Permit (138) � � 4� ��4 MASTER PERMIT
IN '
CITY OF TIGARD rit.
estum,Ilii. COMMUNITY DEVELOPMENT Permit#: MST2018-00073
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/21/2018
T[ aa4:i`;C g Parcel: 1S135BD02100
Jurisdiction: Tigard
Site address: 9584 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 7
Project: Ash Creek Village, Lot 7
Project Description: New SF. 6/22/2018: REPRINT to remove A/C from permit.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 864 sf Basement: 197 sf Left: 3 Parking Spaces: 0
Height: 31.5 Bathrooms: 3 Second: 914 sf Garage: 742 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1975 sf Value: $259,573.33 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
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: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 1
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
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!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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1975
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006 2 1 Hour Fire Rated Eaves
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $29,787.35
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O - 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: t1 ~� .. Permittee Signature: �/t/ ��'./ CII-77hA//
r
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.
CITY OF TIGARD
MASTER PERMIT
` COMMUNITY DEVELOPMENT
T C311.:R.;D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Permit d: 6/21/2 8-00073
Date Issued: 06/21/2018
Parcel: 1 S 135BD02100
Site address: 9584 SW ANNA BELLE CT Jurisdiction: Tigard
Subdivision: ASH CREEK VILLAGE
Project: Ash Creek Village, Lot 7 Lot: 7
Project Description: New SF.
BUILDING
Garage: 742 sf Front: 20 Smoke
Floor Areas
Stories: 3 Bedrooms: 4
First: 864 sf Reuuire`ba�ks Rem_
Height: 31.5 Bathrooms: 3 Basement: 197 sf Left: 3 Parking Spaces: 0
Second: 914 sf
Dwelling Units: 1
Third: 0
sf
Total: 1975 sf Right 3 Detectors: Yes
Value: $259,573.33 Rear: 15
inks: 1 Water Closets: 3 PLUMBING
Washing Mach: 1 Laundry Trays:
Lavatories: 4 Dishwashers: 1 1 Rain Drain: 1
Tubs/Showers: 3 Floor Drains: 0 Sewer Lines: 100 Urinals: 0
Garbage Disp: 1 Water Heaters: 1 SF Rain Storm Sewer 100
Footing Drain: 0 Ice Maker: 1 Water Lines: 100 Drains: 0
Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Catch Basins: 0
Drywell-Trench Drain: 0
Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y
Natural Gas Vent Fans: 5 Clothes Dryers: 1
Heat Pump: N
Furn<100K: 1 Hoods: 1 Other Units: 1
Vents: 0 Woodstoves: 0
Furn>=100K: 0 Gas Outlets: 4
Residential t ELECTRICAL
Service Feeder
1000 sf or less: 1 --- —Tema Srvc/Feeders
0-200 amp: 0 BranchCircuits
Ea add'I 500 sf: 4 0-200 amp: 0 W/Svc or Fdr: 0
201-400 amp: 0 201-400 amp: 0
Mfd Home/Feeder/Svc: 0 401-600 W/O Svc/Fdr: 0
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: Y
BUILDING INFO
Class of Work:
Type of Use:
NEW SF Type of Constr: Occupancy Group:
Vg Square Feet:
Owner: R-3 1975
SAGE BUILT HOMES LLC Contractor:
ML STE 1040 SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 N 169TH OR 97006 STE 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 2 1 Hour Fire Rated Eaves
PHONE: 971-221-4597 PHONE: 971-221-4597
Total Fees: $29,787.35 FAX: 503-533-5164
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
beys. ATTENTION: Oregon law requires permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
dadays. ATTE through q you to follow the rules adopted by the Oregon Utility Notification .19:er. Those rules2are set forth in OAR
direct questions to OUNC by calling 5i 32.19: or 1.800.332.2344.
Issued B
Permittee Signature: ,
..-7..• 75 by 7:00 a.m.for the next available inspection.ate.
