Permit (203) CITY OF TIGARD , .f : MASTER PERMIT
li ,,
a ' COMMUNITY DEVELOPMENT t. 2,/9 •' „ Permit#: MST2019-00311
Date Issued: 08/15/2019
TroARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115A605900
Jurisdiction: Tigard
Site address: 11404 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 4
Project: Willow Brook, Lot 4
Project Description: New SF. 8/28/2019: REPRINT permit to add irrigation backflow.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1854 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 2 Second: 0 sf Garage: 433 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 1854 sf Value: $248,140.93 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Noes Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1854
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
Y1bTS1at` TM$Titt29r1 —__ -__ —
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $31,963.98
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 throug 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 '��rPermittee Signature: Of/ (teY)C--/e`.51-776 A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD MASTER PERMIT
1 . ' COMMUNITY DEVELOPMENT Permit#: MST2019-00311
T i C_,A R f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2019
Parcel: 2S115AB05900
Jurisdiction: Tigard
Site address: 11404 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 4
Project: Willow Brook, Lot 4
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1854 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 2 Second: 0 sf Garage: 433 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Yes
Total: 1854 sf Value: $248,140.93 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
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: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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
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 1854
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
9JTR'STSTE1200 MI5 NE NTH 3T#1200 1 Ersn Orifr(503-639-4175
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $31,928.96
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 o issuance, or if work is suspended for more th- 180
days. ATTENTION: Oregon law requires you to f Ilow the rules adopted by the Oregon Utility Notif -tion Center. Those rules are set f•-, *AR
952-001-0010 through OAR�r01-0090. You may o ain a copy e rules or direct questions to OUNC by calli 503.232.1987 or 1.800.33 4.
/4 / / / /
Issued By: 'I�� Permittee Signature:
Call 503.639.4176 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.
I
Building Permit Application
Residential
FOR OFFICE I;SE ONE)
City of Tigard RECEIVE lip eceived \ c c- _
. Date/By: Permit No. � A(1_( \ `1
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review \ OS--A.
Phone: 503.7182439 Fax: 503.598.1960 J U L 2 5 2019
Date/By: � to � Other Permit '\��
\tAG�'(\J`
la���
TIGARD
Inspection Line: 503.639.4175 Date R ady/By: Jur s: WI Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD No d/Method: 4 - // / l Supplemental Information
. �BUILDING DIVISIO __...
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Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONL\'
City of Tigard Received Permit No.: 4
Associat
M 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
S Phone: 503.718.2439 Fax: 503.598.1960 0 Electrical 0 Plumbing 0 Mechanical
T ;q R 1� 24-Hour Inspection Line: 503.639.4175
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ties No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ 0
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: 0 ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity 00 0
6 Sewer permit. ❑ 0 0
0
7 Water district approval. 0 CI ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control El plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc. CI ❑ ❑
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 ❑ ❑ ❑
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. ID ❑ ❑
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. CI ❑ ❑
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 ❑ 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 0
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. ❑ ❑ 0
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 ❑ CI20 Manufactured floor/roof truss design details. - —
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ D
for four or more appliances. CI CI 0
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 a..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". ❑❑ ❑❑ ❑❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑❑ 0 0 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. 0 ❑ 1:130 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.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE LSE()NEN.
City of Tigard RECEIVE , Received
Date/By:
Permit No.
,T .
IN :11 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit:
Inspection Line: 503.639.4175 JUL 2 5 2019 Juris:
El See Page 2 foryyTIGARD
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
),, 34 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:$
, r " ,,,,../.--,. .,-4,,,,: f./ : : ;.„ a'' firu",10/4ns Ff4 rr :4A46,—,6)6.A. 'J -r „ .
W r " " rI.,0rvf"i{ F ''t")>6ft .••'!0 v, 11,,4:'.,t lt` /*(;; i � �� tf<Fpeo i,.d"` 0141tt b i' ,i �'. ( �"`',f4 �ft� . 5f�� . ; � Yt . r
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description I Qty. I Ea. I Total
� rx 9c Heating/cooling:
f ✓ � �fsrte '' ; i A 1 , l,r s6 f, 4i ,,; f/ ffc. /K, / , A, cm5.46 ,,,,? ,,, c ,,,, ,,.s . ..r, , te ,.�/ . ,,, .r��. Airconditioning
1 46.75
Job site address:11404 SW 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 4 Duct work 1 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 I Lot no.:4 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S115AB05900 Water heater 23.32
'�'F � to ahs r# * 0 tP ,45:r, '�� ,,, 0 , M Gas fireplace/insert 1 33.39
'''"x;, 'P` f w,4''r.;;�''.{.H;'`;`. „' " .,r,.�.r..r. ,.: ,."'"' -r ,''.:. ,Ar"., 41'"..f f�,"3""-;,:'"`"''-r`s`F''-'-'r%
Flue vent for water heater or gas
New SFR fireplace 1 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
f : er' o *"., ,f . r rf%'�,�r 4-44'.511,40-•'' Other: 23.32
,,'-�rr,`^:4" °y'i ' 1 Y'[t °9s''+'.,».v:?;P4;ff rr i"k41 44x1 -t-:'.V'- " l4'')0;g, •1.;r
Environmental exhaust and ventilation:
Name:Same as applicant Range hood/other kitchen
equipment 1 33.39
Address: Clothes dryer exhaust 1 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
•i`^' ? >. " ' % 4
Other: 23.32IFISP7.,/f (iP OP"> / ' 5. ,, � €A•71a3 ; 4 : 61 /
r ,� s ,'. ,, ,� r , r' ,rF ,� , f,.'.,r .✓� „c„i.,' r„r ..Fi,,,A66„r'r ^,
Fuel piping:
Business name:Pacific Lifestyle Homes
$14.15 for first four;$4.03 for each additional
Contact name:Summer Dowell Furnace,etc. 1
Address:11815 NE 99th ST Suite 1200 Gas heat pump
Wall/suspended/unit heater
- City/State/7ip:. —
Phone:(360)573-8081 I Fax: :(360)574-6401 Fireplace 1
Range
E-mail:permits@buildplh.com Barbecue 1
0> # � trts�� ` i 'f h Clothes dryer(gas)%' N00 ` '41 •re,` ., ;r/ 4% „4. , F sr , e ,
Other:
Business name:Area Heating+Cooling 'r ,;V.e 4 r
Address:2721 NE 65th 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
I days after it has been accepted as complete.
Authorized signature, `wt )1) l-C -� ,ri' • (�. �� * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:7/22/19
L\Building\Permits\MEC_PermitApp_040113.doc 440-46I7T(1 1/02/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
CityofTigard Received
b t�ltelL�y 1'ennit tt�'\tAC� ( t'(V
,()��k.
III.---r** (3125 SW Hall Blvd.,Tigard,OR 97223 EC E IVE Ij Plan Review Related Ycntau 1
Phone: 503.718.2439 Fax: 503,598.t 9 0 Date/By:
`• Inspection Line: 503.639.4175 Ready DatelBy * loris HI See Page 2 for
I I t'A It I) g JUL 2 5 2019 NotitiediMethod Supplemental Information
Interne(', www li and-or. ov _ pp
®New construction ❑Addition/alteratifkjDIVISIO(x) Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories
0 Demolition 0 Other: where the available fault current 0 Miarinas and boatyards
iless to fir atll other xcee till ns100 buiidi
v 4 a exceeds IQ,000 ams a t 150 volts or Floating buildwgr:
® 1-and 2-family dwelling 0 Commercial/industrial ❑ Accessory building ,tergal-u;e ayieuhurai
tiOs
❑Multi-family ❑ Master builder ❑Other: 0 Fire pump 0 Installation of 150 kVA,)
u;' 4 d�l ✓.2` # .• 4• e.'.4';' . ❑Emergency system larger separately dorived
❑Addition of new motor load of system
Job#: Job site address: f,�. j�.�_�,) i 1--\ .',j (OOH?or mare. 0 A �l "1.2„ ..1-3.�
-- - ` .�. is cu tae
Ci /State/ZIP:__ ( ❑Six or more residential ands pa y
�__.w City/State/ZIP: i ❑Health-care factlittce p
❑Recreational vefucle arks.
Suite/bid T /a t,4, Project name: ❑Ttaeardous locations. ❑Supply voltage for more than
` p 3 600 volts nominal.
_._. — Q Service or feeder GQO amps ar mor
Cross street/directions to job site: >
Description Qt_y. Each Torsi '..
_..m.— ____ ._ _„ New residential single-or multi-family dwelling unit. 1
Subdivision: v ) ; v- t+ 1) r 1 (`- +C -' 1 Lot 4, a'-\- Includes attached .arage. I
1.000 sq 0 of less 168.54 _ 4
lax map/parcel# 'J I f '1 (-/ ( 50033 92 l
I La add.' sq R or portion
'11 x -,'.11t-1• . ;.1.i:.. Limited energy,residential
0(1 2
i with above s• II
75
IV (1l ' i----_)\ (.2 11 (. (._,�A, I" (•,l,A ' ‘-,1- \("-_. �.1(61 -
Limited energy,multi-family 75 04
residential with shove' ft.
Renewable Ener. ■ See Pare 2
7 At ,1 ' ` r)` •' s -;" " Services or feeders installation,alteration and/or relocation
Name: -'.` i Cr ! _.1--- t, ' ° 200 amps or less 100 70 2
r i
r 201 amps to 400 amps 133 56
Address: _/ C r - _ �.,.
j t• 401 amps to 600 amps 200 34 - 2
Cit /Stats./Z.IP: �t. ; = (I r i 60t amps to 1,000 amps 301 04 2
City/State/ZAP: y y�X: t-l tI.1 _,._. - r
Phone:(- )G - ' <' • I''(')Cf Fax:( ) over 1,000 amps or volts 552.26 2 I
'J + ,� �^ Temporary services or feeders installation,alteration,and/or
Email: i .-i-
'
T
' i_, t )' 1 ` !( ( t relocation
Owner Installation.This installation is being made on property that I own which is not 200 amps or less —msµ59.36 1 1
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125 08 - 2 1.
401 amps to 599 amps 168 54
Owner signature: Date: _ __ vw t ..,. 14
,, ' Branch circuits-new,alteration,or extension,per panel
�� �, � A.Fee for branch circuit;with
Business name:Pacific Lifestyle Homes above service or feeder fee, 7 42 .,
each branch circuit
Contact name:Permit Coordinator B.Fee for branch circuits without
service or feeder fee,first t
Address: 11815 NE 99th Street,Suite 1200 branch circuit 56 18 ,
42.
7
dd'I branch circuit a
City/State/LIP:Vancouver,WA 98682 Each -_ -_-- w-. - . .1 2_
Miscellaneous(service or feeder not included)
Phone:(360)573-8081 Fax: :(360)574-6401 Each manufactured or modular 67 84 ( m..
dwellin•,service and/or feeder _ 4 _ _ f_'___
Email:permits@buildplh.com Reconnect only 67 84 2
7s :r1-, F� ,` Pump or irrigation circle 67.84 , 2
-__.,..__ .. • _, . ,,% , ` t t i�a t s 67.84 _�......_ 2_l
� t
Signal circuits)or limited-energy 0 See Page 2 2 #
Address:402 Valley Ave NW Ste 106 .anal,altenttion,or extension.
t'itylStatelIP:PuyHpup-WA 98371 i. Each additional inspection over allowable in any of the above
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr min) 90 00/hr `
,,, r,
Email:cgentele®gweusa.com Industrial plant(I hr mm) 78.18/hr j
,m,, (C)�� � Inspections for which na fee is 90 40(hr 1
CCB Lie.: 208174 Electrical Li .:;1158 Suprv. Lit:.3 ods
S. 'ifically hsted ''A hr min,
Suprv.Electrician signature,required: ' LilSubtotal:
Print name: Russell Magnuson ---- - ----_.v._ Date: 0 Plan Review Required(25%of permit fee):
"' State surcharge(12%ofrennitfee):
Authorized signature: f0"fAL PERMIT HE:
t
his pl
,......,.. -- 'this permit application expires if a permit is not obtained within IN(I
Print name: Bill Daniels Date: days atter it has been accepted as complete.
• Number of inspections allowed per peril
I.\iO(ding\1'e.nee.Lt.C,icrmtiApp_CL.It REI.doe Rev 5k/i 1/2015 440-4615"1111x05;COM.Wi11
,
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONI.v
City of Tigard lved \I
AlIIIRE C E(\/ 0 ive Permit No.`\\ST c,�11t`"'� -
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 J U L 2 5 2011 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov
, Notified/Method:
Supplemental r r _ b
,. ... .. ,...n s.� .. '.a.a..s.�.,;>.�. � •..,. ";, F,.w.�,N zo.'.., �er.r.F%. .5s-.u.,,�,�.,,..�i#t�.,.....„ .e•-qui
®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)
,,,5::;,,,, ,1-441.',, 'fy, , . r., . j v �F :N/J.':;. f
�4„faSFR 1 bath
312.70"y/FNAVVOIy0„r ,, al F ),1;',„,;7.., ;;,,,P,...,,,,;g,,f,41 � �,404*Jaf
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler sq.ft.) Page 2
f ,. «, { 4 �WAphi,, .,. 1„ s Ota, t ,.'.,, , r%,,-40/., RN �r,/ Site utilities:
Job site address:11404 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.: 1 Project name:Willow Brook 4 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) 1 Page 2
Storm sewer(no.linear ft.:<100) 1 Page 2
Water service(no.linear ft.:<100) 1 Page 2
Subdivision:Willow Brook I Lot no.:4 Fixture or item:
Tax map/parcel no.:2S115AB05900 Backflow preventer 1 31.27
`r ` 6 ':',',1.,`,J1,,,,,,,,,,t;01, 40.
# . r ¢ r ,kA3,% f`:)x` Backwater valve 12.51
'i1iii F ;f /ifr , r: ,r,,, c3 ,�� r40,1e, 4fs
Clothes washer 1 25.02
New SFR 3 bedroom 2 bath all house plumbing with irrigation
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1 9 9 s = fx/ geW. o.,u' Expansion tank 12.510 „ ,dl/)!.:•,,,',4%;,:p4.,"„ r/,z„r�,�firt0.r �✓wl'st „.co.,,, ,,,/,20,41,14,,,,k4
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 1 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 2 25.02
Phone:(360)573-8081 Fax:( ) Ice maker 12.51
rtl : nr l ?1 * % ? / iti r trh!t l''' r '1/7'7'17-gra
Interceptor/grease trap 25.02=,, r,*� f! G ., v.' � s1, 7iASIrx. fr,a `s . „.4uUo: a,04t4',.
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Contact name:Summer Dowell
Primer 12.51
Roof drain(commercial) 12.51
Address: 11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 5 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
---- Phone: )-573 --_ - Fax::066)-57440 - -Tubfultemer/shower
E-mail:permits@buildplh.com Urinal 25.02
,
ra ,` fapgofrr �)„g4 5 r ofr n �f ` f�,, �� s
Water closet 2 25.02
O Ihf _r / iafe„ ft� ,ytg, ,f,< !l fr ' <afYrxMrf" � / A
Water heater 1 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: $72.50
CCB Lic.:201597 / Plan review (25%of permit fee)
Plumbing Lic.no.:PB1416
Authorized signature: ` i State surcharge(12%of permit fee)
\� it..)f' (-r ) "e ( ., fes /(:, f TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Summer Dowell Date:7/22/19
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su$ $ression S stems:
01!):4J14.1411411.14.:3;1
y s%d✓` '' i`�' .`Jr`5g w f`�^""i'`.
� o.,,.";l,Vr:'• : „ 1 .?; r 4 8 $ i,', �4 1 f s,..,' v .,rte V _ ;'
Footing drain-151 100' 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; ams Y;;;; a a l `'4 •r 715, , r b;i;
Storm&Rain Drain-l st 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
[;401'. rtr each additional$100.00 or fraction thereof,to
� �.. i r ..�, r � r,r 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*.
. ,
1xture't° e fo Plan review is required for any of the following.
Work Performed: Capped' Added .;Rei!'"eate
Baptistry/Font Please check all that apply.
CIAny new commercial building with water service 2"and
Bath -Tub/Shower
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 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 qq gg(('+gy {{p qq ii yL ii
1:1:'
Car
Car Wash Drain
El Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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 4\Pertrits and Inspections\PLB_PermitApp.doc
Building Permit Submittal
Original Submittal Date: It 1e-A_
Site Plans: #
Building Plans: # �'
Building Permit#: 2/Enter building permit#above.
Workflow Routing: Gr Planning Iv-Engineering DrPermit Coordinator 2"Building
Workflow Sign-off: 2` 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.
S Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: -- k-x,\k 1,
Engineering Review
1h7Slope at building pad:
'-Conditions "Met"prior to issuance of building permit
E asements (encroachments)per engineering conditions of approval and plat
[rWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 2-No
Assess Water Quantity Fee in-lieu: ❑ Yes Cf-No
LIDA Facility on lot: ❑ Yes C3'No
C Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:�te
2/Approved Approved by Engineering: tet-- Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
VI 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:
Revision Notice 3: Date Sent to Applicant:
.SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: 4 Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes fi4 N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: kik_ Date: 1
I:\Building\Fonns\BldgPermitRvw_RES_022819.docx