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Permit
City of Tigard • COMMUNTI'Y DEVELOPMENT DEPARTMENT V 0 I D ='PIRequest for Permit Action T I t,A RI) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ® Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Polygon Homes WLH LLC Mailing Address: 703 Broadway St., Ste 510 City/State/Zip: Vancouver, WA 98660 Phone No.: 360-695-7700 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: MST2020-00126& SWR2020-00076 Site Address or Parcel#: 14130 SW 165th Ave Project Name: Polygon at Roshak Ridge Subdivision Name: Roshak Ridge Lot#: 165 EXPLANATION: Land use changed to ADU plans-ADU2020-00013 Signature: %gam yt,� Date: 11/24/20 Print Name: Tonia Morris Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys.Amin: Date By Route to Records: Date I Z! By .. 7 Refund Processed: Date By Invoice Processed: Date l 26 /Z j By 11(1 Permit Canceled: Date I 20/21 By eV Parcel Tag Added: Date By I:ABuilding\Forms\RegPermitAction_(20518 oc Building Permit Applicatic! l .2 I Residential t City of Tigard APR 0 8 2020 Received N,�j Permit 7i�,/ 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: ��/7 �GI /�� So �'1�02 Plan Revie r ■ Phone: 503.718.2439 Fax: 503.59 . 9 ,( 1�+�� `l Date/By: Other Pere/ Z.Cd—(��J74 f 1 C A R I) Inspection Line: 503.639.4175 I I ING DIVISION Date Ready/By: Juris: fa See Page 2 for Internet: www.tigard-or.gov 4!1t ivtTar� Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction El 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: $ ® 1-and 2-family dwelling ❑Commercial/industrial ElAccessory building ❑Multi-family Number of bedrooms: 3 ❑Master builder El Other: Number of bathrooms: 2.5 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address:14130 SW 165'Ave New dwelling area: 2734 square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: 638 square feet Suite/bldg./apt.no.: Project name:Roshak Ridge Covered porch area: 67 square feet 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.:165 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 El 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* (Please refer to fee schedule) Business name:Polygon WLH,LLC 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 I Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lie.:204238 Total fee due upon application: $201.60 Authorized signature: Ta ttia, i a This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name:Tonja Morris Date:04/08/2020 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) EDMechanical Permit Applicati EG IV 10R OFIIc is I sE:0yl.A City of Tigard Q '�p20 Received Date/By: Permit No 17- 4 ,. /2� 111 13125 SW Hall Blvd.,Tigard,OR 97223 APR O O Phone: 503.718.2439 Fax: 503.598.1960 Plan ReviewG0 Date/By: Other Permit: T 1 G A R D Inspection Line: 503.639.4175 GiTy Ur ` iQ r dDate Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov B, ILDI% �I� '-"' ' Notified/Method: Supplemental Information TYPE"OF* Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. ,.- . Value $ '1i ws rNa e �,` CATEGORY O' © JGON . 7 � 839 �[y � � )i,}...,`. - N . + p ' " ,s ..., :a F, "` �4aCa�. — � _ � �� . . asjlr .,® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total 4' + 6 1. �ii 2 a �I s C s em 1 i k M d l u t ? �i r 'l -. i , i pig }' o�r , Hearin cooling: Air conditioning 46.75 Job site address: 14130 SW 165th Ave 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:Polygon at 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:Polygon at Roshak Ridge Lot no.:165 Other: 23.32 Other fuel appliances: fax 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 ElPROPERTY OWNER CITENANT 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 9860 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(360)695-7700 Fax:(360)693-4442 Attic/crawlspace fans 23.32 4 , �Hu��iJ .' n-� , ,, - ❑ G`fi? `',,,,. n , ,..+ Other: 23.32 Business name:Polygon WLH LLC Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Tonja Morris Furnace,etc. Gas heat pump Address:703 Broadway St.Ste 510 Wall/suspended/unit heater City/State/ZIP:Vancouver WA 98660 Water heater Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace Range E-mail:permitsubmittalsnpolygonhomes.com Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name:TBD Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: 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:Tonja Morris Date: 1\BuildingWermits\MEC_PermitApp_040113.doc 440-4617T(I I/02/COM/WEB) • Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Ya�rua ►? if t ' I e litittg, -- k � ! $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. C\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application riCIV IOR()HALL l til. 0\1.1 City of Tigard Received �y DateB : 13125 SW Hall Blvd.,Tigard,OR 97223 APR 0 8 ZOZO Plan Review -„/_ ♦ r/ IPAI i Phone: 503.718.2439 Fax: 503.598.1960 _ Date/B : Related Permit#: Inspection Line: 503.639.4175 ttGPF Ready Date/By: Juris: ® See Page 2 for TIGARD �i���� p I '1Iotitied/Method: SupplementalInformation Internet: wwwtigard-or.gov � @drat ,� "tl".ink' cel,k"',= ...