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 O1 FIC E t SE ON1.11VAp
City of Tigard + ° ��A. T E�� Date/By: �� Permit No ( �6
III 13125 SW Hall Blvd.,Tigard,OR 97223 y ` /� 3
_ Plan Review Q Other Permit. Gi
• Phone: 503.718.2439 Fax: 503.598.1960 ?(111%? Date/By: 3 ( r/ ��L ! t/O (iGi�67/
Ins ection Line: 503.639.4175 Date Ready/By: Juris: H See age 2 for
1_<G A 1:D p v Supplemental Information
Internet: www.tigard-or.gov Notified/Me hod: t I L,I(b p� pP
,'11"Y OF TIGAK
I '' i
TYPE OF; W e QIJIREA DATA.I AND 2 FAMIL*DWELLING
II v
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,ove T .1 a e e a it i -MI
work indicated on this applicati /nii alb. .Ja►//
CATEGORY OF CONSTRUCTION
Valuation: $ _
® 1-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms: �y 4 5
❑Accessory building 0 Multi-family j
❑Master builder 0 Other: Number of bathrooms: ,.}.S
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 2 7 1 7
Job site address:9584 SW Anna Belle Ct New dwelling area: 1975 square feet I it(
City/State/ZIP:Tigard Oregon Garage/carport area: 742 square feet g(0({
Suite/bldg./apt.no.: Project name:Ash Creek Covered porch area: square feet 11.1
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USEHE KLIST;
Subdivision:Ash Creek 1 Lot no.:7 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.
New Residential Construction Valuation: $
Existing building area: square feet
New building area: square feet
`q`PROPERTY OWNER ' 0 TENANT` Number of stories:
Name:Sage Built Homes Type of construction:
Address:1815 NW 169th Place Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006 Existing:
Phone:(971)221-4597 Fax:( ) New:
..® APPLICANT " 0CONTACT PERSON, BUILDINGFEES*
PERMIT
Business name:Same As Above
Structural plan review fee(or deposit):
Contact name:Alex Rodriguez
FLS plan review fee(if applicable):
Address:Same As Above —
Total fees due upon application:
City/State/ZIP: —"
Amount received:
Phone:(971)336-6911 Fax::( )
PHOTOVOLTAIC,SOLAR PANEL SYSTEM
E-mail:Planning@sagebuilthomesllc.com Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
Y and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: / g ci 3 lTotal fee due upon application: $201.60
Authorized signatur- ' V This permit application expires if a permit is not obtained
1 within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Alex Rodriguez Date:2/1/2018
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist -.
One- and Two-Family Dwelling FOR OFFICE CSE oNLv
City of Tigard Received
Permit No.:
Date/By:
= a 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
T 1 G A R D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/A
1 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 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system'permit or authorization for remodel. Existing system capacity . 0 0 0
6 •+ Sewer permit:, 0 0 0
7 Water district approval.
48' Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 ❑ i
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 ❑ 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
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.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if El ❑ ❑
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 ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 ❑ ❑
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 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 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- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
for four or more appliances.
:2 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 a..licable to the .ro.ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application R,EC '4 V..
City of Tigard Received
Date/By: Permit#: i/l<T7 c yr/'Yyt23
a 13125 SW Hall Blvd.,Tigard,OR 97223
1--ER P"�eW ` ' / !v �t�ai
Phone: 503.718.2439 Fax: 503.598.1960 i -!i 7 Date/By: Related Permit u:
r l c, i;t Inspection Line: 503.639.4175 Ready Date/By: ' Juris: 65 See Page 2 for
Internet: www.tigard-or.gov i JI'',tr y1 �F'Tt, AR�ied/Method: Supplemental Information
TYPE OF
216
®New construction ❑Addition/alteraOti - r ui mINC �t DIVISION
Please check all that apply P VIEW
p pp y(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 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 14,000 0 Commercial-use agricultural
El Multi-family ❑Master builder amps for all other installations, buildings,
❑Other: 0 pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION
AAND LOCATION 0 Emergency system, larger separately derived
Job#: Job site address W Anna Belle Ct ❑100H Addition of new motor load of system.
