Permit Plumbing Permit ApplicationRECEIVE
Building Fixtures
Received , 1 r�/�
City of TigardDEC 15 2020 Date By' \'L ZzIZo �1�1 Perm t No.:iST2O20�W�SC'‘,
lig ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ CITY OF TIGARD Date/By: othe Pe mit Nn
Phone: 503.718.2439 Fax: 503.598.19 � ��OZ( /�C(q
Inspection Line: 503.639.4175 D q Page 2 for
TIGAIUo Internet'. www.tigard-or.gov BUILDING DIVISION t\'otified/MethodateReady/By: '. 11 //.�( 0 ilia SupplementalSee Information
TYPE OF WORK - FEE* SCHEDULE
t ,
0 New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
Iglu-and 2-family dwelling ❑Commercial:industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional ba lichen 25.02
❑Master builder ❑Other: Fire sprinkler q.ft.)\3$Ca Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: iLvq?4 ,) Ll C 0 ,`r. �6,LACt.
��7 ('�J Drywell,leach line,or trench drain 18.76
City/State/ZIP: `il('�'S 1i ` L o- 1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ekl k I Project name: c `ce_j Manufactured home utilities 50.03
Cross street/directions tokjiab site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: ic,)*W_I C[l _Q . � _ I Lot no.: CO Fixture or item:
'lax map/pared no.: ("� Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
SIX); ,.c,Q _
(\ _Q_kc j 0.Y) - Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: 25.02
Garbage disposal
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax: ( ) Ice maker 12.51
El APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) 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
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
� \� r /� Water heater 37.52
Business name: 10l)..o_ei((Jt� �h� ,�;(�,4)` j LLO�(_Ct Waterpiping/DWV 56.29
Address: >»'S- W ,�lS Q AC_ l.-olR gi,10,f cL(l,JQ Q._a1.0-, Other: 25.02
City/State/ZIP: `'1Qc)J c9 __ q '`l�� Subtotal
Phone:(. 00j 1 k �\ I Fax:({a ��_� civil Minimum permit fee: $72.50
L� 2 Q 7f,- *7 4 f� Plan review (25%of permit fee)
CCB Lio.: PlumbingLic.no.: L
State surcharge(12%of permit fee)
Authorized si e: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: 4�„`C L
Date: 1 L� I t.��l r-�'`� after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I.\Building\Permits\PLMG-PermitApp.doc I0/01/09 440-4616T(10/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
4' • COMMUNITY DEVELOPMENT Permit#: MST2020-00159
Date Issued: 11/24/2020
Tt GAR f~i 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA09100
Jurisdiction: Tigard
Site address: 14424 SW GOLD COAST TER
Subdivision: ROSHAK RIDGE Lot: 91
Project: Polygon at Roshak Ridge, Lot 91
Project Description: New SFA
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 76 sf Basement: 0 sf Lek: 0 Parking Spaces: 0
Height: 35 Bathrooms: 3 Second: 675 st Garage: 604 sf Front: 8 Smoke
Dwelling Units: 1 Third: 637 sf Right: 0
Detectors: Yes
Total: 1388 sf Value: $203,891.48 Rear: 5
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 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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 l 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 1388
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC 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
PHONE: PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $26,318.17
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.-0 You may
y obtain a copy of the rules or direct questions to OUNC by calling/5►033,.23�2.198877(orr 1.8800.332.23444..Q
Issued By: `N` &) 1 b Ca O/ Permittee Signature: 1,,.1' l C. I. J C L 1��
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.
. .
Building Permit Application LOT g I
Residential :-IF(
� /E FOR OFFICE USE ONLY
Cityof Tigard Rec ived. Permit No
g FEB 3 2020 Date/By: 05, ZO2D MST2O2.O 0f59
13125 SW Hall Blvd.,Tigard,OR 97223 P�Review I^�°°��+' ^,', Apr Other Pen,�,,,i'6,�Wf,'RQ7q��7``'' /g1 I^Y
m Phone: 503.718.2439 Fax: 503.598. 1/ }!` ;r'a Date/By: l /`« saris: " CJYV„WLV W iTJ Y
T I G A R D Inspection Line: 503.639.4175 p Date Ready/By: o .do
I El Page 2 for
Internet: www.tigard-or.gov k--'i-..}M�.I... �t\�C?�I'1�� �1 t\ Notified/Method:� S�� .�c� Supplemental Information 1
6-7`'7 rL 7 Al✓/r-
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ a.o31 g'/
El 1-and 2-family dwelling 0 Commercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms: 3,
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 1 .� `q9 2..
Job site address: (y42 C.0 (',
4 6.0pT T-62 j4S12- New dwelling area: �' square feet 637
City/State/ZIP:Tigard,OR 97224 Garage/carport area: '^f. '1 quare feet kiil S
Suite/bldg./apt no.: Project name:Roshak Ridge Covered porch area: square feet !
`
Cross street/directions to job site: Deck area: square feet /
. Ob suit rr asa;e / Oa_ square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Roshak Ridge Lot no.: q, 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.
Valuation: $
' Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon WLH,LLC Type of construction:
Address:703 Broadway St.,Ste 510 Occupancy groups:
City/State/ZIP:Vancouver WA 98660 Existing:
Phone:(360)695-7700 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee scheduleBusiness name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Tonja Morris
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: :( )
E-mail:permitsubmmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Polygon WLH,LLC Submit two(2)sets of roof plan with connection details
and fire depart:went 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 lic.:204238 Total fee due upon application: $201.60
Authorized signature: ` This permit application expires If a permit is not obtained
__ * 1Ihwithin 180 days after it has been accepted as complete.
it - *Fee methodology set by Tri-County Building Industry
Print name:Tonja Morris Date:04/17/2019 Service Board.
T\Rnildinc\Pernitc\RTTP-RFSPermitAnn.rim 02/24/2011 440-46131(11/02/COM/WBB)
, Mechanical Permit Applic a- --ilk e Y" FOR OFFICE USE ONLY
City g
of Tigard , — 3. .I C.Li Received
Permit No.: M8y2OZo'O0 I59
`
.! 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy:
- Phone: 503.718.2439 Fax: 503.598.196�11111
Eg 3 2020 Plan Review
' Date/By: Other Permit:
I s"v{h It I I Inspection Line: 503.639.4175 _t,�/ s Date Ready/By: Jars: El See Page 2 for
Internet: www.tigard-or.gov GIP(i {, E i •(47rii�,t.) Notified/Method: Supplemental Information
aSt Eli° t ..;/,moo/'l l,,.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE—USECBECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
rgi 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB srrE L'SiFORMA'TION AND LOCATIO Heating/cooling:
--� Air conditioning 46.75
Job site address: (Ltc}1,4 G-t eW C CT4 5T T€L 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./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.: 1 , 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
Chimney/liner/flue/vent 23.32
►� PROPERTY OWNER Other: 23.32
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
0 APPLICAN'T 0 CONTACT PERSON Other. 23.32
Fuel piping:
Business name:Polygon WLH,LLC
S14.15 for first four;$4.03 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
IV 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($90.00)
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
/��77� days after it has been accepted as complete.
Authorized signature: wa �u�l Q * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
t:lnuitdingtPermits\MEC_PermitApp_040113.doc 440-4617r(11/02/COMAVEB)
•
Electrical Permit Applicatioii EW�.�E( li --! FOR OFFICE osE•o vLV `` Wi
Received IILSTZa2c') 40/59
k City of Tigard Received
Perm t s:
v 13125SWHallBlvd.,Tigard,OR97223 FEB 3 2020 Plan Review
x '- Phone: 503.718.2439 Fax 503.598.194Q. .,,; - C..�}fit_, Date/By; Re]atedPermit#:
r'•. - Inspection Line: 503.639.4175 (.....1 9 t Jr- 1�k{.l A)n Ready Date/By roris: Id See Page 2 for
• c Internet www.tigardor.gov ,',i,i 1,V�E ri I f i l./C Notified/Method, Supplemental Information
TYPE OF.WORK - ..;-�V. .. ;i PLA2(,.REV,TEW ; . ...
®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 0 Building over three stories.
❑Demolition ❑Offer;
where the available fault current 0 Marinas and boatyards.
' - _ .,. : slt, ': .., .:.-CATEGORY_OF.-CONS FRUCTTON .. ,:J:`.: :' .. . ... exceeds 10,000 amps at 150 volts or El Floating buildings.
E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground or exceeds 1a,0oo ❑comma c al-use erg cultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other. 0 Fire pump. ❑Installation of 150 KVA or
:2, . .'. `. . ' ❑Emergency system. larger separately
70B Sll'E.:INFORMATION`i1ND5:,OCATI02�.`�; ;� gederived
Job#: I Job site address: �{ ❑Addition of new motor load of system
Q6LN T ,. loom)or more. ❑"A" "&,•,"1-2","1-3"
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt#: _ Project name:Polygon At Roshak Ridge 0 Harardoes locations. ❑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 I Lot#: CI I Includes attached garage.
Tax map/parcel# 1,000 sq.ft.or less 168.54 4
• Fa add']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
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
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 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 ❑ 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,
each branch circuit 7.42 2
Contart name:Nichole Thorpe • B.Fee for branch circuits without
Address:703 BroadwaySt Suite 510 service it feederitfee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add']branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 I Fax::(360)693-4442 Each manufactured or modular 67.84 2
dwelling,service 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 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension
City/State/LLP:Portland,OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone:(503)319-2192 J Fax: ( ) Investigation(1 hr min) 90.00/hr
Email:solarptia@me.com Industrial plant(1 hr min) 78.I8/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 199188 Electrical Lic.: c923 Suprv.Lie.: 487S specifically listed('.4 hr min)
ELECTRICAT PERMIT FEES
Suprv.Electrician signature,required: Subtotal
Print name: Kile Rood Date: 03/08/2019 ❑Plan Review Required(25%of permit fee):
//O State surcharge(12%of permit fee):
•
Authorized signature. TOTAL PERMIT rF t:
Date: 03/08/2019, ,,
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood clays after it has been accepted as complete.
* Number of inspections allowed per permit
• Plumbing Permit Application !!
Building Fixtures k. .L(U dv.w I ` [ FOR OFFICE USE ONLY
Received M S 12CZo-t l/1✓/
- City of TigardPermit No.:
v 13125 SW Hall Blvd,Tigard,OR 97223 FEB�C '� Z�Z� Date/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1Q60 i Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ) 1
TIGARD P Date Ready/By: Jurist E1 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 Qty. Ea. I Total
❑ Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
"a^`-x'. CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
El
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AM) LOCATION V;j Site utilities:
Job site address: ,'1'24 (jbw C*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.: 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 Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OE WORK Backwater valve 12.51
ll \V r 1t • � �, Clothes washer 25.02
� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ 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/lavatoiy 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-0442 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:Alliance Plumbing Water piping/DWV 56.79
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 Minimumpemut fee: $72.50
CCB Lie.:184601 4, -L,_ Plumbing Lic.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.
I:/Building\Permits'PLMU•PernitApp,doc 10/0l/09 440-4616T(l0/02/COM/WEB)
City of Tigard
7 q COMMUNITY DEVELOPMENT DEPARTMENT
C
T1cAUD Building Permit Review — Residential
Building Permit #: MST 2020- 00159 Site Address: /41.22/ 2i0 a/d c is / �f/aa
Project Name: (De?0P11 2.� � ra -C Lot #: 97—
Planning Review �JQ
Pro• 'sal: l lJ eko
IG Verify address/suite# active in Accela. In River Terr.ce: ❑ No Yes,River Terrace Review Addendum
Sit: 'Ian Elements: .'''.4 Erosion Control
3/copies of site plan on 8-1/2"x 11"or 11 x 17"paper I' -tamed trees with drip line and tree protection measures
V•. .wn to scale (standard architect or engineer scale) 7 F otprint of new structure(including decks)and FFE
Igi •rth arrow 'ty locations&easements(required for new and additions)
V� a address,project or subdivision name and lot number In Sidewalk/driveway approach
Vi plicant information(name and phone number) II i; ation of wells/septic systems
�' . dimensions and building setback dimensions !/5teeet tree size,type and location
n 1..uare footage of buildings to be demolished SXtet names
Ii ting structures on site VComer elevations(2'contours if more than 4'differ tia1)
• of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ON
impervious area(applicable if R-7,R-12,R-25&R-40) If es,is a storm water .uali facili shown i gli' •Yes o
1 11t Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified Ie7 No Received: ❑ Yes ❑ No
Water Meter Fixture Unit Worksheet—Addi 1 s,Remodels and ADUs
Required: ❑ Yes,applicant was notified .I No —/ Received: ❑ Yes ❑ No
h.' :SC Exemption for ADU applied for: ❑ Yes 17 No Received: ❑ Yes ❑ No
1, Public Facilitylmprovement(PFI) Pemvt:
� quired: Yes,applicant ways notified ❑ No A lied For: YJ Yes ❑ No,stop intake
*lLfLand Use Case#: 4ti�0nQe 00i� l j oning &1�
21 uired Setbacks: Front 0 Rear: .l Side: C/ Street Side: (�/ '-' Garage: c
ld ilding Height: Max.Height: t�/R" Actual He• ht:— -
Landscape Area: -20 % 0 Lot Coverage Max: ' 0/0
Entrance et back no more than 8'from street-facing wall ❑ Parallel to et or offset 45 degrees or less
Windows ❑ minim %of area of all street-facing facades
Garage ❑ Garage door is 'dest street-facing wall V Yes 0 No,one of the following is met:
❑ Door extends no more 'from wall ere is a covered porch extending beyond garage.
❑ Door extends no more than 5' and there is a 12 sq ft.window above garage on 2nd floor.
0 Garage door width is ❑ ' r less ❑ 50%o of facade ❑ 60%or less and includes 7 of following:
❑ Covered po Recessed entrance ❑ Wall o s ❑ 1'Roof cave ❑ Roof offset
❑ Fir gles ❑ Lap Siding ❑ Roof pitch ❑ Gable, ' mbrel roof ❑ Dormer
Accent siding Window trim ❑ Window recess ❑ Window ' ction ❑ Balcony
• 11. Visual Clearance Urban Forestryn
k"` nsitive Lands: ❑ Yes E l No Type:
Conditions met prior to issuance of building permit
No s: _ ���j
Approved By Planning: 7/r Date: 0/2 0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Bui Iding\Fonns\B IdgPermitRvw_RES_122419.doc x
Building Permit Submittal
Original Submittal Date: 2-03 2O20
Site Plans: # 3
Building Plans: # a
Building Permit#: {a-Enter building permit#above.
Workflow Routing: R.Planning Lg' Engineering E-Permit Coordinator le-Building
Workflow Sign-off: ®'Sign-off for Planning(include notes from planning review)
Route Application Documents: If'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
R-Building: original permit application, site plans,building plans,engineer and
beam calculations a•d trust details,if applicable,etc.
Notes:
By Permit Technician: Date: 05-1 3.1L2 ) i
En cheering Review
ope at building pad: 1_0'4io
w,
Conditions "Met"prior to issuance of building permit , 4
,.,,,/
!_KEasements (encroachments)per engineering conditions of aoval and plat
Yam'Water Quality/Quantity Facility: �/
Assess Water Quality Fee in-lieu: 0 Yes l No
Assess Water Quantity Fee in-lieu: 0 Yes e No
LIDA Facility on lot: ❑ Yes No
6 Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:te/
Approved by Engineering: Date: S
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Permit Coordinator Review
jConditions "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:
)21+ SDC Exemption: ❑ Received % Does not apply
LS+SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: ''X Yes 0 N/A
LIDA ❑ Yes eC N/A
likr OK to Issue Permit
Approved by Permit Coordinator: Date: 5I( {120
1:1Building\Forms\BldgPemutRvw_RES_122419.docx
City of Tigard
4 COMMUNITY DEVELOPMENT DEPARTMENT
I
T r c A �D River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: /L{ 2 y „c--2/t. ) (k' 0 ,-i --1 Y..6/ //
Project Name: 1 Lot #:
(New dw subdivision name;Addition or Alteration= t name of owner)
Planning Review of River Terrace Plan Dist ' t Design Standards (18.640.070.L):
Is the project subject to the plan district design standards? 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.
Balcony w/ ass 2 Window Projection Vertical Wall ffset a
Porch min deep ft. de min. 2ft., 5 ft.wide min. 2 ft.,6f wide Gabled dormer
0
0
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: '> )a,0
trances:At least one entrance must meet both of the follo g standards:
3. Max. 8 ft. setback from longes 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 y s, all the following apply s .ft.min.
e street facing entry 1 t.max. roof above floor of porch
5 ft. depth min. 30%min.porch roof coverage
4. etailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
overed porch min. 5 ft wide x 5 ft. deep f 0 Recessed entry area min. 5 ft.wide x 2 ft. deep
all offset min. 16 inchesc 0 Dormer min. 4 ft.wide
V Roof eave min. 12 inch projection /)( ) 06f offset min. of 2 ft. c
❑ Roof shingles either tile or wood le,hip or gambrel roof design fire;jr:�' l
❑ of pitch oriented south min. 500 sq. ft. C( rizontal lap siding min. 3-7 inches wide lV
0 Accent siding min.40%of street facadef/P) I.fd'Window trim min. 21/2"wide by 5/8"deepkkW
❑ %tndow recess min. 3 inches for all street facing 0 Bay window min. 5 ft.wide by 2 ft. deep
It 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 corn r lot.
Setbacks:
No closer to front or side lot line,than longest street-facing wall. Yes 0 No. If No (Check one):
O May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ 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 garage that faces the street with a min. area of 12 sq.ft.
Wid : (Check one)
12-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:
1:1BaildioglForms\BldgPermitRvw_RES_RT_121417.docx