Permit (163) IN 1
CITY OF TIGARD MASTER PERMIT
fi Ig: COMMUNITY DEVELOPMENT Permit#: MST2018-00059
T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2019
Parcel: 1 S 135 B D02500
Jurisdiction: Tigard
Site address: 9514 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 11
Project: Ash Creek Village, Lot 11
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 446 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 4 Second: 841 sf Garage: 360 sf Front: 15 Smoke
Dwelling Units: 1 Third: 892 sf Right: 3 Detectors: Yes
Total: 2179 sf Value: $264,875.30 Rear: 20
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
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 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 2179
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006 2 Fire Rated Eave one side
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $30,089.99
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 obta' a copy of theTules or direct questions to OUNC by calling 503.232.1987 or 1.800.332., 44.
Issued By: ".-e--rL..-,K_- ---�r-� Permittee Signature: A^
603.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
410,BuIldin2 Permit Application ?A is
Residential � ''' 4 q
4
L
City of Tigard i EB t ZO ig ived
Rece
y `� ti ermit No/it l'/�/r es
13125 SW Flail Blvd.,Tigard,OR 97223 A rl Plan Review 7 6 fir. _"� ���y
C Phone: 503.718.2439 Fax: 503.598.1960C'• p •. � Date/By: tel" )3"J tl Other Permit:�tc..."<Uif F�t17
Inspection Line: 503.639.4175 ea€ <„+z,7s. ` i V''�' R Date Ready/By: Jur s: ® See Page 2 for
T 1 G A h D Internet: www.tigard-or.gov Notified/Method: 3 //2% //�its) Supplemental Information
TYPE OF WORK ” REQUIRED DATA: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
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
` Valuation: $
® 1-and 2-family dwelling 0 Commercial/industrial ,- !
0 Accessory building ❑Multi-family Number of bedrooms 7 0 +"'�
7- '-.17 G---
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 as 3 9
Job site address:9514 SW Anna Belle Ct New dwelling area: 2179 square feet I
City/State/ZIP:Tigard Oregon Garage/carport area: 360 square feet 8 qa
Suite/bldg./apt.no.: Project name:Ash Creek Covered porch area: .. square feet $U j
Cross street/directions to job site: Deck area: 25 square feet 14.9 V
aOthers u l. a: *S— square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Ash Creek 1 Lot no.: 11 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DEscRipTioN OF wow( work indicated on this application.
New Residential Construction Valuation: $
Existing building area: square feet
New building area: square feet
7' PROPERTY OWNER Q TENANT Number of stories:
Name:Sage Built Homes Type of construction:
Address:1815 NW 169t''Place Occupancy groups:
City/State/ZIP:Beaverton Oregon 97006 Existing:
Phone:(971)221-4597 Fax:( ) New:
- APPLICANT Q'CONTACT PERSON BUILDING PERMIT FEES*
Business name:Same As Above (Please refertfeesrke4late)
Structural plan review fee(or deposit):
Contact name:Alex Rodriguez
FLS plan review fee(if applicable):
Address:Same As Above
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:(971)336-6911 Fax: :( )
E-mail:Planning@sagebuilthomesllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:i f 3 3 0 / /Al
I Total fee due upon application: $201.60
Authorized signatureThis permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Alex Rodriguez Date:2/1/2018 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
II
Building Permit Application Checklist ' ,- ,
One- and Two-Family Dwelling FOR OFFICE 1 SL OyII
City of Tigard Received
- `, g : Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
Associ Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
T 1 C A k D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No NIA
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: ❑ 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 0
6 Sewerr permit. t 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 :Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
`there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
anddriveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ 0 ❑
and location.
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.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑
for four or more appliances.
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 a s,licable to the s 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. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
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, ❑ ❑ ❑ 1
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 ❑ ❑
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)
Mectanical Permit Applicatio '7, y.. r FOR OFFICE I SF.ONE)
•
A `s, v ''"`" Received
City of Tigard Permit No: ,
11 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:D1 a
IIIIIIL Phone: 503.718.2439 Fax: 503.598.1960 C 13 Plan Review
Date/By: Other Permit:
TIG A R D Inspection Line: 503.639.4175 °-�
Internet: www.tigard-or.gov (1f°° `c �° 3, Date Ready/By: Juris: H See Page 2 for
i � t NG Di,,;;Si N Notified/Method: Supplemental Information
TYPE aF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
Z New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address:9514 SW Anna Belle Ct Air conditioning 1 46.75 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Ash Creek Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision:Ash Creek Lot no.:11 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39
Flue vent for water heater or gas
New Residential Construction fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNEROther: 23.32
� ' 0 TENANT
Environmental exhaust and ventilation:
Name:Sage Built Homes Range hood/other kitchen
equipment 1 33.39 33.39
Address:1815 NW 169th Place Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32 116.60
Phone:(971)221-4597 Fax:( ) Attic/crawlspace fans 1 23.32 23.32
.. APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Same As Above
$14.15 for first four;$4.03 for each additional
Contact name:Alex Rodriguez Furnace,etc.
