Permit CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2020-00255
Date Issued: 10/12/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115AB07000
Jurisdiction: Tigard
Site address: 11401 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 15
Project: Willow Brook, Lot 15
Project Description: New detached residential dwelling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 2 First: 1482 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 13 Bathrooms: 2 Second: 0 sf Garage: 404 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 1482 sf Value: $201,172.64 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckfw Prevntr: 1
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: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<10OK: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
Fum>=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'l 500 sf: 2 201-400 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: D
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 1482
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
11815 NE 99TH ST STE 1200 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $33,363.83
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: k�� '-- Permittee Signature: Ste `t Atio�
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.
Building Permit Application SIiiI70
Residential REC €�tP ED FOR OFFICE USE ONLY �/j'�]
t ` `a- Received '�4 7T ( flO /'���]�tj
Cityof Tigard ��v Permit No.:“ (/1/I�
131 SW Hall Blvd.,Tigard,OR 97223 A U G 2 0 L020 Plan Review.- u
2 • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: /�jj� Other PermitSYVRzIIz/vW ic{
7 l U n R U Inspection Line: 503.639.4175 GiTY +.J i T!'3ARD Date ReadylB Jvris' ® See Page 2 for
Internet: www.tigard-or.gov BUILD:NO DIVISION Notified/Method:/ cr iv — TG 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
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 0 ON 17a.
❑Accessory building ID Multi-family Number of bedrooms: 2
❑ Master builder ❑Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: I C S D W
Job site address//y0/ iW Gabriel St New dwelling area: 1482 square feet )Li g2
City/State/ZIP:Tigard,OR Garage/carport area: 404 square feet
Suite/bidg./apt.no.: Project name: i„444.1 oral 1 £O f/`f Covered porch area: >I< square feet
Cross street/directions to job site: Deek-area^ (]( square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Willow Brook Lot no.: 15 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S115AB07000 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SFR 35'x 60'2 bedrooms and 2 baths with a covered entryway and covered Valuation: $
deck Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99th Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)573-8081 Fax:(360)574-6401 New:
10 APPLICANT id CONTACT PERSON BUILDING PERMIT FEES* ,
Business name: Pacific Lifestyle Homes (Please refer to fee whea
Structural plan review fee(or deposit):
Contact name:Permit Coordinator
FLS plan review fee(if applicable):
Address: 11815 NE 99th Street,Suite 1200
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98682
Amount received:
Phone:(360)573-8081 Fax::(360)574-6401
E-mail:permits@buildpW.coro PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Same Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same Solar Installation Specialty Code checklist.
City/State/ZIP:Same Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:173524 Total fee due upon application: $201.60
Authorized signature: QD z This permit application expires if a permit is not obtained
rj(�/ within 180 days after it has been accepted as complete.
Print name:Summer Dowell Date:8/20/2020 *Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Pemuts\BUP-RESPemtitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
� g Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
8 Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD 24-Hour Inspection Line: 503.639.4175 El Electrical El Plumbing El Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \es No N/:X
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ VA
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0
3 Verification of approved plat/lot. ❑ 0
4 Fire district approval required. Name of district: . ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 A
6 Sewer permit. ® 0 ❑
7 Water district approval. ® LI El
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 El
9 Erosion control ®plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ® ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® ❑ 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
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ® ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ® 0 0
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
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 ❑
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
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 ® 0 0
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 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required Z El El
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 ® El El
architect licensed in Ore_on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 1.1"x 17". ® El 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ® ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 El
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ® 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 ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ® 0 ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0
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.
1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit A licatio EC E' V E I FOR OFFICE USE ONLY
City of Tigard Received
Date/By: PermitNo.:M ST2020 -c 25S
11
" 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 2 0 2020
Plan Review
Date/By:503.718.2439 Fax: 503.598.1960 Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 fur
Internet: www.ligard-or.gov BUILDING DIVISION Notified/Method: "r . Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*arc based on the value of the work
® New construction ❑ Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
® I-and 2-family dwelling ❑ Commercial/industrial fl Accessory building For special informadon use checklist.
❑ Multi-family El Master builder 0 Other: Description Qty. Ea. Total
l' Heating/cooling:SITE INFORMATION AND LOCATION r
��� "�° Air conditioning 1 46.75
Job site address 0W Gabriel St Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Willow Brook 15
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
Other: 23.32
Subdivision:Willow Brook Lot no.: 15
— Other fuel appliances:
Tax map/parcel no.:2S115AB07000 Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 .
Flue vent for water heater or gas
New SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39 _
Wood fireplace/insert 23.32
Chimney/liner/flue/vent . 23.32
ElPROPERTY OWNER IDTENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Pacific Lifestyle Homes Range hood/other kitchen
equipment 1 33.39
Address:11815 NE 9900 St Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 4 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT CI CONTACT PERSON Other: 23.32
Business name:Pacific Lifestyle Homes Fuel piping:
$14.15 for first four;$4.03 for each additional _
Contact name:Permit Coordinator Furnace,etc. 1
Address:11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater 1
Phone:(360)573-8081 Fax::(360)574-6401 Fireplace 1
Range 1
E-mail:permits@huildplh.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Area Heating+Cooling Other:
MECHANICAL PERMIT FEES"
Address:2721 NE 65th Ave Subtotal
City/State/ZIP:Vancouver,WA Minimum permit fee($90.00) ,
Phone:(360)737-0811 Fax:(360)737-6946 Plan review(25°0%of permit fee)
State surcharge(12/a of permit fee)
CCB lic.:64801 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
9 days after it has been accepted as complete.
Authorized signature: `(/(/!�ege * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:8.20.2020
I^.BuildinglPermits'MEC_PermitApp_040113.doc 440-4617T(I I/02iCOM/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\Pemilts'MEC_PemutApp_040113.doc 2
Electrical Permit Application R ECE I°V a�E s.Y, FOR OFFICE USE ONLY
City of Tigard
O Received i ,_gteBY'
II Er
13125 SW Hall Blvd.,Tigard,OR 97223 AUGA�J u e020 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 a3 } rl( p, r1 Date/By: PCrtn1I N�Si LL0(X7L` . ►
Related Permit _
T I G A R D Inspection Line: 503.639.4175 , 2eady DateBy: Sari.s'•�''7` HI See Page 2 for
x Internet: www.tigardor.gov ''' otifiedr'Method: t A Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked).
❑Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition ❑ Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: "1 0 Addition of new motor load of system.
tti .0 I OOHY or more. ❑"
City/State/ZIP ❑Six or more residential units. occupancy.
A \ t/ ❑Health-care facilities. El Recreational vehicle parks.
Suite/bldg./apt.#: Ii Project name: ❑Hazardous locations, 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross strect/directions to job site: F.-. r
,.n . +x. fit'SCREDULE
Description I Qty. I Each I rotas I
New residential single-or multi-family dwelling unit.
Subdivision: (, tk O� f)1�> Lot#: ` 5 Includes attached garage.
n 1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: 4s t 1'54 Ql ore Ea.add'1500 sq.ft.or portion 'V... 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1 1 , ."", '-.1V t (with above sq.ft.) 75.00 2
1v-C.,L.C-/ l \ IL_� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
ROPERTY OWNER ❑ TENANT Renewable Energy CI See Page 2
Services or feeders installation,alteration,and/or relocation
Name: ( -e ` ' P4: l 201 amps to 400 amps 133.56 2
200 amps or less 100 70 2
Address: 4 1�� IV:Sv-I 4� •e_t
401 amps to 600 amps 200.34 2
City/State/ZIP:° tella i- 601 amps to 1,000 amps 301.04 2
Phone: (s3 0 , 1)51 Fax:( ) Over 1,000 amps or volts 552.26 2
r�� ^• I�_ /�� ��y Temporary services or feeders installation,alteration,and/or
Email: �';,-,r !r L t I J( �biki l te ii �� relocation
Owner ins Ilation•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
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel
eM n A.Fee for branch circuits with
Business name: ate'i .. . ,ry c O���/ above service or feeder fee, �i� 7.42 2
p"lr/ s I each branch circuit
Contact name: e (r�`C mot. ( B.Fee for branch circuits without
Address: ) r (L C OPOV1 service or feeder fee,first
J ' d � branch circuit 56.18 2
City/State/ZIP: Each add'/branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:ad 0)10(--‘ , 'l<2 j Fax:: :( ) Each manufactured or modular 67.84 2
Email: ! h2 i t J (' bk_.i iCL yyLJ-L. e_-(}y/1 dwelling,service and/or feeder _
fff( 9-. Y -L Reconnect only67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Address:2890 SE Brookwood Ave. Signalnel,alcteration,
n or limited-energy
❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:permits@garnerelectric.com Industrialplant(lhrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 121159 Electrical Lic.: 34-305C Suprv.Lic.: 3707-S specifically listed(%:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: A..
Subtotal:
Print name: Charles Garner Date: /,9-0(,aO ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: rj,, ,9 ,L TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brittany Burian Date: 91.90 I. -per days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp ELR ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application -City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
Fee for all residential systems combined: $75.00 (NY. l Each Foul
y Renewable electrical energy systems: •
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >l00 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 •
Each additional inspection over allowable in any_of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
•
Inspections for which no fee is 90.00/hr
specifically listed(92 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
btotFee for each commercial system: $75.00 slowed (Enter on Page 1):
(SEE OAR 918-309-0000) ' Number of inspections allowed per permit.