'"`--''vv►1 ]OOHP or more. ❑"A","E","1-2","1-3",
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 Creek 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
Description 1 Qty. I Each 1 Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision:Ash Creek Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq ft or less 168.54 4
Ea add'l 500 sq.ft.or portion 33 92 1
DESCRIPTION OF WORK Limited energy,residential
New Residential Construction (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy
t:+ PROPERTY OWNER 1 CI TENANT Ile See Page 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 169TH Place Suite 1040 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 2
Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less • 59.36 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
_ Branch circuits-new,alteration,or extension,per panel
® APPLICANT ❑ CONTACT PERSON
A Fee for branch circuits with
Business name:Same As Above above service or feeder fee,
each branch circuit 7.42 2
Contact name:Alex Rodriguez B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7,42 2
Phone:(971) Miscellaneous(service or feeder not Included)
336-6911 Fax: :( ) Each manufactured or modular 67.84 2
Email:Planning@sagebuilthomeslle.eom 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 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(1 hr min) 90.0W hr
' Industrial plant(1 hr min) 78.18/hr
Email: LD/t J
! / Inspections for which no fee is
90-00/hr
CCB Lie.: 157891 1 Electrical Lic.: 34-436C [ Suprv.Lie.: Y, 2S specifically listed(t4 hr min) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �-/f
' _ Subtotal:
Print name: Stephen Ross Sir f,.el oSr Date: 0 Plan Review Required(25%ofpermit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Alex Rodriguez Date: 2/1/2018 days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:\BuildiogiPermita\ELC_PernitApp_ELR_EREdoe Rev 06/17)2015 440-4615T.(11705/COM/WEB
•Mechanical Permit ApplicationF C � E FOR OFFICE USE ONLv
City of Tigard Received
lig = g Date/By:2016 Permit No.:Aw s^��/ /(- /17 v)73
13125 SW Hall Blvd.,Tigard,OR 97223 /v` / C 1/(/(/
Phone: 503.718.2439 Fax: 503.598.196014 Plan Review Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639.4175 �
OF ^ 0,j t ate Ready/By:y: Juris: See Page 2 for
Internet: www.tigard-or.gov CITYt IGA'., otified/Method: Supplemental Information
a M �}1VIhfERf."tAL" �*,�Ib , G'1€I�C�ICS".,.�._;
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
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTIONRESIDENTIAL EQUIPMENT/SYSTEMS FEES*,.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB,SITE INFORMATION AND LOCATION: Heating/cooling:
Air conditioning 1 46.75 46.75
Job site address:9584 SW Anna Belle Ct Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Ash Creek 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 Creek Lot no.:7 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
New Residential Construction fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
TENANT Other: 23.32
0
4 PROPERTY OWNER - Environmental exhaust and ventilation:
Name:Sage Built Homes Range hood/other kitchen
Address:1815 NW 169th Place equipment 1 33.39 33.39
Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:(971)221-4597 Fax:( ) Attic/crawlspace fans 1 23.32 23.32
>.: APPLICANT 0 camel' PERSON Other: 23.32
Fuel piping:
Business name:Same As Above
$14.15 for first four;$4.03 for each additional
Contact name:Alex Rodriguez Furnace,etc.
Address:Same As Above Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(971)336-6911 Fax::( ) Fireplace
Range
E-mail:Planning@sagebuilthomesllc.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address:PO Box 1341 Subtotal
City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:48�4595;* I O G S-7 r ( (1II r TOTAL PERMIT FEE
l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Alex Rodriguez Date:2/1/2018
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation. Permit Fee.,
$0.00 to$500.00 Minimum 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\Permits\MEC_PermitApp_040113.doc 2
Y "Plumbing Permit Application R F 1-1
Building Fixtures FOR OFFICE I'SE 011.1
FEBceived A -5T1,0/T-!o '
.� - City of Tigard 1, 1` /(� ('�'�
1 �-� 4 �� � DateBy: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960,-,.,., g �g Other Permit No.:
Inspection Line: 503.639.4175
a1/ ff, 3 ;AREIteBy:
T I G A R D Date Ready/By: Juris H See Page 2 for
Internet: www.tigard-or.gov BUILDING
Bi �Is1 Aed/Method: Supplemental Information
TYPE`OF WORK . �1 s1a FEE* SCHEDULE
