Permit Support Document CITY OF TIGARD MASTER PERMIT
V'I COMMUNITY DEVELOPMENT Permit#: MST2022-00218
i Date Issued: 10/13/2022
T I G All 013125 SW Hall Blvd.,Tigard OR 97223 503.718.2439IVES Parcel: 1 S135AC14000
' Jurisdiction: Tigard
Site address: 11004 SW 95TH AVE
Subdivision: ASHBROOK VILLAS Lot: 5
Project: Ash Brooke Villas, Lot 5
Project Description: New attached dwelling. REPRINT FOR ELECTRICAL CONTRACTOR CHANGE.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: 4 First: 3 Parking Spaces: 0
3 73 sf Basement: 0 al Left:
Height: 32 Bathrooms: 3 Second: 860 sf Garage: 602 al Front: 10 Smoke
Yes
Dwelling Units: 1 Third: 835 sf Right: 3 Detectors:
Total: 1768 sf Value: $264,453,84 Rear: 12
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw 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: 3 Clothes Dryers; 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srve/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: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
N SecurityAlarm: N Vaccuum S N Garage Opener: N All Y
Audio&Stereo: N HVAC: System:
Other: N Other Description;
Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1768
Owner: Contractor:
ABVOZBP21 LLC SAGE BUILT HOMES Required Items and Reports(Conditions)
1815 NW 169TH PL STE 1040 1815 NW 169TH PLACE,SUITE 1040 1 Ersn Cntrl 503-639-4175
BEAVERTON,OR 97006 BEAVERTON,OR 97006 2 Geo Tech Required-
Engineered Fill Present
PHONE: PHONE: 971-221-4597
FAX: 503-533-5164
Total Fees: $27,465.66
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
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Issued By: Permittee Signature: 5 t'e> el fi f lv` 4I D�1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 1
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.
Electrical Permit Application '"l "
City of Tigard r `,3 Rrmehea
13125 SW Hall Blvd,Tigard,OR 97223 1 Plan Ry: Perm cq:
I 1`( tJ l- 11(3a' - Plan Review
Phone: 503 Line:2434 Fax: 50.3.598.1960 Related Permit a:
Inspection 503.639.4175 '3-i_i 1; P, ;,^: MAW)05 '' — wG4��.air
T;C;.;R 111, Ready[hde/By: Allis: la See Page 2 for
Internet: www.tigard-or.gov Noti5ed7Medaod: Supplemental Information
TYPE OF WORK PLAN REVIEW
Ea New construction ❑Addition/alteration/replacement Please chock all that apply(submit 2 sets of pions wfncros checked):
0 Demolition ❑Other. ['Service or feeder 400 amps or more 0 Building over three sores
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 0 Commezcial/industrial ❑Accessory building ro gmom or moods 14,000 0 Commercial-use agricultural
0 Multi-family 0Master builder amps for all other installations. buildings
Other: 0 Fire pump. 0 Installation of 150 KV A or
JOB SITE INFORMATION AND LOCATION ❑Emer gecey system. larger separately derived
Jab site address: c 1,W (� IBIy 0 Addition of new motor load of system.
Job
IO(LI V `7StN /lvEw U6 toOHPwmore. ❑"A'. €",'t-2`•,"1-3",
City/State/ZIP:Tigard, OR 97223 ❑six or more residential mr der. occupancy.
#:
❑HcahMrmc facilities. 0 Recreational vehicle parka.
Project name:Ash Brook Villas ❑Hazardous locations. 0 Supply voltage for more than
❑Savior or feeler 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
•
Desorption I Qty. l Each I Total I "
New residential single-or malty-family dwelling unit.
Subdivision:Ashbrook Villa's lot#: -S Includes attached garage.
1,000 sq.it or less 168.54 r 4 Tax map/parcel#:
Ea_add'I 500 sq.0.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.0.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.0.)
® PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name:ABVOZBP21 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
City/State/ZIP:Beaverton,OR 97006 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email:katie@sagebuilthomesllc.com Temporary services or feeders installation,alteration,and/or
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
® APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension per pane!
A.Fee for branch circuits with
Business name:ABVOZBP21 LLC above service or feeder fee, 7.42 2
earn ttranch tin tit
Contact name:Katie Patterson B.Fee ibr branch circuits without
Address:Same as aboveservice°f feeder fire,fiat 56.18 2
branchh circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:603-50126623 Fax::( ) Each manufactured or modular
dwelling,service and/or fader 67.84 2
Email:katie@sagebuilthomeslIc.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
' Business name:Grizzly Electric
�Inc
� Sign or outline lighting 67.84 2
Address: 1,�1 j(,�, ►'y) `1 S roe Sk- toe'- 117 Signal li erationns)or y limited-energy 0 See Page 2 2
r'/ panel,alteration,err extension.
City/State/ZUP:Vancouver, WA 98660 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(
q 7/-.5'76- f p/ Fax:( ) Investigation(1(sr min) 90.00/Ix
Emai►:grizzlyelectric@msn.com Industrial plant(IIambi) 78.18/hr
Inspections for which no fro is 9000/hr
CCB Lie.:186218 Electrical Lic.: � Suprv.Lic:09:573 specifically lived(•A hr min) ,
�/ `_ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: %' Subtotal:
Print name: ae/ �R�/�y .Lfi : {2/ /4Z 0 Plan Review Required(25%ofpermit fee):
7�i �l _ ! ` State surcharge(12%of permit fee): •
Authorized signature: /le / � TOTAL PERMIT FEE
Thta permit application expires If a permit is not obtained within l/a
Print name:Katie Patterson Date:12/1/22 days after it has been accepted as complete.
• Number of inspections allowed per permit
I/itvildUsg Perrias\ELC_PermaApp ELR RREdoc Rev 06/1712015 44046157i17g5/COM,Wce