Permit (30) CITY OF TIGARD MASTER PERMIT
.,...„ .1
al.'+! 2.:'' COMMUNITY DEVELOPMENT Permit#: MST2018-00320
Date Issued: 01/03/2019
Tt ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 115AB00500
Jurisdiction: Tigard
Site address: 11147 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot:
Project: Willow Brook, Lot 26
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
' Stories: 1 Bedrooms: 3 First: 1910 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 2 Second: 0 sf Garage: 454 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors. Yes
Total: 1910 sf Value: $247,940.70 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 RainStorm Sewer: 100
0
Tubs/Showers: 3 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: 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 add9 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 1910
Owner: Contractor:
PACIFIC LIFESTYLE HOMES PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
11815 NE 99TH STREET SUITE 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
1200 VANCOUVER,WA 98682
VANCOUVER,WA 97682
PHONE: 360-573-8081 PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $30,328.12
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtai - ••• - e rules or direct questions to OUNC by calling 5 3.232.1987 or 1.800.332.234
e...P2,....
Issued By:,JE� .. .` 1 e mittee Signature:
40 503.639.4175 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
Residentialti ,•- FOR OFFICE USE()NEN
City of Tigard 1' ,�,*+,m -. z t Date/By: / / /A 4 ()/T-0 v�C.J
Date iv
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i -. / 11 /. /�� L 71_
Phone: 503.718.2439 Fax: 503.598.1960 ), i. Date/By: a- / 1 r •
T I c;A,,D Inspection Line: 503.639.4175NOV Date Ready/By: uru: H See Page 2 or
Internet: www.tigard-or.gov Notified Method: I( Supplemental Information
'a
< < • • :fit . 4 / ., - .t/...i,: I
'1ia. ;yy "": F �sr1 ,s r+ ':a,t�, -; �' „ �;;+ / 'F" f",,,t ',, r r ,, qtr „r:: �.rr ''''l rte ,i":,'
).04.411-7.,',-� "",.21/0rJfsA'' ,o'r ,,'`�.�` <, r 4 `.:14A. s .-.:� ii, N..441 it,:,y`e, .: Of 14". i 1r i•✓° !I t ,, 9 e: '.
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
,r�` d lfi - rr �` '''''''V. 1 9 rr'c.'
r'rx ,1 ,„,`f � f„rf :` '° 1 f' Wa i t" �� 4ti-'�, i4 r'47 work indicated on this application.
,.r, .. .. ,f . s.r 4.,. .,� .i. ,.�� V.. ,,,,.,44x4 <7N7 9'f o
® 1-and 2-family dwelling a Commercial/industrial Valuation: $ 0 1
0 Accessory building ❑Multi-family Number of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 2
�r<?<,5,,,,. ...•..,,776.77.77.,`A,/„W"%,,, T - -- - 1 {{{�..J.JJ �, ry ,, .;,1.,::,,5,,',',4',41,3,*,"
r ' rr,, � ,r l + ac: � . ,,r otanumer of foors:
Job site address:11147 SW Gabriel St New dwelling area: 1910 square feet 1 q/0
City/State/ZIP:Tigard,OR Garage/carport area: 454 square feet
Suite/bldg./apt.no.: Project name:Willow Brook Lot 26 Covered porch area: square feet
Cross street/directions to job site: Deck area: , square feet
Other structure area: square feet
r E `l ;i *� 41.lc/8 4 Pa ad 1 ,1 � ,•4
�2 r' a,rt:�i.
Subdivision:willow brook Lot no.:26 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:tbd Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
%' ,Fr'7, 4 ,••••.•4,. th. t 4 ? work indicated on this application.
SFR 3 bedroom 2 bath 2 car garage with a covered patio and entryway Valuation: $
Existing building area: square feet
New building area: square feet
i r ,, ., t r y r r 'r,-' z r s : '''",,,',...,4.,•.'.74,;''''.4.4.4,4
'%" s 4,,, '� +# ,t� if rrr' ,, r - „,. r' Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address: 11815 NE 99i''Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)573-8081 Fax:(360)574-6401 New:
Business name:Pacific Lifestyle Homes
Structural plan review fee(or deposit):
Contact name:Permit Coordinator
FLS plan review fee(if applicable):
Address: 11815 NE 99th Street,Suite 1200
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98682
Phone:(360)573-8081 Fax::(360)574-6401 Amount received:
4' ; 4 r ' 8 ,1 r'4
t V t " .. s t
E-mail:permits@buildplh.com ,F .�. ;
of f , ,,, Commercial and residential prescriptive installation of
'?''''';''''B'7:::::
' ,,, , ..<,,.,. ,, ,. ,f ; ,,,: .., .. ,,a•. ,%.... u , , �, orf 4-i.. •.1 roof-top mounted Photovoltaic Solar Panel System.
