Permit 'I la!1 47:1.:14, 7;' MASTER PERMIT
" ii CITY OF TIGARD
: ' COMMUNITY DEVELOPMENT r' ks 2( Permit#: MST2019 00237
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/09/2020
Parcel: 2S107AA13300
Jurisdiction: Tigard
Site address: 16791 SW SUNSHINE COAST ST
Subdivision: ROSHAK RIDGE Lot: 133
Project: Polygon at Roshak Ridge, Lot 133
Project Description: New SF. 2/25/21: REPRINT to add (1)lay to primary bathroom.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 948 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2078 sf Value: $264,303.10 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 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'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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2078
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 1 Hour Fire Rated Eaves
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $34,189.34
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 9.52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
? )'V nL-fCA-j7d
Issued By: 'lit. E E Permittee Signature: C 'v/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica.0 s CE VE D
Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard FEB 2 4 202"i Received Permit
" 131 SW Hall Blvd.,Tigard,OR I_TIGARD °iteJBr: OK�tS /•Z /. ST jL'2►_=(d' �
11 II Phone: 503.718.2439 Fax: 503.5� Plan Review Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION nateReady/By: rwis: ® Sec Page 2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. Ea. J 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
XI-and 2-family dwelling 0 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 sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:1679d-SW SUNSHINE COAST ST 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 'olygon at 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 Lot no.: 133 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
5th lavatory added after plan review Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 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 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(corrupGrciB)) 12.51
Address:703 Broadway St.,Ste 510 Sink/basi ava I ) ,--- 1 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:permitsubmittals@polygonhomes.com Urinal 25,02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:G& B Plumbing&Sons Inc Water piping%DWV 56.29
Address:P.O.Box 92 Other. 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
Plan review (25%of permit fee)
CCB Lic.: 184372 Plumbing Lic.no.:pb634 State surcharge(12%of permit fee)
Authorized signature: '1 .. -_ - TOTAL PERMIT FEE
Print name:Steve Fowler Date: 10/30/20 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set ba Tri-County Building industry Service Board.
I:tTh, i Pamiti/PLMU-PermisAvo.doc 10/01/19 440-4616T110,02/COM'WEB)
CITY OF TIGARD MASTER PERMIT
i COMMUNITY DEVELOPMENT Permit#: MST2019-00237
Date Issued: 12/09/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA13300
Jurisdiction: Tigard
Site address: 16791 SW SUNSHINE COAST ST
Subdivision: ROSHAK RIDGE Lot: 133
Project: Polygon at Roshak Ridge, Lot 133
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 948 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf
Right: 3 Detectors:
Total: 2078 sf Value: $264,303.10 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 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: 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2078
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 1 Hour Fire Rated Eaves
PHONE 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $34,161.32
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
,�neu �a� ap�c �cv
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
A N
Building Permit Application w 1
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard FEB 0 6 2019 Dac yd U is\`� SST Perm[No(\(\5� �� �
• Phone SW Hall Blvd.,Tigard OR 97223 PlanR�"ew( s IAir `�, ..�7,.,`,, 1(',�
C Phone: 503.718.2439 Fax: 503.598.1�6 Q DateB . lY ��� OtherP ��V`-1 K
Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: c p Juds: td See Page 2 for
TIGARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method.‘ //Z .® a 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.
Valuation: $ (p�,3 c3
El1-and 2-family dwelling ❑Cormnerctal%industrial
Number of bedrooms:
❑Accessory building ❑Multi-family
❑Master builder ❑Other: Number of bathrooms:
JOB .SITE INFORMATION AND LOCATION Total number of floors: ,`1 J%
Job site address: ' p�" l S 4 V S Il t V 1(V/�I { toot,S 1� New dwelling area: ),01`6, square feet 113o
City/State/DP: ' Cr VAI 0 7)1 7 " Garage/carport area: (j 0square feet 9.144)
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: 0 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-LSE CHECKLIST
Subdivision:Polygon at Roshak Ridge Lot no.: 1 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
li
^^//(). Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon W LH 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.com
Commercial and residential prescriptive installation of
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 Specially Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)65-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.F
CCB lic.:207247 Total fee due upon application: $2f
Authorized signature: This permit application expires if a permit is not ob
within 180 days after it has been accepted as cor
L _ ' 1 *Fee methodology set by Tri-County Building Indur
Print name:Amanda Gavin Date: Service Board.
LI:1Building\Permits\BUP-RESPertnitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
e
Mechanical Permit Application }P. FOR OFFICE USE ONLY
Cityof Tigard �EC6,,,.IVED Received Permit No.At � .
g Date/By:Received
�'i 5 D V L
° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C. Phone: 503.718.2439 Fax: 503.598.1960 ApR 2 5 2019 Date/By: Other Permit:
T I G A R O Inspection Line: 503.639.4175 Date Ready/By: Turn: 0 See Page 2 for
Internet: www.tigard-or.gov c(i v tit- WARD Notified/Method: Supplemental Information
BUILDING DIVISION
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:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El.1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
Multi-family ❑ Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ((O1 Ct\ (AJ StA.N 5 HI/t!E (.Q Ies-r S T Furnace 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.lapt.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
122 Other: 23.32
Subdivision:Roshak Ridge Lot no.: l J
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
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER El TENANT 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
Fuel piping:
Business name:Polygon WLH,LLC $14.15 for first four;$4.03 for each additional
Contact name:Ionia 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
CONTRACTOR Clothes dryer(gas) .
Other:
Business name:Apex Air LLC
MECHANICAL PERMIT FEES*
Address: 18004 NE 72°a Ave Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)342-8109 Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lic.:203034 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Tim Hay Date:04/08/2019
I:\Budding\Permits\MEC_PermitApp_040113.doe 4404617r(l 1/02/COM/WEB)
Electrical Permit Application RECEIVE FOR OFFICE USE ONLY
City of Tigard Received
Permit amy C�A�(�2'3
-•I 13125 SW Ha11 Blvd.,Tigard,OR 97223 APR 2 ?_ 19 Review
Dan/By: Related Permit Si:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CI i Y ur i ll:thlf L7 Ready Date/By: lure: H See Page 2 for
AL11J.'.l!U Internet: www.tigard-or.gov BUILDING®g� DIVISRC N°tified/MUhod: Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items 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.
E 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑ Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Q�r-•i Addition of new motor load of system.
Job#: Job site address: I(y1q\ SA) S,,�ASA%Y\f, ' OV10011P or more. ❑"A","P','l 2","I-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg-/ap t.#: Project name:Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more.
600 volts nominal
Cross street/directions to job site: FEE SLHJIJ)ULE
Description i Qt1•. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: r 3 3 Includes attached-garage.
1,000 sq.R 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.ft.) 75.00 2
Limited energy,multi-family _ 75.00 2
residential(with above sq.R)
Renewable Energy 0 See Page 2
® PROPERTY OWNER _ ❑ TEN4NT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2
Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/LIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 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 59.36 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
Branch circuits—new,alteration,or extension,per panel
APPLICANT: ❑ CONTACT PERSON A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name:Jolene Smith B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:703 Broadway St,Ste.510 branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l 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
dwelling,service and/or feeder
Email:permitsubrnittais@polygonhomes.com Reconnect only 67.84 2
CONTRACTOR` - . Pump or m-igation circle 67.84 2
Business name:Portland Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 1915 E 5`h St,Ste D panel,alteration,or extension ag
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)314-4945 Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:paul@portlandelectric.biz Inspections for which no fee is
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic ri90ZSr
specifically listed(Yi hr min) 90.00/hr
n ,_ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: a/2,, A� n 6.,� Subtotal:
Print name: Alex Shalya Date: 04/08/2019 04//08/2019 ❑Plan Review Required(25%of permit fee):
pp State surcharge(12%of permit fee):
Authorized signature: �ej� L.4 .C�It l,G� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: MISHCHUK,SERG Date: 04/08/2019 days after it has been accepted as complete.
Number of inspections allowed per permit.
01Buildioa\Psemits\E.LC Permit too ELR FRF.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application
Building Fixtures EGE V ED FOR OFFICE USE ONLY
Received
- City of Tigard APR 2 5 Z019 PermtNo.. �^
a 13125 SW Hall Blvd.,Tigard,OR 972 Plan e M��2�la- d r
Plan Review
Phone: 503.718.2439 Fax: 503.5�$.].QEio Other Permit No.:
``�( ff OI �fS Date/By:
TIGARD Inspection Line: 503.639.4175 rytVigtt�i1/44 DateReady/By: furls: RI See Page 2 for
Internet: www.tigard-or.gov BUILDING :j Noti6cdMethod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description 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(l)bath 312.70
1gt 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
ElAccessory building Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: k tolCl� v 1� •W�' rW � 151 s�- Catch basin or area drain 18.76
1 e s i.
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I 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.: \ 33 Fixture or item: 1
Tax map/parcel no.: Backflow preventer - 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® 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:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water PP €/r m DWV 56.29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler Date:04/08/2019 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 t0/01/09 440-46 16T(10/02/COM,WEB)
. City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
■
Building Permit Review — Residential
TI GAKD
Building Permit #: V --c- \G-(2i:). -
Site Address: /1Q?'9/ 26O Suitekite n. Q7L—
Project Name: 176/ 4 oil .4 Ark2,c "�� ,e Lot #: 1�3
(New ate, g=subdivision name;Addition or Alteration= name of owner)
Planning Review
Pro osal: /U.Q0 s — /
'V Verify address/suite#active in Accela. 4tl In River T .ce: ❑ No IQ Yes, River Terrace Review Addendum,
Plan Elements: I�Er.Sion Control
r
copies of site plan on 8-1/2"x 11"or 11 x 17"paper �' rained trees with drip line and tree protection measures
yawn to scale (standard architect or engineer scale) TA otprint of new structure(including decks)and FFE
orth arrow ty locations&easements(required for new and additions)
address,project or subdivision name and lot number idewalk/driveway approach
I, .plicant information(name and phone number) lion of wells/septic systems
A Lot dimensions and building setback dimensions eet tree size,type and location
'U are footage of buildings to be demolished . et names
a+f:sting structures on site omer elevations(2'contours if more than 4'diffe tial)
LLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? VJYes ❑I�»
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? > Ires o
tiWean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
/Required: ❑ Yes,applicant was notified Vil No Received: ❑ Yes ❑ No
NJ Public Faciliti(lmprovement(PFI) Permit:
quired: ' Yes,applicant was notified ❑ NoizrL Ap lied For: Yes 0 No,stop intake
and Use Case#: �U 4/� WOO //Zoning e�� AO
equired Setbacks: Front: 7�� Rear: JO Side: Street Side: &)/,— Garage: 2Q
Suilding Height: Max. Height: 1�' t/Actual H . ht:
IL Landscape Area: �l7 % 1Q Lot Coverage Max: e °A)
Entrance ack no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ❑ Minimum area of all street-facing facades „
Garage ❑ Garage door is behin treet-facing wall �. ❑ Yes ❑ No,one of the f g is met:
❑ Door extends no more than wall and there is a covered porch ' g eyond garage.
❑ Door extends no more than 5'from wall an i .window above garage on 2nd floor.
❑ Garage door width is 0 12'or less °or less of a 0 60%or less and includes 7 of following:
❑ Covered porch essed entrance ❑ Wall offset ❑ ve ❑ Roof offset
❑ g es ❑ Lap Siding 0 Roof pitch ❑ Gable,hip,or gambre ❑ Dormer
❑ Accent siding Wmdow trim ❑ Wmdow recess ❑ Window projection ony
1;11 isual Clearance Urban Forestry Plan 1 /
74 sensitiveLands: V Yes ❑ No Type: A-000— r it/M k,?126 1- a/1��
,A Condition met prior tgis uan of buil.' g pe t
es: Li dti7.-S Nbt nc A/ 11ral�'' rit iiif.A
Approved By Planning: I r ` -- Date: 6- 1V19
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
. - I:\Building\Forms'BldgPemitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: (1G
Site Plans: #
Building Plans: #
Building Permit#: R"Enter building permit#above.
Workflow Routing: �En eerin
$ G��/Platming gin g C7/Permit Coordinator El/Building
Workflow Sign-off: Er-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.
Et/Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: U1\al\q,
Erineering Review
hi Slope at building pad: Z�
❑ Conditions "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: D Yes itI No
Assess Water Quantity Fee in-lieu: 0 Yes l,,�'/No
LIDA Facility on lot: El Yes C7 No
Ild'Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
[Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 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:
DC Fees Entered: Wash Co Trans Dev Tax: [EYes 0 N/A
(/ Tigard Trans SDC: ❑ N/A
Parks SDC: Yes ❑^�/A
LIDA ❑ Yes N/A
K to Issue Permit
Approved by Permit Coordinator: Date: C/`3 .P1
I:Building\Forms\BldgPennitRvw_RES_o22819.docx
City of Tigard
■ COMMUNITY DEVET OPMENT DEPARTMENT
illihl C
TIGARD River Terrace Building Permit Review Addendum
_ _ _. _ _-_ - --
Building Permit #: T.a0\Ct- Cxla
Site Address: //j / c.c7A ) annht e Qa g71-
Project Name: Po/ ,.elA ShiL Lot #: l '
(New d it al=subdivision name;Addition or Alteration=las a of owner)
Planning Review of River Terrace Plan Dist' t Design Standards (18.640.O7O.1):
Is the project subject to the plan district design standards?V Yes ❑ 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
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch? . deep Gabled dormer
ft. deep min. 2ft., 5 ft.wide min. 2 ft.,6ft. wide
0 0 0 ❑
2. Eyes on the street: a minimum f 12°/ of each street facing facade must include windows or entrance doors.
Percentage Shown: 74/D/a
3. EE trances:At least one entrance must meet both of the folio g standards:
✓Ljd Max. 8 ft. setback from longe street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes 0 No
If 7ses,all the following apply: i-/2 sq.ft.min.
r ne street facing entry 15 ft.max. roof above floor of porch
TA 5 ft. depth min. - 1E 30%min.porch roof coverage
41 -tailed Design:All buildings shall include a min. of five of following elements on all street-facing facades:
I► vexed porch min. 5 ft.wide x 5 ft. deep tR
offset min. 16 inches ecessed entry area min. 5 ft.wide x 2 ft. deep
❑ rmer min. 4 ft.wide
Roof eave min. 12 inch projection f offset min. of 2 ft.
❑ Roof shingles either tile or wood Ild Gable,hip or gambrel roof design
f pitch oriented south min. 500 sq. ft. I�6rizontal lap siding min. 3-7 inches wide
Accent siding min. 40%of street facade */Window trim min.21/2"wide by 5/8"deep
O Window recess min. 3 inches for all street facing 0 Bay window min. 5 ft wide by 2 ft deep
O Balcony min. 5 ft.wide x 3 ft. deep with inside access 0 Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
,�0/ oser to front or side lot line,than longest street-facing wall. 0 Y No. If No (Check one):
ii May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
O 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
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
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: C-)H
I:1Huilding''Tomc‘HldgPerm¢Rvw_RES_RT_121417.docx
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
IIT I G A R D Building Permit Review — Residential
Building Permit #: MsTa'O\q-CC '10.--;
Site Address: /(/ / 2 o SuiVAii (7. g71--
Project Name: PO/ .. 4 71-- eosk, f1 ,p Lot #: l �
(New.tit"g=subdivision name;Addition or Alteration= name of owner)
Planning Review 7/2e : -cv"-/-S b :t T— #''i 1-4 Tz, t74-7-eet "4404
Pro sal: /Veit) S _
'1CJ Verify address/suite# active in Accela. 4d In River
•T7 ce: ❑ No IQ Yes,River Terrace&vier Addendum
• Plan Elements: / Er lion Control
copies of site plan on 8-1/2"x 11"or 11 x 17"paper twined trees with drip line and tree protection measures
t#:.
raven to scale(standard architect or engineer scale) otprint of new structure(including decks)and N'FL
orth arrow address,project or subdivision name and lot number
ty locations&easements(required for new and additions)
idewalk/driveway approach
►. ..licant information(name and phone number) lion of wells/septic systems
YL Lot dimensions and building setback dimensions et tree size,type and location
t 4 ,re footage of buildings to be demolished ,S eet names
Airt 'sting structures on site Vet elevations(2'contours if more than 4'diffe tial)
VA .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? VJYes ❑i
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes Mo
Ocan Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
/R equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Faciliti(Improvement(PFI)Permit:
quired: V Yes,applicant was notified ❑ No Ap lied Fox: Yes ❑y�No,stop intake
�r411and Use Case#: ���� — V/Zoning. i-k2�,,N1 )b)
,Bequired Setbacks: Front: Rear: /0 Side: Street Side: 9k./ Garage: a
uilding Height: Max.Height: c/Actual H ' h : 4
0 Landscape Area: �D % 1G Lot Coverage Max: %
Entrance ack no more than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less
Windows ❑ Minimum area of all street-facing facades
Garage 0 Garage door is behin street-facing wall N. 0 Yes ❑ No,one of the ' g is met:
O Door extends no more than and there is a covered porch . g eyond garage.
O Door extends no more than 5'from wall an i .window above garage on 2' floor.
0 Garage door width is 0 12'or less o or less of ac 0 60%or less and includes 7 of following.
❑ Covered porch essed entrance ❑ Wall offset ❑ ave ❑ Roof offset
❑ - g es ❑ Lap Siding ❑ Roof pitch 0 Gable,hip,or gambr ef 0 Dormer
❑ Accent siding Window trim ❑ Window recess 0 Window projection l�)3 ony
1` isual Clearance Urban Forestry Plan Lao- `/ -��J
:ensitive Lands: 0Yes 0 No Type: !'� # tm/a#M /7 1t'1' ���
J Condition mete rior tc�is itia3 of buil ' pe t
/es: 4 t� +�! p �l - i SS✓kn4
Approved By Planning: — Date: 6- II-I
Revisions (after Building Submittal only) Re ewer Date
Revision 1: ,� Approved 0 Not Approved /�f-1 112,1I70
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
1:1Building\Forms\BldgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: o). I tR
Site Plans: #
Building Plans: #
Building Permit#: R'Enter building permit#above.
Workflow Routing. Er Planning Engineering El/Permit Coordinator 1E1/Building
Workflow Sign-off I'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.
Building original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: �.k\al\Ut
E ineering Review
LI Slope at building pad: 4
❑ Conditions "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: 0 Yes itl No
Assess Water Quantity Fee in-lieu: 0 Yes
� LIDA Facility on lot: 0 Yes liar No
f(d�Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
(Approved by Engineering: Date:
Revisions(after Building Submittal on ) ltt viewer Date
Revision 1: $ Approved glNot Approved Aj ‘ e=.
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
0 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:
DC Fees Entered: Wash Co Trans Dev Tax: (YYes 0 N/A
(/ Tigard Trans SDC: 0 N/A
Parks SDC: Yes ❑❑ /A
LIDA ❑ Yes N/A
K to Issue Permit
Approved by Permit Coordinator: 447Date: C( 3/ I
tO
I:\Building\Forms\BldgPermitRvw_RES_022819.docx