Check Type of Work Involved:
Ti Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
7 Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1BuildingWerrnits\ELC Permi1App_ELR_ERE.doc Rev 06/17/2015
f
Plumbing Permit Application f� G r
Building Fixtures FOR oFFic1: FSE 0N1.1
City of Tigard A U G 2 0 tO20 Received h (CT �,^ 032
Date/By: Permit No.: M 01 (,,./ G
II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
It Phone: 503.718.2439 Fax: 503.598.196(0 TY OF T GARD Date/By: Other Permit No.:
T 1 GARD Inspection Line: 503.639.4175 ZG-1;` l:` , !-..V i :O N Date Ready/By: lurisc ® See Page 2 for
Internet www.tigard-or.gov Notified/Method: �A Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. I Total
❑Addition/alteration/replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:�/i/[)/SW Gabriel St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Willow Brook 15 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:<100) Page 2
Storm sewer(no.linear ft.:<100) Page 2
Water service(no.linear ft.:<100) Page 2
Subdivision:Willow Brook I Lot no.:15 Fixture or item:
Tax map/parcel no.:2S115AB07000 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New SFR
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Pacific Lifestyle Homes Fixture/sewercap 25.02
Floor drain/floor sink/hub 25.02
Address: 11815 NE 99*St.Suite 1200
Garbage disposal 1 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 1 25.02
Phone:(360)573-8081 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Permit Coordinator
Roof drain(commercial) 12.51
Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 3 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)573-8081 Fax::(360)574-6401 Tub/shower/shower pan 2 12.51
E-mail:permits@buildplh.com Urinal 25.02
Water closet 2 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Lippold plumbing and heating inc. Water Pg/
rp m DWV 56.29
Address:PO Box 895 Other. 25.02
City/State/ZIP:Boring,OR Subtotal
Phone:(971)404-7012 Fax:( )
Minimum permit fee: S72.50
CCB Lie.:201597 1 Plumbing Lie.no.:PB141 �n/1•,/y� Plan review (25%of permit fee)
/1f®L•{r/,� wl,,., p /1 6�s• 11 State surcharge(12%of permit fee)
Authorized signature: _ "_ "1J �7 y TOTAL PERMIT FEE
Thispermit application expires if apermit is not obtained within 180 days
Print name:Summer Dowell Date:8/20/2020 PP p r
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I-\Building\Permits\PLMU-PermilApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 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 S1.45 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 S50,001.00 and up $742.00 for the first S50,000.00 and S1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate Please check all that apply.
g
Baptistry/Pont
ElBath Tub/Shower Any new commercial building with water service 2"and
-Jacuzzi/Whirlpoolgreater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thr ❑ 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 _ 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.
-3"
4" Isometric or Riser Diagram
Car Wash Drain
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:
P:Uob Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 15\Peemits and Inspections\PLBPermitApp.doc
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City g Received `j 12QZQ- 2.
of Tigard Permit No.: t v C(�
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 Pl
Date By
■ Phone: 503.718.2439 Fax: 503.598.1960 an Review
Dan
Other Permit No.:
T I G ARD Inspection Line: 503.639.4175 Datc RcadyBy: as' ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: I I Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description I QtY. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address/���)/SW Gabriel St Catch basin or area drain 18.76
City/State/ZIP:Tigard OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 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:Willow Brook Lot no.:15 Fixture or item:
Tax map/parcel no.:2S115AB07000 Backflowpreventer I 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
Clothes washer 25.02
irrigation permit for landscaping
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
A PROPERTY OWNER ❑ TENANT Expansion tank 12.51 .
Name: Pacific Lifestyle Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11815 NE 99th St.Suite 1200
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 25.02
Phone:(360-)573-8081 Fax:( ) Ice maker 12.51
�.2 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Permit Coordinator
Roof drain(commercial) 12.51
Address: 11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)573-8081 Fax::(360)574-6401 Tub/shower/shower pan 12.51
E-mail:permits@buildplh.com Urnal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Trademark Landscapes,INC. Water piping DW V 56.29
Address:PO BOX 2410 Other. 25.02
City/State/ZIP:Oregon City,OR Subtotal
Phone:(503)631-3893 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lie.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Summer Dowell Date:8/20/2020 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.