Bsiness name:Same Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same Solar Installation Specialty Code checklist.
City/State/ZIP:Same Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:173524 `Z ,r1/2?) Total fee due upon application: $201.60
Authorized signature: 4i/ , i / n i a.71-3
This permit application expires if a permitisnotobtained
f W`— within 180 days after it has been accepted as complete.
rint name:Summer Dowell
PkDate:11/20/18 *Fee methodology set by Tri-County Building Industry
Service Board.
ilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE I;SF ONL\'
Cl of Tigard Received
- g Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
I't G A K D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov El Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ 0
4 Fire district approval required. Name of district: ❑ 1:10
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
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 ❑ ❑ ❑
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- ❑ 0 ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20- Manufactm ed flow/roof-truss design details. —— ❑ ❑ ❑
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 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. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
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 ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
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-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
I
Mechanical Permit Application FOR OFFICE L'SE ONLY
City of Tigard Received
g A t*Ps' Permit No.:
u 13125 SW Hall Blvd.,Tigard,OR 97223 View
Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 A ;
Date/
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: IZ1 See Page 2 for
Internet: www.tigard-or.gov
NO1,0tified/Method: Supplemental Information
V 2
.!•!/'
7017Agam ,wfalit t& the value the work
Mechanical permit fees*arebasedon of wo
New construction 1=1 Addition/alteration/re”er. • performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,:.ui.ment labor,overhead and.rofit.
El Demolition 1:1 Other:
Value:$
,.V..A'ffr;rtWSrajKZ'rfrfr?:7W *.c. (Er:ZeIVPrnt.gt,iqr
"ir..7Zrf:"
E 1-and 2-family dwelling 111 Commercial/industrial 0 Accessory building For special information use checklist.
El Multi-family CI Master builder 1=I Other: Description Qty. Ea. Total
Heatinlcoolin::
A,44)' . conditionin
1 46.75
Job site address:11147 SW Gabriel ST Furnace 100 000 BTU ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU ducts/vents) 54.91
Suite/bldg./apt.no.:
Project name:Willow Brook 26 Heat.um.
Duct work 1 61.06
1 23.32
Cross street/directions to job site: H dronic hot water s stem 23.32
Residential boiler(radiator or
h dronic 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,sus.ended,etc. 46.75
Flue/vent for an of above 23.32
Other: 23.32
Subdivision:Willow Brook Lot no.:26
Other fuel a..liances:
Tax map/parcel no.:tbd Water heater 1 23.32
Gas fir-.lace/insert
1 33.39
Flue vent for water heater or gas
SFR 3 bedroom 2 bath with a 2 car garage,covered patio and entryway. fir.lace 1 23.32
Lep:. 23.32
Wood/.ellet stove 33.39
Wood fir.lace/insert 23.32
Chirrme /liner/flue/vent 23.32
Other: 23.32
Environmental exhaust and ventilation:
Name:Pacific Lifestyle Homes Range hood/other kitchen
1 33.39
Address:11815 NE 99ST Suite 1200
Clothes d er exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet com.artments,utilit rooms 4 23.32
Phone:(360)573-8081 Fax:( ) Attic/crawls.ace fans 23.32
a44372:a104: A?0,*#L500414ZO.AZPrji• Other:, 23.32
Business name:Pacific Lifestyle Homes
$14.15 for first four;$4.03 for each additional
Contact name:Permit Coordinator Furnace etc.
Gas heat.um.
Address:11815 NE 99th Street,Suite 1200
Wall/sus.ended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Fir .lace
Phone:(360)573-8081 Fax::(360)574-6401
Ran:e
E-mail:permits@buildplh.com Barbecue
rwrto„:1:.,oimm,srv:,trtgict , ,r:rkd.R Clothes d er :as
Other:
Business name:Area Heating+Cooling
Address:2721 NE 65'Ave Subtotal
Minimum permit fee($90.00)
City/State/ZIP:Vancouver,WA
Plan review(25%of permit fee)
Phone:(360)737-0811 Fax:(360)737-6946
State surcharge(12%of permit fee)
CCB lic.:64801 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signatures_ Oat)ee-)e_--- days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:11/20/18
1ABuilding\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/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 A liFOR OFFICE USE ONLY
City of Tigard ,, .3i 1 i r.t-ri.:
Permit il:
st 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review --MI
', Phone: 503.718.2739 Eas: 503.598.1960 Date/By: Related Permit It
TIGARD inspection Line: 503.639A 175 \iii >¢' lcoqty Date/By: Juris. m See Page 2 fur
Internet: www.tigard-or.gov Notified/Method Supplemental Information
J
TYPE OF WORK •PLAN:REVIEW
® New construction ❑Addition/alteration/repla .i17T' ,r i Please check all that apply(submit 2 sets of plans w/itcros checked):
Irl
❑Service or feeder 400 amps or more ❑Uuiiding over three stories.
