuit(s)or limited-energy ❑ See Page 2 2 el,alteration,or extension. City/State/ZIP:Hillsboro,Or 97123 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 6625/hr Phone:(503)642-2800 Fax:(503)642-5815 Investigation(I hr min) 90.00/hr Email: Industrial plant(I hr rain) 78.18/hr Inspections for which no fee is 9000/hr CCB Lic.: 157891 Electrical Lic: 34436CSuprv.Lic.:-am specifically. listed X hr min — ELECTRICAL PERMiT FEES Suprv.Electrician signature,required: t. Subtotal: Print name: Steve Ross Date: ❑Plan Review Required(25%of permit fee): I State surcharge(12%of permit fee): �/I(� Authorized signature: TOTAL PERMIT FEE:t ��lll"' This permit application expires if a permit is not obtained within 180 Print name: Kylie Hofenbredl Date: days after it has been accepted as complete. Number of inspections allowed per permit. l:lBuaaingvbrmitAELC_Pamienpp_lz.a_F.lta.doc Rev 06/17/2015 440-461sTp1ro5/coWwl:a Mechanical Permit Application City of Tigard �� IDate/By:ei"ea`Jg ' "4 t� mveC� Permit No.: 13125 SW Hall Blvd.,Tigard,OR � .✓ Plan Review Phone: 503.718.2439 Fax: 503.598.1960DatcBy: Other Permit:AW"sy,�Q � ! S)w - Inspection Line: 503.639.4175 F i_.g 9 20116 Date Ready/By: loris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplements[Information CITY OF Aq. L VVISiON Imo*51K l ,Fr . ' 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:5 Ri:S�11Glri1l�Fi�11, . . , �>'B x . ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For spedallnfornemion use checkltst ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total Heating/cooling: Air conditioning 1 46.75 46.75 Job site address:9926 SW MURDOCK STREET Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:PORTLAND,OREGON 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name:MURDOCK Heat pump 61.06Duct work 23.32 Cross street/directions to job site:SW 1001 AVENUE H dronic hot waters stem 23.32 Residential boiler(radiator or h dronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/ventfor any of above 23.32 Subdivision:MURDOCK Lot no.:1 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 1 23.32 23.32 .wow .i Gas fireplace/insert 1 33.39 33.39 Flue vent for water heater or gas NEW RESIDENTIAL CONSTRUCTION fireplace 23.32 Log lighter as 23.32 Wood/pellet stove 33.39 Wood fireplace/insert lace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 Environmental exhaust and ventilation: Name:SAGE BUILT HOMES LLC Range hood/other kitchen equipment 1 33.39 33.39 Address:1815 NW 1691 PL SUITE 1040 Clothes dryer exhaust 1 33.39 33.39 City/State/ZIP:BEAVERTON,OR 97006 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 4 23.32 23.32 Phone:(503)533-5167 Fax:(503)533-5164 Attic/crawls ace fans 1 23.32 23.32 `CONTACT Other: 23.32 Business name:SAGE BUILT HOMES LLC Fuel i in : $14.15 for first four;$4.03 for each additional Contact name:KYLIE HOFENBREDL Furnace,etc. Address:SAME AS ABOVE Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:(971)2214597 Fax::( ) Fireplace Range E-mail:KYLIE@SAGEBUILTHOMESLLC.COM Barbecue PWM"Croft Clothes dryer as Business name:GRAMER HEATING&COOLING Other: M15(.�tANICAI!:1�TIF1�'S' Address:53725 NW Old Wilson River Road Subtotal City/State/ZIP:Gales Creek,Or 97117 Minimum permit fee($90.00) Phone:(503)720-2636 Fax:(503)536-6734 Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.:161571 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 l days after it has been accepted as complete. Authorized signature: 4 ' Fee methodology set by Tri-County Building Industry Service Board Print name:KYLIE HdFENAREDL Date: VBui1ding\Permits\MFC_PmnitApp_040113.doc 440-4617r(11/02/COM/WEB) Plumbing Permit Application Building Fixtures City of Tigard RECE N"_ Received Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard,OR 9722 49 QV '(1 0 1110' Plan Review 4 U9 _& H,5-,r Phone: 503.718.2439 Fax: 503.598.1 598.1 Date/By: Other Permit NoAA.)j %Ol& Inspection Line: 503.639.4175 1, ' _CC015" Internet: www.tigard-or.gov C IT Y Oi_' 1 k, Date Ready/By: Juris: 0 Seepage 2 for Notified/Method: Supplemental Information New construction 0 Demolition For special informadon use checklist Description I Qty. I Ea- Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 - El Accessory building Multi-family SFR(3)bath 1 500.32 500,32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 idTA 6 Site utilities: Job site address:9926 SW Murdock Street Catch basin or area drain 18.76 City/State/ZIP:Portland,Or 97224 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: Page 2 Suite/bldg./apt.no.: Project name:Murdock Manufactured home utilities 50.03 Cross street/directions to job site:SW 1001 Avenue 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 It.: Page 2 Subdivision:Murdock Lot no.:1 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 Clothes washer 25.02 New Residential Construction Dishwasher 1 25.02 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 OWIQM © YEHAIVT Expansion tank 12.51 Name:Sage Built Homes,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 1815 NW 169'Place,Suite 1040 Garbage disposal 25.02 City/State/ZIP:Beaverton,Oregon 97006 Hose bib 25.02 Phone:(503)533-5167 Fax:(503)533-5164 Ice maker 12.51 MSON Interceptor/grease trap 25.02 Business name:Sage Built Homes,LLC. Medical gas(value:$ Page 2 Contact name:Kylie Hofenbredl Primer 12.51 Address:Same as above Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:(971)2214597 Fax: Tub/shower/shower pan 12.51 E-mail:kyIie@sageul1thomesl1ccom Urinal 25.02 77777777777777- Water closet 25.02 Water heater 37.52 Business name:Ed Mullen Plumbing Water piping/DWV 56.29 Address:1601A SE River Road Other: 25.02 City/State/ZIP:Hillsboro,Or 97123 Subtotal Phone:(503)640-0113 Fax: Minimum permit fee: $72.50 CCB Lic.:92689 Plumbing Lic.no.:34-260PB Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Kylie Hofenbredi) Date: 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\Pemits\PLMU-PamitApp.doc 10/01/09 440-4616T(10/02/C0MfWEB)