Address:Same As Above Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(971)336-6911 Fax::( ) Fireplace
Range
E-mail:Planning@sagebuilthomesllc.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:All Time Heating&Cooling Other:
MECHANICAL PERMIT FEES* '
Address:PO Box 1341 Subtotal
City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:1845757 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: 4. * Fee methodology set by Tri-County Building Industry Service Board
Print name:Alex Rodriguez Date:2/1/2018
t:\Building\Permits\MECPermitApp_040113.doe 440-46171'(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
e .
•
Electrical Permit Application ' f;--i um 0H-1( 1 1 sI:0y1,1
Received 41
Cl O 71 and
'7 `, g 201 Date/B ermtt#: ALL., t' ,�
13125 SW Hall Blvd.,Tigard,OR 97223 FEBE3 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 �+ U i- %H` Ready Date/By: Juris: ® See Page 2 for
1) t
Internet: www.tigard-or.gov BU 1`lD l i`)G Di Y e S i�..L'i Notified/Method: Supplemental Information
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current
,:; 1 CATEGORY OF CONS''E*t)G Ohl "`i exceeds 10,000 amps at 150 volts or 0 Float g buildings.darinas and boatyards.
® 1-and 2-family dwelling 0 CommerciaUindustrial 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 0 Other: ❑Fireum .
p p 0 Installation of 150 KVA or
.;Ion ,,, '+ ;Loc J'ti*.. 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: ]\*SW Anna Belle Ct 100HP or more. ❑"A","E","t-2","t-3",
City/State/ZIP:Tigard Oregon ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Ash Creek 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE FCHE1
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision:Ash Creek Lot#: .1I Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
,. D R ION :- OW , Limited energy,residential 75.00 2
New Residential Construction (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
TY OWNER J C TIENANT • Services or feeders installation,alteration,and/or relocation
Name:Sage Built Homes LLC 200 amps or less 1 100.70 100.70 2
Address: 1815 nw 169TH Place Suite 1040 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 2
Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts 552.26 2
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
,�, op,if..,,,,,,,. C C`QNTA I' PE t11 - Branch circuits—new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name:Same As Above above service or feeder fee,
7.42 2
each branch circuit
Contact name:Alex Rodriguez B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
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 67.84 2
dwelling,service and/or feeder
Email:Planning@sagebuilthomesllc.com Reconnect only 67.84 2
4 'CON'!iTRACT Pump or irrigation circle 67.84 2
Business name:Ross Electric Sign or outline lighting 67.84 2
Address:2870 SE 75th Ave 203 Signall, Iern 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:( ) Investigation(1 hr min) 90.00/hr
Email:
/ / q Industrial plant(1 hr min) 78.18/hr
`0 IL ` ! Inspections for which no fee is
90.00/hr
CCB Lic.: 157891 Electrical Lie.: 34-436C I Suprv.Lic.: yII 2 s specifically listed c/:hr min)
FEECTOICAE
Suprv.Electrician signature,required: -1 �Subtotal:
Print name: Stephen Ross "7'r 1D 4;, 055 Date: ❑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 Date: 2/1/2018 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application r �.. n
Building Fixtures FOR OFFICE USE ONEv
City of Tigard 20
F FEB Received• 5 J;`T e f
.� g Permit No.
Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 ? Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 '' Date/B Other Permit No.:
Inspection Line: 503.639.4175 ��( "+� I"t v`�r�- y
T I C A R D Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE®New construction El Demolition For special information use checklist
Description 1 Qty. Ea. .1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath x 500.32 500.32
❑Accessory ❑Multi-family
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:9514 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.: 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 Lot no.: 11 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
'11 PROPERTY OWNER C 0 TENANT Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1815 NW 169th Place
Garbage disposal 1 25.02 25.02
City/State/ZIP:Beaverton Oregon 97006 Hose bib 2 25.02 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
C.4 APPLICANT 0 CONCAG 1"PERSON Interceptor/grease trap 25.02
Business name:Same As Above Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Alex Rodriguez
Roof drain(commercial) 12.51
Address:Same As Above Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)336-6911 Fax::( ) Tub/shower/shower pan 3 12.51 37.53
E-mail:Planning@sagebuilthomesllc.com Urinal 25.02
Water closet 25.02
CONTRACTOR"
Water heater 1 37.52 37.52
Business name:Edwards Mullen Plumbing Water piping/DWV 56.29
Address: 1601 A Se River Rd Other: 25.02
City/State/ZIP:Hillsboro Oregon 97123 Subtotal
Phone:(503)628-3560 Fax:( ) 7 it l2i 1 Minimum permit fee: $72.50
CCB Lic.:92689 bing ►'c.no.:36/26D,14 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
.\__,\..1
This permit application expires if a permit is not obtained within 180 days
Print name:Alex Rodriguez Date:2/1/2018 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(Cal Total Square footage: Permit Pee:
Footing drain-lg 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 aluation: 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
Qty Fee Oa}, Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand 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.
Performed: Capped Added Relocate 9
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
0 Isometricriserdiagramis required for new buildings
Garbage -Domestic-non-food or q 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/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\alejandra\Desktop\Templates\City of Tigard\Plumbing.doc 2
11111 City of Tigard
e COMMUNITY DEVELOPMENT DEPARTMENT
II
T 1 c A R o Building Permit Review — Residential
Building Permit #: "4$7 o/it-006c
Site Address: /L-71 ca) P42 -g/lam a/4.
Project Name: A S h C ree K. OH 619 e Lot #: 1/
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review �( /
Proposal: N J .SF a. - 44,44.-� s%/ c /V I3 ' /4/1
�I Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: yi No ❑ Yes,See River Ten-ace Review Addendum Attached
Site Plan Elements:
ree(3) copies of siteplan
P 'it!"sting structures on siteto plan must be on 8-1/2 x.11 or 11 x 17"paperiii'lli 7 ootprint of new structure(including decks)with finished
�rawn to scale(standard architect or engineer scale) oor elevations
tility locations&easements(required for new and additions)
IJZS orth addarrowress,project or subdivision name and lot number Sidewalk/driveway approach
"WC pplicant information(name and phone number) 1] I° cation of wells/septic systems
'A • dimensions and building setback dimensions III ;a,'sting trees to be retained with drip line,and tree
J Oluare footage of buildings to be demolished • otection measures
7 Lot area,building coverage area,percentage of coverage and 1► treet tree size,type and location
tfnpervious 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? Zes El
4 foot differential) If es,is a storm water .uali facili shown? i1 a Yes No
OTtlean Water Services—Service Provider Let -r(lot platted prior to 9/10/1995):
equired: ❑ Ye ,applicant was notified NI No Received: 1=1 Yes ID No
Public Faci1iti s Improvement(PFI) Permit: ---/;20/-c-1.
/ .2o7 ;CO J
Required: Yes,applicant was notified ❑ No Applied For: Yes�`❑ No,stop intake
P and Use Case#: De- 1S* 0000 1 Sue zic 1S - 0 0003
oning: P--1 /L
AAs
.)
Required Setbacks: Front / Rear ,,20 Side Street Side Garage
?ancdscape Requirement: c20 %
,ot Coverage Maximum:
uildin Hei ht
g g Maximum Height - Actual Height , /,
ue�isual Clearance
nsitive Lands: Yes ❑ No Type A /
Urban Forestry Plan
❑ Conditions "Met"�prior to issuanc of�uilding permit l
Notes: On A'172�J? s-C'L I/ /VII_.7/- �ic-- ' ,attk kCZA.9,lt C
❑ Approved By Planning: ,----",- f Date: //h
Revisions (after Building Submittal only) Revi wer at_te
Revision 1: Approved CI Not Approved ' '1
'
Revision 2: 111 Approved El Not Approved y� V
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPermitRvw RES 061417.docx
Building Permit Submittal Original Submittal Date: Ji/ir
Site Plans: ;:_t___ /___,Z
Building Plans:
Building Permit#: Enter building permit#above.