1:\Building\Permits\PLMU-PcrmitApp.doc 10/01;09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain- 1st 100' 62.54 $1.00 to$5,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 S25,00I.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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4 Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
g q
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:
P:\Job Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 15\Pe rrits and Inspections\landscape app.doc
City of Tigard
14 11 COMMUNITY DEVELOPMENT DEPARTMENT
i Building Permit Review — Residential
TiGARD
Building Permit #: MST'20 Zo oc2
Site Address: 11401 SW Gabriel St
Project Name: Willow Brook Lot #: 15
Planning Review
Proposal: New single detached house
❑r Verify address/suite #active in Accela. CI In River Terrace: El No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: ' .sion Control
Cl: copies of site plan on 8-1/2"x 11"or 11 x 17"paper \,'\-tained trees with drip line and tree protection measures
CI rawn to scale(standard architect or engineer scale) ootprint of new structure(including decks) and FEE
'orth arrow .L:itility locations&easements(required for new and additions)
a.ite address,project or subdivision name and lot number 'i• walk/driveway approach
11 pplicant information(name and phone number) \J iilli cation of wells/septic systems
.t dimensions and building setback dimensions •Street tree size,type and location
l'il.quare footage of buildings to be demolished ,Street names
II xisting structures on site L',,orner elevations(2'contours if more than 4'differential
0 .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? �' es o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° o
IClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑r No Received: ❑Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified El No Received: ❑ Yes ❑ No
SDC Exemption for ADU applied for: ❑Yes ❑o No Received: ❑ Yes ❑ No
0 Public Facilities Improvement (PH)Permit:
Required: ❑r Yes,applicant was notified ❑ No Applied For: ❑r Yes ❑ No,stop intake
❑r Land Use Case#: SUB2016-00011 ElZoning: R-7
❑r Required Setbacks: Front: 15 Rear: 15 Side: 5 Street Side: N/A Garage: 20
❑r Building Height: Max. Height: 35 Actual Height: 13
❑o Landscape Area: 20 % ❑o Lot Coverage Max: 80
Entrance I Set back no more than 8'from street-facing wall ❑r Parallel to street or offset 45 degrees or less
Windows ° Minimum 12%of area of all street-facing facades
Garage ° Gara e door is behind widest street-facing wall ❑r Yes ❑ No,one of the following is met:
Door extends no more than 5' from wall and there is a covered porch extending beyond garage.
Door extends no more than 5' from wall and there is a 12 sq ft.window above garage on 2nd floor.
❑r Gara e door width is 12'or less ❑r 50%or less of facade 60%or less and includes 7 of following:
Covered porch Recessed entrance ❑ Wall offset 1'Roof eave ❑ Roof offset
Fire shingles Lap Siding El RooAiitch CIGable,hi ,or gambrel roof Dormer
lo Accent siding Window trim U Window recess U Window projection ❑ Balcony
isual Clearance ❑r Urban Foxes Plan
CI Sensitive Lands: CI Yes � No Type: Low-value habitat areas
❑r Conditions met prior to issuance of building permit
Notes:
❑ Approved By Planning: -- L Date: 8/20/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
1:1Building\Forms\BldgPermitRvw_RES_122419,docx
Building Permit Submittal
Original Submittal Date: Q 'c 2O'222O
Site Plans: # .3
Building Plans: #
Building Permit#: Enter buildingpermit#above.
Workflow Routing: Planning Engineering CIO Permit Coordinator wilding
Workflow Sign-off: 2'Sign-off for Planning(include notes from planning review)
Route Application Documents: Q'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[Building: original permit application,site plans,building plans,engineer and
beam calculations and .17t details,if applicable,etc.
Notes:
By Permit Technician: % /7/7 Date: f�2.6?O2o
Engineering Review
Sl at building pad: 3lv
n Conditions "Met"prior to issuance of building permit
Ld�l✓a�ments (encroachments) per engineering conditions of approval and plat
ater Quality/Quantity Facility: ////����
Assess Water Quality Fee in-lieu: ❑ Yes L7 No
Assess Water Quantity Fee in-lieu: ❑ Yes ErNo
LIDA Facility on lot: ❑ Yes u No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:��
a Approved by Engineering: Ohs ge Date: fi - f
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ 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: �j
SDC Exemption: ❑ Received -�i-Does not a ly
SDC Fees Entered: Wash Co Trans Dev Tax: M Yes 0 N/A
Tigard Trans SDC: : Yes N/A
Parks SDC: ►. es N/A
LIDA IIYes N/A
OK to Issue Permit
Approved by Permit Coordinator: kJ' g4-- Date:
1:1Bui Iding\Forms\BldgPermitRvw_RES_122419.docx
Plan # IYSZ ,1 f
Floors ( Large
Bed rooms 2- Small y
WC Z-
LAV
Tub Basement
Vent 1st Floor l'($Z
Water Heater 2nd Floor
AC 'N/-12-5 3rd Floor
School / R-3 Total 19 $Z
I Garage L Cf
nn Total i 10
Del #for Elec 2