Permit (79) IN CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00178
�.` Date Issued: 05/29/2019
T 1( A I 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 "r ��
Parcel: 2S115AB06100
Jurisdiction: Tigard
Site address: 11494 SW GABRIEL ST ' '
Subdivision: WILLOW BROOK SUBDIVISION L0 6
Project: Willow Brook, Lot 6
Project Description: New SF.7/23/19: REPRINT to add(1)laundry tray. 8/15/19: REPRINT to add backflow
preventer for landscape irrigation.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1706 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 2 Second: 0 sf Garage: 643 sf Front: 15 Smoke •
Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 1706 sf Value: $236,491.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0
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<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 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
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1706
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
t Ersn Ontri 51;1-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $30,047.78
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 rei_,.;es you to folio the rules adopted by the Oregon Utility Notifi. tion Center. Those rules are set forth in OAR
952-001-0010 through O 95 -001 %,;'•0. Yo ,y obtai c of the rules or direct questions to OUNC by callin• 003.232.1987 or 1.800.334.
Issued By: Permittee Signature: '� -
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.
0,-- CITY OF TIGARDet. MASTER PERMIT
R . `> COMMUNITY DEVELOPMENT1,t ' Permit#: MST2019-00178
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ''.\->"\\
`0> Date Issued: 05/29/2019
CtCatZ. 9 ,'�i Parcel: 2S115AB06100
Jurisdiction: Tigard
Site address: 11494 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 6
Project: Willow Brook, Lot 6
Project Description: New SF. 7/23/19: REPRINT to add(1)laundry tray.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1706 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 2 Second: 0 sf Garage: 643 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 1706 sf Value: $236,491.70 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 2 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
Drywell-Trench Drain: 0 Other Fixtures: 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<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 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
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 1706
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
1284 ----. . 11816-N€86TH-ST#12A6 1- -EfSn
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $29,984.73
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 Notific.tion Center. Those rules are set forth in O,
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling.03.232.1987 or 1.800.332.2344. [�
r I ti/ /
Issued By: ,�� Permittee Signature: ,/...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.
Plumbing Permit Application
Building Fixtures *`"` ... ' �' FOR OFFICE LSE OyLI
City of Tigard U I [ a Z Received
Date/By: I' l V(1 S \ Permit No.:rnc-c ( 'CC 1p(
14 13125 SW Hall Blvd.,Tigard,OR 97223 _ -.l
11111 II
Plan Review
Phone: 503.718.2439 Fax: 503.598 1960 - Other Permit No.:
Date/By:
T 1 G A R D Inspection Line: 503.639.4175 ,# 4 : Date Ready/By: Jur s: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
,.fes
as
.. :-rw., i,.;,::,� ,..� ,._„ .��..,�,,;... ,.,....,. ,, '".: .. ..,,v.,.a. < ..��. � ,;rM.s iv ,..U6.✓:o.rw .,,.r.4,x,, .,. ,.,; k;�.�:•,.,,;'ir�5,r�r�„•,�'�Et,,:S�
®New construction 0 Demolition t.1 ! checklist.
% For special information use
t
❑Addition/alteration/replacement ❑Other: ,2-family dwellings(includes 100tion ft.f r ITotts )
`- -amity in o eachutility ion
,•,:‘,4,,r . ',,✓t a , ' F te .
SFR(1)bath 312.70` „ , . ,
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
� -, ¢ t m .. Site utilities:
Job site address:11494 SW Gabriel St. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Willow Brook 6 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: Lot no.:6 Fixture or item:
Tax map/parcel no.:2S115AB06100 Backflow preventer 31.27
„ r f l, t i , t , r ,� Backwater valve 12.51
Clothes washer 25.02
Extra sink in garage.Missed on original master permit. Dishwasher 25.02
It, �s5 , ' rt! 1 5., Drinking fountain 25.02
Ejectors/sump 25.02
;Jtl`t ` " ifi ; /
: r ;� Expansion tank 12.51%c 1l 1 W r .
