Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT741
Permit#: MST2019 00361
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2019
Parcel: 1S135CD15700
Jurisdiction: Tigard
Site address: 9754 SW WINDSWEPT PL
Subdivision: CANYON COURT Lot: 4
Project: Canyon Court, Lot 4
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 4 First: 680 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1138 sf Garage: 400 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 1818 sf Value: $242,124.28 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF RainStorm Sewer: 100
0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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: Y Vent Fans: 5 Clothes Dryers: 0
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: 3 201-400 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
Y
Other: N Other Description:
Ecompasing.
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1818
Owner: Contractor:
MAOZ LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1800 NW 167TH PL STE 150 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $32,020.12
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 a copy f-the-rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ater-70-.71 -- ermittee Signature: 4 61
.639A175 by 7:00 a.m.for the next available inspe• ion • -.
This permit card shall be kept in a conspicuous place on the job site until completion of the pr• •ct.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
Received
City of Tigard Date/By: `� / 1Apr, Permit No. tit,S —, 010 ._L- t3
y 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 5 2019 PlanReviewqq !
Phone: 503.718.2439 Fax: 503.598.1960 Date/ eyv ( I� l Other Perms ► l` y1—l'VV I
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® SSete Page 2 for
Internet: www.ti and-or. ov • ed/Method: G Supplement al Information
g g BUILDING DIVISION l
TYPE OF WORK REQUIRED bATA:1-AND 2-FAMILY DWELLING
®New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
liID1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 2L0-1 $pg
❑Accessory building ®Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:X.3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 'L'LI$
Job site address: - SW Windsept Place New dwelling area: 1 8'6 square feet 1 1340
City/State/ZIP:Tigard Oregon Garage/carport area::).1 ODsquare feet
Suite/bldg./apt.no.: Project name:Canyon Court Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Canyon Court I Lot no.: A Permit fees*are based on the value of the work performed.
Tax map/parcel no.: t Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
New Residential Construction
Existing building area: square feet
New building area: square feet
►Z� PROPERTY OWNER 0 TENANT Number of stories:
Name:Sage Built Homes LLC Type of construction:
Address:1815 nw 169th Place Suite 1040 Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006 Existing:
Phone:(503)533-5167 Fax:(503)533-5164 New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Sage Built Homes LLC (Please refer tofee schedule)
Structural plan review fee(or deposit):
Contact name:Alex Rodriguez
FLS plan review fee(if applicable):
Address:Same as above
City/State/ZIP: Total fees due upon application:
Amount received:
Phone:(971)336-6911 Fax: :( )
E-mail:planning@sagebuilthomesllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Same As Above Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same as Above Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:189330
Total fee due upon application: $201.60
Authorized signature This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Alex Rodriguez Date: (� *Fee methodology set by Tri-County Building Industry
l�, �� Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
I
F
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard d Received
g Date/By: Permit No.:
® 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
TIGARD 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 es No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ 0 0
4 Fire district approval required. Name of district: El ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. El ❑ ❑
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 ❑
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 El
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ El El
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 ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, El El El
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- El ❑ ❑
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. ❑ ❑ ❑
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 ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ El El
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 ❑ El
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ 0 0
architect licensed in Ore.on and shall be shown to be as I 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". 0 ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 ❑
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, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
*
Mechanical Permit ApplicaticIR ECEIVED FOR OFFICE USE ONLY I
City of Tigard Receive
Permit No
d
IN - 1413125 SW Hall Blvd.,Tigard,OR 97223 SEP 5 2019 Date/By: Tom\ ,1/4;2:‘Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection 503.639.4175 CITY OF TIGARD Date Re
TIGARD p Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑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: '.`t `` . '\ SW Windsept Plac 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:Canyon Court 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:Canyon Court Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
New Residential Construction fireplace 23.32 \\VI I
Log lighter(gas) . 23.32
Wood/pellet stove 33.39
Wood fireplace/insert . 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT 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 169th Place Suite 1040 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)533-5167 Fax:(503)533-5164 Attic/crawlspace fans 1 23.32 23.32
►5 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Sage Built Homes LLC Fuel piping:
$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.:184575 / TOTAL PERMIT FEE
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: ct -s-1`C\
1:\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
4
Electrical Permit Application RECEIVE ! rOu(1111( 1. I til.O\l.,
City of Tigard Received Permit#' ---#. C (�` ��
IIIi 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 5 2nin DateBY' �� rxSc
Plan Review
' I Phone: 503.718.2439 Fax: 503.598.1960 DateBy:
Tt.1 R[) Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By. ® See Paget for
Internet: www.ti ard-or. ov Notified/Method Su lementalInformation
g g BUILDING DIVISIO pp
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Mannas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings
® 1-and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations buildings.
