Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTM:WIr`""
CEIVED
Request for Permit ActionIN
MAY 1 7 2018
T I G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www. ._!..,_4.-•
a•.,_•-• .•• jn.,P+�`'s.�{)(`i•lry.,iigpBUILW�� ,, R, IN
TO: CITY OF TIGARD
Building Division V 0 I
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov /27,%
FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff 40*
---
Check(✓)one
REFUND OR Name: \�1 "
INVOICE TO: (Business or Individual) &446(
Mailing Address: tr-.) Nw V l fit" POCQ_
City/State/Zip: \c, 4147 \}'s - OtZI (17U01
Phone No.: ` )()-5 -`)?33- c:51C7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
❑ REFUND..PERMIT FEES (attach copy of original receipt and provide explanation below).
' INVOICE F R FEES DUE (attach case fee schedule and provide explanation below).
/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#:
`A it ►ii7. S&L,20/ -ee/3 7
Site Address or Parcel#: 13
Project Name: -k \ Cj-ee\(
Subdivision Name: 5A (4"[ ; w /\V\Y(� �`.l`,-�U`�' Lot#: "I
EXP, ' ATION: A I� \o\\-- 4\ie., e 1� +_.�..a__
0 Com, 3"v0•Iv' I
/..
S L L. f/ _ 01/i1. 2. 1' r2-. / Ole/3 �,
Signature: \ i
Date: n _20 (C,?
�/ (�
Print Name: V\ Coper
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date *' i d By Route to Records: Date , �, )4.-- By Ito
Refund Processed: _ Date / By 6., Invoice Processed: Date 0 7 kfr B
Permit Canceled: Date k/7,y�, By, `~ Parcel Tag Added: Date /// By
I:\Building\Forms\RegPernvtAction_ 2314. oc
iii City of Tigard • COMMUNITY DEVELOPMENT
III
Building Division
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TIGARD
INVOICE
TO: Sage Built Homes Customer ID: 189330
1815 NW 169th Pl, Suite 1040
Invoice No.: INV2018-00001
Beaverton, OR 97006 Invoice Date: 6/22/2018
Date Due: 30 days
Site Address Subdivision'-Lotw#or,Prolecrliame: Amount Dues
Case Na. = �°� � � $351.75
MST2018-00131 9544 SW Anna Belle Ct Ash Creek Village,Lot 9
Permit cancelled and resubmitted
new plans under MST2018-00142
All plan review fees due as permit
was cancelled after plan review
was completed.
Invoice Total: $351.75
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2018-00131
Customer ID: 189330
Invoice No.: INV2018-00001
Site Address: 9544 SW Anna Belle Ct Invoice Date: 6/22/2018
Project: Ash Creek Village,Lot 9 Date Due: 30 days
Invoice Total: $351.75
Amount Paid: $
Office Note: Route copy of receipt to Dianna Howse
Please mail payment to:
City of Tigard,Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
I:\Building\Accounting\Invoice.doc 01/14/2011
CITY OF TIGARDill
FEE AND PAYMENT HISTORY
I '- 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIC,A RID
MST2018-00131 - 9544 SW ANNA BELLE CT, TIGARD, OR 97223
Ash Creek Village, Lot 9
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
DC Provision Review, SF-Ping 100-0000-43112 $91.00 $91.00 $91.00
Plan Review 230-0000-43106 $751.34 $751.34 $751.34 5/7/2018 Credit Card 417128 $0.00
Plan Review 230-0000-43106 $260.75 $260.75 $260.75
Totals for Fees $1,103.09 $1,103.09 $751.34 $351.75
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
417128 Credit Card Catherine Patterson 05/07/2018 $751.34
Total Payments: $751.34
Balance Due: $351.75
Building Permit Application
V
j ., ill
Residential . ,1
FOR oFFlcl: I se oL1
City of Tigard A I r.cewea r
r 13125 SW Hall Blvd.,Tigard,OR 97223 l,ateBy: ab 1 Permit No.: lsr2 e"_WE
11111 a Phone: 503.718.2439 Fax: 503.598.1960 Plan Review ` r''= ���-.t�,P�t,9,
Inspection Line: 503.639.4175 �� 2 Q Date Re / �' Other Permit.�e ti��ge 2 for j-r. 3
7 1 C �h D P Date Read B
Internet www tigazd or gov Ready/By: Jam_ I H See Page 2 for
CITY OF"�IGARD'otified/Method /��
t l # fDVI Supplemental Information
� i rYrg.b f f W rR r � �1 ✓r+ f 2 `� rr .` fr me ,r r r. mf r ,
..v, ,l i M y 2 f ff f , } .