Name:same as applicant Fixture sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
�� s# �r ' 1\ ` ms ', r !4 ! , 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 /21-tat.i��y 1 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 'fl2..4 62.54
-_... Fnx::(360)574-6402 ttr /sltowei/slruwet pan _ 12.5I
-
E-mail:permits@buildplh.com Urinal 25.02
�� ' 7 i '*%` ®gra r, ,," f' 0/42-,rr Water closet 25.02
ix ,,ice ..,, / d .... # r>;'''�/ /f40-
• Water heater 37.52
Business name:Lippold plumbing and heating inc. WaterPip S/r rn DWV 56.29
Address:PO Box 895 Other: 25.02
City/State/ZIP:Boring,OR Subtotal
Phone:(971)404-7012 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:201597 Plumbing Lic.no.:PB1416
Plan review (25%of permit fee)
1 State surcharge(12%of permit fee)
Authorized signature , i ,>. r , - , ��,i
CJS n_,d_ f 1// --.`4 ,' /. / r,. '�(' TOTAL PERMIT FEE
Print name:Summer Dowell Date:7/23/19 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\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 Su I I ression S stems:
r J su< s4 .440,044 :
.44,4,444
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 S stems:
Water Service-each additional 100' 37.52 r-" k a' "
a t o f
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
fik 'r 4 each additional$100.00 or fraction thereof,to
�f lF% 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 ch. •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*.
3 0 P
eilfriA
Plan review is required for any of the following.
� s `< � '" Please check all that apply.
Baptistry/Font pp y
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru 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.
-3"
! a i. .6!
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\Jurisdiction Docs\Tigard,City\Applications\PLB_P1rmitApp.doc
CITY OF TIGARD MASTER PERMIT
, 114„ ii
'; 2: COMMUNITY DEVELOPMENT Permit#: MST2019-00178
Date Issued: 05/29/2019
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 5/29/2 B06100
Jurisdiction: Tigard
Site address: 11494 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 6
Project: Willow Brook, Lot 6
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1706 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 2 Second: 0 sf Garage: 643 sf Front: 15 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 1706 sf Value: $236,491.70 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 Storm Sewer: 100
Tubs/Showers: 2 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: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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: 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
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 1706
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: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $29,984.73
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 f 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. 2.1987 or 1.800.332.2344.
By:Issued �-' —�-- Permittee Signature: / � 4! ` /
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 Checklist
One- and Two-Family Dwelling FOR OFFICE LSE ONLY
Cl of Tigard Received
g Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
11 Phone: 503.718.2439 Fax: 503.598.1960
1 ic,ARI)
24-Hour Inspection Line: 503.639.4175
ID Electrical CI Plumbing El Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ El ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. El ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 El
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ p
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ ❑
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 ❑ ❑ ❑
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, ❑ ❑ ❑
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- ❑ ❑ ❑
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. ❑ ❑ ❑
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- ❑ ❑ ❑
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 El ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Man'dad ui ed floor/roof truss design details. — 0 —_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 ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be as•licable 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 11"x 17". 0 ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 El ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. Cl ❑ ❑
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. ❑ ❑ ❑
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, ❑ ❑ ❑
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, ❑ ❑ ❑
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.
uilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit ApplicaRECEIVEDReceived FOR OFFICE ESE O Lv
City of TigardDate/By:
MAY 6 2019 PermitNo.: iG,( M
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II Phone: 503.718.2439 Fax: 503.598,1 Other Permit:
Inspection Line: 503.639.4175 fY III
OF TIGARD Date/By:
TIGARD p BUILDING DIVISION Date Ready/By: Jur s: ® SeePage2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
7,4:,'":
i, 61 9 MW '' a ate 1.1~4,4„ ?' : ,Y "' spi. m@ .16 A Ttv i'it'4? 10°�
«�_ ,,, .- w.�...e_., .4 �:,_ w.• .- . ' .. g,„..007#. - "°`' Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other:
Value $
a/ r r ro*rvlr r v :z e V ,, �, %% s slxFrt ' � ', x � i 3
04, � h
�._., rf,r %/;*o rf', ! v. 0xr*0I Ii , 3 ,,, .0r r/ � ✓�r',VdltA �r 8 1! � , , i ; ;
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
' % 8 �� sl $ tl l ii r a t 9 � r i
Heating/cooling:
f ; r , x, . ,.,, 4, ,r r,i :, i,,, ,, a d,', „;,
Air conditioning 1 46.75 46.75
Job site address:11494 SW Gabriel St Furnace 100,000 BTU(ducts/vents) 1 46.75 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 6 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:Willow Brook Lot no.:6 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S115AB06100 Water heater 1 23.32 23.32
T Gas fir lace/insert 2 33.39 66.78
v„' ,`., .r s, , 4 , , a. .,� .,,4 m t Ot 1'. /jf' ,,, rev ,,, rx`64*1 eP
Flue vent for water heater or gas
New SFR fireplace 2 23.32 46.64
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
vro`? .+r '!' ,r,. ,.sr''4 .•°, ` '; s'''?'' �''.' r, I ''.', iand ventilation:
Environmental exhaust
Name:Pacific Lifestyle Homes Range hood/other kitchen
equipment 1 33.39 33.39
Address:11815 NE 99"'ST Suite 1200 Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:Vancouver,WA 98682 Single duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32 93.28
Phone:(360)573-8081 Fax:( ) Attic/crawlspace fans 23.32
s Other:W r i 1 #, i23.32
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
Phone:(360)573-8081 Fax::(360)574-6401 Fireplace 2
Range 1
E-mail:permits@buildplh.com Barbecue 1
f �... . .,'..f�'r r¢ �r
e , „ .' � i * Clothes dryer(ga9
), ;) p; * *i� i ®,t 'rr ** ' > rx,< ,
Business name:Area Heating-1-Cooling Other:
Address:2721 NE 65t1i Ave Subtotal
City/State/ZIP:Vancouver,WA Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)737-0811 Fax:(360)737-6946 State surcharge(12%of permit fee)
CCB lie.:64801 TOTAL PERMIT FEE
/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature4.`�M.,,UL _.` ./ ` Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowel Date:5/6/19
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1l/02/COM/WEB)
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
$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
,
Electrical Permit Application --City of Tigard
Page 2---Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE.SCHEDULE
Fee for all residential systems combined: $75.00 Description QiY.T Each 1 Total 1-
Renewable electrical energy systems:
Check Type of Work involved:
5 kva or less -�- -- 1(8).70 I 2
5.01 to 15 kva 133.56 - 2
V7
Audio and Stereo Systems* 15.01 to 25 kva 20034 2
Wind generation systems in excess of 25 lova:--- ------
Burglar Alarm 25.01 to 50 kva 30104 2
50.01 to 100 kva 552.26 2
I I Garage Door Opener* — (lee
— —
>100 kva(lee in accordance 552.26 2
with OAR 918-309-0040)
i Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7_42
V acuum Systems* >100 kva-no additional charge 0.0
( Each additional inspection over allowable in any of the above:
f Other: Each additional inspection is 66.25/hr I 1
- - charged at an hourly(1 hr thin)
— ----- Inspections for which no fee is
00,061 t,
' specifically listed CA iir min) I i I
COMMERCIAL WORK ONLY: ELECTRICAL PERNMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enteron_Page 1):
= Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
1 Boiler Controls
Clock Systems
I I Data Telecommunication Installation
I Fire Alarm installation
I I HVAC
Instrumentation
ri Intercom and Paging Systems
I I Landscape Irrigation Control*
I Medical
I Nurse Calls
Outdoor Landscape Lighting*
r Protective Signaling
11 Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
i'..noitding\i'enniisa.ELU t'ennitApp.ELR ERE dor Rev Oti/l 7!2015
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE LSE O\l.\
City of Tigard MAY 6 2019 Received Permit
13125 SW Hall Blvd.,Tigard,OR 97223 PlDate an Review Reviermew � �
Phone: 503.718.2439 Fax: 503.598.13§VDate/By:OF TIGARD Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReady/By: Juris: ® SeePage2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
r ,., :'-.:- :7::! ,',',,°x.rz r .7rv,, .. '-ig' * ' . `"T --,''f.'7, 77:;:,..'::.-i71<,,7. v im.. .;.a r ,. 7.:7,77-7: n..e�.a77-' ';
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
t"#//IF"%.;� t r,rr r 4 Ar`r 4;✓,� xd ! f /F, ,r , + r rV �+ ,d
'%,� �''s, �� E^. , ,j . rW1)rt ,pil't f,f6:4'�s f f SFR(1)bath 312.70
Z 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Page 2
Fire sprinkler( sq.ft.)
