Permit (7) CITY OF TIGARD MASTER PERMIT
$ ' COMMUNITY DEVELOPMENT Permit#: MST2019-00420
T I G R.C0 A .. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2020
Parcel: 2S115AB07800
Jurisdiction: Tigard
Site address: 11199 SW GABRIEL ST
Subdivision: WILLOW BROOK SUBDIVISION Lot: 23
Project: Willow Brook, Lot 23
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 1814 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 0 Second: 0 sf Garage: 433 sf Front: 15 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: Yes
Total: 1814 sf Value: $226,047.87 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: 5
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'I 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 1814
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: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $31,804.01
This permit is issued subject to the regulations ntained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance wito -••roved plans. T permit will pire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: 0 -.on > oires y to follow e r adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throug *AR• 0 i090. Yo a 'e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ,/
Call 503.639.4175 by 7:00 a.m.for the next available inspection d9te.7 /
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.
Buildtig Permit Application
1�`"sidentlal 1 I FOR OFFICE USE ONLY
City of Tigard DReceived Permit No.: I���y
. all13125 SW Hall Blvd.,Tigard,OR 97223 NOV ���� Plan Review��� � f � ���� " �'
IN
Phone: 503.718.2439 Fax: 503.598.19 r"' Date/By: 1 I f elik
Other Permit: g�C�t t� 0��'50 S.--
Inspection Line: 503.639.4175 i1T� " I ': ' ;,.1 Date Ready/By: / # Juris ® See Page 2 for
TIGARD s! Per y p af" 9+• i14 Ay fi
Internet: www.tigard-or.gov .> ' otified/Methor , / 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
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling IDCommercial/industrial Valuation: •
,5259;06r ZZ(fI 041
ElAccessory building ❑Multi-family Number of bedrooms: 3
❑Master builder ID Other:
Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: 1 27 -11
Job site address: 11199 SW Gabriel St New dwelling area: 1814 square feet
City/State/ZIP:Tigard,OR Garage/carport area: 433 square feet
Suite/bldg./apt.no.: Project name:Willow Brook 23 Covered porch area: _,quare 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.:23 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S115AB07800 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 3 bedroom 2 bath with a 2 car garage,Covered entry and covered patio Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ 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:
F APPLICANT ® 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
Amount received:
Phone:(360)573-8081 Fax::(360)574-6401
E-mail:permits@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 lic.:173524
Total fee due upon application: $201.60
Authorized signature: 1-Le 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
Print name:Summer Dowell Date:11/13/19
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
Date/By: Permit No.:
71
13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
m Phone: 503.718.2439 Fax: 503.598.1960
TIUARD
24-Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing ❑ Mechanical
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. ❑ El ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ 0 ❑
4 Fire district approval required. Name of district: . ❑ 0 ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ 0 ❑
7 Water district approval. ❑ 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 ❑
9 Erosion control El plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ El ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 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. ❑ ❑ ❑
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 ❑ ❑ ❑
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 El El ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ 0 0
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 ❑ ❑ ❑
1 architect licensed in Ore:on and shall be shown to be a.plicable 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". ❑ ❑ 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ 0
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. 0 ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. 0 ❑ Cl
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 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, ❑ ❑ 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(I 1/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
Date/By:
• 13125 SW Hall Blvd.,Tigard OR 97223 c c
gA Plan Review
i Phone: 503.718.2439 Fax: 503.598.1960 4'. ''"�' Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris a See Page 2 for
Internet: www.tigard-or.gov NOV 13 2019 Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CHECKLIST
Mechanical permit fees*arc 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:11199 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 23 Duct work 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.:23 Other. 23.32
Other fuel appliances:
Tax map/parcel no.:2S115AB07800 Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
New SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER ElTENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 1 33.39
Address: Clothes dryer exhaust 1 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ® 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
Gas heat pump
Address:11815 NE 99th Street,Suite 1200
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
007 /6& This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized sign to * Fee methodology set by Tri-County Building Industry Service Board
Print name:Summer Dowell Date:11/13/19
I:\Building\Pennits\MEC_PermitApp_0401I3.doc 440-4617T(1I/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_040 I 13.doc 2
EIectrica Per Applicatimi roiz(*.incr. Lim,.()NIA'
City offigiird Received
Permit il:
;,. f t 3::::-•- 1-...... ,• : " 11125 SW Hall Blvd.,Tigard OR 972ti r-1 ,31„.1v1_.r-7,. Plan Review —
Phone:' 503.718.2439 Fax:' Datenty.
503,598.I)60 6"""'"'"r""'"' ' ?-,--,.,--''' Date/By: Related l'en»ii II:
Inspection Line: 503.6.39A 1 75 Ready Date/fly- lutis RI See Page 2 for
T 1 GARD NOV13 2019
Internet: www.ligurd-or.gov Notified/Method: Supplemental Information
TYPE OF ‘116IRIni 0-‘,- -- -, - ..
`' " i Lir IPLARD PLAN REVIEW
Please check all hut apply(submit g sets of plans%villeins checked):
r New construction 0 Addition/altettAlkitr, 7 filvici )r.
., f, - 0 Service or feeder400 amps or more 0 Buildingd over ace stories
0 Demolition 0 Other: where the available fault mimeo! 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps ai 150 volts or 0 Floating buildioga.
less to ground,or exceeds 14.000 0 Commercial-use agrienhinal
4 I-and 2-family dwelling El Commercial/industrial D Accessory building
amps for all oilier installations. buildings
[7] Multi-family Ej Master builder D Other: El Fire pump. 0 Installation oil50 K VA or
JOB SITE INFORMATION AND LOCATION 0 Onergeney system. larger separately derived
0 Addition of new motor load of system.
Job Ii: Job site address: 1 1 Ct StiC's 67A bn e-1 3-t- - 100HP or more.
0 Six or more residential wits occupancy.
City/Statc/Z1P:7— c,- / j Cle___) 0 llealth-cure facilities. 0 Recreational vehicle parks.
—
--,,, ,- 0 Supply voltage for more than.Suite/hldgiapl.
Suite/bldg./apt.#: , Project name: 1,4_ )1 x 1 C)1.. brt-,DkilJ ,:/2::,",'_.) 0 I•lazardous locations.
El Service or feeder 600 amps or more. C430 rill nomil,a)
Cross street/directions to job site: FEE SCHEDULE
_
Description I Qty. I End; I Toni' LL_
New residential single-or multi-family dwelling unit.
Subdivision: Lot II: Includes attached garage. __
' 1,000 sq.II or less — 1 I 68.54 4
Tax map/parcel 4: *
, )
,::)'
E W Ea.. W1 500 sq.it,or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
_ 75.00 2
f, - (with above sq,It)
,
ok, Limited energy,multi-family .
75.00 2
residential(wills above sq.I).)
. .
-- Renewable Energy 13 See Page 2
Ei PjjiERi ' OW' ' 1 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2.
401 amps to 600 amps 200.34 2
City/Slate/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552,26 1
Temporary services or feeders insiallation,alteration,and/or
Fmai I: relocation _
Owner installation:This installation is being made on properly that I own which is not 200 amps or less 59.36 1
intended For sale,lease, rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 mops 1 25,U8 2
Owner signature: Date: 401 amps to 599 amps _ 168.54 2
APPLICANT CONTACT PERSON
Branch circuits-new,alteration,or extension,per panel
El %
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
service or feeder fee,first
Address: 11815 NE 9941'Street,Suite 1200 brunch circuit 56,18 2
_
City/State/ZIP:Vancouver,WA 98682 Each add'I branch circuit 7.42 2
!Miscellaneous(service or feeder not included)
Phone:(360)573-8081 Fax: :(360)574-6401 Each manufactured or modular
67,84 2
dwelling,service and/or feeder
limail:permits@buildplh.com
Reconnect only 67 84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
— --- - . Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 2920 SE Brookwood Ave,Suite A panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Beaverton,OR 97006 Additional inspection(I hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) , 78.18/hr
Lilian: inin ora to(0,ga r nereled ric.coin
Inspections for which no lee is
90.00/hr
. .
C'CB Lie.: 121159 Her:Irk:al l;..: -305C Suprv. Lie::31 pi 5 specifically listed(%hr min) -
ELECTRICAL'PERMIT FEES
Suprv. filet:Irk:4m signature,require . Subtotal:
Print name: Chuck Garner
i 4,,
,,,,,,, : Date: 1 Iii-rqi 61 0 Plan Review Required(25%of permit fee):
r / p- '
Slate surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
. This permit application expires if a permit is not obtained within 180
, I
Print name: CIA,715 A adrj cli Date: 1 I-,5)/ 9 days after it has been accepted as complete.
--— " Nunther of inspections allowed per permit
I IltaildinspVerniinAFI.0 Permit App aft I ItC,sloe Rev 06117/2015 440-46 I 571 i ties/cora/wen
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
•
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
.yescripOon
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 Audio and Stereo Systems* 15.01 to 25 kva 200.3,1 2
Wind generation systcnis in excess of25 kva:
I Burglar Alarm 25.01 to 50 kva 301.04 2
_50,01 to 100 kva 552.26
I I Garage Door Opener*
>iou kva(fee in accordance
552.26 2
with OAR 918-309-0040)
I Heating, Ventilation and Air Conditioning
solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
Vacuum Systems* ›loo kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above;
Other: Each additional inspection is
66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is
90.00/hr
specifically listed(Ya hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
Number of inspections allowed pa permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
I I Audio and Stereo Systems
Boiler Controls
Clock Systems
I I Data Telecommunication Installation
n Fire Alarm Installation
I I HVAC
I I Instrumentation
EI Intercom and Paging Systems
I I Landscape Irrigation Control*
I I Medical
r Nurse Calls
I I Outdoor Landscape Lighting*
El Protective Signaling
O Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
IAwildi.op,,..,iipct.c Ir nil AppiSLR_ERE due Rev OW I 11015
Plumbing Permit Application
$nilding Fixtures ( FOR OFFICE USE ONLY
' Cr EICiEV.
City of Tigard w wed Permit No.:
q 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
NOV 01'b
lan Review
C Phone: 503.718.2439 Fax: 503.598.1960 ate/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description 1 Qty. Ea. Total
❑ Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 1 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11199 SW Gabriel St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Willow Brook 23 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:<100) 1 Page 2
Storm sewer(no.linear ft.:<100) 1 Page 2
Water service(no.linear ft.:<100) 1 Page 2
Subdivision:Willow Brook Lot no.:23 Fixture or item:
Tax map/parcel no.:2S115AB07800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
Dishwasher 1 25.02
New SFR Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Same as applicant Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 1 25.02
City/State/ZIP: Hose bib 2 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Permit Coordinator
Roof drain(commercial) 12.51
Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 3 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)573-8081 Fax::(360)574-6401 Tub/shower/shower pan 2 12.51
E-mail:permits@buildplh.com Urinal 25.02
CONTRACTOR Water closet 2 25.02
Water heater 1 37.52
Business name:Lippold plumbing and heating inc. Water piping/DWV 1 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)
Authorized signature.
aje0 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
c
Print name:Summer Dowell Date: 11/13/19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1 s`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 S5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
Other Inspections or Fees QtY. Fee(ea) Total
and including S10,000.00.
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.
Work Performed: Capped Added Relocate �1
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 ❑ Isometric or riser diagram isrequired for new buildings
Garbage -Domestic-non-food gg
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 23\Permits and Inspections\Plumbing for House application.doc
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Received
City of Tigard :" Date/By: Permit No.:
Illi a 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Q( y 0 Date/By: Other Permit No.:
Ti GARD Inspection Line: 503.639.4175 Date Ready/By: Juris ElSee Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
Ca New construction ❑Demolition
Description Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
t <.' i�z,t:> . •as .,t,. :,• Site utilities:
Job site address:11199 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 23 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 Lot no.:23 Fixture or item:
Tax map/parcel no.:2S115AB07800 Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Back Flow for Irrigation
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: 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 ® 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 99u'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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Trademark Landscapes,INC Water piping/DWV rn DWV 56.29
Address:PO BOX 2410 Other: 25.02
City/State/ZIP:Oregon City,OR Subtotal
Phone:(503)631-3893 Fax:( ) Minimum permit fee: $72.50
j 2%, i f;I /6 Plan review (25%of permit fee)
CCB Lic.: ` Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: .- 0.7k..)---e----q TOTAL PERMIT FEE
Print name:Summer Dowell Date: 11/13/19 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.
1:\Building\Permits\PLMU-PeanitApp.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 S5,000.00 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
h and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 S148.50 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 S 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 S 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 Relocate4
Baptistry/Font Please check all that apply.
Bath Tub/Shower ID 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 Thni ❑ 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 ElIsometric 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:AJob Folders\Oregon\Subdivisions\Willow Brook(113th Ave)\Lot 23\Peimits and Inspections\Irrigation application.doc
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
1101
T I G A R D Building Permit Review — Residential
Building Permit #: //?S7- ,j`K--U0tr�
Site Address: .1111 S i G n`a ST.
Project Name: kkfillov v rnk Lot #: L3
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review D ( u Cowl P�ro�osal: Pik/ S 1' . Qio It ) �i. 3 ll u L6,T'1J 2-9r` peke l l •cam j f 104t1
LSd Verify address/suite#active in Accela. +L7 In River Terrace: LJ No !❑ Yes,River Terrace Review Addendum
Sit- Ian Elements: oston Control
IS opies of site plan on 8-1/2"x 11"or 11 x 17"paper ,�Retned trees with drip line and tree protection measures
6 11 .wn to scale(standard architect or engineer scale) LLIK•tprint of new structure(including decks)and FFE
L ,rth arrow P :'ty locations&easements(required for new and additions)
2telddress,project or subdivision name and lot number ►Sidewalk/driveway approach
licant information(name and phone number) IPA .- ation of wells/septic systems
+,['Lot dimensions and building setback dimensions ��S eet tree size,type and location
Yam• are footage of buildings to be demolished ,L,�S.S�treet names
L :sting structures on site [ 'Corner elevations(2'contours if more than 4'differential)
P. .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ai' es ❑No
tm ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Ys�7No
l Clean Water Services—Service Provider Letter of platted prior to 9/10/1995): 1.-9
RR) utred: ❑ Yes,applicant was notified lfd" No Received: ❑ Yes ❑ No
[U/Public Facilities Improvement(PFI)Permit - toJ aik
quired: ❑ Yes,applicant was notified 2
Lid' No
nd Use Case#: $ Applied For: [ . es ❑ No,stop intake
UQZolb -D00(� SLR e16 OOOO �oning: �—
/ toL� Required Setbacks: Front: �S Rear: �� Side: S Street Side: �- Garage:
El Building Height: Max.Height: SS Actual Height: VI'
('Landscape 4rea: °/a kiAll,ot Coverage Max , 0/0
Entrance yS't back no more than 8'from street-facing wall lid'Pimarallel to street or offset 45 degrees or less
Windows [l/ um '?12%of area of all street-facing facades i,
Garage Garage door is behind widest street-facing wall IXes ❑ 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 wilif and there is a 12 sq ft.window above garage on 2nd floor.
gl Garage door width is ❑ 12'or less i0i 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 ❑ Window recess ❑ Window projection ❑ Balcony
,- isual Clearance L�U' ban Forestry Plan
Sensitive Lands: Ly' Yes ❑ No Type: Goo L, 1�Cvr'
Conditions met prior tio�issu nce of bt,ildin ermit
oteess•' Ci 4i 4 t" "t �r�, -. (l �,v�o� ✓�K
LVApproved By Planning: ,&.t C - Date: . ,i ('1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_0228 19.docx
Building Permit Submittal
Original Submittal Date: toy
Site Plans: # y
Building Plans: #
Building Permit#: El— er building permit#above. � //
Workflow Routing: Canning engineering [ Permit Coordinator L`i'"fuilding
Workflow Sign-off: [, „i off for Planning(include notes from planning review)
Route Application Documents: L5'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
o_ al plan review routing form.
R13u i1ding. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: —7
,�___ t Date: /1kik,.
Engineering Review
^ S`lope at building pad: �r
Ge' ; nditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
2-"Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ErNo
Assess Water Quantity Fee in-lieu: ❑ Yes l2r-No
LIDA Facility on lot: ❑ Yes ErNo
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
K--Approved by Engineering: li-N UA 1', 14- 2. Date: /1—J V -1'?
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Rion Notice 3: Date Sent to Applicant:
E SDC Fees Entered: Wash Co Trans Dev Tax: r es CI N/A
Tigard Trans SDC: s ❑ N/A
Parks SDC: Yes 0 1qA
LIDA ❑ Yes N/A
OK to Issue Permit
/l fi 41 67
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPennitRvw_RES_022819.docx