ElMulti-family ❑ Master builder ❑Other: ❑Fire pump 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
Job site address: ❑Emergency system. larger separately derived
Job 4: tY�`- Q\ exceeds
of new motor load of system.
GI`�''�� �. � `L 1. 100HP or more. ❑
City/State/ZIP: Tigard Oregon ❑Six or more residential units occupancy.
Health-care facilities 0 ❑Recreational vehicle parks
Suite/bldg./apt.4: ' Project name: 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
Deseription i Qtr. 1 Each l Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: .4 Includes attached garage.
1,000 sq ft or less 168.54 4
Tax map/parcel 4: Ea.add'l 500 sq.ftor portion 33 92 I
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft) 75 00 2
New Residential Construction Limited energy,multi-family 7500 : 2
residential(with above s4 It)
® PROPERTY OWNERRenewable Energy 0 See Page 2
0 TENANT . Services or feeders installation,alteration,and/or relocation
Name: Sage Built Homes LLC 200 amps or less 1 1 100 70 1 100 70 12
Address: 1815 nw 1697"Place Suite 1040 201 amps to 400 amps I 133.56 I 12 !,
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
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 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
IS APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, ,er panel
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'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971)336-6911 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67 84 2
Email:Planning@sagebuilthomesllc.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 1 67.84 2
IBusiness name:Ross Electric Sign or outline lighting I I 67.84 1 12
Signal circuit(s)or limited-energy g
Address:2870 SE 75th Ave 203 panel alteration or extension 0 See Pa e 2 2
City/State/ZIP:Hillsboro Oregon 97123 Each additional inspection over allowable in any of the above
^Additional inspection(I hr min) 66.25/hr
Phone:(503)642-2800 I Fax:( ) Investigation(1 hr min) 90.00/hr
I /� Industrial plant(1 hr min) 78.18/hr
Email: t t)( r
� Inspections for which no fee is 90 00/hr
CCB Lic.: 157891 J Electrical Lic.: 34-436C I Suprv.Lic.1.1S specifically listed(v:hr min)
Z^ ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:
if_ rr Subtotal:
Print name: Stephen Ross 5 j.. e h,,, kala f Date: 0 Plan Review Required(25%of permit 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 i Date: 2/1/2018 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I\Building\Permits\ELC_PennitAppELR ERE doe Rev 06/17/2015 440-46151(11/O5/COM/WEB
' Plumbing Permit Application
.wilding Fixtures RECEIVE FOR OFFICE USE ONLY'
City of Tigard Received
. g Date/By: Permit No.YvbsJ-�- v\pit ' A.. `)r
13125 SW Hall Blvd.,Tigard,OR 97223 SEP 5 2 19 ` 1
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OFTI GAR D DateBy: Other Permit No.:
T I G n R D Inspection Line: 503.639.4175Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Z New construction LI Demolition For special information use checklist
Description I Qty. I Ea. I Total
LI 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
buildingSFR(3)bath X 500.32 r f '�I
❑Accessory ®Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: SW Windsept Place 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.: I Project name:Canyon Court 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:Canyon Court I Lot no.: k Fixture or item:
�aokfle ur y ewer I t I z t �7 I 11 77
Tax map/parcel no.: �b
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
New Residential Construction
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 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 Suite 1040
Garbage disposal 1 25.02 25.02
City/State/ZIP: Hose bib 2 25.02 50.04
Phone:(503)533-5167 Fax:(503)533-5164 Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Sage Built Homes LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Alex Rodriguez
Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory J 25.02 11S -
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)336-6911 Fax::( ) Tub/shower/shower pan Z 12.51 25,02
E-mail:planning@sagebuilthomesllc.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37.52
Business name:Edward Mullen
WaterPp i m WV 56.29
Address:1601A SE River Rd Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)572-4586 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:92689 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ^_ J t,// ` TOTAL PERMIT FEE
Print name:Alex Rodriguez I �' Date:�' 1`�✓► This permit application expires if a permit is not obtained within 180 days
r ` 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 Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-U'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. Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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 anyof the following.