®New construction El Demolition For special information use checklist
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building ❑Multi-family SFR(3)bath x 500.32 500.32
Each additional bath/kitchen 25.02
0 Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9584 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard Oregon Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:Ash Creek Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Ash Creek 1 Lot no.:7 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DE
SCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
Dishwasher 1 25.02 25.02
New Residential Construction Drinking fountain 25.02
Ejectors/sump 25.02
ii 'PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169th Place
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton Oregon 97006 Hose bib 2 25.02 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
sr® 'APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Same As Above Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Alex Rodriguez
Roof drain(commercial) 12.51
Address:Same As Above Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)336-6911 Fax::( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:Planning@sagebuilthomesllc.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Edwards Mullen Plumbing WaterPip 1 1n WV 56.29
Address:1601 A Se River Rd Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)628-3560 Fax:( ) 74 bo Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:92689 Plumbing Lie.no.:31..a&JV'IO�(6
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Alex Rodriguez Date:2/1/2018 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(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site`Uti.itiesQty. Fee{ea) Total„ Sq la re Footage: Permit Fees
Footing drain-l'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation* Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$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
Other Inspections or Fees Qty. pee°(ea)F Total each additional$100.00 or fraction thereof,to
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3,'
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\alejandra\Desktop\Templates\City of Tigard\Plumbing.doc 2
Albert Shields
From: Albert Shields
Sent: Tuesday, February 27, 2018 5:14 PM
To: 'Planning@sagebuilthomesllc.com'
Cc: Gary Pagenstecher
Subject: RE:Ash Creek Village, SUB2015-00003, PDR2015-00001
Alex and Kylie, please note my email of 2/8/18 below. As I explained, you are required to arrange for a site inspection by
the project planner before the 8th permit is issued. You have not done so and you have submitted 3 more permit
applications for a total of 11.
Because you have failed to comply with Condition of Approval No. 27 of PDR3025-00001 I am classifying these 3 new
permit applications, MST2018-00073, -00074, &-00075 as "Approved for Plan Review but Not Released." Plan Review
will proceed but the permits will be put on Hold until the required inspection is requested, performed, and
approved. Similarly, I am putting MST2018-00033, representing the 8th permit, on Hold as "Approved but Not Released"
until the required inspection is performed and approved.
Please let me know if you have any questions.
Albert Shields
Permit Coordinator
City of Tigard
Alberttigard-or.gov
503-718-2426
From:Albert Shields
Sent:Thursday, February 08, 2018 2:42 PM
To: 'Planning@sagebuilthomesllc.com'<Planning@sagebuilthomesllc.com>
Cc: Gary Pagenstecher<Garyp@tigard-or.gov>
Subject:Ash Creek Village,SUB2015-00003, PDR2015-00001
Alex or Kylie, please note that you have now submitted 8 building permit applications and that Condition of Approval
No. 27 of PDR2015-00001 says: "27. Prior to issuance of the 8th building permit, or within 36 months from the date of
this decision, the applicant shall schedule an inspection with the project planner to verify the installation of the
community gardens, as detailed on the proposed plans, including an on-site water supply."
Please contact your project planner, Gary Pagenstecher, 503-718-2434, at your earliest convenience to schedule the
required inspection.
Thanks for your cooperation.
Albert Shields
Permit Coordinator
1
1" ,1 gg
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
•
T 1 c a izD Building Permit Review — Residential
Building Permit #: ,' ��/ `-f �X0,73
Site Address: c
58`I \,/ Ana edIc Cl.
Project Name: r'-Aj1 Crul- V1L Lot #: 7-
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: (,- 'Tric1l's^ oA- nt,,i S F 1 - /tdt/�
r.-.9( /lei ) (Si )-c- /`!GI
i erify site address/suite# exists and active permit system.