-r .. ;,: .,r, r;..-T PF OF,if(94.,i i} . F, s i4pAgitii ii Sf. ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. . CATEGORY OP CQ ? �� Po ����� � � ;� ��� exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or . ,,.;1 :41r„ r "t iiN� °.h ! 07EHOR ."' .' °� N T "4's" 'r`)7444 `,' ;�,a.:.. 0 Emergency system. larger separately derived Job#: I Job site address: 14130 SW 165th Ave ❑Addition of new motor load of system. 100HP or more. ❑«A" "E" "1-2" "I-3„ City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Polygon at Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 11 4' , I — r ' ifk gam s :_ Description I Qty. Each Total_ r" New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#: 165 Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 I .,, D CRIT IO0O WO1U Limited energy,residential 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 - <�°PROPERTY`OWNER ❑'T- , — Services or feeders installation,alteration,and/or relocation Name:Polygon WLH LLC 200 amps or less 100.70 2 Address:703 Broadway St.Ste 510 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Vancouver WA 98660 601 amps to 1,000 amps 301.04 2 Phone:(360)695-7700 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 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 CI APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH LLC above service or feeder fee, 7 42 2 each branch circuit Contact name:Tonja Morris B.Fee for branch circuits without Address:703 BroadwaySt.Ste 510 service or feeder fee,first 56.18 2 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: :(630)693-4442 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Finail: permitsubmittals(polygonhomes.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:TBD Sign or outline lighting 67.84 2 circuit(s) gy Signa Address: panel,)alteration,00r extensioner 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%hr min) r ." 'PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Tonja Morris Date: days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: 'MSIDENTtAtr!. ',. "'%'d .a,Y'a'nli�kLkw* x _ hi�rnR + Fi Cl Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 E Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 El Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%hr min) C()1VC ' EI CII\L G Jt '-Cl ,, � r l� '' r ? tal~AI : s ft Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ri A• udio and Stereo Systems ❑ Boiler Controls El C• lock Systems ❑ Data Telecommunication Installation ❑ F• ire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* n M• edical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1'.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 Plumbing Permit Application,- 4POEIVP ''' Building Fixtures �'°� FOR 01F1( 1: 1 SF ()NIA City of Tigard APR 0 8 2020 Received Permit No 13125 SW Hall Blvd.,Tigard,OR 97223Vil � Date/By: 57�ay"wr.2� r r gF Plan Phone: 503.718.2439 Fax: 503.598.19 1 y Of- � �AH Planpate Review Other Permit No.: Inspection Line: 503.639.4175 pp pp��/'+ V$Sk, y T I G A R D !1��_ �,1l1� �� !v-r Date Ready/By: Juris: gi See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information a `, ,� 7. TYPE OF WORK l t pi :4 ®New construction ❑ Demolition For special iiformation use checklist Description Qty. I Ea. I Total 0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connectionL R_" w.F.i 1 CATEGORY OF,CONS SFR CONSTRUCTION. SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 ,IOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14130 SW 165" Ave 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:Polygon 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:Polygon at Roshak Ridge Lot no.: 165 Fixture or item: 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 ❑ 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:(360)693-4442 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:TBD Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Tonja Morris 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. 1:\Building\Permits\PLMU•PermitApp.dor 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: i�,�aB�Lr-�d sac ° a Sfte° tlleS „ . ,0 m . '� j"�fa�¶ x Square F ►ota e` ,'. � �p �)( A r . � Footing drain-1' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 iitt`: tour " e Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for "t '° z; "to ; �'0 4 (e , each additional$100.00 or fraction thereof,to it � � � a `� and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Other Fixtures: Commercial Fixture Work: Are you capping,adding or replacing fixtures? if"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. ()windy Fixture Type fur placer 01�IanR see w far'P iu m4ir►g ti toa l a h.b nWvrk'!erforted; Cakp .. Added Relocate Plan review is required for anyof the following. Baptistry/Font 9 Bath Tub/Shower Please check all that apply. Jacuzzi/Whirlpool El Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator 0 New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic 0 Medical gas and vacuum systems for health care facilities. Drinking Fountain 0 Any multipurpose fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. Car Wash Drain }}�� Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings Disposal -Domestic-food related g q g -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the C:\Users\ProfileDisk\dianna\AppData\Local\Microsoft\Windows\INetCacte\Content.Outlook\G6Y9WB9T\Polygon at Roshak Ridge Area 4 Plumbing App.doc City of Tigard 11 COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 c A R n Building Permit Review — Residential Building Permit #: /Ii S`c,20 cP-p -(j0%Z.(v Site Address: 1 LH 30 Svc I loth - Project Name: (Z,aC VIa.`C. ¢va 0-e_, Lot #: (L S Planning Review Proposal: 011A f thou Verify address/suite# active in Accela. In River Terrace: ❑ No X'Yes,River Terrace Review Addendum Site Plan Elements: rosion Control 1.2 copies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures ,)rawn to scale(standard architect or engineer scale) 12F. ootprint of new structure(including decks)and FFE forth arrow ►' tility locations&easements(required for new and additions) 3SkSite address,project or subdivision name and lot number Sidewalk/driveway approach Applicant information(name and phone number) Ng/Location of wells/septic systems Ni at dimensions and building setback dimensions n treet tree size,type and location tit: quare footage of buildings to be demolished 21 treet names is xisting structures on site Xomer elevations(2'contours if more than 4'differential) W Lot area,building coverage area,percentage of coverage and ,>11,000 sf of impervious area created or replaced? s qt h o impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es •No X"Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified KNo Received: ❑ Yes ❑ No XWater Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: ❑ Yes,applicant was notified *,No Received: ❑ Yes ❑ No SDC Exemption for ADU applied for: ❑ Yes X No Received: ❑ Yes ❑ No ,K Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified )No Applied For: ❑ Yes ❑ No,stop intake La Land Use Case#: P D9--2-02 O L5 -0000 y:1 Zoning: R-L/T•C. Required Setbacks: Front: 5 Rear: l O Side: 3 Street Side:N I P Garage: 20 la Building Height: Max. Height:3D Actual Height: 20 Landscape Area: 2D % l. Lot Coverage Max: b Entrance \ Set bac no m re than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows III Minim 12° of a.-a of all street-facing facades Garage II arage door' be ' a widest street- actie,C, ❑ Yes ❑ No,one of the following is met: • oor tend• s ore than ' om wall and there is a covered porch extending beyond garage. ■ or xten s. s .••re than 5'"TagTd the i s a 12 l ft.'. . so v o 2nd floor. II Garag- oo wid . is 1\ 12'or le. or 1 c g r`6 '/o • 1 sg incl des 7 of following: ❑ Coveted po h a Recesses en ❑ Wa offset r 1'Roo eave ❑ Roof offset ❑ Fire hingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ Acc t siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony fgA-Visual Clearance .Urban Forestry Plan ,K Sensitive Lands: ❑ Yes No Type: ›K Conditions met prior to issuance of building permit Notes: X Approved By Planning: A-"Cr—feA-- Date: L( 13 I1-0 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: /6P/20 Site Plans: # ' Building Plans: # 3 Building Permit#: 9—Enter building permit#above. Workflow Routing: OPlanning Engineering tl'Permit Coordinator ilding Workflow Sign-off: [ —Sign-off for Planning(include notes from planning review) Route Application Documents: ,I- 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: /.7/20 Engineering Review [lope at building pad: 3 , Conditions "Met"prior to issuance of building permit EPEasements (encroachments)per engineering conditions of approval and plat X7ater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ( No Assess Water Quantity Fee in-lieu: El Yes No LIDA Facility on lot: ❑ Yes L'No /2 Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes:te I(d' Approved by Engineering: Date: /e, 2 ' 2p Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: Cl Approved ❑ Not Approved Permit Coordinator Review `I 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: Cl Received Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA ❑ Yes 'N/A 1L OK to Issue Permit Approved by Permit Coordinator: Date: I 0 ZO I:\Building\Forms\BldgPermitRvw_RES_122419.docx