Work Performed: Capped Added Relocate 9
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 ❑ 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 ❑ 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 ❑ Isometric or riser diagramis required for new buildings
Garbage -Domestic-non-foodq g
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
Washer-Clothes Note: If the fixture work under this permit results in an
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\Subdivisions\Canyon Court\Apps\Plumbing.doc2
City of Tigard
: q COMMUNITY DEVELOPMENT DEPARTMENTI
Q
T 1 c n R D, Building Permit Review — Residential
Building Permit #: & , - L Q'
Site Address: ! ; .5 r ) 4,21 e r 1l-
Project Name: ,i A— lid Lot #: 2-/
(New = subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pr• .osal: -ek)
AVerify address/suite# active in Accela. n River Terr e: 4a No ❑ Yes, River Terrace Review Addendum
Sit Plan Elements: 9CJEr.sion Control
Iliopies of site plan on 8-1/2"x 11"or 11 x 17"paper Il'�`stained trees with drip line and tree protection measures
raven to scale(standard architect or engineer scale) TAootprint of new structure (including decks)and FFE
Fre orth arrow ''ty locations&easements (required for new and additions)
vile address,project or subdivision name and lot number iQSidewalk/driveway approach
• plicant information(name and phone number) `i A` ')cation of wells/septic systems
Lot .• ensions and building setback dimensions 7 reet tree size,type and location
�' are footage of buildings to be demolished 1 'eet names
���., g g
11;N 'sting structures on site 7 Corner elevations(2'contours if more than 4'cliff ential)
IA Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace.? VJYes E o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown?lp ,/Yes No
`1, T'
1. lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
equired: ❑ Y s,applicant was notified No Received: ❑ Yes ❑ No
Vi Public Facili • s Improvement (PFI) Permit:
Required: Yes,applicant� was notified ❑ No Appli For: Yes ❑ No,stop intake
e:k.and Use Case #: l P - Q0j9 )O / Of Zoning: E1.2
equired Setbacks: Front: i,c— Rear: /5 Side: Street Side: IL .I Garage:
E/Building ►Height: Max. Height: - Actual Heigh�•j &
Landscape %gea: % •/ Lot Coverage Ma _ 'L %
Entrance ►' t back no more than 8'from street-facing wall b Parallel to street or offset 45 degrees or less
Windows .. um 12%of area of all street-facing facades
Garage V Gaarrap door is behind widest street-facing wall CI Yes CJ No,one of the following is met:
1a Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.vviryd'ow above garage on 2nd floor.
tic"-Garaige door width is ❑ 12'or less ❑ 50%or171 of facade �( %or less and includes 7 0 following:
12'0. overed porch ❑ 'ecessed entrance Wall offse/t 1'Roof eave 2Roof offset
V Fire shingles In Lap Siding ❑ Roof pitch la Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding K Window trim ❑ Window recess ❑ Window projection ❑ Balcony
a IV Visual Clearance A Urban Forestry Plan
110i'eensitive Lands: ❑ Yes I7" No Type:
F Conditions met prior to issuance of building permit
Not : _
Approved By Planning: /liL..► Date: 1D
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw_RES_022819.docx
Building Permit Submittal i
Original Submittal Date: a`�l rei
Site Plans: #
Building Plans: #
Building Permit#: gi Enter building permit#above.
Workflow Routing: D/Planning C EngineeringEY Permit Coordinator C""-Building
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: Q'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
0 Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: CZ\ \ Ini
En,ineering Review
1P Slope at building pad: 2 4
Conditions "Met"prior to issuance of building permit
4/1'Easements (encroachments)per engineering conditions of approval and plat
[ 'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Cil/No
Assess Water Quantity Fee in-lieu: ❑ Yes RYNo
LIDA Facility on lot: ❑ Yes No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:te
Vi'Approved by Engineering: _ .� Date: 9,7/40
Revisions (after Building Submittal only) / Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
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:
ei,�'SDC •Fees Entered: Wash Co Trans Dev Tax: [L'Yes ❑ N/A
CCCfff Tigard Trans SDC: ['Y,e§" ❑ N/A
Parks SDC: Yes ❑,3/A
LIDA ❑ Yes N/A
VOK to Issue Permit
Approved by Permit Coordinator: A Date: 9//4°//7
I:\Building\Fonns\B1dgPermitRvw_RES_022819.docx
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 1 G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ,r \1\ Y DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: PNe i6ti1e.
COMPANY: SCj,G)ci CO&r`-\ t\V \\L. a le
PHONE: OM - '-);LQ -U Ct t I CEA
RE: C c Wt '1 ' \ULe , 01 ` — `I
(Site Address) (Permit Number)
@CkA '\ r'� 1. .
(Project n e 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):
REMARKS: Q()1\u‘NAA)c. 1Z„'.`` yt, I Gt t-/ _ Ca lc
r�
(777:
FOR FFIC USE ONLY
Routed to Permit Tec ' ian: Date: uP ( `, Initials: 1�'4'"
Fees Due: 171Y s No Fee Descri 'on: Amount Due:
(/2 �c1\ (.<4 $
$
Special
Instructions:
Reprint Permit(per PE : ❑Yes 'TX-No 0 Done fic,_
Applicant Notified: Date: /6(fee/( Initials:
1:\Building\Forms\TransmittalLetter-Revisions 061316.doc