1
l River Terrace Neighborhood: 2No El Yes,See River Terrace Review Addendum Attached
S.t Plan Elements:
ree(3)copies of site plan l�"'sting structures on site
$ite plan must be on 8-1/2"x 11"or 11 x 17"paper L�Footprint of new structure(including decks)with finished
D
l wn to scale(standard architect or engineer scale) or elevations
Orth arrow i ity locations&easements(required for new and additions)
.ite address,project or subdivision name and lot number I idewalk/driveway approach
®/ splicant information(name and phone number) 0 �. ation of wells/septic systems
IE of dimensions and building setback dimensions E.Kxisting trees to be retained with drip line,and tree
Ti�Xiare footage of buildings to be demolished p)otection measures
IFE' t area,building coverage area,percentage of coverage and [ reet tree size,type and location
/impervious area(applicable if R-7,R-12,R-25&R-40) hQStreet names
LldProperty corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? 132'Yes C7 No
4"zoof differential) If yes,is a storm water quality facility shown? ❑INo
Le Clean Water Services—Service Provider Lettey(lot platted prior to 9/10/1995): 1. App. LAj\
equired: ❑ Yes,applicant was notified [V No Received: ❑ Yes ❑ No �� Vy�
L�. Public FacilitiiImprovement(PFI)Permit:
� R quired: p' Yes,applicant was notified ❑ No Applied For: GlYes ❑ No,stop intake
L7 and Use Case#:
r012- LOIS— 00001 1-3 eFL lois-ooN i
Ltd Zoning: R-U. (PO)
iu' equired Setbacks: Front 2_0 Rear I S Side 3 Street Side 0- Garage 2,0
Rfkandscape Requirement: 20
L—y'/Lot Coverage Maximum: (,�
0,0
la Building Height: Maximum Height 35. Actual Height )! S
isual Clearance __/ t +
iS
ensitive Lands: L� Yes CINo Type G nµ� S )ygii i-PZ,,.�� I t�t,h F Arm Le
Ir Urban Forestry Plan
El Conditions "Met/ prior to issuance of building permit
Notes: li,jki
C tri .•., lrr 4 p.f r 4", ()N1Ji Orr.l i3(v1Att
ES/Approved By Planning: '.1-61" Date: Z-1 -(
Revisions (after Building Submittal only) Reviewer Da e
Revision 1: ig Approved ❑ Not Approved l 1 Ct3 lc
Revision 2: El Approved ❑ Not Approved �J
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Building Permit Submittal /
Original Submittal Date: ,_ /(6/171--
Site Plans: #
Building Plans: #
Building Permit#: ► nter building permit#above.
Workflow Routing: P'Planning p7Engineering Permit Coordinator Building
Workflow Sign-off: P' Sign-off for Planning(include notes from planning review)
Route Application Documents: LP'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ,r
A.
By Permit Technician: AK i d /Aid LillL%liir�I6 Date: /
Engineering Review
Slope at building pad: ife,
/
f� Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
/)Zr Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: El Yes No
LIDA Facility on lot: ❑ Yes No
El Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: / P Date:
Revisions (after uilding Submittal only) Revie er Date
Revision 1: Approved ❑ Not Approved 4'L `/ Z. V / 6)
f
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved El Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit ,/
Approved,NOT Released: cf,9% c9.7-------
Notes:
9.7 ����' '"ate: 2_- .� ��d
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
PSDC Fees Entered: Wash Co Trans Dev Tax: tg=1Yes ❑ N/A
Tigard Trans SDC: 11—Yes El N/A
Parks SDC: HP'Yes ❑ N/A
LIDA ❑ Yes N/A
OK to Issue Permit /
-4 icy jt S'-------
Approved by Permit Coordinator: / Date:
I:\Building\Fonns\BldgPennitRvw_RES 010118.docx I l ,t,
LCA- 1
FOR OFFICE USE ONLY—SITE ADDRESS:
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
711 Transmittal Letter
T ll%\%\n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: (BUN JUN 1 1 2018
1 C 5 Y
COMPANY: l l\- kom6 BUiILa �
rr � ,
:Z1 S..Fita..3 ,.`
3y�
PHONE: — 2S3 — (4)`J S By:
RE: 653t-t Sw hAYNO. Se\Ie_ U 1tk$i-70 i5—W 3
(Ste Address) (Permit Number)
Ctee,k 10 i- 1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Descrption
Additional set(s) of plans. k.
Revisions: Qti lS
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:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
1:1Building\Forms\TransmittalLetter-Revisions 061316.doc
Lo.\- 1
FOR OFFICE USE ONLY-SITE ADDRESS:
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
III Transmittal Letter
r �,t 1 1 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: S3Q-AiN dlo♦ JUN 1 1 2018
COMPANY: UA1\ kU j BJ L ,: ,� i,, ,, 1
PHONE: �' - 23 - ( C JS BY:
RE: CnSt AVM& SeA It 0 ASS-?AS -60(113
(ke Address) (Permit Number)
( ee, c_ 101-- 1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: _ Description:
Additional set(s) of plans. Revisions: /,4 j/14 1 pitaAS
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:
FOR OFFICE USE ONLY
Routed to P ' echnician: Date: Initials:
Fees Due: Y No Fee Description: Amount Due:
1 1- &ov.r �. r.tv\'r,& $ (-(<7.4.------'
P $
$
Special
Instructions:
Reprint Permit(per PE): No E Done
Applicant Notified: 1) Date: _ l_t isf/X Initials
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
Plumbing Permit Application
Building Fixtures ,: FOl4 OFricE t si oNi.l
Received
City of Tigard z l lL % 0 "' Date/By: ,ZS f/ Pent T ` 7?
III ill 13125 SW Hall Blvd.,Tigard,OR 972 C Lu I. Y i
Plan Review
1 Phone: 503.718.2439 Fax: 503 598(19.60 Date/By: � Other Permit No.:
T i i;:1 l:t) Inspection Line: 503.639.4175 ,,' Date'tfteady Suns: El See Page 2 for
Internet: www.tigard-or.gov a�:e..- -- _, . .-- ,Nsti,
rg�/�y',�. Supplemental Information
s s i - ^av , a s 5 3 �$ + i * ` e j zi "` .' ,:.,G -n.r<+] J F s�r'; •
i
,,„vasa. .. - . .-. a. .. .,.
®New construction El Demolition IP '1' For special information use checklist
Description I Qty. Ea. I Total
El Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
fj° .P.' •,,
x i �'1`' t� i x- SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building El Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
f w 6 ,*,- s (1FA!i ,:' Site utilities:
Job site address:9584 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: ( Project name:Ash Creek Village Manufactured home utilities 50.03
Cross street/directions to job site:SW 95th 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 ft.:_) Page 2
Subdivision:Ash Creek Village I Lot:7 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
New residential construction/Plumbing contractor revision Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.e P(itourrir OIN ki 4a ,„..K:'!,:' '' 'r ` '. Expansion tank 12.51
Name:Sage Built Homes,LLC. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169th Place,Suite 1040
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 25.02
Phone:(971)221-4597 i Fax ( ) Ice maker 12.51
1 ':".,:-:!7
t Ar p,-.= � , ,j Interceptor/grease trap 25.02
-
Business name:Sage Built Homes,LLC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ben Cooper
Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)258-6658 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:planning@sagebuilthomesllc.com Urinal 25.02
a Water closet 25.02
' _v. .. , 4'
. �, t= ,,. , -. Water heater 37.52
Business name:Max Plumbing Service Inc Water piping/DWV 56.29
Address:PO BOX 230674 97281 Other: 25.02
City/State/ZIP: Tigard,OR 97281 Subtotal
Phone:(971)-275-0198 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 205392 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Ben Cooper Date:7/23/2018 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su i s ression S stems:
..� � x,�,. .�. t r"tom 1 ..4411,4„:L.
��.
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Medical Gas S�stems
Water Service-each additional 100' 37.52
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
each additional$100.00 or fraction thereof,to
d t t ' uand 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 char:e-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 char:e-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 char:e 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*.
{►
Quantity by Fixture Type
Fiaturc Type for Reptacdoeat �
Capped Added Riele Plan review is required for any of the following.
Work Perfurme¢ Please check all that apply.
Baptistry/Font
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru D New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Riser Dia m
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/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
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\kylie\Downloads\PLMF_PermitApp.doc 2
FOR OFFICE USE ONLY—SITE ADDRESS:
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
Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
:o` �
��,
n AUG 2 3 2018
FROM: 1i� r
COMPANY: 3 Gfu1�- kom-v-5 3a,ldDIA,,:-, ivi�`.,
PHONE: r'6Z•S '-516 l A tP
ms-r- f,._
RE: of 5 )t SW61\0•. _ --eC -- o 0C-13
(Site Address) (Permit Number)
16/V C.rNe;1c l o V—
Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Y. Revisions: vv\.pvt,, tAiA Pavati3 kw r)
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:
FOR FFI E USE ONLY
Routed to Pe • echnician: Date: Q. 2.3 ("(� Initials: Ali-
Fees Due: Yes ❑No Fee Desc ' tion: Amount Due:
�V�.(,c") $ `i S .�
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9584 SW ANNA BELLE CT, TIGARD, OR, 97223 November 9, 2018 at
10:03:26 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00073
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9584 SW ANNA BELLE CT, TIGARD, OR, 97223 November 14, 2018 at
10:01 :12 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00073
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9584 SW ANNA BELLE CT, TIGARD, OR, 97223 November 14, 2018 at
10:08:52 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00073
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
Street tree certificate received
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9584 SW ANNA BELLE CT, TIGARD, OR, 97223 November 14, 2018 at
10:01 :57 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00073
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed
Violation Summary:
Inspector Contractor
RECEIVED
.9AY 2 2 201$
8iv
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ci
1114 Request for Permit Action � .
h ,;;,It Cl 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑X Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Sage Built Home
Mailing Address: 1815 NW 169th Place Suite#1040
City/State/Zip: Beaverton,OR 97006
Phone No.: 503-533-5167
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
0 REFUND ' RMIT FEES (attach copy of original receipt and provide explanation below).
M • • a - FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST2018-00073
Site Address or Parcel#: 9584 SW Anna Belle Ct
Project Name: Ash Creek Village
Subdivision Name: Ash Creek Lot#: 7
EXPLANATION: Requesting to remove A/C from permit and a refund
Signature: b'z eggs, Date: -572-V
Print Name: Ben Cooper ((//
Refund Policy
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 processin refund requr
processing refund
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'5. (v/ GtJ<( /2. ---e__,-c.?/�qFa) ie -T/2 L:- ,_
Set, 3 C_, s'�5 /7 r'7- !s ie /:.0 'tz . 7 ..
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date, 2y q :•'r'"
Refund Processed: Date 0/72.//,(--' By AZ/ Invoice Processed: Date By
Permit Canceled: Date A,`� By ", -v Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
I
TIGARD
City of Tigard
July 16,2018
Sage Built Homes
Attn: Ben Cooper
1815 NW 169th P1, Suite 1040
Beaverton, OR 97006
Re: Permit No. MST2018-00073
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 9590 SW Anna Belle Ct
Project Name: Ash Creek Village,Lot 7
Job No.: N/A
Refund: ® Check#228969 in the amount of$52.36.
0 Credit card "return"receipt in the amount of$
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$
Comments: Per applicant's request to remove A/C from permit;refund 100% of permit
fees paid as request was received prior to permit issuance.
If you have any questions please contact me at 503.718.2430.
Sincerely,
.01:127534.20—ze"---s.<_
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
T I G A R D Accela Refund Request
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 DATE: 6/22/2018
1815 NW 169th Pl, Suite 1040
Beaverton, OR 97006 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 417953 Case#: MST2018-00073
Date: 6/21/2018 Address/Parcel: 9584 SW Anna Belle Ct
Pay Method: CreditCard Project Name: Ash Creek Village,Lot 7
EXPLANATION: Remove A/C from issued permit;refund 100%of permit fees paid as request was
received before permit was issued.
.faiLTOW e.:
S e e
. �L w �°�' �'�� `� � x� f tatw �« ,g� �w�4a"� - ,o- � 8 � 'fie `
W7at
Mechanical Permit Fee 230-0000-43102 $46.75
12%State Surcharge 100-0000-24001 5.61
TOTAL REFUND: $52.36
APPROVALS: SIG T S/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
II! T TION$ o` T/
Case Refund Processed: Date: 20 j By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9584 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00073
Inspection Type: Inspector:
205 Footing David Young
Result:
PASS
Comments:
Initial erosion control approved.
Setbacks appear ok per contractor strung property lines and City approved plans.
No geotechnical report required per approved plans.
Ufer ground tagged.
Holdowns installed.
Low point drain sleeve installed.
Expanded piers ok.
Violation Summary:
Inspector Contractor