a ,,Sa,,`%e ,� r 4' c, i6 s4�e! I i I , 4 *k r r$. :'}r r
r%vrg�'rY,,,/i"r,�i,. ,.�,r'{r„a,.,, fr,e,,,,,:,,,,,:,; ;; ;,..„,1,1,. .,,,.�. . ,...� .,, ....�,`r;.F¢��r,rx�z'���,. .. Site utilities:
Job site address:11494 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:Willow Brook 6 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 1 Lot no.:6 Fixture or item:
Tax map/parcel no.:2S115AB06100 Backflow preventer 1 31.27 31.27
�
12.51
,db ` vr'r JY ,7?;;-,c;;,,,,,,,, ,,,,,,,,
f i 5y 74Yf0fi r r� Backwater valve
, e frr,r, .� Irfror y ,r :ip rr .,,,, / rat4 �"" „', 114
Clothes washer 1 25.02 25.02
New SFR
Dishwasher I 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
4 �, $ r , ,`, ✓ r
' ° Expansion tank 12.510:41 41 1fi ; , , .V. t11y
Name:Pacific Lifestyle Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11815 NE 99'ST Suite 1200
Garbage disposal 1 25.02 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 2 25.02 50.04
Phone:(360)5734 8081 Fax ( ) § #wlr Ice maker 12.51
/r . ,, r . rFf + s�' ! ra
,.:_✓ rA ..._ Interceptor/grease trap 25.02
f� /rr ;� r,„ ,.,4 .,:r .s ! „hr �r. . ! ,c ,.rr,r� . r, , . <r x
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 75.06
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 25.02
E-mail:permits@buildplh.com Urinal 25.02
r 4{r a,p ✓ rr;, r'i�' r ,.�r...p r, ,it..,t r ,, 1 q / fmye�i r;izwg of fes, Water closet 2 25.02 50.04
? .r r,.f 4r r ..., , . ?460�r.110 4; it '0,,, x ,',,40.1 .''`ru`
Water heater 1 37.52 37.52
Business name:Lippold Plumbing and Heating inc. Water piping/DWV 56.29
Address:PO Box 895 Other: 25.02
City/State/ZIP:Boring,OR 97009 Subtotal
Phone:(971)404-7012 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:201597 Plumbing Lic.no.:PB1416 Plan review (25%of permit fee)
I State surcharge(12%of permit fee)
Authorized signatur / kt-.) TOTAL PERMIT FEE
Print name:Summer Dowell Date:5/6/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee �ayy„�Iogy ger yy T*_!n„nry g,,;lrl;ng 1n i„try Sn,;tea An*,.i
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
♦ * f
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su. 'ression S stems:
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 S stems:
Water Service-each additional 100' 37.52 >>
tA r4 F , ,r j 4 r1;3,4,
r42.4.144.444, ` r".. , v 'sWp '
Storm&Rain Drain-1st 100' 62.54ti
$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
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(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*.
a ,� Hittite TI`' ,,'r'.J�X. i
Fixture Tnie for RifPlace
rk Plan review is required for anyof the following.
Werk Pe orei Added , Reim 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 ❑ 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" _ _- r f`"�w °' -,✓. , 5r',F s.xr%"r's�,.;�/r"x r :,a4'/a `'^' ., t`
Car Wash Drain etd '{ t X46 R .,�`�J <.4 ,+. . °, 4,., ., ro
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 thisermit results in an
Washer-Clothes p
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 6\Per2tits and Inspections\PLB PermitApp.doc
City of Tigard
11111 ■ 'I COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R D Building Permit Review — Residential
Building Permit #: \X\ --C kCq-tf \
Site Address: / 1 I/91 Sw 6 Abt',Cf
Project Name: (.0/.//o 641, •Zie4 Lot #: 6
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: N.jj S'F-._
..124.--Verify address/suite#active in Accela. ❑ In River Terrace: Eg—o ❑ Yes,River Terrace Review Addendum
Site Plan Elements: rosion Control
ies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures
L-d'Drawn to scale(standard architect or engineer scale) rint of new structure(including decks)and F1-'E
arrow Qtraty locations&easements(required for new and additions)
PASite address,project or subdivision name and lot number ,051-dewalk/driveway approach
„Q-Applicant information(name and phone number) s/septic systems
't dimensions and building setback dimensions et tree size,type and location
n feetage of buildings to be demolished Street names
•. ii : structures on site !CJC.orner elevations(2'contours if more than 4'differential)
3 .t -a,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 21 iNo ti.
