Permit (7) CITY OF TIGARD MASTER PERMIT
1 . COMMUNITY DEVELOPMENT Permit#: MST2019-00349
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2019
Parcel: 2S 115AB06000
Jurisdiction: Tigard
Site address: 11444 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 5
Project: Willow Brook, Lot 5
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 985 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1320 sf Garage: 676 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2305 sf Value: $315,211.78 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 RainStorm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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: 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 2305
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: $33,428.76
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 obtain a co• • e ru- • direct questions to OUNC by calling•03.232.1987 or 1.800.332.2 4,.
)# i i l i
Issued By: ; Permittee Signature:
--e_g_
39.4175 by 7:00 a.m.for then- . ailable 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
RECEIVE
Residential FOR OFFICE USE ONLY
City of Tigard AUG 2 9 2,� Received Date/By: ! r�
1111 L! !� ,j� , Ji �v�`/
. 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGHRD Plan Review Q �
Phone: 503.718.2439 Fax: 503.598.196(U I L D I N G DIVISION Date/By: 1 I U f 1 �� ---' ,&t'
I f C A R D Inspection Line: 503.639.4175 Date Ready/By: / I Juris El See Page 2 for
Internet: www.tigard-or.gov tified/Method: �1 I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION
® 1-and 2-family dwelling El Commercial/industrial Valuation: ,000 l ` ,
0 Accessory building ❑Multi-family Number of bedrooms: 4
❑Master builder 0 Other: Number of bathrooms: x 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 2 1 10 (
Job site address:11444 SW Gabriel St New dwelling area: 2305 square feet X37
City/State/ZIP:Tigard,OR Garage/carport area: 676 square feet a Vs--
Suite/bldg./apt.no.: Project name:Willow Brook 5 Covered porch area: X square feet
Cross street/directions to job site: Deck area: 0 square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Willow Brook Lot no.:5 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S115AB06000 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SFR 40'x 44.5'4 bedroom 2.5 bath with a 3 car garage.Covered patio Valuation: $
Covered entryway. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99th Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)573-8081 Fax:(360)574-6401 New:
APPLICANT /1 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Pacific Lifestyle Homes (Please refer to fee schedule)
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:
E-mail:permifs@buildplh.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business 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
je_
�� Total fee due upon application: $201.60
Authorized signature:/ •J i)v ]J/'�'/ \ This permit application expires if a permit is not obtained
1 1/C x within 180 days after it has been accepted as complete.
Print name:Summer Dowell Date:8/29/19 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist ..
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
-IN ■ 13125 SW Hall Blvd.,Tigard,OR 97223 AssociaDate/Byted
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
T I GA K D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes 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. ❑ ❑ ❑
4 Fire district approval required. Name of district: • ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. 0 ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
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 ❑ 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
lheet 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 El ❑ ❑
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 0 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 ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/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 .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". ❑ ❑ ❑
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. ❑ 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 0
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, ❑ 0 0
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)
Mechanical Permit Application FOR OFFICE USE ONLY
ry r CE
I E Received
City of Tigard �� jr� Date/By: Permit No.:
- 0 13125 SW Ha11 Blvd.,Tigard,OR 7
Phone: 503.718.2439 Fax: 503.598.19 Plan Review
`A U G 2 9 2,01g Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
cITY OF TIGARD
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CHE ST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address:11444 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 5 Duct work 1 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydropic) 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.:5 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S115AB06000 Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
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
Oth
® PROPERTY OWNER 0 TENANT er' 23.32
Environmental exhaust and ventilation:
Name: / Range hood/other kitchen
-}'t-1 1 (.L r:( } , (`l4_,-i, j , t:(.-i t equipment 1 33.39
Address: Clothes dryer exhaust 1 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 7 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans , 23.32
El APPLICANT ►1 CONTACT PERSON 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. 1
Address:11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater 1
Phone:(360)573-8081 Fax::(360)574-6401 Fireplace 1
Range 1
E-mail:permits@buildplh.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Area Heating+Cooling Other:
MECHANICAL PERMIT FEES*
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
jj / ) days after it has been accepted as complete.
Authorized signature: '�/0l LC �_ �i ���� * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:8/29/19
1:\Building\Permits\MEC_PennitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$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
1
Electrical PermitYAQjj ati01' FOR OFFICE USE ONLY
4.,Z2-...,..,.::,:,:m Received
irkgftgal City of Tigard ECEIVE® Permit 4:
IIIr v 1... L)Ite/13y:
ft
" 13125 SW Hall Blvd,Tigard,OR 9 Plan Review
Phone 503.718.2439 Fax: 503.598.1960 Related Pennit 6:
DatclBy:
s a Inspection Line: 503.639.41 75 AUG 2 9 2019 Ready Date/By: runs. See Page 2 for
' _- Internet' www.tigard-or.gov NotNotified/Method: ( BI Supplemental Information
- TYPE x ,,111 ( TiGARD •PLAN REVIEW. .
®New construction ❑ Addition/Aeration/replacement Please check all that apply(subunit 2 sets of plans wlilcros checked):
❑Service or feeder 400 amps or more 0 Building over three stories
❑ Demolition ❑Other: - where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-land 2-family dwelling ❑Ctmunercial/industrial [1:1 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps fix all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other, 0 Fire getup. 0 Installation of ISO kVA or
JOB SITE INFORMATION AND LOCATION •• 0 Emergency system. larger separately derived
�(/� 0 Addition of new motor load of system.
,lob#: Job site address: 114114 s(.&/ ((Cluj e, n 100H'or more. ❑"A" "F" "1-2""I-3„
r- 1 ❑Six or more residential units occupancy.
City/State/ZIP: I a...fre / 2-1 �—
❑Health-once facilities. ❑Recreational vehicle parks.
t- 0 Hazardous locations. 0 Supply voltage for more than
SuileJblclg./apt. tl: Project name: L1)t(_r;1, rz)l
---------.--_-- ---__—.._ 600 volts nominal.
---.---- 0 Service or feeder 600 sings or more. —
Cross street/directions 10 job site: FEE SCHEDULE
--_._
Description _ Qty. Earl, Totali._^__
r' � —_.. __ New residential single-or multi-family dwelling unit.
Subdivision: VV i �D�� I,ot#: Includes attached garage.
( {.Q _---- 1,000 sq.ft.or less _ 168.54 4
Tax map/parcel#: 2.... j !(a Aoct_c l a.add'I 500 sq.ft.orpotiion 33.92 l
DESCRIPTION OF WORK
Limited energy,residential 75.00 2
,a'`-' _(with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: C-��t 1 � . (( -4 /9 1£C,i(�� f- - , 200 amps or less 100.70 2
Address: `'1/ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/71P: 601 amps to 1,000 amps 301.04 2
Phone:( ) �1 Fax:( ) Over 1,000 amps or volts 552.26 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 200 amps or less 54.36 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 [S] CONTACT PERSON
Branch circuits-new,alteration,or extension,per panel
A.Fee Jar branch circuits with KU
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
service or feeder fee,first
Address: 11815 NE 99"'Street,Suite 1200 branch circuit56.18 2
City/State/ZIP: Vancouver,WA 98682 Each add'l 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,eorn 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
T _. Signal circuit(s)or limited-energy ❑ gee Page 2 2
Address: 2920 SE Brookwood Ave,Suite A panel,alteration,or extension.
City/State/ZIP: Beaverton,OR 97006 Each additional inspection over allowable in any of the above
Additional inspection(l hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(I hr min) - 90.00/hr
Email:m morato®garnerelectric.corn Industrial plant(I hr min) 78.18/hr —�
_ Inspections for which no fee is 90,00/hr
CCB Lie.: 121159 1 Electrical L''.: -305C Suprv.,Lie.:'310i 5 specifically listed(t4 hr mm)
- '- . . ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require Subtotal:
Print name: Chuck Garner r f r,y` Date: l `� 0 Plan Review Required(25%of permit fee):
., y�'. State surcharge(12%of permit fee):
Authorized signature: IA ``J TOTAL PERMIT FEE:
r This permit application expires if a permit is not obtained within 180
r
I Print name: I C �1 tai``/f di Date: ,- h/ 9MI1 q clays after it has been accepted as complete.
111 7 I ' Number of inspections allowed per permit.
I'.Buiklingtiermiis\ELC_PermitApp tiL.R tiRt.doe I1ev 06/17/2015 440-461514 11105/CosowLB
Electrical Permit Application--City of Tigard
Page 2—Supplemental Info nun t ion
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE.SCHEDULE -
Fee for all residential systems combined: $75.00 nesewan �� Each Total �_
Rennewable electrical energy systems:
Check Type of Work Involved:
5 lava or less —^— — 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 2S kva: ----Burglar Alarm 25-01 to 50 kva 301.04 2
50.01 to 100 ka 552.26 2
Garage Door Opener*
>100 kva(tee in accordance
2
with OAR 918-309-0040} _ 552.26
f i 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:
Each additional inspection is
O• ther: 66.251 hr
-------- charged at an hourly(1 hr loin)
Inspections 1hr which no lee is 90.00/hr
specifically listed('A hr inia)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n A• udio and Stereo Systems
Boiler Controls
n C• lock Systems
Data Telecommunication Installation
I I Fire Alarm Installation
HVAC
Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control*
Medical
E Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
I I Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
'13uitding\t e,;nits'•.ELC.,PenniiAp1_ELR_ERE doe Rev Salt 712015
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
. Date/By: Permit No.:
111 ll
13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 9 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Rim: H See Page 2 for
Internet: www.tigard-or.gov (BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I OW. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 1 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen .5 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11444 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 5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:<100) 1 Page 2
Storm sewer(no.linear ft.:<100) 1 Page 2
Water service(no.linear ft.:<100) 1 Page 2
Subdivision:Willow Brook I Lot no.:5 Fixture or item:
Tax map/parcel no.:2S115AB06000 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New SFR plumbing for 4 bedroom 2.5 bath Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
2 PROPERTY OWNER 0 TENANT Expansion tank 12.51
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
_' - "` ►4 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Permit Coordinator
Roof drain(commercial) 12.51
Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 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
Water closet 3 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Lippold plumbing and heating inc. WaterPg/
ip m DWV 56.29
Address:PO Box 895 Other: 25.02
City/State/ZIP:Boring,OR Subtotal
Phone:(971)404-7012 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:201597 Plumbing Lic.no.:PB1416
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: L Mild.* l 1-C r TOTAL PERMIT FEE
Print name:Summer Dowell Date:8/29/19 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-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty., Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Ins ections or Fees QtY. Fee(ea) Total each additional$100.00 or fraction thereof,to
hand 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace!
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
-4" Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food 111 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/Lay -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 5\Periits and Inspections\PLB PermitApp.doc
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Cityof Tigard Received
- g q (
Permit No.:
.1111 ■ 13125 SW Hall Blvd.,Tigard,OR 97 G L+ 9 p
PlanRe
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 TIGARD Date/By:
TIGARD CITY N Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov R•)11_ DIVISION Notified/Method:
Supplemental Information
TYPE OF WORK ��
FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description I Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
IDAccessory building ElMulti-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION , Site utilities:
Job site address:11444 SW Gabriel St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Willow Brook 5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Willow Brook J Lot no.:5 Fixture or item:
Tax map/parcel no.:2S115AB06000 Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
Back flow preventer for landscape irrigation. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER , ❑ TENANT Expansion tank 12.51
Name:Same as applicant Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ►1 CONTACT PERSON ' 4 Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Pacific Lifestyle Homes
Primer 12.51
Contact name:Permit Coordinator
Roof drain(commercial) 12.51
Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 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 12.51
E-mail:permits@buildplh.com Urinal 25.02
13 iWater closet 25.02
) ff. CONTRACTOR
Water heater 37.52
Business name:Trademark Landscapes,INC.
Water piping/DWV 56.29
Address:PO Box 2410 Other: 25.02
City/State/ZIP:Oregon City,OR 97045 Subtotal
Phone:(503)631-3893 Fax:(503)631-4737 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: �q �� �jPlumgbi�ng Lie,no.: State surcharge(12%of permit fee)
Authorized signature-����[ hi j l f/"v e.-1
�-t TOTAL PERMIT FEE
Print name:Summer Dowell Date:8/29/19 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-PemiitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Stonn&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
P 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.Performed: Capped Added Relocate9
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4 Isometric or Riser Diagram
Car Wash Drain ❑
Garbage -Domestic-non-food 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 5\Periits and Inspections\Irrigation app.doc
City of Tigard
Ifp COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G AR D Building Permit Review — Residential
Building Permit #: /At Sr/ W r'I---(3 i
Site Address: MIL/2/ a) 6 j-1,p( .974
Project Name: )&0 & k_ Lot #: s
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: -2 j�
70 Verify address/suite#active in Accela. ❑ In River Terra e: Lid No ❑ Yes,River Terrace Review Addendum
SitPlan Elements: Erosion Control
V3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper A tained trees with drip line and tree protection measures
VD .wn to scale(standard architect or engineer scale) A F,otprint of new structure(including decks)and FFE
r, .rth arrow % + .ty locations&easements(required for new and additions)
V,S. address,project or subdivision name and lot number I Sidewalk/driveway approach
plicant information(name and phone number) ,��.I�, ,cation of wells/septic systems
Lot dimensions and building setback dimensions 1V eet tree size,type and location
4°,4 uare footage of buildings to be demolished Y. reet names
V‘ sting structures on site Comer elevations(2'contours if more than 4'diff enttal)
7.Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replac Yes ❑ o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes No
;lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
K!Public Facilt Improvement(PFI) Permit:
equired: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
sUz(1(1;t:and Use Case#: 4S7462m1CQ— e,Od ❑ Zoning: "
equired Setbacks: Front: iS Rear: /' Side: Street Side: /0 Garage: %C)
9
.:uilding Height: Max. Height: 3S Actual He ht: tuG.5
IA Landscape ea: 1CJ% Lot Coverage May %
Entrance V t back no more than 8'from street-facing wall iDi Parallel to street or offset 45 degrees or less
Windows ' um 12%of area of all street-facing facades
Garage Garage door is behind widest street-facing wall ❑ Yes ✓o,one of the following is met:
❑moor 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. • ow above garage on 2nd floor.
Garage door width is CI 12'or less ❑ 50%orr/19aS of facade 0%or less and includes 7 of following:
Covered porch tQ Recessed entrance g Wall offset V'1'Roof eave V Roof offset
❑ ire shingles ❑ Lap Siding ❑ Roof pitch I Gable,hip,or gambrel roof ❑ Dormer
VQ Accent siding Window trim ❑ Window recess ❑ Window projection ❑ Balcony
IV,1• u isual Clearance a rban Forestry Plan
ensitive Lands: Li Yes ❑ No Type: /!& ' i
V Co 'tions met prior to issuance of building permit "�
No s:
Approved By Planning: _ ' L� 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\BldgPennitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: I__/ 7 7
Site Plans: #
Building Plans: #
Building Permit#: 0.tEnter building permit#above.
Workflow Routing: lanningngineering ermit Coordinator 7Building
Workflow Sign-off: Sign-off foraP1 nning(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: I /
B Permit Technician: a... /(7Y /��_I� I�� .��1/�,�/�/ Date:
',1185111MINNIMMEM r
Engineering Review
ErSlope at building pad: v Z
[W onditions "Met"prior to issuance of building permit
CL'"tasements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Er No
Assess Water Quantity Fee in-lieu: 0 Yes 0--No
LIDA Facility on lot: 0 Yes C'No
Ek-Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
g'.---Approved by Engineering: �� �� Date: 5/W/9
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved 0 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:
g'SllC Fees Entered: Wash Co Trans Dev Tax: i2/Yes ❑ N/A
Tigard Trans SDC: Pies 0 N/A
Parks SDC: Yes 0 N/A—
VLIDA ❑ Yes Yd'N/A
OK to Issue Permit . /� l/�
Approved by Permit Coordinator: /-Date: /
I:\Building\Fonns\BldgPennitRvw_RES_022819.docx