Workflow Routing: Planning Cngineering ❑ Pert Coordinator , Building
Workflow Sign-off: Sign-off for Planning(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.
p.Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician: Rta �l�2 Date: p'{4W/oF
Engineering Review
J,Lf
Slope at building pad: a
/J/J Conditi "Met"prior to issuance of building permit
/ as:ne:(encroachentsperenginee . g) conditions of approval and plat
/WaterQ
uality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes i No
❑ Final Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
AApproved by Engineering:, P Date: �- 7 kr
Revisions (after Building Submittal only)IDR�>,were �Date��
Revision 1: A Approved Not Approved ,.r//J Z.#
AZ.
2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
El Con 'ons"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:
DC Fees Entered: Wash Co Trans Dev Tax: i.NYes ❑ N/A
Tigard Trans SDC: Or Yes ❑ N/A
Parks SDC: ] Yes El N/A
LIDA /❑ Yes f N/A
111°OK to Issue Permit �/
Approved by Permit Coordinator: Date: .___ (___(1_______r O
I:\BuildingTonns\BldgPermitRvw_RES 010118.docx A---L `C
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN .
MAY2 201
Request for Permit Action
TI .;A It 1 i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-61.41)f) NP fl \,tip f ,'
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑X Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Sage Built Home
Mailing Address: 1815 NW 169th Place Suite#1040
City/State/Zip: Beaverton,OR 97006
Phone No.: 503-533-5167
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ 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#: MST2018-00059
Site Address or Parcel#: 9514 SW Anna Belle Ct
Project Name: Ash Creek Village
Subdivision Name: Ash Creek Lot#: 11
EXPLANATION: Requesting to remove A/C from permit and a refund
Signature: /3.14- �gQ.4
p, , Date: `,22//cf.'
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.
,Tia f /.3--_s-et cz... p z/6- fYez - / ',/ ele /€ 6/.2 /,1`
c
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date ,,,//r¢ By.&-e2Y Invoice Processed: Date By
Permit Canceled: Date 44i By arcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
Lo\-- k
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
g Transmittal Letter
r ;\ E<rl 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION _ . r
FROM: Oey,
C JUN 1I2018
1
COMPANY: ` Q 3tA:t -k- , ori 1
PHONE: "Ii I -25$-665 By:
0---.
RE: q51 t 5W hAna Bil Ie- Cit" Msk (o g-0105c(
(Site Address) (Permit Number)
Ac1\ 10 -
(Project name orçK
division name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: ' Description:
Additional set(s)of plans. Revisions: /60Ca/605a N5 I Si V.,
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 1 CE USE ONLY
Routed to P a cian: Date: � (� [t/ ) Initials: FPI-
Fees Due: �E No Fee Descrip Ion: Amount Due:
$ bb
) tir�r; $ �.r-
P $
Special
Instructions:
Reprint Permit(per PE): o [ Done
Applicant Notified: �,�-.0-3....- Date: C }-r/f( f Initials: /9
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
Lok-
FOR
oiFOR 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
111 Transmittal Letter
1 .,:\r,I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISIONRECF +J -
FROM: SeA Col2pr ryJUN 1 I 2018
COMPANY: &T., BU L, D ri:DiON
PHONE: "!l I —750-666' BY: r
RE: 85111 514 knna 1c C, sk- t g-U)O5c1
(Site Address) (Permit Number)
ASS ççRK to( J e orname
and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions: k 1 till t I'S SIZ-0
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: [ Yes 0 No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit(per PE): ❑Yes ❑No ❑Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions o61316.doc
CITY OF TIGARD MASTER PERMIT
.111
COMMUNITY DEVELOPMENT Permit#: MST2018-00059
T @GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2019
Parcel: 1 S 135BD02500
Jurisdiction: Tigard
Site address: 9514 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 11
Project: Ash Creek Village, Lot 11
Project Description: New SF. 8/14/2019: REPRINT permit to add NC.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 446 sf Basement: 0 sf Left: 3
Parking Spaces: 0
Height: 28 Bathrooms: 4 Second: 841 sf Garage: 360 sf Front 15 Smoke
Dwelling Units: 1 Third: 892 sf Right: 3 Detectors: Yes
Total: 2179 sf Value: $264,875.30 Rear: 20
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1
Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain
0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains:
Bckflw Prevntr: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group:Y Square Feet:
NEW SF
VB R-3
2179
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1 1NW 169THP--L-$TE404g _ __1815 NW- 88TH-PLACE - _- _—4 € 5O339.475
BEAVERTON,OR 97006 BEAVERTON,OR 97006 2 Fire Rated Eave one side
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $30,489.75
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: % 9 Permittee Signature: r � ,c ' � ��U Al
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit ApplickikiWnc El V E
City of Tigard qq UG
2 Received
• 13125 SW Hall Blvd,Tigard,OR 972231 U G 1 2019 Date/By: �/ Perrriit No Sri G—00 7
Phone: 503.718.2439 Fax: 503.598,1960 Plan Review
Inspection 503.639,4175 CITY OF TIGARD Date/By: other Penna.
11"A
1 tJ A R T7 p Date Ready/By ruF s.
Internet www;ttgardorgov BUILDING DIVISION ®seementzler
Notifwd/Method
Supplemental loformalion
l`tY ':W*-, '`_ " ,1m V,` ....:
ui 1i ,..�u'
®New construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed,Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other
mechanical materials equipment labor overhead and�rafit
Ott «I{t'OF CONST*'tidTiilN"` nl Value:$
; 4:4 �. I r ,
EJ I-and 2-family dwelling 0 Commercial/industrialID) 1�Aci fo
0Accessory building
For special Information use checklist,
0 Multi family 0 Master builder 0 Other: DescriptionQtyEa,
� OB,SITS .F R Heatin coohn . �, Total
�. w � �wIATIt}N OCA'TI 19 z >z/ • q• .,
Job site address: 9514 SW Anna Belle Ct Air conditioning i 46,75 46.75
Fumace 100,000 BTU(ducts/vents) T46.75
City/State/ZIP: Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt,no.: Project name: Ash Creek Village Heat,pump 61.06
Cross street/directions to job site: Duct work 23,32
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: Othe
Otherr:fuel appliances:
1 Lot no.: 11 23,32
Tax map/parcel no.:
• � r- Water heater
23.32
„� .`� °, , t.: Cas fireplace/insart 33.39
Adding A/C TO existing Permit:MST2018-00059 Flue vent for water heater or gas
fireplace '. 23..32
-,Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPS iTY Q\3'lYi' #t,�':
Chimney/liner/flue/vent 32
ey/liner/flu , 23.
Other:
2132 Environmental exhaust and ventilation:
Name: Sage Built Homes llc Range hood/other kitchen
Address: 1815 SW 169th Place Suite 1040 equipment 33.39
Clothes dryer exhaust 33,39
City/State/ZIP: Beaverton Oregon 97124 Single-duct exhaust(bathrooms,
Phone:( 971)336-6911 toilet compartments,utility rooms) 23.32
Fax ( 503)533-5164 ttic%rawlsA a ac fans 23.32
® APIPLItA i `Q CO1VtACT,?ERSf►N _ Other: 23,
Business name: Same As Above
Fuel piping:
Contact name:
S14.15 for first four;54,03 Or each additional
Alex Rodriguez Furnace,etc.
Address: Gas heat pump
-
City/State/ZIP:
_Wall/suspended/unit heater
Water heater
Phone:( )
E-mail: planning@sagebuilthomesllc.com Range
{{ /.�. y� Barbecue -,
, „ � . "�' � "_ i Clothes dryer(gas)
Business name: All Time Heating&Cooling Other:
Address: PO Box 1341 a✓! �!�..�� ��� hT1� i*
City/State/ZIP: Lake Oswego OR 97035 Subtotal W.7S
Minimum permit fee($90.00)
Phone:( 503 p08-2278 1 Fax:( ) StatPlanesurcrehar e 12%view((25%ofof permit fee)
) �'
CCB lie=; 1845757 g permit feeCo
TOTAL PERMIT
Thie-permit appiteaioa expires if a permit is not obtained within 180
Authorized signature: 0/1/ tai t�/per -�, days after it has been accepted ast complete.
/ L e'l'7lc' .. Fee methodology set by Tri-County Building Industry Service Board
I Print name: Alex Rodriguez 1 Date:
t IN r`; / � to ed
1.1BuildingiPermitslMEC_PermitApp 040I13.doc --
440-46171'(1 i/02/COM/WEB]
Tt37Z9z-- /53. /tom.
Mechanical Permit Application -City of Tigard
Page 2 Supplemental Information
Commercial&Multi-Famil Fee Schedule:
$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
$109000.00.
$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.
INBuildinePointtethetfatmapp O4O113.doe 2
Plumbing Permit Application A
Building Fixtures „ l OR orrlt l: i F o,l,l
Date B a ` / � /(�4 V/t�-0610
18
City of Tigard y perm,t
II II 13125 SW Hall Blvd.,Tigard,OR 97223 t' - t Plan Review
Phone: 503 718.2439 Fax: 503.598 19 Gl; ;, . jr ateBy: Other Permit No.:
i i 1,i Inspection Line: 503.639.4175 Date Ready By: 7uris: See Page 2 for
Internet: www.tigard-or.gov Notified Method's , Supplemental Information
F pmt j},... Af' .5 ....#,;.$4,„.4:tL.. K„ :....!....4,,,.sr , ."":. +' .., y.r'"4",
r r, , t t 2 A.' m I fa { w..
®New construction ❑Demolition For special•information use checklist
Description I Qty. I Ea. I Total
El Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
r t `- ,�. .: z ., + :r._ SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
- -' SFR(3)bath 500.32
EIAccessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
4. '" r r s l.
"' ' t .. " 1 ! t "! ire * Site utilities:
Job site address:9514 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Ash Creek Village Manufactured home utilities 50.03
Cross street/directions to job site:SW 95th Avenue Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Ash Creek Village I Lot: 11 Fixture or item:
Tax map/parcel no.: Backflow prevent
31.27
" Backwater valve 12.51
t : tlt 1 !,' t r -.-,''''''1,1x v',,t '
Clothes washer 25.02
New residential construction/Plumbing contractor revision Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
�q ! ! h Expansion tank 12.51
Name:Sage Built Homes,LLC.
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1815 NW 169th Place,Suite 1040
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
P' Ai P ICAN'1 ` NTAGT PERSON Interceptor/grease trap 25.02
Business name:Sage Built Homes,LLC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ben Cooper
Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)258-6658 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:planning@sagebuilthomeslIc.com sagebuilthomesllc.com Urinal 25.02
r > Water closet 25.02
btl ! ' -
' Water heater 37.52
Business name:Max Plumbing Service Inc Water piping/DWV 56.29
Address:PO BOX 230674 97281 Other: 25.02
City/State/ZIP: Tigard,OR 97281 Subtotal
Phone:(971)-275-0198 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 205392 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Ben Cooper Date:7/23/2018 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-
440-0616T(10/02/COM/WEB)
County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s t ression S stems:
egg !
...a;: .,J+ F k�J' $. m� .'.. Y.;.. rv*tftge. �.." x�.vS � +v ...
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•reater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5 000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
o 4' d s and includin:$10,000.00.
Inspection of existing plumbing or for ■ ■ $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum char:e-1/2 hour and includin:$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char_•e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and includin:$50 000.00.
Additional plan review for revisions - 90 00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum char•e-1/2 hour each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quad fty bz Fixture; e ' s �4
Fixture fY for s Plan review is required for any of the following.
WorkPerfort'ed: Capped:"<: =74ddgd Relocate
Please check all that apply.
Baptistry/Font
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 ❑ 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.
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\kylie\Downloads\PLMF_PermitApp.doc 2
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN Transmittal Letter
1 1(i n It rl 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or. v
TO: DATE RECE +ED:
DEPT: BUILDING DIVISION , ;_ ,f $
Ne? . vcdy,, �9- APR 2 2019
FROM: �
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SGC 'bJV\-\- \\r- � _,
COMPANY: � ap BUI�C� :� t_.)n /�
PHONE: q1\33.Q uc 1 By. �tJ
RE: C\n'‘I 9;6)\e,C • 100a-- -4_1 TA\ 8--00
(Site Aress (Permit um er)
Ps� \o\— \\
PProject name or subdivision name and lot nu 1k
14 lo
ATTACHED ARE THE FOLLOWIN , ` ► S: \
Copies: Description:
` Co 4 ies: Description:
Additional set(s)of plans. X Revisions: .-V)0'1 )l l 1
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: ``v U\ -- 5\lei \AGl) Ghokcl -
FO OF ICE USE ONLY
Routed to 'e clinician: Date: �l('i j5? Initials: 1\4--
Fees Due: J. ❑No Fee Description. Amount Due:
t 2 qOtin f to )(A—) 1 $ Z (V
Sp- ial
Instructions:
Reprint Permit(per PE): 0 Yes 0 No E Done
Applicant Notified: Date: G/&)// / Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
1
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide permit for ac installed without permit.
No further inspection done at this time.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Correction for completing cleanouts under entry not done.
Investigative fee for re inspection applied for scheduling inspections prior to corrections
being complete and ready for inspection.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved final erosion control inspection prior to building final.
No inspection done at this time.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide city required documents issued with permit for building final inspection.
All else appears ok.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9514 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2018-00059
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Moisture barrier form received.
Moisture content form received.
High efficiency lighting form received.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor