Permit Plumbing Permit Applicat' rat r
Building Fixtures FoR of iici: (-SE ONLY
�7 Received I� 1-7 �7
City of Tigard DEC 15 .IZZ 1z.ozc Nv Penult No.:'\I IS 1 �,b�41-CO to
13125 S W Hall Blvd.,Tigard,OR 97223 DateBy:
Plan Review
lig s • Phone: 503.7182439 Fax: 503.598 0 OFTIGARD I f j3/soul ACG, Other Permit No.:
UateBy:
iii_,ti1) Inspection Line: 503.639.4175 i1 DING
DIVISION Date Ready/By: )M �{f/1 I HSee Page 2 for
Internet: www.tigard-or.gov ��'�DIIW,.I Dt Notified/Method: /�!/K/0 -`�.L/ �j' Supplemental Information
TYPE OF WORK FEE* SCHEDULE
"TNew construction 0 Demolition For special information use checklist
• Description I Qty. I Ea. I 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
Y�` SFR(2)bath 437.78
kil 1-and 2-family dwelling ❑Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional� �bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(j sq.ft.)`7a Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: -f + id t -� Catch basin or area drain 18.76
'Zit
( I ,l - , Drywell,leach line,or trench drain 18.76
City/State/ZIP: `CV-s .. - (10_�-�"
Q� � Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:93 eyJ 14-I Project name:e..0C11 _ Manufactured home utilities 50.03
Cross street/directions idjob 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: ticOn Nlc_' li,t G211'� I Lot no.:'�-et Fixture or item:
'Fax map/parcel no.: -�tf Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
�1 t� ` 1 I it2s _-- ®� Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 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
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: -
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
1 • ' Water heater 37.52
Business name: lr I'),ci 0 (,%lrtt t,Ly�E= (/1 6( . Water piping/DWV 56.29
Address: 10. if( -, t_dk.1. r)l (L �L. ))stAl.I Other: 25.02
City/State/ZIP: <1-Q norkcag ( _ Q(% (X9 Subtotal
Phone:(( lG{.7.� /-l9 Fax:( ( (, o 7 q/ gii/ Minimum permit fee: $72.50
CCB Lie.: //.2_7 Plumbing Lie.no.: `G-(c - if Y Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signaLyLe: 4. TOTAL PERMIT FEE
Print name: ery.. wet, Date:rL�,'1 J rr-V 4J This permit apphraa ftetmrn
it expires tf a permit is not obtained within 180 days
has been accepted as complete.
'Pee methodology set by Tri-County Building Industry Service Board.
1:1Building\PermitsWLMU-PanoitApp.doc 10N1/09 440-4616T(10/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
s ' COMMUNITY DEVELOPMENT Permit0: MST2019-00102
Date Issued: 09/09/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S107AA07900
Jurisdiction: Tigard
Site address: 14391 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 79
Project: Polygon at Roshak Ridge, Lot 79
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 562 at Basement: 85 sf Left: 0 Parking Spaces. 0
Height: 28 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors. Yes
Total: 1209 sf Value: $165,002.85 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 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: 3
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: 2 201-400 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 SFA VB R-3 1209
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Required Prior Tp
Pour
3 NFPS 13D Spronklers
PHONE: 360-695-7700 PHONE: 360-695-7700 Required
FAX:
Total Fees: $24,536.40
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. T •' •=rmit 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 y•, • 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. Y•.. y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987
orr/1.800.332.2344.
Issued By: %i, '_=.. Permittee Signature: 4t
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
is 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.
\-A-0 L't \c\(3 # \*
� 0
Building Permit Application _[�
. 7\--- —3\--q
Residential tEGEI M�]
ED FOR OFFICE USE ONLY
Received Permit No..}`, ( ^�
- City of Tigard 1AR 1 2019 Date/By. 3JIa � c1 -�,r 1 .,, 1.i. .,(1^1
1111 r 13125 S W Hall Blvd.,Tigard,OR 9722 Plan Review ��� ,\� �QC
Phone: 503.718.2439 Fax: 503.5qq��.lrp 1 �y DaleBy: y[( O her Peruu. J
1/I1 T OF 1�UAIIID
In : 503.639.4175 Date D� 7 Julia El See Pa e 2 for
TIGARD BUILDING DIVISION
Notified/Method O TInternet www.tigard-or.gov SupPlementalInfo
rmation
-1
TYPE OF WORK REQUIRED DATA:1-AND 2- AMILY DWEI.LiNG -
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other equipment,materials,labor,overhea an, d[he profit for the
CATEGORY OF CONSTKUCTION work indicated on this application. 1 (x}7.,,..-
Valuation: $
® 1-and 2-family dwelling 0 Commerciallindustrial
Number of bedrooms: a
m 0 Accessory building ❑Multi-family
v+J 0 Master builder ❑Other: Number of bathrooms:
\ o JOB SITE INFORMATION Total number of floors: ` .eS
vAND LOCATION
Job site address: )AIM 1 5 I(o01-t-'` 'L k New dwelling area: ��141 of square feet 567Z
City/State/ZIP:Tigard,OR 97224 Garage/carport area: C F 1,451/square feet 6(eZ
Suite/bldg./apt.no.: 1LA. Project name:Polygon at Roshak Ridge Covered porch area: 0 square feet C
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIS I
Subdivision:Polygon at Roshak Ridge Lot no.:' )- I Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map'pareel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SF/} Valuation: $
Existing building area: square feet
New building area: square feet
® PROPER"fY OWNER ❑ TENANT Number of stories:
Name:Polygon WLH LLC Type of construction:
Address:703 Broadway Street Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Polygon WLH LLC
Structural plan review fee(or deposit):
Contact name:Amanda Gavin
FLS plan review fee(if applicable):
Address:703 Broadway St.Ste 510
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Amount received:
Phone:(360)695-7700 Fax: : (360)693-4442
- - PHOTOVOLTAIC SOLAR PANEL.SYSTEM FEES*
E-mail:permitsubmittals@.polygonhomes.corn
ra
Commercial and residential prescriptive installation of
r�
{ Irf CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lie.:207247 Total fee due upon application: $201.60
Authorized signature:C This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Amanda G in Date: �1 S lot Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02//COM/WEB)
. w.
•
Mechanical Permit ApplicatittECEIVED FOR OFFICE USE ONLY
City of Tigard �RI��V Date/By:Received
y���\1�+��Q�
Permit No..\'`l , dV
13125 SW Hall Blvd.,Tigard,OR 97223 2 2019
Plan Review
Phone: 503.718.2439 Fax: 5'03.598.1960 AP Date/By: Other Permit:
1 1 11+.P i.. Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Jura: 0 See Page 2 for
Internet: www.tigard-or.gov CITY' 11V^1G�p11ISI®N of Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
— Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
X 1-and 2-family dwelling El 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:
tI4 C 1..X.)
I to bFurnace
conditioning 46.75
Job site address: ` 'S Z� F F Air urnacease 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Roshak Ridge 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:Roshak Ridge Lot no.: —IA Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
. Wood/pellet stove 33.39
Wood fireplace/insert 23.32
i Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
S14.15 for first four;S4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
01 CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(590.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
AA� � ' days after it has been accepted as complete.
Authorized signature: W �' * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
L\Buildisg\Permits\MEC_PermitApp 040113.doc 440-46l7T(I 1/02/COM/WEB)
a r-
Electrical Permit Applicatl1ote-- r "' t 7-1 ) - §FOR OFFICE USE ONLY 3 °§
Received
City of Tigard .JUL 2 2019 Permit#,` 1 •
n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503 598.1960 I sr f Date/B . Related Perron#:
Inspection Line: 503.639.4175 E" 1 a p%t14 c Inds: ® See Page 2 for
P ,{� �g�{J,G"�`?, Ready Date/By: g
T/GAKD Internet: www.tigard-or.gov ' -'' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ElBuilding over three atones.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:�I n l S W l to qTM � � ❑Addition p of new motor load of system.
IOOH or more, ❑"A" " '9-2""1-3"
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
b g ❑'Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#:11 Includes attached garage.
1,000 sq.8.or less 168.54 ' 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.91 75.D0 2
UPN\A3-C2. ts\r\ Il1S77.-0Iq—c0l02 Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:William Lyon Homes,Inc. 200 amps or less 100.70 2
Address: 703 Broadway St Suite 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax: (360)693-4442 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 I 59.36 1
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 El CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: William Lyon Homes,Inc. above service or feeder fee, 742 2
each branch circuit
Contact name:Nichole Thorpe • B.Fee for branch circuits without
serAddress:703 BroadwaySt Suite 510 branchne it feederitfee,first 56.18 2
circuit
City/State/ZIP:Vancouver,WA 98660 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
ng,se and/or feeder
Email:permitsubmittals@polygonhomes.com Reconnect only
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Alameda Electric Sign or outline lighting 67.84 2
Address:3415 NE 44th Signalnel, circuit(s)or limited-energy
0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Portland,OR 97213 Each additional Inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com •
Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lie.: c923 Suprv.Lic.: 4871$S specifically listed(.r hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: /f :� TOTAL PERMIT FEE:
// This permit application expires if a permit is not obtained within 180
Print name: Kile Rood Date: 03/08/2019 days after It has been accepted as complete.
* Number of inspections allowed per permit.
Plumbing Permit Application_
Building Fixtures REGE-IvFn FOR OFFICE USE ONLY
- City of TigardUL 16 2019 ived
Date/By: PeunitNo�ST \q-�� :
st 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
Phone: 503.7182439 Fax: 503.5 }yg OF'TIGARD"") Date/By: Other Permit No.:
��r y i tl f�a�r t�� e O See Page 2 for
TIGARD Internet: Line 503.639.4175 BUILDING
ILDING DI\''• DateReeaeletho t° �
Internet: www.tigard-or.gov V NotiCred/Metflod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description I Qty. Ea. I 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 ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ®Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinldder(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1(-1 l 1 6,9 -r-}. Ps-i.e, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: [ Project name:Roshak Ridge 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:Roshak Ridge I Lot no.: '71 Fixture or item:
Tax map/parcel no.: Backliow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
r C d ea O(1 .. -c Z,Q`(\ b U(UZ Clothes washer 25.02
V Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
C.I PROPERTY OWNER 0 TENANT, Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP: Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permits ubmittals polygonhomes.com Urinal 25.02
rr
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: 572.50
CCB Lic.:184601 Plumbing Lie,no,:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date: 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.
idBuilding'Permits1PLMl1-PermitAeo.dne 10/01/09 440-4616T/10/02/COM/WEBI
, s
City of Tigard
71 i • COMMUNITY DEVELOPMENT DEPARTMENT
T l c It D Building Permit Review — Residential
s
Building Permit #: MST OIq-(;) \();-
Site Address: 11391 SW lGi!' #Vt.
Project Name: Poly0A al- Rtu k Rii4e Lot #: -1
(New dtvelling=subdivision name;Ad lion or Alteration=last name of owner)
Planning Review /�
PProoposal: 1J(A.&) S 1(.A . ROW►}
10USe,
IL/Verify address/suite# active in Accela. Ot'`In River Terrace: ❑ No 'Yes,River Terrace Review Addendum
Sit /
1an Elements: USE lion Control
l copies of site plan on 8-1/2"x 11"or 11 x 17"paper [12I eetained trees with drip line and tree protection measures
IF P awn to scale(standard architect or engineer scale) L,�F otprint of new structure(including decks)and FFE
I!' .rth arrow Li20,,,n ity locations&easements (required for new and additions)
►5§ife address,project or subdivision name and lot number [j idewalk/driveway approach
`f'licant information(name and phone number) ►P ..cation of wells/septic systems
Wtot dimensions and building setback dimensions l'Set tree size,type and location
Iare footage of buildings to be demolished LNSet names
Ili*
structures on site Comer elevations(2'contours if more than 4'differential)
t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Mes ❑No
ipervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑ No
g Clean Water Services—Service Provider Letter t platted prior to 9/10/1995): LI4lI ii in*
quired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
la Y J�
Public Facilitie provement(PFI)Permit
Required: PlYes,applicant was notified 0 No Applieded Foe. Yes 0 No,stop intake
/
Cs3' ..nd Use Case#: POK2 I7'OOOO Z EW Zoning 1nH I Z
[T !:equired Setbacks: Front: Rear: 0 Side: 0 Street Side: 3 Garage: s
L 13,uilding Height: Max. Height: Actual H ' t: ZerS
Landscape Area: L % Lot Coverage Max: iJ
�� ntrance 0 Set back no more than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less
Windows ❑ Minimum 12%of area of all street-facing facades
Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
l ' ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2ad floor.
ji;rite ❑ Garage door width is 0 12'or less 0 50%or less of facade 0 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset 0 1'Roof eave 0 Roof offset
O Fire shingles 0 Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
O Accent siding Window trim ❑ Window recess ❑ Window projection ❑ Balcony
Visual Clearance Urban Forestry Plan
Lei Sensitive Lands: Yes [1Io Type:
0 Conditions met pticir issuance of b ding permit
`otea: C./J. 1164 III- 1 tlt rvor-Altriar-r-i� i�5✓anc2Approved By Planning: Date: 3-19-2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
1:1Building Worms\BldgPermitRvw_RES_022819.docx
, `t
Building Permit Submittal
Original Submittal Date: 3 1 a 1 '1 q
Site Plans: # '?j
Building Plans: #
Building Permit#: Enter building permit#above. _/
Workflow Routing. [ [Planning "Engineering 3/Permit Coordinator M Building
Workflow Sign-off: 2' Sign-off for Planning(include notes from planning review)
Route Application Documents: E(Engineering (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[K/Building original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: • k. ;�,` Date: . 1 a� I he
Engineering Review �y
cSlope at building pad: J lO
onditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
- Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ):2/No
Assess Water Quantity Fee in-lieu: 0 Yes 41 No
LIDA Facility on lot: 0 Yes E'J No
0 Final Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
Z-- iCi
Approved by Engineering: Date: 4 ,6 J g
Revisions(after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
O 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
�L,1/SDCR Fees Entered: Wash Co Trans Dev Tax: 7e -s 0 N/A
v
Tigard Trans SDC: if, es ❑ N/A
Parks SDC: Yes �❑ N�
LIDA 0 Yes L�VN/A
OK to Issue Permit
Approved by Permit Coordinator: Dater/71)11
I:\Building\Forms\BldgPermitRvw_RES_022819.docx
City of Tigard
COMMUNITY DEVF.T OPMENT DEPARTMENT
i II ■
T l c A R D River Terrace Building Permit Review Addendum
Building Permit #: MST a'OAC\- 0(_. l b 4
Site Address: 1'131I SW 6`U— Art,
Project Name: Po yq n. c 1 k � Lot #: 4 f1 _
(New elling=subdivision name;A i.Lion or Alteration=last name of owner)
Planning Review of River Terrace Plan Diist t Design Standards (18.640.070.I.):
Is the project subject to the plan district design standards? [d Yes 0 No
1.Articulation:a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 ft deep Balcony w/access 2 Window Projection Vertical Wall Offset a Gabled dorm
/� ft.deep min. 2ft.,5 ft.wide min. 2 ft.,U VF Eft wide
[T ❑ S
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 13.`j 1.0.6
itrances:At least one entrance must meet both of the folio g standards:
ax. 8 ft. setback from longest street- facing wall ' Parallel to street, angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: IYYes 0 No /
If yew,all the following apply:
ti,d'25 sq.ft.min.
FU1O e street facing entry I 9.-fft.max. roof above floor of porch
inir5 ft. depth min. 2"'30%min.porch roof coverage
4. Dled Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
D'Covered porch min. 5 ft.wide x 5 ft deep F ❑ essed entry area min. 5 ft.wide x 2 ft. deep
❑ V 1 offset min. 16 inches C e'er min.4 ft.wide.
Goof eave min. 12 inch projection f/s I�f R f offset min.of 2 ft. j
❑ Roof shingles either tile or wood l e,hip or gambrel roof design FA'
❑ Ij<of pitch oriented south min. 500 sq. ft. [f:Iorizontal lap siding min. 3-7 inches wide s
®/Accent siding min.40%of street facade F 0 Window trim min. 2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing �❑ B window min. 5 ft.wide by 2 ft.deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access I'Attached garage is 35% or less of street facade F
5. Garages and Carports:May face the front or side lot line on a corner lot.
IV'f� Setbacks:
I`�4 o closer to front or side lot line,than longest street-facing wall. 0 Yes 0 No. If No (Check one):
lb, 0 May extend up to 5 ft. if there is a covered front porch and garage does not extend beyond the front porch.
ii4
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
5(-"It ove the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
EV2-foot-wide garage door 0 40% max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: }� Date: 3 1Y-Li
I;1Building1Forn BIdgre,mitRvv RES RT_I 21417.docx