, . . .., f5 ;.. .; f ,.{„f f f l L� � i w1� � jsG 1�4�� ��)���
®New construction �..„,,,,,,„;,,_,:„:,,,.3.„,,,,,,, �. , ., <; � �.,r•„� �, r,,�.
❑Demolition Permit fees*are based on the value of the work performed.
0 Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
❑Other
t; f f ,<
equipment,materials,labor,overhead,and the profit ..'
P
Aik. t,� ': f, A` ` R` ',O'' work indicated on this application.
f . is n ., jai
® 1 and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building
IDMulti-familyNumber of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 4
r.,r , ,r ! � � TION Total number of floors: 3 n/
Job site address:9544 SW Anna Belle Ct New dwelling area: 2101 square feet $SS-.
City/State/ZIP:TIGARD,OR
Garage/carport area: 350 square feet '7 9,V
Suite/bldg./apt.no.: I Project name:Ash Creek Vi iftu,x , ? e
” 1 Lc,—/— { Covered porch area: square feet 4 sip
Cross street/directions to job site:
Deck area: 'j 4 square feet
Other structured area: square feet
Subdivision:Ash Creek µ .'; ; } k A
I Lot no.:9 Permit fees*are based on the value of the work performed.
fax map/parcel no.: � # Indicate the value(rounded to the nearest dollar)of all
f 1, t'Y r,r r �, ,; '
equipment,materials,labor,overhead,and the profit for the
f”"�r"'f f "`"'"" '' ' � -' V:w f `° work indicated on this application.
NEW RESIDENTIAL CONSTRUCTION �����
Valuation: $
Existing building area: square feet
„ r New building area: square feet
V t.; tE ,x. «; ,,; Nustories:mber
4 -. '. �` �� um
Name:SAGE BUILT HOMES LLC
Type of construction:
Address: 1815 NW 169TH PL.SUITE 1040
City/State/ZIP:BEAVERTON,OR 97006 Occupancy groups:
Phone:(503)533-5167 Existing:
Fax (503)533-5164
r, r
New:
Business name:SAGE BUILT HOMES LLC
Contact name:Ben Cooper Structural plan review fee(or deposit):
Address:SAME AS ABOVE FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application:
Phone:(971)258-6658 I Fax::( ) Amount received:
E-mail:Ben@SAGEBUILTHOMESLLC COM
•, z � _ ;, �Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:SAGE BUILT HOMES LLC Submit two(2)sets of roof plan with connection details
Address:SAME AS ABOVE and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
Phone:( ) I Fax:( ) and administrative fees): $180.00
CCB lie.:189330 State surcharge(12%of permit fee): $21.60
-----)t
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:Ben Cooper pp *Fee methodology set by Tri-County Building Industry
Date: l_70 l
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011
440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
OFFICE l'SE ONE One- and Two-Family Dwelling FORr
City of Tigard
Received' Permit No.:
Date/By:® 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
s Phone: 503.718.2439 Fax: 503.598.1960 0 Electrical 0 Plumbing 0 Mechanical
T 1 G A RD 24-Hour Inspection Line: 503.639.4175 ❑ er
Internet: www.tigard-or.gov
l es '�0 1/A
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 0 0 0
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. ❑ ❑ ❑
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. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc. ❑ 0 0
10 3 'Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state
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 0 0
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. ❑ 0 0
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. ❑ 0 0
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater,
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. 0 0 0
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
prescriptive path analysis provide specifications and calculations to engineering standards. 0 0 0
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 0 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 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
0
0 0
20 Manufactured floor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑
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 0
architect licensed in Oreton and shall be shown to be a..licable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS 0 0 0
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 0 0
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. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 ❑ 0
27 "Drawn to scale"indicates standard architect or engineer scale.
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 0
Street Tree List. ❑ 0 0
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines,
and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 0
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.doc 02/24/2011 4404613T(11/02/COM/WEB)
Mechanical Permit Application „UR orr►(,I:I sI:0yl.1
City of TigardDate/By: Permit No.:
n 13125 SW Hall Blvd.,Tigard,OR 97223 n 7 u,._
_ Phone: 503.718.2439 Fax: 503.598.1960 MAY ' t Other Permit:
t I G A R D Inspection Line: 503.639.4175 _• ,y/gy. aur s: H See Page 2 for
Internet: www.tigard-or.gov CITY OF TI Cc!.
ethod: Supplemental Information
,�ys��� BUILDING D
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.
11`A `E GORY ,C!11 )1t
Value:$
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
` ! l : F} 0� q0011
Heating/cooling:
Air conditioning 1 46.75 44.75
Job site address:9544 SW Anna Belle Court Furnace 100,000 BTU(ducts/vents) 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 Village Duct work 23.32
Cross street/directions to job site:SW 95th Avenue 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 Village Lot no.:9 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
New residential construction fireplace 1 23.32 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
>>,
Other: 23.32
� �a+ 0� Jli
- r _ �4_ :` ''''''''':;,4;,-:.
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) 4 23.32 93.28
Phone:(971)221-4597 Fax:( ) Attic/crawlspace fans 1 23.32 23.32
=' A,POOST:: ':, 1?1, Other: 23.32
Business name:Sage Built Homes,LLC. Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Ben Cooper Furnace,etc. 1
Address:Same as above Gas heat pump
Wall/suspended/unit heater _
City/State/ZIP: Water heater 1 _
Phone:971-258-6658 Fax: :( ) Fireplace _ 1
Range 1
E-mail:planning@sagebuilthomesllc.com Barbecue
. Clothes dryer(gas)
Business name:All Time Heating&Cooling Other:
irll!I44 )
Address:PO Box 1341 Subtotal
City/State/ZIP:Lake Oswego,Oregon 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: i * Fee methodology set by Tri-County Building Industry Service Board
Print name:Ben Cooper Date: 6----1- Lo 16
I:\Building\Permits\MEC_PermitApp_040I 13.doc 440-46177(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.
C\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit ApplicationflECE,VE FOR OH It 1 `NI: 0\1.1
ed
City of Tigard eceivy Permit u � l Zi'L/C/ 2/
7 201 >�teB
13125 SW Hall Blvd.,Tigard,OR 97223 y V 1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 MAY. Date/By: Related Permit 4:
Inspection Line: 503.639.4175 p ir«.�u dy DateBy: Iuris la See Page 2 for
F I G A R D Internet: www.tigard-or.gov � 1 l� 'fi dlMerhod: Supplemental Information
TYPE OF;;w0RBUtLD1NG DMPLAN 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 stones.
0 Demolition 0 Other:
where the available fault current ❑Mannas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system
Job#: Job site address: 9544 SW Anna Belle Ct 100HPormore. ❑"A "E "1-z", I-3",
City/State/ZIP:Tigard,Oregon 97223 0 Six or more residential units. occupancy.
g g ❑Healthcare facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name:Ash Creek ['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 l Qty, l Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Ash Creek Lot#: 9 Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft,or less 168.54 4
Ea.add'l 500 sq.tt.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft,) 75.00 2
NEW RESIDENTIAL CONSTRUCTION Limited energy,multi-family '
residential(with above sq.ft.) 75,00 2
Renewable Energy ❑ See Page 2
° PROPERTY OWNER I 0 'gNNANI` Services or feeders installation,alteration,andtor relocation
Name:SAGE BUILT HOMES LLC 200 amps or less 1 100.70 2
Address: 1815 NW 169TH PL.SUITE 1040 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:BEAVERTON,OR.97006 601 amps to 1,000 amps 30104 2
Phone:(503)533-5167 Fax:(503)533-5167 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 i
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
7,4 APi'LICANT [] CONTACT PERSON
Branch circuits—new,alteration,or extension,per panel
A,Fee for branch circuits with
Business name:SAGE BUILT HOMES LLC above service or feeder fee, 7 42 2
each branch circuit
Contact name:3,y\ Cco p'e,( B.Fee for branch circuits without
Address:SAME AS ABOVE Jd`��� ervice r feeder fee,first
bc
ranch circuit 56.18 2
b
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) ! Fax: :( ) Each manufactured or modular 67.84 2
Email y\@SAGEBUILTHOMESLLC.COM dwelling,service and/or feeder
�; Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Sign or outline lighting 67.84 2
Address:2870 SE 75th Avenue,203 Signalel,alcteration,
n or limited-energy
0 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:(503)642-5815 Investigation(1 hr min) 90,00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 157891 Electrical Lie.: 34-436C Suprv.Lie.:yul. —E specifically listed('/hr min)
ELECIfRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
.Authorized signature: ,TOTAL PERMIT FEE:
C This permit application expires if a permit is not obtained witbia 180
Print name: i3e,A, r✓ Date: C-.7 ...-7_01.3 days after it bas been accepted as complete.