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes 121< 6
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): > tyu3V C-E -kr__ ,pk ZX 4,
R wired: 'Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
Public Facilities provement (PFI) Permit: a tYt tt ct
Required: es,applicant was notified ❑ No Applied For: 1=1No,stop intake ',4r
VLand Use Case#: S j)7 61(o -000/(/ .:],toning: R-7
Required Setbacks: Front: /. Rear: 6 Side: 5 Street Side: Garage:
❑ Building Height: Max. Height: 3S Actual Height: 13
Landscape Area: 2 % ❑ Lot Coverage Max: re)
Entrance ,...2"let back no more than 8'from street-facing wall 1---1 llel to street or offset 45 degrees or less
Windows ❑ Minimum 12%of area of all street-facing facades ���
Garage Garage door is behind widest street-facing wall 1=1 . NoYes ,one of the following is met:
$Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.wwinddo-w� above garage on 2nd floor.
Garage door width is ❑ 12'or less CI 50%or less of facade •2. GU%or less and includes 7 of following:
.,2 C ered porch Recessed entrance ❑ Wall offset .8'1'Roof eave eloof offset
Fire shingles 1p Siding ❑ Roof pitch ..e-Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony
,1,2'V' al Clearance Urban Forestry Plan
.IBJ Sensitive Lands: ❑ Yes ErNo Type:
2 Conditions met prior o issuance f buil n permit
�, P_ gP _ /] /��,
Notes: CeeKC�, ;aj5 7rJ ' . rte,,-�, '� 9 ,$sivav►c'P .`dee (�'-4`t
❑ Approved By Planning: „--57-- ��J� . Date: _S-174?
�
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_022819.docx
Building Permit Submittal
Original Submittal Date: t l t kCit
Site Plans: # 5
Building Plans: # S
Building Permit#: gl Enter building permit#above.
Workflow Routing: ["Planning ["Engineering ["Permit 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.
[/Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: \---g...-1\_,A.------- Date: j,k,S?,\io,
Engineering Review
Slope at building pad: 30
• Conditions "Met"prior to issuance of building permit
2—Easements (encroachments)per engineering conditions of approval and plat
al-Vater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes es-No
Assess Water Quantity Fee in-lieu: ElL�
Yes 2/No
Er-
LIDA Facility on lot: ❑ Yes �No
LJ -inal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
21Approved by Engineering: 14 4514-1(--- Date: .c g( '
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Re ' 'on Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: e/Yes ❑ N/A
Tigard Trans SDC: s ❑ N/A VParks SDC: Yes El
LIDA ❑ Yes I N/A
OK to Issue Permit
S* l
Approved by Permit Coordinator: K#�/Date: r
I:\Building\Fonns\BldgPermitRvw_RES_022819.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
71 Transmittal Letter
i c,A Ei n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ALgy4 - - DATE RECEIVED:
DEPT: BUILDING DIVISION
j� MAY 9 2019
FROM: 1(`�) ' ��jj L C ry
COMPANY: fact--6‘c, Life IL -HuyvyBuLDiEbL, Dr v'i : N
PHONE: 6gQ'�-13 - W f
By:
RE: l I" C'' SO 66d0h d Si - VAST iq `DO►-166
(Site Address) (Permit Number)
WI i DikROYDat1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. '. -- Revisions: I Y ti ` -4
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: P -69'( V v 1�Vt-t/t p11 c -t_- .d S Pr e_4- 0
'-�--02 oc't-i-t_ voctix ,
_ , __ _
Routed to PermitTe clan: Date: t5 t Initials: 'Ai"
Fees Due: V.Y•s El No Fee Desc Option: Amount Due:
$ po
y,_ tprr. rev .v-'i $ L{Si"---, . -_,..34._,,
$
$ **-) 511
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No 1 ❑ Don;' •
Applicant Notified: Date: ' c[�/ '7 Initials- ' i/
I:\Building\Forms\TransmittalL.etter-Revisions 061 3 16.doc
- — -.., „:......,,. , .,.....
. . ..4 _ki 'z.,„q
Electrical Permit Aoplicatioart5,,....,,,,,k:,,r, ''v L,,,i,.....,.. Fol(orywi: I.S1: 1)Nl.1
City of Tigard Received
Permit#-
IN ee 4 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 7 .?-p'19 -171D-rrni"ateille';:iseW-- r.-1757-4Q41 1 9 -6"/7'
Related Permit 0:
- a Phone: 503.718.2439 Fax: 503.598.19p,,, „,.....1,.,: ,-.,t. Dalef8v:
Inspection Line: 503.639.4175 1.,i1 I - ",-,t , lk,':,i'''"!“--,' Ready Date/By- HI See Page 2 foe
l'It'Aillp
' Internet: www.tigard-or.gov ,i:-:?! ! t..,::,,.) ,-.,,!.t:::: ',,:.-,,.i%,,f,::-.',c.:,,,Lt10,,ific!iimethod, .,,,H Supplemental Information
i4 New construction 0 Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked)
0 Service or feeder 400 ampsi or more 0 Building over three sissies
0Demolition 0 Other: where the available fault current 0 Marinas and boatyards
774,i,61',1'59:4MtlITRET.;:AG7,..,StAtt,tifr , ifi',...:14.,411,9::',,: ,-,-a..-.,',:,c„ilLih,,N.!itiT'N 'i exceeds 10.900 amps at 150 volts or 0 Floating buildings
1
F---):,-,, I-and 2-family dwelling 0 Commercial/industrialEi Accessory building less to ground,or exceeds 4,000 0 Commercial-use agricultural
amps for all other installations buildings
ri Multi-family 0 Master builder El Other: 0 Fire pump 0 Installation of 150 KVA or
14"'''li.":"4"7 i btt*ti*titbtcAiqtt:Watio-'A-Tii7741 ''t"'-';''7-''' 0 Emergency systein larger separately derived
D Addition of new motor load of system
Job 4:90-18-0006 Job site address: 11494 SW Gabriel Street 100HP or more
. --__________ _
u Six or inure residential units occupancy
City/State/ZIP: Tigard,OR 97224 0 Health-care facilities 0 Recreational vehicle parks
Suite/bldg./apt.II: Project name: 0 Hazardous locations. 0 Supply voltage for more than
------- ----------—-- 0 Service or feeder 000 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Durham Road,south on SW 113th Ave al-t27,,i-NoppEci4,:txtteittlartA
thewripticat 1111 , Eatil ,„„.mIti...„0
New residential single-or multi-family dwelling unit.
Subdivision: Willow Brook Lot 4: 06 Includes attached garage.
1,000 sq 0,or less 168.54 4
Tax map/parcel 4.•. 2S115AB06100/R2209666
Ea,addl 500 sq ft or portion - 33.92 1
7":R;.t."t:?rr.rlg;ig-IgiNik,#e„lt';.., 1;r..i?,',„,(e',.44,)T4',.i;.f,",'J'i.,17;477,010?Ol ,,,lillillti411141111VIRWIt111V.t9 Limited energy.residential 7
75 00
-1...4-..Art-...-L-ff7 tes (with above sq 1)
,, ,,—- s;-;-,_ 1/4_CLAC-122."9*C.-,7F17-- _ _. Limited energy,multi-family '
1 ,
75 On . 1
1 residential(with above sq O.1 4
—
l 1 Renewable Enerzy 1 n See Page 2 I
1 : p' 5#"It.,.. ;1e1t4141' "illF,TrItt,SrAF*7.y413-totANT, ,, ':'''"-"--- r--------.----,------ -7.-----7---"` ----— ---"'""-----7-j----
I„, . - s" .,.. ,,,s ..* „,e- ,'s 2,-,',,,..,•`.,..,,-,'.,.'v,.'''s,',. ' ,..
I .... -.:.. 1_5ervices or feeders installation,alteration,andior,pelocattoo,„ ,
Name: Pacific Lifestyle Homes,Inc. 200 amps or less T 1 00.70 ! 2„,i
Address11815 NE 99th Street #1200, - ---
201 amps to 400 amps 1 133 56
: , -------„:---------
Cis /State/ZIP: Vancouver WA 98682 401 amps to 600 amps 1., 200.34 r , ,
I 2
[ 601 a
,........_ mps to 1 000 amps 301 04
Phone:( 360 )213-0813 Fax:( ) Over 1,000 amps or volts 552,26
.,.. ...„- --:-. •
Temporary services or feeders installation,alteration,and/or i
Entail: permits@buildplh.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less -------1'''''''''"'- 36
I 59
...4
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps ! 1 - 125 08 I 77.1
Owner signalurel"....., , „.................................... _____„________._____ _Date:...„„„„,,„„,,,__„,„_„.„„____.
401 am r!!' '111.1?!._ _. L(.18,1'11—.... ......12.I
,,,..:4.:00.-ikot, ,,::::,,,,,A,,zi,stioiliii,Ntfor,,,i,,,,„:740,1,04.-oirys,,,, ,,,,,„, Branch circuits-new,alteration or extensiol„per i arel_
, A.Fee for branch circuits with
(
Business name:Pacific Lifestyle Homes above service or feeder fee, t 1 .'‘
7 42 2 I
I
each branch circuit
Contact name:Permit Coordinator B.Fee for branch circuits without
- ' .
Address: 11815 NE 99th Street,Suite 1200 service or feeder fee,first branch circuit )6 18 2I
City/State/Z1P:Vancouver,WA 98682 Each addl branch circuit 7 42 . 2 i
.,ViscellatteousAselyiee or feeder nothicludelt,_
Phone:(360)573-8081 Fax: :(360)574-6401 , Eh manufactured or modular
I 67 84 {dwelh2
ort service and/or feeder ,
Email:permits*buildplh.com I Reconnect only 67 84
,'Ah4,• .,.:,'.° ...... ... ''-‘;! ', ' - ,,-,-LPump or irrigation circle 67.84 2 1 ,
1 Business name:Garner Electric WA LLC Sign or outline lighting 67.84 ' 2
Address:402 Valley Ave NW Ste 106 n set Page 2 --- 2- •--
p4anci,alteration.or extension.
--- ”'
ty/Stale/ZIPPuyallupWA 98371 Each additional inspection over allowable in any of the above
Ci : .
_ 1_________„ __ _ _ Adilit101101 ill3P6A390O(I hi milt) 66,25/hr
Phone:(253)872-6051 mml Fax:(253)872-1801 Investigation(1 In min) 90 00/li_
_
1 - --
Industrial plant(1 hr min) 78.18/hr
Email:egentele@gweusa.com ________ —
... ,.. Inspections for which no fee is •
90 00/h
CCB Lie.: 208174 Electrical Li,.: 01158 r
supr,.L ic.4/...2...25-s S '10callv listed(V1hr1,'nia),
Suprv.Electrician signature,required: /
Subtotal: -.........-
Print name: Russell Magnusortm,--- -----_,,. Date: 0 Plan Review Required(25%of permit fee): .
(....-- -- -- -..., State surcharge(12%of permit fec): 444 _4,4,
TOTAL PERMiT FEE:
i
Authorized signature: 7 .--- .._,.....,)
- . -. —1
„ -- This permit application expires if a permit is not libtsinvM
iwithin MO
1Print name: Bill I)aniels Date: days after it has been accepted as complete.
__, _„„,„ ... Number of inspections allowed per permit
1\BuildingTerinits\ELC Permit App_ELR_ERE disc Rev Ceti 7nois 440.461310 I/O SiCOMAVEZ
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