❑ Demolition ❑ Other: where the available fault cllrreni ['Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volis or ❑Floating buildings.
® I-and 2-tardily'dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-15C agricultural
amps lipr all other installations. buildings
❑ Multi-Enrtily ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 K VA or
JOB SITE iNFORrMA'I'ION AND LOCATION • 0 Emergency system- larger separately derived
O Addition of new motor load of system.
Job If: 1,1ob site address:dd�� ?t/..��,. ` ('' >
-- — V tK_ a- ��/L l JtS�I V�� \ w • IOUor o more. ❑occupancy.
cc :an
'_.r' -rl � 1�4----t.
aced p me
City'ISltlle/Z1P: � ❑Six or more residential units. I� Y"
3 - C 7 ❑Recreational vehicle parks.
__---_----- _--_._ ❑tlenhh-cure k�icthies. I
Sri le/bldg./apt. ff: 1Project ii one:'`AD t\ •� ❑Hazardous locations. ❑Supply voltage for marc than
--------_--_ J --- ��1 L) CJrv.� GOO volts nominal.
❑Service or feeder 600 amps or more-
C.'ross street/directions to job site: FEE SCHEDULE
Description j Qty. I Each [ Total L___._
- New residential single-or multi-family dwelling unit,
Subdivision: V�(,-� t Lot#:` includes attached garage.
_-.. > 1,000 sq.It.or less 1 168.54 11,0 4
Tax map/parcel#: I Ea.add'I500sq.ft.or portion 33.92 6---7,04- i
DESCRIPTION OF WORK Limited energy,residential
Z '-R _(with above sq.ti.) 75.00 2
- J EL /) +&1 r -C cu-c3�'T�"`� _7 _ Limited energy,multi-family
�Qj (J residential(with above sq.It)
75.00 2
'Ce"` ��`" Renewable Energy 0 See Page 2
® PROPERTY O'14'NER ❑ T NT Services orfeeders installation,alteration,and/or relocation
lxlaltle: 200 amps or less 100.70 2
Address; G
201 amps to 400 amps i 133.56 1330(02
i �' 3-0
h t 401 amps to 600 amps 200.34 2
City/State/ZIP: V 1( n ,;V' LU f - q D/ 601 amps to 1,000 amps 301.04 2
Phone: ? c t g0 ( )Fax: Over 1,000 amps or volts 552.26 2
" O} J� — Temporary services or feeders installation,alteration,and/or
Email: • •A ( ) Pr. C_orvi relocation Owner installation:installation:This installation is being made on properly 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. 201 amps to 400 amps 125.08 2
Owner signature:_ Date' 401 amps to 599 amps 168.54 2
® APPLICANT 12g CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A Fee for branch circuits with
Business name: Pacific Lifestyle Homes above service or feeder fee, 7 42 2
— each branch circuit
Contact name: Permit Coordinator B.Fee for branch circuits rritlhoui
service or feeder fee,first
Address: 11815 NE 9911f Street,Suite 1200 branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98682 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)573-8081 Fax: : (360)574-6401 Each manufactured or modular 67.84 2
Email; permits@buildplh,eom dwelling,service and/or feeder _
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 ❑ Sec Page 2 2
Address:2920 SE Brookwood Ave,Suite A panel,alteration,or extension.
City/State/ZIP: Beaverton,OR 97006 Each additional inspection overallowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(I hr min) 90.00/hr
Entail:nlrnorato�r�garnerelectric.coin
Industrial plant(I hr min) — 78.18/hr —_
Inspections for which no fee is 90,00/hr
CCB Lie.: 121159 J Electrical L''.: -3050; Suprv.Lie.:'3-1 015 — specifically listed(%hr mm)
:an ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require Subtotal:
Print name: Chuck Garner 4t 4t,: < Date: to rf 0 Plan Review Required(25%of permit fee):
�y.. State surcharge(12%of permit fee):
Authorized signature: '` A _ Tom",PERMIT FEE:
CIA
This permit application expires if a permit is not obtainers within 180
Print name: CI / C e� i `/7 di Date: (0 `(q-i # days after it has been accepted as complete.