• Number of inspections allowed per permit.
I:1DuitdingtPeraatstELC_PerinitApp_ELR_ERE.dos Rev 06/17/2015 440-461S7(1 i/05/COM/WEB
Plumbing Permit Application ‘,EIVE
Building Fixtures
MAY 7 2018
Received
City of Tigard PermitNo.:
1111 111 » 13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: Pi cgT i r-CO fii
O�- IGIanReview OtherPennitNo.:
Phone: 503 Line:
43. Fax: 503.598.15. .,-`11-YILDING DIVISl
Inspection Line: 503.639.4175 y
1't�;A IL D � t ReadyBy: 7uris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
': !:q Qlt� 1. l x P V.NR;165r4
®New construction 0 Demolition For special information use checklist
Description j Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
., , iTF R'Y" 1+ co zj o pfd SFR(1)bath 312.70
®1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 1 25.02 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
(}B Sl ' ii.:R :TCON,- LCCATICQ I Site utilities:
Job site address:9544 SW Anna Belle Court 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:Ash Creek Village Manufactured home utilities 50.03
Cross street/directions to job site:SW 95'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 no.:q Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
:_ Backwater valve 12.51
; uESC1UFTIO v tF 1'ORE
Clothes washer 1 25.02 25.02
New residential construction
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
i tRoiti TV #W B Q 1IA Expansion tank 12.51
Name:Sage Built Homes,LLC. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169'Place,Suite 1040
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 2 25.02 50.40
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
tit' rruc ;:_ t ;CO A NN- 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 5 25.02 125.10
City/State/ZIP: Solar units(potable water) 62.54
Phone:971-258-6658 Fax::( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:planning@sagebuilthomeslIc.com Urinal 25.02
Water closet 25.02
?lU1t �t_; v Water heater 1 37.52 37.52
Business name:Ed Mullen Plumbing Water piping/DWV 56.29
Address: 1601A SE River Road Other: 25.02
City/State/ZIP:Hillsboro,Oregon Subtotal
Phone:(503)720-2636 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:92689 Plumbing Lic.no.:34-260PB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: P ', TOTAL PERMIT FEE
Print name:Ben Cooper Date:5 l _201 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\Pemtits\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:
Sits'I titlitres Fee(ea) TOWquta ootia 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 $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 E Fee:
Storm&Rain Drain-1st 100' 62.54 1 $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
Feeor (ea); Tow additional$100.00 or fraction thereof,to
xand 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 '"lu til cs ew' or';l?`luir ibing installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate 4
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"
Car Wash Drain :isometric or Aiser Diagram
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:
C:\Users\kylie\Downloads\PLMF_PermitApp.doc 2
Plumbing Permit Application
• Building Fixtures FOR ()rrlu i. I-si: Oyi.l.
City of TigardECEIVE ,Received Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: evps7d.. i tv _6
0 Phone: 503.718.2439 Fax: 503.598.1960 2018
Plan Review it � "r/
q�NN p 7 � 8 Date/By:
Other Permit No.:
T I G\R p Inspection Line: 503.639.4175 MAY 1. L o 1 U Date Ready/By: 'uric' la See Pae 2 for
Internet www.tigard-or.gov g
Notified/Method: Supplementallnformahon
R, �E' 7► 9
®New construction � �� �N Clidt4�G� . . _ �,. . , •�, ,. .,�
Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
r°
R 'OF CONSTRU O I ,,-,' SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft) Page 2
, I7E INFOMAON
RTI AND LOATIOP1
% •<. ��}B Site utilities:
Job site address:9544 SW Anna Belle Court 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 Lot no.:q Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve
� C { .VfOJ '.` 12.51
Backflow Permit Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
; ',.,,; ANT Expansion tank 12.51
Name:Sage Built Homes,LLC. Fixture/sewer cap 25.02
Address: 1815 NW 169th Place,Suite 1040 Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon
Hose bib 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
;� CONTIRN Interceptor/grease trap 25.02.
