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FOR OFFICE USE ONLY
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Permit r/
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a 13125 SIA Hall Blvd., Tigard,OR 97223t 31 wr1 Plan Review
t.- Plume: 503.718.2439 lax: 503.5461916y ...i 1" °1�.7C'vr+ " Date/By:y. Related Permit 0:
:La
t g y t r 5 NI ReadyDale/13 taris. C�1 See Page 2 fur
fri :- � Inspection Line: SU3.63)q 1 T5 g ti"'0� �' , g s �N )-
p '''''' -`•l� `' ' '° Notified/Method: Supplemental Information
�� ��- Internet' vvw'(v ttgard-or.gov ---
_ TYPE OF WORK • PLAN:REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories
❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Floating buildings.
'-- less to ground,or exceeds 14,000 0 Commercial-use agrieuhmal
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 K VA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job II: Job site address: J-1. �'t, '6cd7Yl el C,�
100HP or more.
g /� occupancy.
I j al ` ❑0 Six or more residential(alts
City/Slate/ZIP: /� Health-care facilities. 0 Recreational vehicle parks.
J C " 0 Supply voltage for more than
Suite/bid t,/a t.ft: Project name: �` 0 Hazardous locations.
P _ _ J 4 ♦1� L^.� J�� � � --- -- 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
-- - -- _
Description i Qty• I tad+ I 'Total _1_"
_ _, New residential single-or mlti-family dwelling unit,
Subdivision: \ ti L:-� Lot#: Includes attached garage, -_-_--
U`Jj � ���t'-�..{�( (•` l� �— 1,000 sq.It.or less �I 16854 4
lax map/parcel#: Z n," l r�01.0 I L) Ca.add'I 500 sq.it.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75 00 2
-._—N�k9) S.)=-'V--1 ._e��QeJ r1 co-,L_ _ (with above sq.it.)
Limited energy',multi-family 75.00 2
residential(with above sq.It.)
-. Renewable Energy Q See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
C j 200 amps or less 100.70 2
Name: � � � 114 C�>� '
` -201 amps to 400 amps 133.56 2
Address: l
401 amps to 600 amps 200.34 2
City/State//.IP: 601 amps to 1,000 amps 301.04 2
Phone:( ) _ Fax:( ) Over 1,000 amps or volts 552.26 2
— - Temporary services or feeders installation,alteration,and/or
Email: relocation _ 1
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 20l amps to 400 amps 125.08 2 I
Owner signature:_ -___-._.__ __._Date: 401 amps to 599 amps 168.54 2
® APPLICANT ® CONTAC"I' PERSON. Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with 1 -f^t,
above service or feeder fee,
Business nature:Pacific Lifestyle Homes 7.42 2
each branch circuit
Contact name: Permit Coordinator B.Fee for branch circuits without
service or feeder fee,first
Address: 11815 NE 99°t Street,Suite 1200 branch circuit 56.18 2
Cily/State/ZIP:Vancouver,WA 98682 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not it eluded)
Phone:(360)573-8081 Fax::(360)574-6401 Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Email:permits@buildplh.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting _ 67.84 2
Signal circuit(s)or limited-energy Q Sec Page 2 2
Address:2920 SE Brookwood Ave,Suite A panel,alteration,or extension.
-te - - - Each additional inspection over allowable in any of the above
City/State/ZIP: Beaverton,OR 97006
Additional inspection(I hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:mmoratotr garnerelectric.corn- _
Industrial plant(1 hr min) 78.181 hr -
Inspections for which no fee is 90,00/hr
CCB Lic.: 121159 Electrical L' ' -305C: Suprv.,Lie.:'331 b, 5 speciticall/listed('V,hr min)
- - ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requireAr Subtotal:
Print name: Chuck Garner W A Gate: q' '1
0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
"TOTAL PERMIT FEE:
Authorized signature:/� r 'L `,� - This permit application expires if a permit is not obtained within 180
Print name: r' 1A i / A t� y -c / Dale: q® 9_ flays after if has been accepted as complete.
�}IIr al •L ! ' • Number of inspections allowed per permit.
I`ItuildingO'ermmiOF.t"C-.PermitApp ELR ERE due Rev 56/17/2015 440-461011I V05/COAtiWEB)
l+:lectrical 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 -n°gs �� Eno 1 Tow l-
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or fess 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15,01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
I1 Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to IOU kva 552 26 2
t I Garage Door Opener* >100 kva(fee in accordance w
with OAR 918-309-0040) 552.26 2
L i 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:
r-1 Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no lee is
specifically listed('6 hr min) 90.001 hr
COMMERCIAL WORK ONLY: _ ELECTRICAL PERMIT FEES
Subto
Fee for each commercial system: $75.i}0 ollowe at(Enter on Page 1):
(SEE OAR 918-309-0000) Number ofinspectionsdluwedper permit.
Check Type of Work Involved:
Ii Audio and Stereo Systems
❑ Boiler Controls
r Clock Systems
Data"Telecommunication Installation
Fire Alarm Installation
I MVAC
Instrumentation
I I Intercom and Paging Systems
Landscape Irrigation Control*
I Medical
Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
I I Other:
Total number of commercial systems
*No licenses are required. Licenses are required for all
other installations
1'13uildjng\Pennilc-5LC'_Pen101App_ELR_ERE doe Rev 05117)2015
• Plumbing Permit Application- Y
., .. t qtr
Building Fixtures FOR OFFICE USE ONLY
City of Tigard SEP 5 2019 Date/By: Permit No. \' l
DaIU 13125 SW Hall Blvd.,Tigard,OR
I te/By:
Plan Review
Z Phone: 503.718.2439 Fax: 503. 1960`,-) ' 'aT );/,'...., Other Permit No.:
s, Date/By:
T I GARD Inspection Line: 503.639.4175 110 w" I N fl 8 r 1p S i(, 1'N Date Ready/By: .runs: IRI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description Qty. I Ea. 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
® I-and 2-family dwelling I=1Commercial/industrial SFR(2)bath 2 437.78
SFR(3)bath 500.32
❑Accessory building 0 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:11477 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 9 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.:9 Fixture or item:
Tax map/parcel no.:2S115AB06400 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
Plumbing for New SFR
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
w:t PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Same as applicant Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 1 25.02
City/State/ZIP: Hose bib 2 25.02
Phone:( ) Fax:( ) Ice maker 12.51
►1 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 4 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 piping/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)
State surcharge(12%of permit fee)
Authorized signature: yin v 2.l/ On L1 TOTAL PERMIT FEE
Print name:Summer Dowell Date:9/5/19 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 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$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 $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
(minimum charge-1/2 hour) each additional$100.00or fraction thereof,to
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*.
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 ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ 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 LI 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:\Job Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 9\Perl�iits and Inspections\PLB PermitApp.doc
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 Valuati