1111 /1 'fifff I / Number of inspections allowed per permit.
1 nuildingnE'enniissEl.C_.PennitApp ELIC IiRli doe Rev 061117/2015 440-461ST(1 i3OSA:O LINED
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 stems combined: $75.00 Irescri Zion um Euvb 'inial I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less — �` 100.70 2
5.01 10 15 kva 133.56 2
Audio and Stereo Systems* i5.0l to 25 kva 20034 2
Wind generation systems in excess of 25 Rea: —
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 10 100 kva 552.26 2
Garage Door Opener*
>100 kva(fee in accordance
— — --
with OAR 918-309-0040)
552.26 2
Li Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems' >100kva–noadditional charge 0,0 3
Each additional inspection over allowable in any of the above:
f—J Other: Each additional inspection is 66.25/hr
---------- charged at an hourly(1 hr min)
— Inspections for which no fee is 90.00/hl
specifically listed(%lir min) -
COMMERCIAL WORK ONLY: mm ELECTRICAL rr;R IT FEES
Fee for each: commercial system: $75.00 allowe al(Enter on[age 1):
(SEE OAR 918-309-0000) Number of inspectionsdlowed per permit, ):
Check Type of Work Involved:
I 1 Audio and Stereo Systems
Boiler Controls
I J Clock Systems
J Data Telecommunication Installation
Fire Alarm Installation
I I HVAC
Instrumentation
I I Intercom and Paging Systems
I J Landscape irrigation Control*
Medical
Nurse Calls
J J Outdoor Landscape Lighting*
n Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
!'.nuildnng\Peiinits`.L:L(' PermilApp_ELR_EREdoc Res'06/1'1)2015
Plumbing Permit Application
Building Fixtures FOR OFFICE USE oyLv
City of Tigard Received
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Pl
' Date/By:
I Phone: 503.718.2439 Fax: 503.598.1960 an Review Other Permit No.:
D
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Suns: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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4
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
r ff , ,, ) rlR ° i %1r %
SFR(1)bath 312.70
s £H ., ` , y , r , 5Ir! ,st.P ,
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
pFire sprinkler( sq.ft.) Page 2
4,. ',. t,,, a'. 4�.,,_ ,. , 1 a ., ,,,,,, , ,, {: , ! , . ;,r �„ T Site utilities:
i
Job site address:11147 SW Gabriel St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:Willow Brook 26 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) I Page 2
Water service(no.linear ft.:<100) 1 Page 2
Subdivision:Willow Brook I Lot no.:26 Fixture or item:
Tax map/parcel no.:tbd Backflow preventer V 31.27
r , r I Y I . Backwater valve 12.51
. . ,,., .., i_...s. , . ... ... .. „ <v ,„, . i 4?..,.. ...,,, Clothes washer 1 25.02
SFR 3 bedroom 2 bath with 2 car garage.Covered patio and entryway. Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
j Expansion tank 12.51
`' ,f
Name:Pacific Lifestyle Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11815 NE 991h 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
X ,r l v' r ' t' '
r g7 r b� ! � 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 99'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 3 12.51
E-mail:permits@buildplh.com Urinal 25.02
re; , 4r r - Water closet 2 25.02
x x C' 4 10'9 0.
.,-rv,� ,rv. <I r.,�:s. r, ,„u.. ,,, > , . .,,, , ,y., ,r, , ,. . rr 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 Plumbing Lic.no.:PB1416 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: / 2 / 9 9 TOTAL PERMIT FEE
Print name:Summer Dowell Date:11/20/18 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:ABuildingAPermits\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:
. r f
, 2:1;;;',4:11':-#,4, d /gri
MOY1
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 it4g 44 ""' ;' a , , �,, d �1 x'�`?;t4-...,41;
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
�. „":"s .'J"`�1E;.`�✓6„Fr: „r,a ,' �f ?'.tet . f s
s.. r 1
aSeach 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*.
4107
Clyft:tun TYPe �. :0 °4.rA <;4 ,,4'4
Fixture Type
. ;
Werk Card Added, < Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 1=1 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 Thnr 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.
