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Permit (21) lei 7. f tit CITY OF TIGARD MASTER PERMIT IN 1 ' COMMUNITY DEVELOPMENT Permit#: MST2019-00111 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2019 T i�'' j ' 9 Parcel: 2S115AB08300 Jurisdiction: Tigard Site address: 11123 SW GABRIEL ST Subdivision: WILLOW BROOK SUBDIVISION Lot: 28 Project: Willow Brook, Lot 28 Project Description: New SF. 8/28/2019: REPRINT to add irrigation backflow. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 979 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 1404 sf Garage: 468 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2383 sf Value: $304,636.75 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 3 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 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: 4 201-400 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 2383 Owner: Contractor: PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions) _ _--1'r8151vt 99TH 5T5TE1Z0U" - 1113n-14E-99TH ST#1700 =fi -$99-4't-75-- - VANCOUVER,WA 98682 VANCOUVER,WA 98682 PHONE: 360-573-8081 PHONE: 360-213-0813 FAX: 360-574-6401 Total Fees: $31,673.79 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 througF 1R 9 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198e'"?'/)t.,161/1-7-"Ail 7orr1.800.332.2344. Issued By: � `'"¢ '/ ( Permittee Signature: d� C i /d'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 a. COMMUNITY DEVELOPMENT Permit#: MST2019-00111 13125 SW Hall Blvd.,Ti Date Issued: 05/23/2019 fC .,�R. i and OR 97223 503.718.2439 9 Parcel: 2S 115AB08300 Jurisdiction: Tigard Site address: 11123 SW GABRIEL ST Subdivision: WILLOW BROOK SUBDIVISION Lot: 28 Project: Willow Brook, Lot 28 Project Description: New SF. - BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 979 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height 25 Bathrooms: 3 Second: 1404 sf Garage: 468 sf Front 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2383 sf Value: $304,636.75 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Drains: 0 Tubs/Showers: 3 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: 5 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: 4 201-400 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 2383 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: $31,638.77 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 R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5,4.232.1987 or 1.800.332.2344. , .�►., A' ,Issued By: Permittee Si nature: 9 � �� fille L 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 timeofa.cb pa-tfr . Building Permit Application \_,C.---VC Residential RECEIVED FOR OFFICE LSE ONLI Cityof Tigard Received % `i Li S� 5T 1O �n g Date/By: ` �i ; Permit No.: ` 1 l 13125 SW Hall Blvd.,Tigard,OR 97223 AP R 0 1 2019 Plan Review ��.��.,�} _ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permi�l � 111,...E-1"t Inspection Line: 503.639.4175 Date Ready/By:' Juris: H See Page 2 for I [GARD p �:11Y I1Ca R� ' Internet: www.tigard-or.gov 3, ILDING DIVISION .i ed/Method: ' , ' Supplemental Information �1 tJIV ,, �' Y';d ,'' r, ,7..m. „.. : € ,... .; 41/,{ r, ,% .Ili ..�„� +� fl Jr e' d% :re-F ,? * ,,," ®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 0 Other: equipment,materials,labor,overhead,and the profit for the M44:9 ;4 " 4,. %8`f � ri $� rr;* ; �', ,F' ,f work indicated on this application. ..& ..y'%,;.AFF N0 ,F'0,0 ,r . ...,/,','',„,,;;„,,,,,. ..,,r '''0 y^r'0,;� ,.sk'FA�;O, +`F:: �,rc,sr'. ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: —X75,900 --) 0‘.1(�3� 0 Accessory building ❑Multi-family Number of bedrooms: 4 0 Master builder 0 Other: Number of bathrooms: `j �r 'xr ' ' in! 4x , ' 4M:tta st s r :t#,� �r` �' ' Total number of floors: 2 ...,;,,; �.,F ^f,!£� �:`r � ., .. Job site address:11123 SW Gabriel St. New dwelling area: 2383 square feet '(4 oq City/State/ZIP:Tigard,OR Garage/carport area: 468 square feet el Suite/bldg./apt.no.: Project name:Willow Brook 28 Covered porch area: square feet ! ) + Cross street/directions to job site: Deck area: square feet Other structure area: square feet ' 93'6',''''4%a 68 ft4tl}i a *'''''''''',4-:•:J # i 1 i�, Subdivision:willow brook 1 Lot no.:28 Permit fees*are based on the value of the work performed. Tax map/parcel no.:2S115AB08300 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the ,46 li F `M'f/ r,f.' :#-?4 ''0`4,=i':Ne* ' .. €0.4 FIl a fl y`g ��' .K"0"F,�'' �'" r`'f0,. /x,00.�,�^''�0;. . 4 , , ,r�r� ',r .,0A 0„ .:�'0 ,. . .rf,,,,y �'5' ' work indicated on this application. SFR 4 bedroom 2.5 bath Valuation: $ Existing building area: square feet New building area: square feet r fe 66 41 ,Z ; k#/ ? . e` at,,' iM . , y . t . Number of stories: � � , ,f s # Yfe .tflwrr, .lea4Pry:L�f uFry .»rn, „ VSf ? . Name:Pacific Lifestyle Homes Type of construction: Address:11815 NE 99t1i Street,Suite 1200 Occupancy groups: City/State/ZIP:Vancouver,WA 98682 Existing: Phone:(360)573-8081 Fax:(360)574-6401 New: . rr; ;,; �'r f i+ ,;r: .�r%' ��✓;.s r'� .,� '� A� �,dq„w '' a6”� s;'��;c/� �;; ,�,�� f .rte -000,010.0r00,00.700000.3 " 0.,,;,,,A0,<.4-..,0,1,1,0,,,,„ s� .11:,3' r,'54''►E,t, Ai's;( a¢1✓ �, �„ ,* e<�s f"�r , „,,!,.O.;',),.,:-.,,P- ° ...A,-' F.ar;:.. ";'” s",�,z,�'�,-' 4, %,tsi.'I./0 &'0b4.- 1 ,,,.' rF '',�r.:t r �%��4;x".r,.+�x''u�,'t , ldw-� x,6.fi ;�6;,^ t+, ,:- `�"';,,,,� .F.<i:"�rfr �''�„' Business name:Pacific Lifestyle Homes �YICYY1�i! tO A` Structural plan review fee(or deposit): Contact name:Permit Coordinator Address: 11815 NE 99th Street,Suite 1200 Z I FLS plan review fee(if applicable): �3c�— 3— U$ 3 Total fees due upon application: City/State/ZIP:Vancouver,WA 98682 Amount received: Phone:(360)573-8081 Fax::(360)574-6401 r , E-mail:permits@buildplh.com com .pS i.fiYi�g:, u �,,i fug .,r, "M.-S.. V4 . FA, 74.44,',I04. „vy „rot y ,� 1 o A, ,�e Commercial and residential prescriptive installation of ",” , %J; ;,, ,. Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE LSE ONLI City Tigard Received Permit No.: , *4 13125 SW Hall Blvd.,Tigard, OR 97223 Associated permits: I Phone: 503.718.2439 Fax: 503.598.1960 � rt) 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ID Mechanical Internet: www.tigard-or.gov 0 Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l'es No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 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 0 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 CI 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 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 0 basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 ❑ ❑ 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 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 ❑ ❑ 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ 0 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 ❑ ❑ 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 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 0 ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 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 Manufactured floor/roof truss designdtails. ❑ ❑ Q 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ El 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 ❑ 0 ❑ architect licensed in Ore:on and shall be shown to be a..licable to the .r&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". ❑ El ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ El ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 ❑ 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, ❑ ❑ ❑ 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, 0 El El 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 City of Tigard Received Date/By: Permit No.: VEdminemENEEENNE 1111 41 13125 SW Hall Blvd.,Tigard,OR 97223 �� ' � � Q Plan Review Phone: 503.718.2439 Fax: 503.598.1960 APR 1 2019 Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 Date Read/B J u Internet: www.tigard-or.gov Ready/By: ® See Page 2 for ui Iv oh I(taARD Notified/Method: Supplemental Information II k 3 II 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 0 Demolition 0 Other: mechanical materials, equipment,labor,overhead,and profit. w„,49,-,440 . . 4' Value:$"� rk ? + ` / `% f\ f fi fxY ft ;,: ;r„ s3 T 7� ., " �u, w?4n E -� #,lit 4fes17✓d tt/t� ,c �� tfoxnfYF ,.fir „ ' i` -' B . ..,, , '` . �J,r,- 8 , ^k sy-f$` ® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi family 0 Master builder 0 Other: Description I Qty. I Ea. I Total flv,4.e .v+ : /3 t;,,.mY f-44.,.; !"'"'f �r;/.”f :" 4' s l';`,,,'-',, "`'rF ?1 'F' f 9 41.1' ;.,�,,`°f00"P X 04 t1: F I t'>f t s f f' 41f, cF,,�41ff f Heating/cooling: Air conditioning 1 46.75 Job site address:11123 SW Gabriel ST Furnace 100,000 BTU(ducts/vents) 1 46.75 City/State/ZIP:Tigard,OR 97123 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name:Willow Brook Heat pump 61.06 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.:28 Other: 23.32 Other fuel appliances: Tax map/parcel no.:2S115AB08300 Water heater 23.32 .41 2,, f `,i,�'ff„�� fff! „b” �1 ,t ti :fl^a+�t) t yl f';q:i itY,44} / Gas fireplace/insert 1 33.39 " gA Flue vent for water heater or gas SFR 4 bedroom 2.5 bath 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 ft-i:rx t o( ';::.,r1'14„/':t f 7 i fl, - g , f v 2 "� Other: 23.32 ,,,, itaWe„'.1 ,,y1 .,, A1!) .t ,04vxele ''Ail C ;.7:'r�, 41:4. #d 0 f Environmental exhaust and ventilation: Name:Pacific Lifestyle homes Range hood/other kitchen Address:11815 NE 99th ST equipment 1 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 6 23.32 Phone:( ) Fax ( ) ��!f � �,! � � � Attic/crawlspace fans 23.32 vg ,9c,: `C„af, t51mig %tr .` -744 , ,,.,'„- ,:„:.71',:$ !,,,,f„data Other: 23.32 Business name:Pacific Lifestyle Homes Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Permit Coordinator Furnace,etc. 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 I Fax::(360)574-6401 Fireplace 1 Range 1 E-mail:permits@buildplh.com Barbecue 1 *Slr l o it t ' a'11.!7;;:;,:,,,:4!",,a;;.. 4,2 r % , �:4 frYj. Clothes dryer(gas) Business name:Area Heating+Cooling Other: 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 lic.:64801 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signator : I days after it has been accepted as complete. ” * Fee methodolo 3 set b Tri-Coun Buildin.In n s' Print name:Summer Dowell Date:3/28/19 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/VVEB) 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 ii. Cativ71 1/ � FOR OFFICE USEONLY �It�Ofiii7:111:131211,4y1.(1;9d, Received Date/By: Permit iI;M�T � � �� E 'r13125Sot' "Tigard,Olt 97223 APR 01 2019 PlanReview _�, !he 501=ax: 5(}3.598.1960 Date/Uy: 14 Related Permit a: TIG•ARD Inspection Line: 503.639.4175 { d �+ P`��- i q "� Ready Dale/13y: loris. 0 See Page 2 fur :n Internet: w'ww.tigard-or.gov NoliticdlMelhotl: Supplemental Information 3UILDING DNISION ---J _ TYPE OF WORK PLAN:REVIEW ®New construction 0 Addition/triteration/replaeernetlt Please check all that apply(submit 2 sets of plans w/items checked): ❑ Demolition ❑Other: ❑Service or feeder 400 amps or wore 0 Building over three slories. where the available Omit current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION — exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® I-and 2-11mily dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 141100 0 Cemmcrciii use agricultural amps for all otter installations. buildings. Q Multi-family 0 Master builder • Other: ❑ ID Fire pomp. 0 Installation of 150 K VA or JOB SITE INFORMATION AND LOCATION - - • 0 Emergency system. larger separately derived fob 11; 106 site address: j f �4 (-7( C ❑Addition of new motor load of system. _. ^_._ — --r i - .t` ( AL 1 3{ ' _�� IQOHI'ormote. City/State/Z. P: ( `__ 1 ❑Sxormoleresulenlialntnit5 occupancy. p ilea!!-came f;Et hies ❑Re rennonal vehicle parks. Sulk/bldg,/apt.#: Project name: t - _ ❑Hazardous locations. ❑Supply voltage for more than __. ---,- � �� f� -t ��Y�'(�f�/ .._,_� GOOvottsnotnimti 0 Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE -_-__-- Description l Qty. l Each { Total New residential single-or multi-family dwelling nniL Subdivision: C O Includes attached garage. d'� 1 c!. TZ.. � Lot#; Tae map/parcel#: • •c C )� �tY� 1,000 sq.R or less 168.54 I 4 4 4 1 1 A6 O n C Ea.add'I 500 sq.ft,or porion �,7 33.92 !2"j ci 1 DESCRIPTION OF WORK __ y. Limited energy,residential 75.00 2 l �%�,L�/;' / 2' it— ' 4 _(with above sq.ti.) — .� II Limited energy,multi-family residential(with above sq.ft.) 75'00 2 Renewable Energy ® PROPERTY OWNER 0 TENANT ❑ See Page 2 / Services or feeders installation,alteration,and/or relocation Name: 1.---)6 ( l't(.- .� f�..- th2" p 100.70 2 , L L. ,,4 C 200 amps or less Address: C� L-7.- 2 Ci C C L 201 amps to 400 amps ( 133.56 1 `% 2 I I c...1 , , L '� �� d01 amps m 60D amps 200.34 2 City/State/ZIP: I/y /S ) - ,(G 51 � c' � �j', �"I LtL 601 amps to 1,000 amps 301.04 2 Phone:( ��))C5'� 1) 0 t Fax:( ) Over 1,000 amps or votes 552.26 2 �( ��, — Temporary services or feeders installation,alteration,and/or Email: -p(1 •)'7i i-1( /cj ' b.(f IelpL- - (Cui.-t relocation Owner installation:This installation is being ma a on property that 1 own which is not 200 amps or less .59.36 I intended lin-sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: — Date: 401 amps to 599 amps 168.54 2 ® APPLICANT ® CONTACT' PERSON Branch circuits-new,alteration,or extension,per 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 without Address: 11815 NE 990'Street,Suite 1200 service or feeder fee,fust 56.18 2 branch circuit City/State/ZIP:Vancouver,WA 98682 Each add'!branch circuit - 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)573-8081 Fax: :(360)574-6401 Each masulitetured or modular Email:permits@buildplh,com dwelling,service and/or feeder 6784 2 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 circuits)or limited-energy Sec Page 2 2 Address:2920 SE Brookwood Ave,Suite A panel,alteration,or extension. City/State/I,IP: Beaverton,OR 97006 Each additional inspection over allowable in ally of the above Additional inspection(I he milt) 66.25/hr Phone:(503)648-4552_ Fax:(503)642-7925 Investigation(I hr min) 90,00/lir Email nnnorato@garnerelectric.com Industrial plant(I hr min) —� 78.18/hr Inspections for which no fee is CCB I,Ic.: 121159 Electrical L' .: -305( Suprv.Lie.: 3101 S specifically listed(Yr hr min) 90.011!hr — ELECTRICAL PERMIT FEES - Suprv.Electrician signature,require Subtotal; Print name: Chuck Garner f r e `' (25% 3 '. °" r r_. Date; '_�2 f6iI i + 0 Plan Review Required of permit fee): y ' 1.x _ r�' State surcharge(12%of permit fee): _ Authorized signature: iL `,4 Tarn',PERMIT FEE: ///�� r This permit application expires if a permit is not obtained within 189 -Print name: Cap/)5e A -' /f Kid/ Date: 4-66/l Cl, days after it has been accepted as complete. G1.[ y L/1. ' Number of inspections allowed per permit. 1 ltuildim 2Pmitx'P'ir_pauaiWyp 14.11.lilt:Arw 14..4/6H746+5 44p:aor Till TOJSitvrVWEII - _ Electrical Permit Application—City of Tigard Page 2---Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: --- FEE SCHEDULE D9 ipdon Oly. 1 Each 1 Total 1 " Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work involved: 5.01 to 15 kva 133.56 2 11 A• udio and Stereo Systems* 15C1 to 25 kva 200.34_ 2 Wind generation systems in excess of25 kva: Burglar Alarm 25.01 to 50 kva 301.01 2 50.01 to 100 kvn 552 26 2 Garage Door Opener* >100 kva(fee in accordance — _2 with OAR 918-309-0040) 552.26 11 H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7,42 3 I 1 V• acuum Systems* >100 kva–no additional charge 0.0 3 Each additional inspection over allowable in any of the above_ 1-1 O• ther: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) — Inspections for which no fee is 90.110/hr specifically listed(%a hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERM-IT FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 ' Number of inspections alluwed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: Audio and Stereo Systems E Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation I iHVAC Instrumentation Intercom and Paging Systems I I Landscape Irrigation Control* I Medical Nurse Calls Outdoor Landscape Lighting* I Protective Signaling Other: Total number of commercial systems; *No licenses are required. Licenses are required for all other installations I'13uitding\Pennils',.ELC_Per App—ELR_ERE dee Rev-06111'2015 Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE ESF ONL\ City of Tigard Received Permit No.:w57-" ._I et_Q\ Date/By: i 1 13125 SW Hall Blvd.,Tigard,OR 97223 APR 01 2019 Plan Review '�\ \` Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: Date/By: Ti G A R D Inspection Line: 503.639.4175 Ut i-Y OF 1 IGAR® Date Ready/By: rur s: ® See Page 2 for Internet: www.tigard-or.gov o M 1 r Notified/Method: Supplemental Information r'-. ''" ,.. ,>,; .t." 3r ,- x.x..... . . ; :.F',.,,....-. ...« ,F�`.. ., ' ,'...-. .. .3, ...:.ass z wtz"a. `sYz %w'... i,;; ., wa :.:.`.'.' rw';; ❑New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total El Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) k � ryr�r; er p ';', ":"'' t ' n *7?; tom`!", f f z ? rr .b SFR(1)bath 312.70rs t , r ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 1 437.78 437.78 ❑Accessory building ElMulti-familySFR(3)bath 500.32 Each additional bath/kitchen .5 25.02 12.51 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 4.0044,.:4$7, 000;',':...'" ;• , 4 3 �„7.�`,'� 1, '. r ,. ' 1 �1 i f" ,g# 4 f{0> '%1, ,r v r�'' �;f " "��" Site utilities: Job site address:11123 SW Gabriel St. Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97123 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Willow Brook 28 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:<100) Page 2 Storm sewer(no.linear ft.:<100) Page 2 Water service(no.linear ft.:<100) Page 2 Subdivision:Willow Brook l Lot no.:28 Fixture or item: Tax map/parcel no.:2S115AB08300 Backflow preventer 1 31.27 rtra 41/4 110. ,,I M r : 1y 9 �u Z r y� r �� Backwater valve 12.51 WSP 1 „r ?4 � ; ' . f f ,k3 Clothes washer 1 25.02 SFR 4 bedroom 2.5 bath Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 f.,, ,� r Y _ .; #x v;..ro „6 tSrt t.; 3/,;,. �' 7 �'* r:�✓,' a i?-= Expansion tank 12.51 s.` J '. .4 sDl 0. f j" .0 �j 1 f .. a xrat2 h'.3,�r,;. . �� .,,....=,..;.,),•r...;��r .� r� .v''� :' �,. „af�frl„`rl�..,� r�,. r,>, x„�,,...., f�,'.�'�`�'1/1- Name:Pacific Lifestyle homes Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:11815 NE 99th ST Suite 1200 Garbage disposal 1 25.02 City/State/ZIP:Vancouver,Wa 98682 Hose bib 2 25.02 Phone:(360)573-8081 Fax:( ) Ice maker 12.51 %f , ff f aya t,-T,r fry fti� `" f . , i ' 7' • ;�; �rr a, Interc tor/ rease tra , F . r k , !-`/t' ir „ eP g p 25.02 Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Permit Coordinator Roof drain(commercial) 12.51 Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 5 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 fr r r " r /r ;f r 1, r i r us Water closet 3 25.02 f„, , , , , x ; ,, ? ,f , .s rh , ; f Water heater 1 37.52 Business name:Lippold Plumbing and Heating Water piping/DWV 1 56.29 Address:PO BOX 895 Other: 25.02 City/State/ZIP:Boring,OR 97009 Subtotal Phone:(971)404-7012 Fax:( ) 7 Minimum permit fee: $72.50 CCB Lic.:201597 Plumbing Lic.no.:PB144 Plan review (25%of permit fee) � , / py State surcharge(12%of permit fee) Authorized signature: �Ld-7 / t y2 yl eA_ I( /IJ Ex--_e_ TOTAL PERMIT FEE Print name:Summer Dowell Date:3/28/19 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. -Pee methodology set by T1T-County Shirai$$IMuSTry Service Board. -- I:\Building\Permlts\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 4.11111111 - Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su a a ression S te sms: x Footing dram-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: Asa l ��r Water Service-each additional 100' 37.52 t, $b g �� 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 each additional$100.00 or fraction thereof,to ;4.7,A4,;•%„1, . � , ssf .., .;� 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 cha :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 cha •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 cha _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* Qu by e T ;' e # , t r j ,s., FixtureT fox eappea. Ame *eIocate =` Plan review is required for any of the following. ° Please check all that apply. Baptistry/Font 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. Car Wash Drain 0 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:\Job Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 28\Pe2nits and Inspections\PLB_PermitApp.doc City of Tigard v?PICOMMUNITY DEVELOPMENT DEPARTMENT III T 1 c A R D Building Permit Review — Residential Building Permit #: \\(\c--c'9\Ckl_ ( CU( Site Address: 11 I_73 5 w 6,44-;et S-71. Project Name: W-/),04/.2 1 Book Lot #: 07 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: AJe411 .CFR Verify address/suite#active in Accela. ❑ In River Terrace: �No ❑ Yes,River Terrace Review Addendum Site Plan Elements: ion Control 2opies of site plan on 8-1/2"x 11"or 11 x 17"paper gained trees with drip line and tree protection measures -Drawn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE arrow ,.motility locations&easements(required for new and additions) SLS i address,project or subdivision name and lot number .-2-Sidewalk/driveway approach inApplicant information(name and phone number) �,St� wells/septic systems of dimensions and building setback dimensions .I��,�reet tree size,type and location ElSgaxre footage of buildings to be demolished ..2 eet names -DErizisting-stfuctures on site - eur er elevations (2'contours if more than 4'differential) j2r-ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced?-EtTes E No r.j-5;4/ impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? CI Yes [Nds*J 5;P Clean Water Services–Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified 2"---N-o Received: ❑ Yes ❑ No blic Facilities Improvement (PFI) Permit: Required: 12rfe–s applicant was notified E No Applied For: s ❑ No,stop intake . Land Use Case#: SV B a O/G-60611 ❑ Zoning: "7 r equired Setbacks: Front: ($ Rear: l5 Side: S Street Side: /v Garage: Er Building Height: Max.Height: 35 Actual Height: .aLandscape Arr • v % Lot Coverage Max: 76) Entrance ,®'"Set back no more than 8'from street-facing wall . Varallel to street or offset 45 degrees or less Windows .. 1 inimum 12%of area of all street-facing facades Garage 2roarage door is behind widest street-facing wall .lees ❑ No,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.window above garage on 2°d floor. - Garage door width is ID 12'or less X� 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim E Window recess ❑ Window projection ❑ Balcony Visual Clearance I trban Forestry Plan 'Sensitive Lands: ❑ Yes 2--No Type: ,B'Conditions met pri,rjo issuance of}building permit Notes: �oe7CI' ia,f /c-e me"/ %�:o� �c e i4ktnc_2 ❑ Approved By Planning: Date: 21////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\BldgPermitRvw RES 022819.docx Building Permit Submittal Original Submittal Date: I� ' Site Plans: # Building Plans: # Building Permit#: CYC'Enter building permit#above. N/ Workflow Routing: 2 Planning 2'Engineering [2/Permit Coordinator [ Building Workflow Sign-off: l ' 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: Date: U, I\ '\0, Engineering Review E Slope at building pad: 30 E - nditions "Met"prior to issuance of building permit [ Easements (encroachments)per engineering conditions of approval and plat 2-Tater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes �No Assess Water Quantity Fee in-lieu: ❑ Yes l No LIDA Facility on lot: ❑ Yes 2'-No 8''1 final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes:/ L� Approved by Engineering: /214., teR/4.. Date: 14 •2-/ ' 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: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: 'Yes ❑ N/A Tigard Trans SDC: Efes ❑ N/A Parks SDC: Yes ❑E NJA LIDA ❑ Yes LAN/A OK to Issue Permit 71_ Approved by Permit Coordinator: Date:"4 I:\Building\Forms\BldgPennitRvw_RES_022819.docx Electrical Permit Application AUGFOR OFFIM. I sr.011.1 Cl of Tigard AUG 7 2019 Received permit Y /7- O/// �+ Date/Liv' - '+' /. ftp '+ 13125 SW Ilan Blvd.,Tigard,OR 97223 _ �_. g s .,Flan Review It Phone: 503.718.2439 Fax: 503.598.1960,,,,f\r k.:,,q- 6 , ., ,?' _,batelBv: Related Permit u Inspection Line: 503,639,4175 ?) I)i "'4 iltkly Date/BY:funs mmm ® Sec Page 2 for. _ I I('ARI) Internet: www.ligard-or.gov " .--- ' ` Notitied/Method Supplemental Information 'a-, 2 ,.' 0 ,la`7.7 a :: tm. ;Zw.t...,,.Z-m,.,w�.,, .all 1:+.�.�a*- a s. i; ®New construction ❑Addition/alteration/replacement Please check all that apply(s ,ubmit;sets of plans w/items checked) []Service or feeder 400 amps or more 0 Building over three stories 0 Demolition 0 Other: where the available fault current Marinas and boatyards fs 4 ' �� r exceeds amps or ®Floating buildings ' l � a i > J'' less to ground,or exceeds 14,000 0 Commercial-use agricultural huraly1-and 2-family dwelling 0 Commercial/industrial ❑ Accessary building qI amps for all other installations.: buildings, I Multi-family ❑Master builder ❑Other: 0 Fire pump 0 Installation of 150 KVA or �, g 3m, t# t, h os d � 0 Emergency system- larger separately derived ,, 1 Fit 'i t 1 , ' ❑Addition of new motor load of system.. Job#:90-18-0028 Job site address: 11123 SW Gabriel Street IOOHP or more C,tty/Stats./Z1P: Tigard,OR 97224 Six or retort residentied orals x ctrpancy, 0 Health-care facilities, 0 Recreational vehicle parrs Suite/bldg./alit, # Project name: 0 Hazardous locations. 0 Supply voltage for more than •WW 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: SW Durham Road,south on SW 113th Ave `, t)rtewitetiau m' t iaeh. 'teats! New residential single-or multi-family dwelling unit. Subdivision Willow Brook I L.,ot 4: 28 Includes attached garage. 1 `"' """'""" 000 Std ti 47r less .161 54 4 Tax map/parcel 4: 2S115AB08300/R2209688 Ea add'I 500 sq ft or portion 33.92 ! Stl • ( l'l �18' 1,. 4- _ a ,1i s &„.t�_ ) „4,7..w.5,;,,,1;., Limited energy,residential 7500 2 � ._o_ . ___. r Limited energy,multi family TS OC} 7 residential(with above std.11 1 r + ►.r # M rt '� , °°r .-.Renewable Energy See Page 2 s : u, .. a: - ,i . 7,�•z :.. ,,,, Services or feeders installation alteration and/or relocation Name: Pacific Lifestyle Homes,Inc. , 200 amps or less 100 70 , 2 201 amps to 400 arnpc 133 56 Address, 11815 NE 99th Street,#1200 - - - -_a--• ---- 401 amps to 600 amps i 200,34 7 / Vancouver,WA 98682 City/State/ZIP:IP: 601 amps to 1000 amps 301 04 2 i 1 Phone.( 360 )213-0813 1 pax:( ) (?ver 1,000 amps or volts 552.26 1 2 ` Temporary services or feeders installation,alteration,and/or Email: permits@buildplh.com relocation Owner installation,This installation is being made on properly that I own which is not 209 amps or less .1 59.36 r I 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 stops125.08 , 7 Owner signature: Date, 401 amp to 599)amps § l6854 2 . . Branch circuits-new,alteration,ornextenstoq,pew nei I uwr 4s 0 ! RE a. F da .. est= . l-_� ` -:-,!,,,--0,",t)14‘, � '� '. ..w _._.f_._e --, � - - � A.Pec for branch circuits wuh Business name: Pacific Lifestyle Homes above service or feeder fee, . I 47 2 ---�� --,•- -------�- .— ------ each branch circuit Contact name:Permit Coordinator B.Fee for branch circuits without I li _ _. _ service or feeder fee,tarsi I Address 11815 NE 99th Street,Suite 1200 branch ciruot 56,18 E Each arld'I branch circuit 7 42 (sty/State/IIP:Vancouver,WA 98682 1 ' ._ .. - t 'illseetlatteous rvlce or feeder not itieltidid, Phone (360)573-8081 Fax ;(360)574-6401 I Mach manutactured or modular 67 84 .e� - _ _ dweiim servYe and/cr feeder t .._ _... .. ...._... ... Email:permits@buildplh.com Reconnect only 67 84 d 15.,,, .5, ..,,Colt.,41. ; v ,.i...,,' ; ,--r.-.0.1,4,7o,.- Pump or irrigation circle 67 84 2 l i Business name:Garner Electric WA LLC Sign or outline lighting 67 84 _i2,:i • --:v --- e -_ - ■SeePa"e/ Address.dif�Valley Ave NW �e 106 ane! alteration or extension g (`ity/State/7rP: Puyallup.W A 98371 Each additional ins ection over allowable in any of the above -.. ,..�...�...... ......._. .....�.�,„, Phone:(253)872-6051 Jax:(253)872-1801 Investigation(t hr min) 90.00/hr Email:cgentele@gweusa.com (10 Industrial plant(I hr mm) _ 78 l8/hr ______. ......_ .__,_....__..._......... ...........______.,., _.._._.. _.n,.. ..... _.,_.,.. Inspections for which n0 fee is 9 / .. . .,,1 CCB Lic.: 208174 Electrical Liss.: Cl 158 Suprv. L ic,•T ;- .s s ie c specttily listed 1'h hr.„:!,,9 it )o /hhr E - _ _ Suprv.Electrician signature,required: .„--”" : �' 1tG -�"71Subtotal: Print name: Russell Magnuson___----------------,- Date: 1 I.Plan Review Required(25%of ermit fee) i State surcharge(12%of ermtt fee) f Authorized signature: r',r' ( 767;l Pk RNfI I I EE: c. .expires Ica permit is Print name: Bill I)aniels _ I Date: s I Numberhis nof daysit application gal hawed enrapcplefiaecepted as complete.not wit(ttm Ia0 1.\ituiidingwertnits`.ELC_Permit App_Ett,R_ERE.dot Rev 06/17/7015 440.4615'rt 1 I/05/COM/wttl