Business name:Sage Built Homes,LLC. Medical gas(value:$ ) Page 2
Contact name:Ben Cooper Primer 12.51
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
, . , M , C1loR
Water closet 25.02
Water heater 37.52
Business name:Truscapes
Water piping/DWV 56.29
Address:1600 NW Amberwood Drive
Other 25.02
City/State/ZIP:Hillsboro,Oregon Subtotal
Phone:(503)531-9216 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:7962 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ) �r'� TOTAL PERMIT FEE
Print name:Ben Cooper Date: J C 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\Pernots\PLMU-PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information .
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . ciyx lee z s oe, ,Squ te, Mitage; Permit Pee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52
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 `-.Vain-anon; 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
each additional$100.00 or fraction thereof,to
other InSpeetions or Fees , QtX; = 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 .
.P n Review";for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stallengineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
Dishwasher
i
Cuspidor/Water Coirator
Dshwashherer -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.
4" Isometric or Riser Diagram"
Car Wash Drain ❑ 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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
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
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R D Building Permit Review — Residential
Building Permit #: rid; l r=c)C 4 31
Site Address: 9'5/1/3 4h, q Bak C-71
Project Name: v4S4 Creek Lot #: 9
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: /Jew? SFR
Verify site address/suite#exists and active in permit system.
..B--River Terrace Neighborhood: 0.-N-6 ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
ree(3) copies of site plan structures on site
XJ Stte plan must be on 8-1/2"x 11"or 11 x 17"paper . 1 t botprint of new structure(including decks)with finished
.215 wn to scale(standard architect or engineer scale) floor elevations
RN-orth arrow --Q.1.1-tilitriocations&easements(required for new and additions)
address,project or subdivision name and lot number ewalk/driveway approach
2plicant information(name and phone number) .El±,veatiou.of wells/septic systems
„1:11.at dimensions and building setback dimensions ghees to be retained with drip line,and tree
0o age of buildings to be demolished of _ pro ection measures
area,building coverage area,percentage of coverage and "T S et tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) i.r Street names II
roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Wes ❑No
4 foot differential) If yes,is a storm water quality facility shown? ❑Yes [21 o 6,---1-
-5 JJ
'Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified -Ei-No Received: ❑ Yes ❑ No
ieri:ublic Facilities Improvement (PFI) Permit: 5 - ()49/1/9Required: E Yes,applicant was notified E No PR ? Applied For: t.1;1-7f-es es ❑ No,stop intake
,Land Use Case#: $?) v/5- 003
„2"--Zoning: P- la (pp
Required Setbacks: Front /5 Rear wy.6, Side 3 Street Side g Garage a n
Landscape Requirement: (9 t) %
Lot Coverage Maximum:
Building Height: Maximum Height 335 Actual Height 3/—
'nfiTisual Clearance
Sensitive Lands: ❑ Yes C'—o Type
Jrban Forestry Plan
- Conditions " et" rior to issuance of b permit
Notes: P e
L1-Approved By Planning: , Date: S 7//7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: 5/7/i 1
Site Plans: #
Building Plans: #
Building Permit#: miter building permit above.
Workflow Routing: manning ICI.•��gineeringermit Coordinator C—Britaing
Workflow Sign-off: -off for Planning(include notes from planning review)
Route Application Documents: neering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: ' Date: 5/4/, '
Engineering Review
C/Slope at building pad: jff„.1
Conditions "Met" rior to issuance of buildingpermit
p
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: E Yes No
LIDA Facility on lot: ❑ Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
❑ Approved by Engineering: k ,9 Date: 5-44-
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:
vision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes CI N/A
LIDA
CI 'FS'N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: › ."
I:\Building\Forms\BldgPermitRvw_RES_010118.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
"II _ ~ Transmittal Letter
c;n is i) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: TO/1 DATE RECEDEPT: BUILDING DIVISION REcEivED�
MA'i'1.6 8
FROM: �LV \ COO-fr(
CITY OF TIGARD
COMPANY: f*e_ 3L& * LiorneS BUILDING DIVISION
PHONE: Gj BY:A v ` "
� 2J� �- ` g
RE: 75-4/Y SA} 'N'S- CrlAkte - I
(Sit Address) (Permit Number)
Abp GMK_ + 9
(Project 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. ( 7 ) - Engineer's calculations.
Other(explain): r
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials: 4/11"
Fees Due: ❑Yes ❑No Fee Description: Amount Due:
Akt,t2K7N-e.,/ $
$
Special 1 l/1,11 L j /
Instructions:
Reprint Permit(per PE): ❑Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc