Permit r
•
Plumbing Permit ApplicatilmCEI V ED
Building Fixtures FOR OFFICE USE ONLY
SEC 15 2020 eceive '^
City of Tigard R DareBy:d 2Z w '^{!�+
\2 ZOZO permit No.:MST W 'pO%S 1
illig ■ 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
I - Phone: 503.718.2439 Fax: 503.59 0 0 9A6.4 Other Permit No.:
�� 'OF TIGARD Date/By: y 6 Y
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: f Jura61 See Page 2 for
Internet: www.tigard-or.gov BEMniNf nlvlsIQN Notified/Method: 41��G'/ 00 1� Supplemental Information
TYPE OF WORK FEE" SCHEDULE
IgNew construction ❑ Demolition For special information use checklist
• Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 it.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
1-and 2-family dwelling Accessory building El
❑Multi-family SFR(2)bath 437.78
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( q.ft.)\\I,O1b Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: VALI Lk 3 lei() eCA'T'S - '�_(..z7 INCc_ Catch basin or area drain 18.76
ty `-A\ l D `7f) ` +� C Drywell,leach line,or trench drain 18.76
City/State/ZIP: +/ Yr C' `
Cl A Footing drain(no.linear ft.:� Page 2
Suite/bldg./apt.no.: 1 Project name: F
F� �-;✓, k�-- 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:c.cchclx3t
1 i i Lot no.: K1 Fixture or item:
Tax map/parcel no.: Backflowpreventer 31.27
DESCRIPTION OF.WORK Backwater valve 12.51
Clothes washer 25.02
^, p _ v Dishwasher 25.02
' tta Q\ n Al" 4 s (0 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
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
��.�
Business name: �� Q.(;;,0,1 1\k (1iici„ C ,IO \ t. `C^J Water piping/DWV 56.29
Address: (0.)71S Lk) 1t 9 ti^c; l C,Ltinl A Q-'` 1-k�LsY-i, Other: 25.02
c k City/State/ZIP: CA-AAA AA l A - c\' 0 Subtotal
Phone:( �([3q i lj Fax:co,.. ) (01,0 -C-M 1 Minimum permit fee: $72.50
CCB Lie.: I1 1 r22 .:0 I Plumbing Lie.no: l,�q f$ Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized si ire: TOTAL PERMIT FEE
������llll���l 1application expires if a permit is not obtained within 180 days
Print name: �5.\C erM Date:��.t ��I�Z� This permit after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\Per mits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COMPNEB)
t CITY OF TIGARD MASTER PERMIT
' 1 :':, COMMUNITY DEVELOPMENT Permit#: MST2020-00157
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/24/2020
T I:G r A l O 9 Parcel: 2S 107AA08900
Jurisdiction: Tigard
Site address: 14444 SW GOLD COAST TER
Subdivision: ROSHAK RIDGE Lot: 89
Project: Polygon at Roshak Ridge, Lot 89
Project Description: New SFA
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 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 st 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
Drywell-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 add'I 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: 360-695-7700
FAX: 360-693-4442
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�throuuggh 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.
Issued By:40 i Permittee Signature: OTh Qpp,G CSC (N1
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 • L--0 7 8c3 .
Residential V �'" FOR OFFICE USE ONLY
,,a �.I
City of Tigard DDteiveya. j) / 2Q20 PemitNo.:Msr202D-00157
. - • 13125 SW Hall Blvd.,Tigard,OR 972233EB 3 ZOZ] Plan Review � �.�( t�/fj���/yt�
Phone: 503.718.2439 Fax: 503.598.19 t Date/By: lQ ij Pit 3 Other Pe W I` W I
T I GARD Inspection Line: 503.639.4175 ,41-T-Y OF •��1:ARO Date Ready/By: A rars I H See Page 2 for
Internet www.tigard-or.gov 1 i�ERlre. 1�.�1��i� �` Notified/Method: a,# 2 l .�� Supplemental Information
r31JI� N A7-19,L ,✓
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 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: $ l lei ' 152
❑Accessory building 0 Multi-family Number of bedrooms: 'L
❑Master builder ❑Other. Number of bathrooms: 3
JOB`LSITE INFORMATION AND LOCATION Total number of floors: 3 \46
Job site address: I I{ T el tj(A LOry s-r 1" - New dwelling area t' square lffeet 56 Z
uo
City/State/ZIP:Tigard,OR 97224 Garage/carport areasquare feet 662,
Suite/bldg./apt.no.: Project name:Roshak Ridge Covered porch area: square feet 144
Cross street/directions to job site: Deck area: -' square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Roshak Ridge Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: �� Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
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*
Business name:Polygon WLH,LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Tonja Morris
Address:703 Broadway St.,Ste 510 FLS plan review fee(if applicable):
City/State/ZIP:Vancouver WA 98660 Total fees due upon application:
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 department access,along with the 2010 Oregon
Address:703 Broadway St.,Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lie.:204238 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Tonja Morris Date:04/17/2019 *Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
•
Mechanical Permit Application_ C,,.,C - FOR OFFICE USE ONLY
Cityof Tigard y > .. i Received ♦ .�,�y
g Date/By: Permit No.: 64 c'r�f/Izo,•f r „6—
ligll. 13125 SW Hall Blvd.,Tigard,OR 97223 V w w r
Phone: 503.718.2439 Fax: 503.598.1960 FEB 3 2020 PlaDan Review Other Permit:
1 14.?? 1,l j Inspection Line: 503.639.4175 Date Ready/By: orris:
Internet: www.tigard-or.gov C'9`rO((" ' lf-,'�Rf y o' S See Page l2 for
a.!l I � „i f" �,v7,(ya.i.= Notified/Method: Supplemental Information
TYPE OF WORK i COMMERCIAL FEE* SCHEDULE — USE CHECKLiST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
igi 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
` ly Air conditioning 46.75
Job site address: ti4 Goa) C 5-r '�4.�9.- 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.: 8 el 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
ID PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
1 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: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:per mitsu13mittals@polygonhornes.eom Barbecue
AAN CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMrr.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 lie.:209001 TOTAL PERMIT FEE
ZS This permit application expires if a permit is not obtained within 180
rJ' ba days after it has been accepted as complete.
Authorized signature: C L * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
I:1Building\PeraiLs\1 C_PmmiEApp_040113.doc 440-4617r(11/02/COM/WEB)
FCEl'/E D
Electrical Permit Applicatid'li FOR OFF10E;1.[s.FT ON17-.
I . City of Tigard FEB 3 2026 DReceived - Permit it: t�l(SI �/er`Gb15
r - ° 13125 SW Hall Blvd.,Tigard,OR 9 ry -L._ /_,r n�-5 1. t Plan Review Related Permit tl:
t - Phone: 503.7182439 Fax: 503 59 l (.J 1-- I r�ariR Dates :
-. Inspection Line: 503.639.4175 31 i 1! i ' 1 f i\/i s in)(\,' Ready Date/By: Twist El See Page 2 for
TIGARD .
b Internet www.tigard-or.gov Notified/Method: Supplemental Information
. tPPk OF.WORK ....f . ' =`PLANcREwVP.w.';" '"'..,i.
®New construction ❑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 ❑Other
where the available fault current 0 Marinas and boatyards.
- ... .r IEGORY_OF-CONSTRUC'TiON -..,.,.. . . exceeds 10,000 amps at150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0amp Multi-family ❑Master builder 0 Other 0 Fire nstallations buildings.
ags
Fire for all other pump, ❑Installation of 150 KVA or
�t L .:: JOB S11'h:INFORMATTOWAND'LOCATION i - ❑Emergency system larger separately derived
w`,`
['Addition of new motor load of system.
Job#: Job site address:
y444 Grew (sT-"Tie,,g 10013P or more. ❑"A","E","1-2","1-3",
City/State/G1P:Tigard,OR 97224 ❑Six o mom residential units. occupancy.
❑Healthcare facilities. ['Recreational vehicle parks.
Suite/bldgJapt#: _ Project name:Polygon At Roshak Ridge ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominaL
Cross street/directions to job site: FEE SCHEDULE
Description - I Qty. I Each I Total I a
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: el Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
• Ea add'l500sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited mergy,multi-family 75.00 2
residential(with above sq.ft)
Renewable Energy O. 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, 7.42 2
each branch circuit
Contact name:Nichole Thorpe B.Fee for branch circuits without
Address:703 Broadway St Suite 510 branch circuit or y fee,first 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each addl 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: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 t(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension
City/State/ZIP:Portland OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(11u min) 66.25/br
Phone:(503)319-2192 Fax( ) Investigation(1 hrmin) 90.00/hr
Email:solarpdx@me.com •
Industrial plant(1 hrmm) - 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4875 specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Kite Rood Date: 03/08/2019 ❑Plan Review Required(25%of pemrit fee):
•
¢ State surcharge(12%of permit fee):
Authorized signature:• / TOTAL PERMIT FEE:
1.. r. This permit application expires if a permit is not obtained within 180
Print name: Kile Rood - Date: 03/08/2019 days after ithas been accepted as complete.
- ' Number of inspections allowed per permit
* ' Plumbing Permit Application ... , . .
Building Fixtures L- - y '.-:
3 FOR OFFICE USE ONLY
Cityof Tigard FEB� 2020 Received Ms 20 57
g
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Date Ry: Permit No.:
plan Re
C. Phone: 503.718.2439 Fax 503.598.1960 (, ! A 1``t. Date/Bview Other Permit No.:
TIGARD Inspection Line: 503.639.4175 ` Date Ready/By: rwis: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description f Qty. 1 Ea. ( Total
LI Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION IVO (1)bath 312.70
El1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
ElAccessory building El Multi-familySFR(3)bath 500.32
Each additional bath/ldtchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION :IrinaVa Site utilities:
Job site address: 114 4Litt (IX_J C4Ji1-ST l ..0- 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 I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
_` ' w, �G3 ZQ, Clothes washer 25.02
U 11 1J Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name:Polygon W LH,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: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:'Buildiag1Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
r►•
City of Tigard
p11,111 COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: NiT 2-020'001 G7
Site Address: /� AJ (3V1 gaS4 7 ric '
Project Name: fduq�n (0.-� � � / � Lot #:
Planning Review (IC7
Pro: i sal: &eh)
I% Verify address/suite# active in Accela. IZ In River Terr.ce: ❑ No Yes,River Terrace Review Addendum
Sit: 'Ian Elements: a Erosion Control
3,copies of site plan on 8-1/2"x 11"or 11 x 17"paper 11' tained trees with drip line and tree protection measures
IP. .wn to scale(standard architect or engineer scale) 11 F otprint of new structure (including decks) and FFE
ti •rth arrow 'ty locations&easements(required for new and additions)
IA a address,project or subdivision name and lot number I>,Sidewalk/driveway approach
lZ plicant information(name and phone number) MI i s ation of wells/septic systems
v/Af dimensions and building setback dimensions S eet tree size,type and location
uare footage of buildings to be demolished iai lZSt names
sting structures on site I Comer elevations(2'contours if more than 4'differ tial)
t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 'es ONy
impervious area(applicable if R-7,R-12,R-25&R-40) If es,is a storm water •uali facili shown, ,11" ■Yes o
1 a1 Clean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified 6a No Received: ❑ Yes ❑ No
(Water Meter Fixture Unit Worksheet—Addis,Remodels and ADUs
Required: ❑ Yes,applicant was notified 'IQ No / Received: El Yes ID No
\1" I IOC Exemption for ADU applied for: ❑ Yes 1Q No Received: ❑ Yes ❑ No
L Public FacihtieImprovement (PFI) Permit:
Qquired: Yes,applicant wasd notified ❑ No1 lied For: Yes ❑ No,stop intake
and Use Case#: s'(hJ Q�2a/ — 0000/ t1 „ oning £12 f�
quired Setbacks: Front: Y> Rear: �, •� // Side:_U Street Side: .A4— Garage: / . c-
ding Height Max.Height: l'U1 Actual Heght:_
Landscape Area: -2C) % ❑ Lot Coverage Max:
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 be •dest street-facing wall �1 Yes ❑ No,one of the following is met:
O Door extends no more 'from wall ere is a covered porch extending beyond garage.
O Door extends no more than 5' and there is a 12 sq ft.window above garage on 2°d 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 0 Roof offset
❑ Fir gles 0 Lap Siding ❑ Roof pitch ❑ Gable, , ambrel roof ❑ Dormer
Accent siding , Window trim ❑ Window recess ❑ Window ' ction ❑ Balcony
Visual Clearance VJ Urban Forestryn
IV nsitive Lands: ElYes 1I No Type:
Conditions met prior to issuance of building permit
No s:
Approved By Planning: o� Date: /0 .2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BIdgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 72/03,/Z42O
Site Plans: # 3
Building Plans: # 3
Building Permit#: [Enter building permit#above.
Workflow Routing: al' Planning LE'Engineering ik Permit Coordinator I - uilding
Workflow Sign-off: 112'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.
[ Building: original permit application, site plans,building plans,engineer and
beam calculations an. . st details,if applicable,etc.
Notes:
By Permit Technician: ;iii/ Date: i96—l3 202o
Engineering Review
Slope at building pad: 200 �l
Conditions "Met"prior to issuance of building permit 4,
l"Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ["No
Assess Water Quantity Fee in-lieu: ❑ Yes �1Vo
LIDA Facility on lot: ❑ Yes liAo
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
diApproved by Engineering: ✓ Date: `517 6 — o
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved Cl 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:
73. SDC Exemption: ❑ Received .Z Does not apply
., SDC Fees Entered: Wash Co Trans Dev Tax: AT yes ❑ N/A
Tigard Trans SDC: X Yes ❑ N/A
Parks SDC: .IISt' Yes ❑ N/A
LIDA ❑ Yes A( N/A
la OK to Issue Permit
Approved by Permit Coordinator: A y A Date: 51,1[2.0
I:\Building\Forms\BldgPennitRvw_RES_122419.docx
City of Tigard
w COMMUNITY DEVELOPMENT DEPARTMENT
1111111
T I G A R D River Terrace Building Permit Review Addendum
ft
Building Permit #:
Site Address: /W91/ S '2 p J (�VC7L !! ,4)C
Project Name: A yi .371 ,.�ik pe/ ) Lot #: _,- 7
(New dwe 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 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/ a ss 2 Window Projection Vertical Wall ffset a
Porch min. 5 deep ft. de min. 2ft., 5 ft.wide min. 2 ft., 6f wide Gabled dormer
0
0
2. Eyes on the street:a minimurp of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: ,L2P/
1trances:At least one entrance must meet both of the folio 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: V s t.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 façades:
overed porch min. 5 ft.wide x 5 ft. deep 0 Recessed entry area min. 5 ft.wide x 2 ft. deep
Tall offset min. 16 inchesc 0 Dormer min. 4 ft.wide
Id Roof eave min. 12 inch projection / Vf offset min. of 2 ft. �S
❑ Roof shingles either tile or wood le,hip or gambrel roof design It'.
❑ of pitch oriented south min. 500 sq. ft. 142ontal lap siding min. 3-7 inches wide 1—
0 Accent siding min.40% of street facadef J [ Window trim min. 2 1/2"wide by 5/8"deepreI
❑ ,indow 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 ❑ 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.
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. : : (Check one)
1% 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:
BEluildingTormA3IdgPermilRvw RES_RT_121417.docx