Permit (89) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00308
I t A R!� 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2019
T
Parcel: 2S 115AB07900
Jurisdiction: Tigard
Site address: 11173 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 24
Project: Willow Brook, Lot 24
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1854 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 16 Bathrooms: 2 Second: 0 sf Garage: 433 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 1854 sf Value: $248,140.93 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add']500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1854
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
--448t5ivE-9vfi-efl 44ett ___._..-Item-st99i#8itiliee a l _--_ _ ---._- _----._-__ —_____
VANCOUVER,WA 98682 VANCOUVER,WA 98682
PHONE: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $31,963.98
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi.-tion Center. Those rules are set forth in OAR
952-001-0010 through OAR -001-009 . You obtain a copy• the rules o direct questions to OUNC by callin• •03.232.1987 or 1.800.332.234
/
n �J •
Issued By: Permittee Signature: .4/All !
Call 603.639.4175 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.
Biilding Permit Application
Residential FOR OFFICE LSE ONLY
Cityof Tigard q i Received 4 e y. _ PermitNo.: , ; 7/ ' - ,
E Date/By: / 4't = 1 /� J C .d L/
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �/� � ��
I
Date/By: ( / Other Permi.
Phone: 503.718.2439 Fax: 503.598.1960 e� •
° " !"r 1) �!I) Date Ready/By: T p� oris: H See Page 2 for
T 1 t;A 1:D Inspectionerne: Line: 503.639.4175 1 t L / Supplemental Information
Internet: www.tigard-or.gov No d/Method: / � PP
i Y t t 4 ' t‘ L1. _ 'x _
ss im d k xx,q d H!"'''':'7'7;.,7-7:'70:::';. .,,,,";;;;-:,0-g'0-07,-7;-;,,',0•,-;;---.:,x,.,,,.. s•.qm,
-a r 01 g.', r0 r '''''.72. 1'''''''7'''-�. r „*-0:','% 0'0;, # nr,,g I $ 4° . ,'� r,,z A.. n 0,z bAA.- :07,—,-.--,,;;.:-.7,-;7:-.;;;;;t-_,..7,-7,--;',"•?,!. ,, ,,,- L., .., «.,.:
", .,r,r .0,- -. . c"r',, fir.F ..x 0:—,,,,,,,,,, aa� ,o r� :,.: r '= . .. er:
r� ;r �.,�,,. :{.fes,;rr ,•-,„r .,� >. .„�,.�
❑Demolition Permit fees*are based on the value of the work performed.
®New construction Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement D Other: equipment,materials,labor,overhead,and the profit for the
4 4 ��, s s; t ®1 t .�, ,r r N4** work indicated on this application.
:: : .,, � , a�'3,1Y°
Valuation: n- ,
® 1-and 2-family dwelling ❑Commercial/industrial
Number of bedrooms: 3
0 Accessory building 0 Multi-family
[:1 Master builder
CI OtherNumber of bathrooms: 2 .
. r s;f 2 Total number of floors: 1 �-.e
l)°Y� ) i: all ,i„
,; . r�rr„y.sl,r"'�i J,;.,%5, r. ..,:',1,,,,,•;1;,./;.,•,.;',1-•,,,,,,„,•ss;r „,,,,,-,1,4 W. _ > .
Job site address:11173 SW Gabriel St New dwelling area: ,�• ��i7'-.ware feet ( .,'l.+
City/State/ZIP:Tigard,OR Garage/carport area: 433 square feet lI
Suite/bldg./apt.no.: Project name:Willow Brook 24 Cove edti rch area: square feet
Cross street/directions to job site: • >a< square feet
Other structure area: square feet
s0 ,.''''''' '''-i''''..;;;441:47;71';c8,• 1 4y 3` 11 ,, rt
.,# , l ,0
Subdivision:Willow Brook Lot no.:24 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:2S115AB07900 equipment,materials,labor,overhead,and the profit for the
r.r r ri” � ;r ' t g V, f I g r4 r� O ,: work indicated on this a..lication.
New SFR 40'x 55'with a 4'nook bump out.Covered entryway and covered deck
Valuation: $
Existing building area: square feet
3 bedroom 2 bath with a 2 car garage.
New building area: square feet
/ ; F;f i . , ,,.s +,' rsrFr '"04#te ry 'gr ' i Number of stories:
` f1 . ,'tP'' ; 4g ?
Building Permit Application Checklist ,,
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
0 13125 SW Hall Blvd.,Tigard,OR 97223 Dateciat Permit No.:
I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
I 1 C A(:D 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. El ❑ El
3 Verification of approved plat/lot. ❑ ❑ 0
4 Fire district approval required. Name of district: ❑ El ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 ❑
6 Sewer permit. 0 0 ❑
7 Water district approval. 0 ❑ 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. El ❑ 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state El El ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ 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- El ❑ ❑
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. El ❑ ❑
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- El El ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ El
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
—
20 Manufactured floor/roof truss design details_ 0 ID ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required El El 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 El
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. El ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. El El ❑
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. 0 0 ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ El ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, El ❑ El
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, p ❑ ❑
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)
FOR OFFICE USE O Lv
McT,hanical Permit Application
Received
City of Tigard ` Permit No. �'
�� = `J g .-.T 3"", g y �,-bate/By: ����✓�.>�''�• VU
q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960c 1 1 j( Date/By:
Inspection Line: 503.639.4175 ,� l. "�
T 1 G A R D Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov y -;;Notified/Method: Supplemental Information
F..,, ,,. Y Z
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
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:
"�,ia",'r'✓°`,c':.�; 0; 1 ,;rf '1,i5 tfi.+.tr �-,„+r
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
,' ,.; - Heating/cooling:
0 off 1°V'x'2'0*� 14: Ica 1. 1}„ �8 ”"AA ,�1 ,�. • r``4
Air conditioning 1 46.75
Job site address:11173 SW Gabriel St Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Willow Brook 24 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 Lot no.:24 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2s115AB07900 Water heater 23.32
,'19,;40,;40444.0W;44.420:`,
` ' Gas fireplace/insert 1 33.3944;Wr; r I / 4 ^ ?
Flue vent for water heater or gas
New SFR fireplace 1 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
, ,r r� Other: 23.32
,' ;�" l W ' . Pt.I F, `1•. f �`•^+�✓.,' - s}?t'-`�'. ?'e4., �'d`
Environmental exhaust and ventilation:
Name:Pacific Lifestyle Homes Range hood other kitchen
equipment 1 33.39
Address: 11815 NE 99th ST Suite 1200 Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32
Phone:(360)573-8081 Fax:( ) Attic/crawlspace fans 23.32
r � � r r� � �r z"' '' n � '.�r ,l f 07,03, � r�r'�f2 Other: 23.32
��&r /n-Px y� pm, 84 i1)> c k Ilr a
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 Fax: :(360)574-6401 Fireplace
Range
E-mail:permits@buildplh.com 1f
Barbecue
'` ,?=7; J "`,'fi " f Clothes dryer
(gas)" //it� i dfs4r 410; ;
Other:
Business name:Area Heating+Cooling j l
V01-):74:1”44,0de ;t74():,
):,
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
days after it has been accepted as complete.
Authorized signature�' ! /' ��-� .'�V� '✓ �' * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:7/24/19
440-461 TT(11/02/COM/WEB)
I:\Building\Permits\MEC_PermitApp_040113.doc
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
F'
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application
LL , .
City Tigard ' :ftec'Aived • . ''
of 1 igard { , s Re,,-,wed
Penna �� .,
1111 ' 13125 SW Flail Blvd,Tigard,OR 97223 Plan Rev ew
II Phone' 503 7[8.2439 Fax 503,598.1960 ii ii 9 4 Dt,IteiBy RelatedYertntty
Inspection Line: 543.639.4175 ,11✓ €t •
R,adv Date/By W, tvris Eil See Page 2 for
11i1AItD Internet www.tigard-ocgovhoo6cdlMethod Supplemental Information -
sp .cs'c ant' Please check all that apply(submit 2 sets of plans wiitems checked).
®New construction ❑Addition/alteration/r
❑Service or feeder 400 amps or more ❑Building over three stones
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards
'" a. ,' 9 t', , 4;: a _.. exceeds 10,000 amps at 150 volts or ❑Floating buildntgs
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less ro ground,in,exceeds 14,000 ❑Cnntmereial-use agricultural
amps Ott sill other installations buildings.
❑Multi-family ❑Master builder 0 Other ❑Fire pump 0 Installation of 150 KVA or
. E$+ r O: r' ❑Emergency system larger separatefv lensed
. ., 2tk 'f' ' } `y system
..
❑Addition of new motor load of
lob 4: Job site address: I •,- `-_; , ('i(l,_�Jl I`( t cj 10BHP or more 0"A 1,' 'l-2" "1-3"
. ,
t' "- _ ❑Six or more restdeutial units ixuipancy
' City/State/ZIP: .±( C'(f,1. C I C�' ' i 0 Health-care facilities. ❑Recreational vetticic parks.
l'--- "" "' ' .� '"--' 0 Supply voltage for more thou
I Suite/bldg./apt.4: Project name: 1 ❑Ha ardo r locations_
I
J L (✓ j(,r } i(+ ,- 600 molts oonunal
} � � Q Service or feeder 600 tunpx or more.
Cross street/directions to job site: :. f' t ` ,, F
W __ _ _ __ ,
Description ) Qty. Each 'ratel
_
Subdivision:;. � ^
New residential single-or multi-famil•dwellingunit.
_ -, ( • Lot 4: / Includes attached garage.
`
i
1 0 so Il.or less Z 168.54 4
`lax map/parcel 4: /'---> ' 1`)9 ( i t ( ( Ea,add'I 506 sq.R or portion 'L:. 33 92 1
E
Limited cher
..� ' h..� ;,,u; � .;',':1:.''''., 8Y,residential s yy p (with above sq ll.) 75 00 ,
q
i\• (�,( .! 'f-'1,:12- t ( t t -_ i 10 1 1 V---- ('t 1,, � 4 l ( l(t. Limited energy,mulls family 75 00 2
residential with above sq 1 j 4
Renewable Energy Sec Page 2
y ��. .tee t)' i ��� Services or feeders installation,alteration,and/or relocation
Name: I l c , i• 1 . i.i fA; • .1)'Li } 2 tramps of iasis 100,70 s 1 2
b C(i -
201 amps to 400 amps 131 56 t 2
Address: `` 14 I l_ti_ et`� ( �)( t C tui. _. i
�,� 401 amps to 600 amps 2)v 14 2
City/State/GIP: 601 amps to I000 amps 301 64 _4_2
_._. _.._. __ i
Phone:( ) Fax:( ) i •• Over 1,000 amps or volts 552.26 1 - / 2
%- Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not i 200 amps or less 59.36 t
intended for sale, lease,rent,or exchange.according to ORS 447,449.670.and 70 I. 201 amps to 400 amps all 125 08 2
Owner signature: Date. 401 amps to 599 amps anil
Branch circuits-new,alteration,or extension,per panel
dt s
A.Fee for branch circu:ts 111th d I
Business name:Pacific Lifestyle Homes above service or feeder fee, 7 42 2 1
each branch ctrcun
Contact name:Permit Coordinator B.Fee for branch circuits nohow
__ ° service or feeder fee,first
Address: 11815 NE 99t5 Street,Suite 1200 branch cin uu t 56 18
City/State/ZIP:Vancouver,WA 98682 Each udd'l branch circuit 7.42
t_`.
-- _-- Miscellaneous(service or feeder not included
Phone:(360)573-8081 Fax: :(360)574-6401 Each manufactured or modular 07 84
222-21- -.- - dwelling,servtee and/or feeder , 1
Email:permits@buildplh.com Reconnectnnly 6784 1
U _ �
PJ i" {?ik�: i�i � 2
�� - I� � Pump or irrigation circle 67.84 1 "t
Business name:Garner Electric WA LLC Sign or outline lighting 67.114 i 2 t
- Signal circuits)or limited-energy
- . Andress.4O a18y Aw-N-W Ste-466-_ . -- p See Page 2 2
(5tylSrarell[P:Puyallup,WA 98371 Each additional inspection over allowable in any of the above
.................... ... -..-_-_..,._.___..._.. ._.-.._-_ Aililtrivnal utapct<tiuu t I hi mitQ • 56 tot hi
Ph
ne:(253)872-6051
ht
F,moail:cgentele@gweusa.com Fax:(253)872-1801 /� lnduslriat' tforlwli lin) 78 18/hr
`/ t
/' plant(l hr mm) 78 18/hr''� 90 00118{v ( Inspcchon no ice is
CCB Lic.: 208174 Electrical Li ,: C.l 158 Suprv. ?U
?J s 'iflcall, listed V,hr min
,.
Suprv.Electrician signature,required: �/ _. Subtotal:
Print name: Russell Magnuson ---------- Date: 0 Plan Review Required(25°/u of permit fee):
State surcharge(12%of permit fee):
Authorized signature: X/7/1/(:::::;;*
r' ���/ tip IOTA)if PF:RMI t t(,E:
r.. 'this permit application expires a permit rs not obtained within lea
Print name: Bill Daniels Date: days after it has been accepted as complete.
..,..,.,... --- --------- ' Number of inspections allowed per permit.
1'.auildtngiPermksj.t C ParemitApp ft.R_ERI dcoe Rev05 15210' t49.4ol57tt USSiCOM,.'64El9
Pl' mbing Permit Application
Building FixturesFOR OFFICE LSE ONLY
Q o�
' , 'Recei
City of Tigard r ved
Date/By: Permit No c,-t- }1(�� C�T'F1,./`�
13125 SW Hall Blvd.,Tigard,OR 97223 ; y C t `�'�`�
■ Phone: 503.718.2439 Fax: 503.598.1960 !' i 2 `.u 1 � Date/By:Plan Review Other Permit No.:
i �
Inspection Line: 503.639.4175
T I G A R D Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov t t t• <r.= tified/Method:
B �� Supplemental Information
',fill(' y
®New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
fff� f r J f' 1 1 :> rrr !4fffi p
SFR 1 bath•./..'"#-.-;4p'.:'4,4;7"::;.4., 5,'
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 OtherFire sprinkler( sq.ft.) Page 2
:'41-af 'lf „Vs ,•,1 1. i , . ..'*-44,;,,P.:; „,,,', /,%.-f3 t /rr °N ," 00f 009.
'.v''/4"''''''' ."''',
sl" falfi,,,1 Pa „.s.44fF��. /. :.:: ;�'ftf� �ff14 StCUtlhtles
Job site address:11173 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.: Project name:Willow Brook 24 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 1 Lot no.:24 Fixture or item:
Tax map/parcel no.:2S115AB07900 Backflow preventer 1 31.27
' 7,;is ' J o .JrJ 19 " % i t .f rff� dfr '.'r r '
Backwater valve 12.51
4 u10114 ,i ,4ixii ir ;: . % . yrf 4XN
Clothes washer 1 25.02
Plumbing for SFR Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
7•4:V ✓ t o ' i . f f•:'; xff .1 0; v xrf
Expansion tank 12.51
. s ,.„ , � f ..17-;>Z04.-",41°'.4 rF f
Name:Pacific Lifestyle Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:Same as applicant
Garbage disposal 1 25.02
City/State/ZIP: Hose bib 2 25.02
Phone:( ) Fax:( ) Ice maker 12.51
"y'fr„fJ, 1. tg a.off'' "f„+h;` 3; �"�w, x r"faw, ","' B.t.;frl rs'"^
r 11 e °rrJ � Interc tor/ reale trap
0r 4 t f,,A 0f sa ff , ?,4•414•7". .. <,,, fa i f eP g 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Permit Coordinator
12.51
Address: 11815 NE 99'Street,Suite 1200 Roof drain(commercial)
t' Sink/basin/lavatoryk `-=`;' _'.1-;';'''...) 1
City/Sta(460)-173
tje/ZIP:":.Vancouver,pp��pp�� WA 98682 • Solar units(potable water) J62.54
(160 173'-'�l'S'1 ---___ __..___..___..,-raw..--(-368)-Y7-1-6101
E-mail:permits@buildplh.com Urinal 1
"1f 7ff54 � pf1 Z,'r ° 1n"' � vuJ ff
Water closet 1
, x ,i, ` %1 r s , `i, r.,F ` f,o , f% f fi
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).t State surcharge(12%of permit fee)
Authorized signature.: r� �' i
\ \ t TOTAL PERMIT FEE
Print name:Summer Dowell Date:7/24/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su I 'ression S stems:
h,
Footing drain-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 k xkS
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..t . ".W'f Al »� 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*.
, +,t¢ 1 a r oar 3 a b r s
+ a a
ire Type for Plan review is required for any of the following.
Wiwi;Perfgule °ate s ' 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 Thm ❑ 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 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
P:Uob Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 24\Pqmits and Inspections\PLB PermitApp.doc
City of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
11111
T I G A R D Building Permit Review — Residential
Building Permit #: MS's \G-U6 C6
Site Address: ///9-3 ,c) ( h / c
Project Name: d0%7/0u) jf ()J Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pro/osal: ✓ t1
I Verify address/suite# active in Accela. n River Terr e: NJ No ❑ Yes,River Terrace Review Addendum
Sit Plan Elements: L1dErosion Control
'opies of site plan on 8-1/2"x 11"or 11 x 17"paper •; 'o:tained trees with drip line and tree protection measures
�awn to scale(standard architect or engineer scale) E '..otprint of new structure(including decks)and FFE
Vorth arrow 1% r *ty locations&easements(required for new and additions) .
e address,project or subdivision name and lot number i►.Sidewalk/driveway approach
4Q aplicant information(name and phone number) Ii t..cation of wells/septic systems
E •t dimensions and building setback dimensions g SS et tree size,type and location
M'•uare footage of buildings to be demolished et names
I1 e:'sting structures on site vorner elevations(2'contours if more than 4'diffee ntial)
N. •t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace ? LIQYes 0
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown?0 Yes ACJ No
lean Water Services—Service Provider Lette of platted prior to 9/10/1995):
equired: ❑ Ye ,applicant was notifiedo Received: ❑ Yes ❑ No
L/J Public Faciliti Improvement(PFI) Permit: 1
quired: Yes,applicant was notified ❑ No Applied For: `VJ Yes ❑ No,stop intake
�and Use Case#: s(J t2O J— OOJ/// ❑ Zoning: � l
equired Setbacks: Front: /�" Rear: /S Side: Street Side: U� Garage: '` �
wilding Height: Max. Height: 1 Actual Hei ht: /5; S-
Landscape rea: ...-20 %0 Lot Coverage May
Entrance pet back no more than 8'from street-facing wall V Parallel to street or offset 45 degrees or less
Windows um 12%of area of all street-facing facades
Garage rIli Garage door is behind widest street-facing wall Yes ❑ 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 w and there is a 12 sq ft.window above garage on 2nd floor.
(!J Garage door width is ❑ 12'or less 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
` ❑ Accent siding C Window trim ElWindow recess ❑ Window projection ElBalcony
i 4 isual Clearance /Ij'es
rban Forestry Plan /
II ensitive Lands: ❑ No Type: Ll/�tA.A., /k7L-
Iy6:
Conditions met prior to issuance of building permit
Approved By Planning: _ /// Date:
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: "-A-' I‘Ci
Site Plans: #
Building Plans: # 3
Building Permit#: Er Enter building permit#above.
Workflow Routing: 2/Planning ®'Engineering [ Permit Coordinator [ Building
Workflow Sign-off: [/Sign-off for Planning(include notes from planning review)
Route Application Documents: ["Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
IS/Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: -......4AA Date: ' t eG,
Engineering Review
2<-3-e at building pad: 027
2onditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
ater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes �\To
Assess Water Quantity Fee in-lieu: ❑ Yes
LIDA Facility on lot: ❑ Yes No
I2- Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
L7rcpproved by Engineering: 4¢40 Ks Date: 7,3& -I q
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: /
VDC Fees Entered: Wash Co Trans Dev Tax: IP/Yes ❑ N/A
Tigard Trans SDC: E Yes ❑ N/A
7Parks SDC: es ❑ NJA
LIDA
El N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 73'
iii 1
I:\Building\Forms\BldgPermitRvw_RES_022819.docx