Permit (128) 4CITY OF TIGARD {�
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71COMMUNITY DEVELOPMENT l��z� AP
MASTER PERMIT
Permit#: MST2018-00074
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/22/2018
T 18 D 9 Parcel: 1 S 135BD02000
Jurisdiction: Tigard
Site address: 9590 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 6
Project: Ash Creek Village, Lot 6
Project Description: New SF. 6/22/2018: REPRINT to remove NC from permit.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 864 sf Basement: 197 sf Left: 3 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 914 sf Garage: 742 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1975 sf Value: $259,573.33 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 1
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1975
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $29,830.88
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 OAR2-.% •:90 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
, ED�G'�C�
Issued By: Permittee Signature: � ✓Q ���
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD MASTER PERMIT
INf ` COMMUNITY DEVELOPMENT ' ' r..
Permit#: MST2018-00074
Date Issued: 03/22/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135BD02000
Jurisdiction: Tigard
Site address: 9590 SW ANNA BELLE CT
Subdivision: ASH CREEK VILLAGE Lot: 6
Project: Ash Creek Village, Lot 6
Project Description: New SF. 4/10/18: REPRINT to change the class of work from ALT,to New.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 864 sf Basement: 197 of Left: 3 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 914 sf Garage: 742 of Front: 20 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1975 sf Value: $259,573.33 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 1
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1975
Owner: Contractor:
SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 168TH PLACE 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006
PHONE: 971-221-4597 PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $29,785.88
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 -001-0090. You ay obtain copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/�-{ e> z l �r„Gl
Issued By: Cr�Gy� r Permittee Signature: „Sr,—Tf`' C �/
i✓ Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
/./J 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.
RECEIVEr
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAY 2 2 2018
Ni Request for Permit ActionCITY OF TI A-:
BUILDING
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner 0 Applicant ❑ Contractor ❑ City Staff
Check(✓)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 (✓):
• t N£ VOID PERMIT APPLICATION.
40, REFUND ERMIT FEES (attach copy of original receipt and provide explanation below).
•ICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MST2018-00074
Site Address or Parcel#: 9590 SW Anna Belle Ct
Project Name: Ash Creek Village
Subdivision Name: Ash Creek Lot#: 6
EXPLANATION: Requesting to remove A/C from permit and a refund
Signature: 5edt, Date: -512 2/,
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. 5_5-
, 7$ 2 7' `ftp _ 9
VY
Ste, �. /p, y 7
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date I' / Bye"`
Refund Processed: Date 0/22// - By. - Invoice Processed: Date By
Permit Canceled: Date 4J/,4 By arcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
1111 '� �
TIGARD
City of Tigard
July 16, 2018
Sage Built Homes
Attn: Ben Cooper
1815 NW 169th Pl, Suite 1040
Beaverton, OR 97006
Re: Permit No. MST2018-00074
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permits) as
follows:
Site Address: 9590 SW Anna Belle Ct
Project Name: Ash Creek Village,Lot 6
Job No.: N/A
Refund: ® Check#228969 in the amount of$41.89.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comments: Per applicant's request to remove A/C from issued permit;refund 80% of
permit fees paid.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
° City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Sage Built Homes DATE: 6/22/2018
1815 NW 169th Pl, Suite 1040
Beaverton, OR 97006 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 416272 Case#: MST2018-00074
Date: 3/22/2018 Address/Parcel: 9590 SW Anna Belle Ct
Pay Method: CreditCard Project Name: Ash Creek Village,Lot 6
EXPLANATION:: Remove A/C from issued permit;refund 80%of permit fees paid.
a '$ r" < � 'A�a
IRS p1 rsfit�p ;+f e
.Ss
0.1 tqiv,4
Mechanical Permit Fee 230-0000-43102 $37.40
12%State Surcharge 100-0000-24001 4.49
TOTAL REFUND: $41.89
APPROVALS: SIGN U S/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
r, O TIDE ',SYS 0,1k4 fM1NIS`>tUTIQN? Sg ONLY " .w.V
Case Refund Processed: Date: 3/I‘0/ By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
Plumbing Permit Applicata}
Building Fixtures " Fo►i of l I 'l: I SE ON 1.)
City Of Tigard JuL + c3 G 1<
Date/By: 1ozch�ir l 1 'ennitNNyk5 r-4,26/U ( 6671
Ili II 13125 SW Hall Blvd.,Tigard,OR 97223 y
Plan Review
Phone: 503.718.2439 Fax: 503.59811960 Date/By: Other Permit No.:
Inspection Line 503 639 4175 1 :_•,..,.. ,, •
I I t. �I [7 '� I7dte Re Juns ® See Page 2 for
Internet www tgard or gov N Supplemental Information
+. .- yY wt. s` # g ' l gy8/ •$.'-fir ."sy -� "" r :1-1$. " +. `. ate .,
;e,.:- . s'�,. -..h.« . >.a..+w .,9 .. ."r t ..' �''' -tw rule P Y'.ic r i1
®New construction ❑Demolition I, For special information use checklist
f" Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'' r:: ;, '7 a n ti ,,�, • .. `, p "a . :- al,,--;,:,.**.., SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family -
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
yti x , U._%,4°. i.tr'7•••••7=77..,.“.# • 1 # # t; Site utilities:
Job site address:9590 SW Anna Belle Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Ash Creek Village Manufactured home utilities 50.03
Cross street/directions to job site:SW 95th Avenue Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Ash Creek Village I Lot:6 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
c t - 1 -,� Backwater valve 12.51
s 1 r 6 94 1 t t ` 5 m '� t .AVAP A` 3�
t..,., rt xr .- Clothes washer 25.02
New residential construction/Plumbing contractor revision Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,'. x; Expansion tank 12.51
Name:Sage Built Homes,LLC. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1815 NW 169'Place,Suite 1040
Garbage disposal 25.02
City/State/ZIP:Beaverton,Oregon Hose bib 25.02
Phone:(971)221-4597 Fax:( ) Ice maker 12.51
e c CONT ' 1Interceptor/grease trap 25.02. �
Business name:Sage Built Homes,LLC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ben Cooper
Roof drain(commercial) 12.51
Address:Same as above Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)258-6658 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:planning@sagebuilthomesllc.com Urinal 25.02
LYf OR Water closet 25.02
., F ,.
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-County Building Industry Service Board.
I:\Building\Pernms\PLMU-PemitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s t ression S stems:
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 S stems:
Water Service-each additional 100' 37.52 1 vc
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
Itrt ;. each additional$100.00 or fraction thereof,to
' • ` and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum char_e-1/2 hour ■ ■ and including$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char•e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions - 90.00/hr - $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum char:e 1/2 hour each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantiy by Fixture Type „`
i 0 8 ilstall�ti._l►> s
Fixture Type for Replaeet Plan review is required for any of the following.
Work Perfoirmed:.. Capped Added Relocate
Please check all that apply.
Baptistry/Font pp y`
Bath Tub/Shower
D 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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain i Isometric;(ft' is t t . t
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