Permit Plumbing Permit Application
Building Fixtures RECEIVE I FOR OFFICE USE ONLY
City of Tigard Recaeived\A 2Z '?1020 Permit No.:N1ST 2020 -00,se
:�_, •■ 13125 SW Hall Blvd.,Tigard,OR 97223 DEC 15 2020 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/ByI/efr/2 021 AC-67 Other Permit No.:
Inspection Line: 503.639.4175y y H See Page 2 for
TIGARD CITY OF TIGARD Date Read B �f_/ /
Internet. www.tiga[d-Or,gov NotiSed/Method:• ,/vl` Z' L V Supplemental Information
BUILDING DIVISION
TYPE OF WORK FEE* SCHEDULE
[ INew construction ❑Demolition For special information use checklist.
Description FQty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-familydwelling SFR(2)bath 437.78
I" g ❑Commercial/industrial
ElAccessory building El Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(Rsq.ft.)\\(0 8 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ((\.L‘1..0 ¶j AZ) ( CQ(\ �. : \((�j(�/ I^ Catch basin or area drain 18.76
rl �. s- Drywall,leach line,or trench drain 18.76
City/State/ZIP: �(FpQ 0 C.2 7
1, Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:1 k I Project name: '(L ‘ 'c 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
Subdivision: �y ` C /7 LIF CIO Water seeorice(no.linear ft.:_) Page 2
�1� I i,�1 � Lot no.: Fixture or item:
Tax map/parcel no.: "F�'-' Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
SpG(; r��/ ///'''��� �[� / �. Dishwasher 25.02
JI 1 tW , 9�c D I 4 -lL/ Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ 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
Business name: Medical gas(value:$_) Page 2
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
I'.-rn;ail Urinal 25.02
Water closet 25.02
CONTRACTOR
(3 usiness name: Water heater 37.52
1✓C.t,C {� I •i,� l 1� � C Waterpiping/UWV 56.29
Address: \�4� � ��1Sa{ � e�����1 n1 T...allot.:
25.02
City/State/ZIP:QQ WA 6.4 c C.cI.00 'J1� Subtotal
Phone:(.y9 .-4_ \1.: t Fax:(�it (AC-1 C1f]C1 Minimum permit fee: $72.50
J (� Plan review (25%of permit fee)
CCB Lie.: 1\- '7 7 7 Q Pf Pr
Lic.no.: 7,c,...11 y J q Et-,
�[ State surcharge(12%of permit fee)
Authorized signature: `�vAV, �``7 ,,,//f��`� TOTAL PERMIT FEE
•
Print name: el con( Date: '''� 1! �I.2 2 C)This permit application expires if a permit is not obtained within ISO days
- ` `�' lJ after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Per.nits\PLMU-PemutApp.doe 10/01/09 440-4616f(10/02/COM/WEB)
l
CITY OF TIGARD MASTER PERMIT
s'a COMMUNITY DEVELOPMENT Permit#: MST2020-00158
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1 1 124/2 0 2 0
Parcel: 2S107AA09000
Jurisdiction: Tigard
Site address: 14440 SW GOLD COAST TER
Subdivision: ROSHAK RIDGE Lot: 90
Project: Polygon at Roshak Ridge, Lot 90
Project Description: New SFA
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First; 44 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 35 Bathrooms: 3 Second: 562 sf Garage: 500 sf Front: 8 Smoke
Dwelling Units: 1 Third: 562 sf Right: 0
Detectors: Yes
Total: 1168 sf Value: $169,152.92 Rear: 5
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
0
Tubs/Showers: 2 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
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 3 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 addl 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 1168
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: 360-895-7700
FAX: 360-893-4442
Total Fees: $25,262.57
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.-0i90 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 oorr 1.8800..✓332..22.34444,.,_�^
Issued By: `� L .J tRJ�.Q/ 1 Permittee Signature: Cr\ a}-y(L C� s t T
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 -� Lurgo
Residential tn n FOR OFFICE USE ONLY
Fr 3 �U�'J Received.
City of Tigard �-° 13-2620 Permit No.M5r2f20'MiSg
I • 13125 SW Hall Blvd.,Tigard,OR 97223i LI.
Datey:
la Phone: 503.718.2439 Fax: 503 598°1S 11 (� 1 f 1 Plan Rev ew �A A(' �q4/p �020 n
i J I :a-'tip Date/By: 2 rJr, Other P`i�gypV r� O2O OVI22
TIGAK D Inspection Line: 503.639.4175 -.I !I l 9 r\1 i\11 C i n ii..' Date Ready/By: J/ rmis: I H See Page 2 for
Internet www.tigard-or.gov Notified/Method:f� -k) � J Supplemental Information
G31 C—. iti-.27-650-
TYPE OF WORK ' REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF.CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 1 1 f '62-
❑Accessory building 0 Multi-family Number of bedrooms: /
❑Master builder ❑Other: Number of bathrooms: 3
't,1 JOB SITE INFORMATION AND LOCATION/ l Total number of floors: 3 t(QUA
LttoJob site address: I* O G0u ST Tee"- New dwelling area: -• ssqquare feet 56Z
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet 5(0
1,
Suite/bldgJapt no.: Project name:Rosbak Ridge Covered porch area: square feet 149
Cross street/directions to job site: Deck area: -1 square feet
• Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Rosbak 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
k�
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 0 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*
Business name:Polygon WLH,LLC (Please refer to fee schedule)
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
Phone:(360)695-7700 Fax::( ) Amount received:
E-mail:permitsubmmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon WLH,LLC 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): j
Phone:(360)695 7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:204238 l- Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Tonja Morris Date:04/17/2019 *Fee methodology set by Tr County Building Industry
Service Board.
1:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard '!,� _ �' +a i Received Permit No.: MSTZOZU-00158
14
ii: 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: g 503.598.1960FE Date/By:
Zppp Date/By: Other Permit:
1 I GAP.17 Inspection Line: 503.639.4175 _ Date Ready/By: turfs- RI See Page 2 for
Internet www.tigard-or.gov CITY OF"33 ri/- "' '_%r= Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USECBECKLISI
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
ISI 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist
Multi-family El Master builder El Other: Description Qty. Ea. Total
(��JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: �"L�-kQ /1 �� Y Air conditioning 46.75
�a'Q ST 1 ji- 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 of no.:
O Other: 23.32
L
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 ❑ 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/7TP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone: (360)695-7700 Fax:( ) Attic/crawispace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon Will,LLC
$14.15 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.permits ubmittalsCpolygonhmnes.com Barbecue
ANI CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/LIP: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
aI days after it has been accepted as complete.
Authorized Signature: a �u �� * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
1`Building\Pcrmhs\MEC_PernitApp_040113.doe 440-4617T(11/O2/COM/WEB)
Electrical Permit Application ` K_i } i R Q F c>uids o,-AV �
t 4 ,,?d— 1 r,,'ri. y,-O .r 40. t, .r - r
d Q +�/�
City of Tigard w Received Permit#: IAsr20�c0015g
Date/By:
1• . .^ 13125 SW Hall Blvd,Tigard,OR 97223FEB3 2020
Plan Review
Pi. • Phone: 503.7182439 Fax 503.598.1960 Date/By: Related Permit it:
T1GAxL] Inspection Line: 503.639.4175 1i{V l' '-gI`° tlC RcadyDate/By: Juris: H See Page 2for
v� i ..��" .a�tir_.
a Internet: www tigardor.gov 3l.;1! NG 1.-)Ril '(',04ctjEedMMethod: _ Supplemental Information
_ TYPE OF WORK r s. . . ..;a:';',- :-.-. ?--PLAN REVIEW El New New construction ❑Addition/alteration/replaceuient 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.
0 Demolition El Other:
where the available fault current 0 Marinas and boatyards.
"°';'; _ .:=CATEGORY._OF,CONSTRUCTION,.. exiPn s 10,000 amps et 150 volts or D Floating buildings.
LEI 1-and 2-family dwelling I:Commercial/industrial ElAccessory building less ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other. ❑Fire pump. 0 Installation of 150 KVA or
'-q.: . JOB Slims:flVFORMATiOIVAND'LOCATION/,'�'- ❑Emergency system. larger separately derived
Job#: Job site address: 1{,''114� C, `•t ST T ❑IQOlIPCn of new motor load of system.
�y`\`TV wa. l IOOHP or more. ❑"A" "E'"1.2„"l_3„
City/State/ZIP:Tigard,OR 97224 0 Six orMale residential units. occupancy.
❑Healthcare facilities. ❑'Recreational vehicle parks.
Suite/bldgJapt#: Project name:Polygon At Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than
0 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 1 .
New residential single-or multi-family dwelling unit
Subdivision:Polygon at Roshak Ridge Lot#: 90 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft or less 168.54 4
Ea.add'I 500 sq.R or portion 33.92 1
DESCRIPTION OF'WORK M Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy la See Page 2
®_PROPERTY;OWNER':`. . ❑ 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 amens 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
Contact name:Nichole Thorpe • B.Fee for branch circuits without
serviAddress:703 Broadway St Suite 510 branch
ciirrcufeeder fee lint 56,18 2
City/Stater/JP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not induded)
Phone:(360)695-7700 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 orisrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
SAddress:3415 NE 44th panel, a )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) 6625/lrr
Phone:(503)319-2192 Fax( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(l hr min) 78.18lhr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4874 specifically listed(5 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: ,J air- TOTAL PERIvRT 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.
— n Number of impactions allowed per permit
• . Plumbing Permit Application
Building Fixtures 1 _� 6,,,C_.„,.3 ,; l a.. FOR OFFICE USE ONLY
gli 13125 HaTigard _ 77 tt� Received MS/20.70 M/5
111 `, rC3 3 C�2U Date/By:
Permit No.: �-t1L w
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0' Phone: 503.718.2439 Fax: 503.59$1 DateB Other Permit No.:
Inspection Line: 503.639.4175 )l7r 1 y
TIGARD - Date ReadyBy: .turn: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION x . "� SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ®Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: V& MO G o(,D T lin, Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Roshak Ridge I Lot no.: go Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
# Backwater valve 12.51
DESCRIPTION OF WORK *
'Vr� q�� � � Clothes washer 25.02
�/gu�` � �1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) 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: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: $72.50
CCB Lie.:184601 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:\Building1Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WER)
I I
*b
City of Tigard
NI ® COMMUNITY DEVELOPMENT DEPARTMENT
e Building Permit Review — Residential
TIGARD
rP
Building Permit #: MST-2020-Wi 56
Site Address: qq1710 --00 d aft-C'7` ,fr C4?
Project Name: 7 en <7- L Lot #: 9i)
Planning Review V
Pro, •sal: IUD/,°
IA Verify address/suite# active in Accela. 0 In River Te. .ce: 0 No Yes,River Terrace Review Addendum
Sit: Ian Elements: J Erosion Control
1P.5 ,copies of site plan on 8-1/2"x 11"or 11 x 17"paper IVI -tained trees with drip line and tree protection measures
IIK,rawn to scale(standard architect or engineer scale) X F otprint of new structure(including decks)and FFE
rth arrow l ty locations&easements(required for new and additions)
1 ite address,project or subdivision name and lot number f►Sidewalk/driveway approach
Oi pliant information(name and phone number) 1 I1 !. ation of wells/septic systems
dimensions and building setback dimensions 7.2 S eet tree size,type and location
1%1.auare footage of buildings to be demolished grS,,tatet names
i PJ .sting structures on site letorner elevations (2'contours if more than 4'dif�fer tial)
V at area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Yes ❑N
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water .uali facili shown j i' ■Yes r Io
1 at Clean Water Services-Service Provider Lett (lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified No Received: 0 Yes ❑ No
(Water Meter Fixture Unit Worksheet-Addis,Remodels and ADUs
Required: ❑ Yes,applicant was notified 1Q No Received: 0 Yes ❑ No
1`l" ,•C Exemption for ADU applied for: E Yes " No Received: ❑ Yes ❑ No
ilt Public Faciliti Improvement (PFI) Permit:
�yquired: I Yes,applicant was notified ❑ No A lied For: 1� Yes 0 No,stop intake
l! and Use Case#: c�UgQt?/. - CO t V:,„Zoning: £12 ! f�
l quired Setbacks: Front: 40 Rear: � 77 Side:_U Street Side: /�-' Garage: lY�•
ding Height: Max. Height: i/v�> Actual Hei ht:- -
Landscape Area: -20 % 0 Lot Coverage Max: %
Entrance et back no more than 8'from street-facing wall E Parallel to et or offset 45 degrees or less
Windows ❑ Minim %of area of all street-facing facades
Garage ❑ Garage door is be ' 'dest street-facing wall k•J Yes ❑ No,one of the following is met:
0 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.
❑ Garage door width is ❑ 'or less ❑ 50%o of facade ❑ 60%or less and includes 7 of following:
❑ Covered po Recessed entrance ❑ Wall o s 0 1'Roof eave ❑ Roof offset
O Fir ' gles ❑ Lap Siding 0 Roof pitch ❑ Gable, , mbrel roof ❑ Dormer
Accent siding Window trim CIWindow recess ❑ Window • ction ❑ Balcony
a Visual Clearance Urban Forestry
, 1\\) nsitive Lands: ❑ Yes No Type:
Conditions met prior to issuance of building permit
s:
Approved By Planning: Date: /0 .2 -1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
i:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal F
Original Submittal Date: a2-a3-1020
Site Plans: #
Building Plans: # 3
Building Permit#: RI"Enter building permit#above.
Workflow Routing: 5kPlanning Engineering fl'Permit Coordinator Building
Workflow Sign-off: [�Sign-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
C'Building: original permit application, site plans,building plans,engineer and
beam calculations and details,if applicable,etc.
Notes:
By Permit Technician: �,//11� Date: O5 13-207-4
En eering Review
Vz,Slope at building pad: A2 /
L✓1 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: ❑ Yes lNo
Assess Water Quantity Fee in-lieu: ❑ Yes INo
LIDA Facility on lot: El Yes 1ZNo
fd Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
t' Approved by Engineering: Date:
Revisions(after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ 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:
SDC Exemption: ❑ Received Does not apply
IKSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes El N/A
Parks SDC: Yes ❑ N/A
LIDA 0 Yes ] N/A
4"OK to Issue Permit
Approved by Permit Coordinator: •il Date: 51 )9,(2
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
f
City of Tigard
IIIr COMMUNITY DEVELOPMENT DEPARTMENT
II
T 1 A � River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 111'/96 ci / C.,�2CL .a
Project Name: ) Lot #:
(New dw subdivision name;Addition or Alteration= t name of owner)
Planning Review of River Terrace Plan Dist ' t Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? 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/ a ss 2 Window Projection Vertical Wall ffset a
Porch min deep ft. de min.2ft., 5 ft.wide min. 2 ft.,6fywide Gabled dormer
2. Eyes orn the street: a minimu of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: >a t',o
1trances:At least one entrance must meet both of the follo g standards:
Max. 8 ft. setback from longer street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If y s,all the following apply: s .ft.min.
e street facing entry 1 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 ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep
all offset min. 16 inches S 0 Dormer min. 4 ft. wide
1a Roof eave min. 12 inch projection /��X ❑ of offset min. of 2 ft.
❑ Roof shingles either tile or wood le,hip or gambrel roof design fr�J
❑ of pitch oriented south min. 500 sq. ft (Wnzontal lap siding min. 3-7 inches wide 1—
IQ Accent siding min.40%of street facade' I!d'Window trim min. 2'/2"wide by 5/8"deepr'�'1`'"-
❑ }7Clmdow recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
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):
❑ 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 - garage that faces the street with a min. area of 12 sq.ft.
WI. .1: (Check one)
16 12-foot-wide garage door 0 40%max. of street façade
O 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: - Date:
1:1Building\Forms\BldgPamrtRvw_RES_RT_121417.docx