�
Car Wash Drain ,..g „t,;
,<,r aa ', !, •74,/, a i,„ ...0
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 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 26\Pqmits and Inspections\PLB_PermitApp.doc
City of Tigard
.74 r COMMUNITY DEVELOPMENT DEPARTMENT
1
T 1 c n 1t D Building Permit Review — Residential
rP,
Building Permit #: �frL,s��0 I G2c)
Site Address: U 11 SW 64t-q1 c .
Project Name: 'oll4 j Brnk Lot #: 2.6
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 1ft' S F Z; Z Wt1 2. b;,.- �i^-<;vt4 pa—n) ' eifirTwit7e
,/Verify site address/suite#exists and active permit system.
LLQ River Terrace Neighborhood: LV1 No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
15Q ree(3)copies of site plan Existing structures on site
ite plan must be on 8-1/2"x 11"or 11 x 17"paper ❑ ootprint of new structure(including decks)with finished
FV ! awn to scale(standard architect or engineer scale) or elevations
A •rth arrow tility locations&easements(required for new and additions)
f►,S)te address,project or subdivision name and lot number Sidewalk/driveway approach
Di pplicant information(name and phone number) II' .cation of wells/septic systems
i!a Lot dimensions and building setback dimensions L Existing trees to be retained with drip line,and tree
l' Sfivare footage of buildings to be demolished pr tection measures
Lfd'Lot area,building coverage area,percentage of coverage and [treet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) LtdStreet names —/
L�Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [ s ❑No
4 f t differential) If yes,is a storm water quality facility shown? Otik4=1No
Clean Water Services—Service Provider Lette of platted prior to 9/10/1995):
,equired: 1:1 Yes,applicant was notified [1 No Received: ID Yes ❑ No �,r l
L5 Public Facili tie�Improvement(PFI) Permit: ��"�
equired: g Yes,applicant was notified ❑ No Applied For: MlYes ❑ No,stop intake
It'and Use Case#: ra01 "QOOi1rZ 2-0j.
g. f.-1- �-011
4onin
equired Setbacks: Front IS Rear 1 S Side 5 Street Side C0 Garage ) a
Y;andscape Requirement:
E of Coverage Maximum: gv
OA
Building Height: Maximum Height 3S Actual Height I ,S
*isual Clearance
le Sensitive Lands: L/ Yes ❑ No Type G-0,1(t( S'La,'
grUrban Forestry Plan
Ig Conditions "Met"prior to iss nce of building permit
�‘(-4-
� r, 2 6
Notes: �0 �s,� V{6,4 �Su�c 0� �Of
/Approved By Planning: AJ- riAL
Date: 11-2-1-1 f
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\BldgPemutRvw REs 061417.docx
Building Permit Submittal /1T
Original Submittal Date: /f 441
Site Plans: # 3
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning Engineeringrrmit Coordinator Building
Workflow Sign-off: Sign-off for Pl rung(include notesme
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: /vim , 41,1,�I/�=; Date: /2 //)//r—
Engineering Review
Ce lope at building pad: d-" —
2"--Conditions "Met"prior to issuance of building permit
12-Easements (encroachments)per engineering conditions of approval and plat
2'''Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Rryo
Assess Water Quantity Fee in-lieu: ❑ Yes E "No
LIDA Facility on lot: ❑ Yes L/ No
2/Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
12-"Approved by Engineering: ( g4/ /C;St} Date: /2 -/7-,5
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance-of-building permit
l'S;Approved,NOT Released: C'e44"-, Date: 12 I lcl `(g
Notes: 1\leP_d WV std he(z)c t2c) pia-4)- a.v d revved g v hum} rr_op r- `krec. sk c t'�. `o
Revisions (after Building Submittal only) —reCOVCo -�1 p1a� 1sS M W -trte hots law,t- irei 51'"`-'t
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
JX-SDC Fees Entered: Wash Co Trans Dev Tax: "Yes ❑ N/A
Tigard Trans SDC: 'R'Yes 0 N/A
Parks SDC: iZ.Yes ❑ N/A
LIDA 0 Yes $ N/A
XOK to Issue Permit
Approved by Permit Coordinator: 76Gd1C`"0 de et - Date: 121 1 (1-
I:\Building\Forms\BldgPermltRvw_RES_O 101 18.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11147 SW GABRIEL ST, TIGARD, OR, 97224 April 30, 2019 at 9:23:09 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00320
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Previous corrections completed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11147 SW GABRIEL ST, TIGARD, OR, 97224 May 10, 2019 at 10:11 :26 AM
Record Type: Record ID:
Residential - Master Permit MST2018-00320
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Previous corrections completed.
Final erosion control passed
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor