Permit (100) CITY OF TIGARD1111 MASTER PERMIT
II: COMMUNITY DEVELOPMENT Permit#: MST2018-00035
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2018
Parcel: 1S135BD01800
Jurisdiction: Tigard
Site address: 9537 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 4
Project: Ash Creek Village, Lot 4
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 574 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 4 Second: 900 sf Garage: 370 sf Front: 15 Smoke
Dwelling Units: 1 Third: 1009 sf Right: 3
Detectors: Yes
Total: 2483 sf Value: $299,372.85 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 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: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
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 2483
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
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $30,826.29
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 OAR 952-001-0090. You may obtain les or direct questions to OUNC by calling 503.232.1987 or 1.;••332.2344.
.-�
tr
Issued By: :`/ ��.7Z,-**** ---- ,,,---"" Permittee Signature: �
.639.4175 by 7:00 a.m.for the next available inspection •: e.
This permit card shall be kept in a conspicuous place on the job site until co •leti. of the project,
Approved plans are required on the job site at the time of each' spe, ion.
•
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
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY U E sC»>n s
Fee for all residential systems combined: $75.00 Description �" Each Total 1
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in an of the above:
n Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%:hr mm)
COMMERCIAL WORK ONLY::. I ELECrwCAL PERMIT FEES
Subtotal(Enter on Page i):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n F• ire Alarm Installation
n HVAC
n 'instrumentation
❑ Intercom and Paging Systems
❑ L• andscape Irrigation Control*
n Medical
n N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_EKE.doe Rev 06/17/2015
Plumbing Permit Application
Building Fixtures FOR OFFICE FSE ()NLN
City of Tigard �., ; -,i R:,eived Permit No.:
- g 13125 SW Hall Blvd.,Tigard,OR 97223 I t "`'` "' 'e e /�S �l� `�ti��
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q ) + Date/By: Other Permit No.:
TI G n R D Inspection Line: 503.639.4175 r N i'� 18 L.C l Date Ready/By: .runs: Ea See Page 2 for
Internet: www.tigard-or.gov ,Notified/Method: Supplemental Information
TYPE OF WORK f•,`1 1 8( ASF'' 1 it'l t.) FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. Ea. I Total
0 Addition/alteration/replacement 0 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
111Accessory building ❑Multi-family SFR(3)bath x 500.32 500.32
Each additional bath/kitchen 1 25.02 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9537 SW Anna Belle Ct Catch basin or area drain 18.76
City/State/ZIP:Tigard Oregon Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I 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 I Lot no.:4 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION 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
t:< PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Address:1815 NW 169th Place Floor drain floor sink/hub 25.02
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
r, APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Same As Above Medical gas(value:$ ) Page 2
Contact name:Kylie Hofenbred Primer 12.51
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)221-4597 Fax::( ) Tub/shower/shower pan 4 12.51 50.04
E-mail:Planning@sagebuilthomesllc.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37.52
Business name:Edwards Mullen Plumbing WaterPip l to DWV 56.29
Address: 1601 A Se River Rd Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)628-3560 Fax:( ) / Minimum permit fee: $72.50
?( �� Plan review (25%of permit fee)
CCR'Lic. 91689' a•t4' ' 4,1600iiig Lit? " • �; • State surcharge(12%of permit fee)
Authorized signatur . r TOTAL PERMIT FEE
Print name:j�\- 5 p e , Date: 'his permit application expires if a permit is not obtained within 180 days
1 i 1 L �i &� \-j } after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:tBui ' L1W-PanshApff.doc 9ifmtn9 440-4616T00/02/COM/WEB)
F
•
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. fee tea) Total Square Footage: Permit Fee:
Footing drain-Pt 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 $23320
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 Fee tca) Totaleach additional$100.00 or fraction thereof,to
pand 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 requiredis for anyof the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
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 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 ❑ 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"
4" Isometric or-Riser-Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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:
S:\Sage Built\Purchasing&Planning\Subdivisions\Ash Creek\Plans\Lot 42kpplications\Plumbing.doc
RECEIVE)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAY 2 2 2018
'PI Request for Permit ActionCITY OF FIG/ o
-
y UIL D1NG IVISIoF'
TIC�\It D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigaror.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 0 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.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST2018-00035
Site Address or Parcel#: 9537 SW Anna Belle Ct
Project Name: Ash Creek Village
Subdivision Name: Ash Creek Lot#: 4
EXPLANATION: Requesting to remove A/C from permit and a refund
Signature: app Date: .f12 7---//t,"-
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 processing refund requests.
/VC' / /-SCU C7 "' /°t.-r 0 vc if/a– 72-17—//V 6/0/ £ 02-/,--,t6
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date /1//.9 By Ili Invoice Processed: Date By
Permit Canceled: Date "i1/.7"7 By # _ arcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
City of Tigard
111COMMUNITY DEVELOPMENT DEPARTMENT
r I A o Building Permit Review — Residential
Building Permit #: ,. . 4 r' - ,T5---
Site Address: ' 531 SW A n n c" e C;-I-.
Project Name: ASV) Creek, Nii W I Ci CJ€ Lot #: 4
(New dwelling=subdivision name;Additio or Alteration=last name of owner)
Planning Review
Proposal: IV eikid S'rP L ,4d.,frd S (i_s '7'i? ‘<oir, f/&I i
w Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: /1 No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
E Three(3)copies of site plan E Existing structures on site
❑Site plan must be on 8-1/2"x 11"or 11 x 17"paper ❑Footprint of new structure(including decks)with finished
E Drawn to scale(standard architect or engineer scale) floor elevations
❑North arrow ❑Utility locations&easements(required for new and additions)
E Site address,project or subdivision name and lot number ❑Sidewalk/driveway approach
❑Applicant information(name and phone number) ❑Location of wells/septic systems
ELot dimensions and building setback dimensions ❑Existing trees to be retained with drip line,and tree
CI Square footage of buildings to be demolished protection measures
E Lot area,building coverage area,percentage of coverage and ❑Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ❑Street names �/'
❑Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? E2 es ❑No
4 foot differential) If yes,is a storm water quality facility shown? /Yes ❑No
7 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
/ Required: ❑ Yes,applicant was notified /�1 No Received: ❑ Yes 1=1 No
i Public Facili . s Improvement(PFI) Permit:
Required: Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
7 Land Use Case#: f7 0 2.0i 5 .._00001 r Su e 'O I S OOCX3
/ Zoning: / 1 2-
XX Required Setbacks: Front IS Rear j 5 Side 3/' _ Street Side i0 Garage 2-0
it Landscape Requirement: Z 0
Lot Coverage Maximum: v0
n
Building Height: Maximum Height J 5 Actual Height
Visual Clearance
Sensitive Lands: ❑ Yes No Type
Urban Forestry Plan
4 Conditions "Met"prior to issuance of g buildinermit
j
Notes: n fiti% 01 21 `n1I e eflC Onj
❑ Approved By Planning:, L^ Date: I/ig I i 5
Revisions (after Building Submittal only) 'evie er D to
Revision 1: XApproved ❑ Not Approved `/ Il!1� ' l P
Revision 2: ❑ Approved ❑ Not Approved hOlU/3
Revision 3: ❑ Approved ❑ Not Approved
l:\Building\Forms\B1dgPermit Rvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: i . ; 41
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning engineering ermit CoordinatorSuilding
Workflow Sign-off: Sign-off forPlanning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
7Building: original permit application,site plans,building plans, engineer and
// beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: i _ •, /�A,� y Date: ,� l _
Engineering Review
lope at building pad:
Conditions "Met"prior to issuance of building permit
I2 r;asements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 121'No
Assess Water Quantity Fee in-lieu: ❑ Yes E`No
LIDA Facility on lot: ( ( ❑ Yes 1r No
['Final Plat Recorded: it LoR,(�t,U
❑ NOT Approved by Engineering: \ Date:
Notes: Cfltd,-naJ 02.1 �, 'a 1 LAtks-
Approved by Engineering: K. ¢,gJ Date: 2--214 -/g
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ,� Approved ❑ Not Approved 11 _4•11/ /
Revision 2: ❑ Approved CI Not Approved ++++'"'
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes: L �4"iiic-bt 21 )un g 'r' f�ST: & c. � 3.
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:
SDC Fees Entered: Wash Co Trans Dev Tax: \..Yes ❑ N/A
Tigard Trans SDC:
'A Yes ❑ N/A
Parks SDC: X Yes ❑ N/A
LIDA ❑ Yes N/A
OK to Issue Permit
0.4e1M3
Approved by Permit Coordinator: /701Date:
•
l:\Building\Fonns\B1dgPennitRvw_RES_O10118.docx (� 0311`/
LOV LI
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
:1111 ill Transmittal Letter
r ,;.\1 i r 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISIONRECF " A
D
FROM: @ex\ are.r--- JUN 1 1 2018 !
COMPANY: Srr,e )llu 4Q(V1L EIU $`' ' . ::;,1
PHONE: q P. ( (5 -- C By:
RE: q5 SW A i3eie a 20 L O —( o3E
( ite Address) (Permit Number)
PcCall\ CMCK_ ,-01— L
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. Revisions: f, 96:415 O fiord
-
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 ^iw
Routed to Perm' ec 'cian: Date: Initials: err
Fees Due: Y&' E No Fee Description: Amount Due:
k 04n. CiAk L+- S
$
$
Special
Instructions:
Reprint Permit(per PE): ►i' o E Done
Applicant Notified: . Date: Z,(,)- 1/( Initials:/Ak
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
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
`I = r Transmittal a smlttal Letter
I ( n Et D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: \ DNN1 DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: ek... Vi,-,6\\ope, - FEB 2 7 2018
COMPANY: s.,),(Ae ` 0 _ `lC • CITY OFTJ(h' q
RD
`�
ON
PHONE: L ►I a J �,Q C i U � I By:
RE: Clk.V2D(Site s4. ��- � bCk/ke. C� 'Number) l(Permit 0 v esa
\N- -C-)C \ \ll aut I bk °C.
( roP jest name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. _ Revisions:
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): l ,1
REMARKS: fv ( e ,,./. -.•-a Lr ,A/".75( ( ! S/ rk)z2 - �Gr '
Stic e-t-i ve-e 7 e* 3 - 1,-a,f,-- - 5 n
/
FOR OFFICE USE ONLY
Routed to Permit Technician: ate: ...1 - J 9 - J S' Initials:
Fees Due: ❑Yes No Fee Description: Amount:
akt.v,ScJ )4..,,d. we i•-ffen $ -.
V\ 010•NS til 7a $
IvoFr%i 43.. E $
$
Special
Instructions:
Reprint Permit(per PE): [] Yes ra No 7 [] Done
Applicant Notified: p _ Date: g 0,?-1/S' Initials: "AiL-
1:
\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9537 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00035
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9537 SW ANNA BELLE CT, TIGARD, OR, 97223 April 18, 2019 at 9:23:34 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00035
Inspection Type: Inspector:
399 Plumbing final Jeremy Burrows
Result:
PASS
Comments:
Correction complete
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9537 SW ANNA BELLE CT, TIGARD, OR, 97223 April 22, 2019 at 10:57:46 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00035
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Corrections completed
No A/C
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9537 SW ANNA BELLE CT, TIGARD, OR, 97223 April 26, 2019 at 8:46:15 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00035
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Final erosion control passed
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
Plumbing Permit Application
Building Fixtures -" FOR orr►cH: L SE oil."
City of Tigard Received 7/A c- 1 l , Permit)( 7 0/g /YS s3S'-`
IN • 13125 SW Hall Blvd.,Tigard,OR 97 i3 9 n 1, Date/By: V` (� tiC�/
U Phone: 503.718.2439 Fax: 503.998-1696& U t P�,lats•eview Other Permit No.:
Inspection Line: 503.639.4175 _ j
I 1 1 t 1 Internet: www ti and or ov .;„,..1,1,.:':',,,; ' y Juns ® See Page 2 for
g gf�j ethod Supplemental Information
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®New construction ❑Demolition IP 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)
" f ti a .:-.*„ .-::',V..'''.7.,,%,.77: -, SFR(1)bath 312.70t 4y vi , t t
® 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) I Page 2
- > t � f` y '�.t Site utilities:
. „ , JoB - .,P! ;. am
Job site address:9537 SW Anna Belle Ct Catch basin or area drain 18.76
City/State/ZIP:Tigard,Oregon Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I 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 J Lot:4 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
fi; fy✓
t t a e, y, Backwater valve 12.51
�`f .'''v w ,. ".' ,' :;:•'''''''' ' "" ':''''5':' Clothes washer 25.02
New residential construction/Plumbing contractor revision Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
�;f` R e (jVp11iFR 4 ,- 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'h Place,Suite 1040
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
7 't r� APPLIC ° I 7',,, CONTACT PEfst AInterceptor/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@sagebuilthomes►Ic.com Urinal 25.02
r Water closet 25.02
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CONTRACTOR '''t.,:.7-;,..-............-. 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
Plan review (25%of pennit fee)
CCB Lie.: 205392 Plumbing Lic.no.:
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\Permrts\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression Systems:
� 0Ii46 ,{ z otai tz 4 *ll` , age:
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 Systems:
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
a I;2 each additional$100.00 or fraction thereof,to
e i n i . Q'$ 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 a !i Relew ft-.'' mbin 3 aH orris
Fixture Typefor 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 1=1 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 ❑ 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"
Car Wash Drain SOlnet 3r R1�S ria ri!)m; t,4
Garbage Domestic-non-food ❑ 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:
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