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Permit " CITY OF TIGARD +. ; MASTER PERMIT 111 COMMUNITY DEVELOPMENT �. frA !'�� Permit#: MST2015-00316 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2016 Parcel: 251060003000 Jurisdiction: TIGARD Site address: 13835 SW 175TH AVE Subdivision: RIVER TERRACE NORTHWEST Lot: 1 Project: Polygon at West River Terrace, Lot 96 Project Description: New SF. Model home. 8/4/2016: REPRINT permit to add 111 sf patio cover. 9/14/16, REPRINTED to add a/c. 9/16/2016: REPRINT permit to correct address from 13849 to 13835. ` BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 978 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1251 sf Garage: 280 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 2229 sf Value: $271,874.58 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecom pasin 9: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2229 Owner: Contractor: ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 7600 EAST DOUBLETREE RANCH 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 RD,STE VANCOUVER,WA 98660 2 A geotechnical report is SCOTTSDALE,AZ 85258 required before the footing PHONE: PHONE: 360-695-7700 FAX: Total Fees: $31,582.79 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 1 r Permittee Signature: piv •‘ T'/ e-fe'9T70/✓ 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. CITY OF TIGARD I' a; MASTER PERMIT I COMMUNITY DEVELOPMENT iy " ' Permit#: MST2015 00316 TII A.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 /� Date Issued: 01/27/2016 Parcel: 251060003000 Jurisdiction: TIGARD Site address: 13849 SW 175TH AVE Subdivision: RIVER TERRACE NORTHWEST Lot: 1 Project: Polygon at West River Terrace, Lot 96 Project Description: New SF. Model home. 8/4/2016: REPRINT permit to add 111 sf patio cover. 9/14/16, REPRINTED to add a/c. ' BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 978 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1251 sf Garage: 280 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 2229 sf Value: $271,874.58 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 3 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 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add,500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2229 Owner: Contractor: ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 7600 EAST DOUBLETREE RANCH 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 RD,STE VANCOUVER,WA 98660 2 A geotechnical report is SCOTTSDALE,AZ 85258 required before the footing PHONE: PHONE: 360-695-7700 FAX: Total Fees: $31,582.79 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. IssuedBCPermittee Signature: Com ,_,J.-f/ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. -Mechanical Permit Application _ FOR OFFICE USE ONLY City of Tigard Received Q /I, / a y / y Permit No.: w 13125 SW Hall Blvd.,Tigard,OR 97223 DateB : (p ♦ NGj1'�L'jf$%GYM 31 / Phone: 503.718.2439 Fax: 503.598.1960 r Plan RDate/By Review Other Permit: T I GAR D Inspection Line: 503.639.4175 AUG 2 2 2 016 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TI ARD .UIl I.0DIVISION l � r� r�rsr. cnu�= F Mechanical permit fees*are based on the value of the work ►1 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 ..sf..=. a. il+l _ Value: $ AEiiiGlf1'I . - W_til!1 _ .:_ ._ G_ TRX_ F I1l , 1;, faV 0,11: TVC , il§ OxLy ® 1-and 2-family ❑Commercial/industrial ❑Accessory building For special information use checklist ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. I Total 4 x ,-1 =TJOB SITE-3111 bRMA JCQ11111I >v Eta ifi7 Heating/cooling: Au conditioning 1 46.75 46.75 Job site address: �� p, 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 West River Ter Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 2332 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 West River Terrrace Lot no.:9Other: 23.32 tit Other fuel appliances: Tax map/parcel no.: Water heater 23.32 s l ,11 C i<iiN OE ©Rid: Gas fireplace/insert 3339 sF. . ?:.- f 4 ".- .,- 1.-, ._ 414 ''._. .-.'._':;. Flue vent for water heater or gas Add AC fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 • ... Other:- pRP r ANir 23.32 fil_. .,_WCt5Y . _ __ ',_ ,_._. T ,_..._.. Environmental exhaust and ventilation: Name:ADVL Land Holdings,LLC Range hood/other kitchen equipment 33.39 Address:7600 E Doubletree Ranch Road Clothes dryer exhaust 33.39 City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(602)694-4031„ ki. f Fax:(. ) Attic/crawlspace fans 23.32 Fr.,r A} Other: 2332 Fuel piping: Business name:William Lyon Homes,Inc. $14.15 for first four;$4.03 for each additional Contact name:Angela Grajewski Furnace,etc. Address:109 East 13th Street Gas heat pump WalUsuspended/unit heater City/State/ZIP:Vancouver,WA 98660 Water heater Phone:(360)695-7700 I Fax::(360)693-4442 Fireplace Range E-mail:Angela.Grajewski@polygonhomes.com Barbecue .' ' '' =;T 3 ':-nr*�>9 n.._' .t',. {�, ri- �, .a` " k'" ,#-t `��S- -- Clothes dryer(gas) Business name:Apex Air LLC Other M Address:18004 NE 72na Ave �� ` ... Subtotal City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(360)342-8109 I Fax:(360)326-1769 State surcharge(12%of permit fee) CCB lic.:203034 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 r days after it has been accepted as complete. Authorized signature: affr * Fee methodology set by Tri-County Building Industry Service Board Print name:Angela Grajewski I Date:8/22/16 I I:\Building\Permits\MEC PemsitApp 040113.doc 440-4617T(1 1102/COM/WEB) 11 CITY OF TIGARD � MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00316 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2016 Parcel: 251060003000 Jurisdiction: TIGARD Site address: 13849 SW 175TH AVE Subdivision: RIVER TERRACE NORTHWEST Lot: 1 Project: Polygon at West River Terrace, Lot 96 Project Description: New SF. Model home. 8/4/2016: REPRINT permit to add 111 sf patio cover. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 978 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1251 sf Garage: 280 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right 3 Detectors: Yes Total: 2229 sf Value: $271,874.58 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Bckflw Prevntr: 0 Catch Basins: 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: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2229 Owner: Contractor: ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 7600 EAST DOUBLETREE RANCH 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 RD,STE VANCOUVER,WA 98660 2 A geotechnical report is SCOTTSDALE,AZ 85258 required before the footing PHONE: PHONE: 360-695-7700 FAX: Total Fees: $31,485.43 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 throe. OA' • 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.199or 87 or 1.800.332.2344. Issued B �� Permittee Signature: g'/() • �"'/e)L•/t l-770,1 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. City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT ■ �',�, Building Permit Review — Residential I R,Building Permit#: pls-r }/5-7-co,3/6, Site Address: 1384 q S W I if fl, G1 tf Project Name: PO/9�y0 n 0 weft 2(Vl r- Terrei cz_ Lot #: q (New welling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: New ,,S (R ( rv)0662A t t c vliJ) Verify site address/suite#exists and active in permit system. 0 River Terrace Neighborhood: Yes ❑ No Site Plan Elements: OThrec(3)copies of site plan Existing structures on site to plan h on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished Dmust I& to scale(standard architect or engineer scale) f floor elevations North arrow Utililocations(required for new,mayapply for additions) ( 9 PPY ite address,project or subdivision name and lot number $tVeation of wells/septic systems 7? information(name and phone number) kttrosion control(including drainage-way protection,silt fence ,Lot dimensions and building setback dimensions design,location of catch basin,etc.) l ..ot area,building coverage area,percentage of coverage and 1treet names impervious area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location Property corner elevations(2 foot contour lines if more than --Er lsting trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified 0 No Received: 0. Yes 0 No ///X Public Facilities Improvement(PFI)Permit: Required: 0 Yes,applicant was notified 0 No Applied For: )Yes 0 No,stop intake ,LandUseCase#: ()Pg. 201c- (00004 ' U( 2,0(‘ - Q0006 / Zonin?: g- 7 PO , Setbacks: Front j 1 Rear is Side 3 Street Side 9 Garage 20 AI Landscape Requirement: C % , l Q Lot Coverage Maximum: tll D % , i // Building Height: Maximum Height S Actual Height 2-7 b gVisual Clearance lEasements /A] Sensitive Lands: /Yes ❑ No Type 4 Urban Forestry Plan onditions"Met"prior to issuance of building permit1( ores: hitnajhih9 bOht f7Or7J / Ar)Yla+ (S.Sue Usti( fO !4!Li2"G(/ Approved By Planning: 'o 0 i e- 8 il.o et Date: ' i Z/ ?(:)//) Revisions(after Building Submittal only) Reviewer Date Revision 1: CX Approved El Not Approved M d h t-e,,, iqd c 712_7 / 0. Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved 1:\Building\Fo,ms'BldgPennitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: WO/y Site Plans: # }� Building Plans: # Building Permit#: L�En building permit# ve. �, __// ��!/ Workflow Routing: lanning gineering ril4ermtt Coordinator L�YSuilding Workflow Sign-off: 0-'5gn-off for Planning(include notes from planning review) Route Application Documents: [ngineering: (1)copy of permit application,(1)site plan,(1)building plan and original plan review routing form. G3."11. i1ding original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: /� By Permit Technician: d,;��..,,e-v Date: / 3//t3` Engineering Review � Slope at building pad ✓ W ❑ Conditions"Met"prior to issuance of building permit ❑ Easements(encroachments)per engineering conditions of approval and plat ErWater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ,E(No Assess Water Quantity Fee in-lieu: ❑ Yes ,ErNo LIDA Facility on lot: 0 Yes -E"No ❑ NOT Approved by Engineering: Date: Notes: magi-L. J4ovw, � Approved by Engineering: IfIKc WMITc. Date: f (&/t4 Revisions(after Building Submittal only) Re ewer a Date l Revision 1: Approved 0 Not Approved AL /`' �p Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review ❑ Conditions"Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions(after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant Revision Notice 3: Date Sent to Applicant•. SDC Fees Entered: Wash Co Trans Dev Tax: IFP Yes 0 N/A 7, Tigard Trans SDC: ttr Yes ❑ N/A Parks SDC: It Yes ❑ N/A ?, ' ;;i,OK to Issue Permit • pproved by Permit Coordinator: 1 Dater 1:1Building\Fortes\BIdgPermitRvw_RES_070915.docx FOR OFFICE USE ONLY-SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov TO: �(5 ) DATE RECEIVED: DEPT: BUILDING DIVISION FROM: �jl}�� CiatletAr-j6iJUL 27 2016 COMPANY: V V l t',.4rn Lp Y tlO rns ciTyt) PHONE: q C I LA\A r«` T RE: (Sit 2Adclr( t.. )r) 60 v'Jf t�'.�\ x( V 1�j� N)�J ( - Permit Number) oi 3w t ' -tv, 616 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Additional set(s) of plans. I Revisions: qo16. ✓ V?(1j1 h o Cross section(s)and details. Wall bracing and/or lateral Maly§is. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): ► REMARKS: I ' ( .W not ` o 11 k. . ?i1 rn I \i\jr efit \\ Q A)C fuk {Y\S .v r Routed to Permit Technician: Date: S -a _ Fees Due: ►.a4 Yes ■ No Fee Descri.tion: Amount Due: $ $ k Elm $ o Special ' J i fr ) $ Si -7_ A,y,v Instructions: 7-3 rn_ o Re.rint Permit .er PE : MILIMIIMII ❑No ❑Done A• @ licant Notified:, /E- Date: - _ • I.\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 Building Permit Application �. eidlti - FOR OFFICE U SE ONL) City of TigardDate1v s� Permit No.: ® 13125 SW Halt Blvd.,Tigard,OR 97223 U Plan Review' f s ` it Phone: 503.718.2439 Fax: 503.598.1960 a 1 Date/By: ) e6 _ Other Permit: SL°d •1 r 1;T—Q";# j Inspection Line: 503.639.4175 4 ; � Date Ready/By: Juris: 0 See Page 2 for Internet: www.ti and-or. oVftis', i Notified/Method: 1 SupplementalInformatioe g g6�j1' 1 ®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 work indicated on this application. ® I-and 2-family dwellingValuation:a r � � $ ❑CommerciaUindustrial ❑Accessory building ElMulti-familyNumber of be ooms: ❑Master builder ❑Other: Number of bathrooms: 2. .3 Total number of floors: 2 s Job site address. e SS New dwelling area. square feet City/State/ZIP:Sherwood,OR 97140 Garage/carport area: CX_/ square feet Suite/bldg./apt.no.: Project name:Polygon at West River Ter Covered porch area: square feet _ Cross street/directions to job site: Deck area: square feet Other structure area: square feet Subdivision: Lot no.:96 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 work indicated on this application. New Single Family Detached Construction Valuation: $ Existing building area: square feet New building area: square feet Number of stories: Name:Polygon WLH,LLC Type of construction: Address:109 E 13`'Street Occupancy groups: City/State/ZIP:Vancouver,WA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: Business name:Polygon WLH,LLC Structural plan review fee(or deposit): Contact name:Maggie Gordon FLS plan review fee(if applicable): Address:109 E 1P Street City/State/ZIP:Vancouver,WA 98660 Total fees due upon application: Phone:(360)695.7700 Fax::(360)693.4442 Amount received: E-mail:maggie.gordon@polygonhomes.com �- ,, �., �.,: 3.. •• �_�- _.� Commercial and residentialprescriptiveinstallation of 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:109 E 13"Street 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.:207247 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Maggie Gordon Date:12/11/15 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application ' Q Rceeivc[t _ City of Tigard 77,,,,: T . let 13125 SW I lall Blvd.,'figard,OR 97223 gip+ � .k Plan Rc.ic- f hone: 503.718.2439 Fax: 503- 0'�� palerlty: I inspection Line: 503.639.4175 Date Ready/liy: See Page 2 for Internet: www.tieard-or.gov ?i��l NotiGcd:Mcillod: pplemental Information = r, :t•�ws. a �•-,rcr ^^-'� p�vs .� s _ �7^,,�y.:.r_ x ::�Ll�":�i'�.)(](''a� s mo.` s+ .—_'.�_', Y• �I:P^7k 4T,�`_ '#'.. ::+his•`.• ID� � - 6—.,S^c'� A.k _ ®New construction ❑Addition/alt 1r ICCiJ)4't r 's Please checkall that apply(subnlil 2, to of plana t.'htems checked bdmc)- : t 5= • ❑service or["ceder 400 amps or more ❑Budding oter three stones ❑ Demolition ❑Other: avherc lite available laull current ❑Marinas and huahnrds , coeds 10.000 amps at 150 rolls or ❑Floating building, �a -<:F z CA ®R'1'.(3F 1�7STRiCi IN Icss In ground.or exceeds 14.000 ❑Convnttctai-use agrioduual ® I-and 2-Nmily dwelling ❑Commercial/industrial E]Accessory building amps Car all oilier Installations buildings ❑Multifamily ❑Master builder ❑Other ❑Fire pump ❑Installation of ii K VA or t a a a» ❑lancrgency s�'slem. larger sepatalcl.Jem cd>}stem sx 't sae-r ., � xQ�- TCIIbJy ❑Addition of neer motor load of El c.i _. -. Job no.: Job site addresses 10011P or more. occupancy - ` -. ❑Sis or more rcstdenlial nails ❑Recreational tehtcle p:u'ks _P Lily/$tai : �"1 N O to ❑I tealth-care facilities ❑Supply.oltacc lir n,urc than c� ` ❑1 hwardous locations 6011,ohs nonmkal Si. Idg./apt.no.: Project name: ❑SLrvice ur feeder(too amp,or Inor[ CIA- oss sired/directions to job site: -N--e-r Deseri'lion I Qlv. - Fee. TOW New residential single-or multi-family dwelling unit. I Includes attached garage. Subdivision: Lot no.: 1.000 sq n.or less 16834 4 la.add']500 sq.Il.or potion 3392 1 Tax map/parcel no Limited energy.residential (with above: .ft> � - . .•�....3' ._.-... fit::P .21`r...:� .._r.:t:w.� .a-. t. c.a...i.-. � •.•: .. ....,_...0 ..1. ... .�:-:: Limited energy-multi-lamily 75 oft 2 New electrical service and wiring residential(with above sq.11) - Services or feeders installation,alteration,and/or relocation 2(10 amps or less 100.70 2 201 amps to 400 amps 133.56 - _ 401 amps to 600 amps 2W.34 2 Name: OVA blit amps to 1,000 amps 301.N '_ b Address: , a O V ` Over 1.000 amps or\roles A 55226 q Temporary services or feeders installation,alteration,and/or City/State/7_II': W � relocation Phone: D) (� Fax:LTU�) 2(M)amps or less -sq 36 1 301 amps to 400 amps 135 U3 Owner installation: This installation is tx:ing made on property that I own which is not 401 amps to 599 amps 169 54 intended for sale,(case-rent,or exchange-according to ORS 447,449.670,and 701. Branch circuits—new,alteration,or extcmion,per panel Owner signature: Date: A.Fee for branch circuit,with � - - y above service or 2742 2 cder lee. 2 a u �t '.; 1� ' X13 � �` ` ``"' .t- each branch circuit - 13.Fee for branch circuit~wirhon) Business nam[: service or feeder Ice.first 56 18 Contact name: branch circuit Each add'I branch circuit 742 2 Address: Miscellaneous(service or feeder not included) n („ d Each manufactured or modular CitylStale/7111: lrU t lJj, da�ellin service and/or feeder6794 !'hone:( ) Fax::( ) Reconnect only 6794 2 �• Pump or irrigation circle 6794 j 2 F:mail b V ` • Sign or outline lighting 6784 ': x s. fl r: GIp Signal circuit(s)or limited-energy Business name:Simply Electric nt .alteration.or extension Page 2 2 Each additional inspection over allowable in any of the above Address.PO Boa 822408 Additional inspection(I hr min) 66 25/hr Investigation(I hr min) 66.25/hr City/Stale//ZIP:Vancouver,WA. 98682 Industrial plain(1 hr min) 78 19/hr Phone:(503)849-8202 Fax:(360)314-4945 Inspections for which no fee Is 90.00/hr specifically listed(Y:hr min) CCB Lic.: 204615 Electrical I.ic.: . 067 Suprv. Lic.: 4394S ELEGiR1GX'It-K l]i'.; ': S Subtotal Supt•.Electrician signature,rcyuircd: e fG flan fC\'IC\\(75%OI perltlll[cc) Print name: Victor Aarzhitsky Date: 1 1 17/2015 State surcharge(12%ol'perinit 1ec). TOTAL PERMIT Il-:H. Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Prim name: Date: Numlxr of inspections allowed{xr pent"[ onntno 440-46 IS nuu;•rost[sys11 Mechanical Permit Auplicatiom _ City of Tigard ."' '.1112S SW-Hal awcl�7r—dol�. P6pae 403 718.3439:Faac 5�}3S. Other LNt hmpeWon1l= 303.6394175 �� 6Acadr.By,. �• O Sce:l'apcy torI�rmet�ut�wAigard-orgov t Supp}emeniatInlnrmati�a; . ." � . _ MGCI18ntC8�pCanSf":�S*BLC11On�IiCVaInC"Ut'$1t ROr�'. .. I�Taw ccitnstruciloti [�Additton�att iMac enY perf lad c to the val¢e.(rounded to the nearer dollar)of all ❑Q;DOther_ inectie)vW_n rsiats labor,ovahrait aaa ra& _cmali(ion _ �atitcs-$ i=,attd2=SaYaily ming O.comroft-c r>ndusutal El Awry bttlldmg ro!*eaal hgw-adax use a6eddt C lAd-'Billy. p Mester bnt7aea 11 Od=. tXsaiii6oai Qty. Es. Total .. : 46.75 obi ..:.. .�,_ FiwtacC 3 1ld0 t3TiJ l ;CrtylStaTr1,LII~ .�rcnsa0 It)D MG+.STO(dr�f Sllao 5491 61,06 2332 SW Proiect.oai» O t�uu 2332 FnSs simittGitions to job siteJ2 Eivdr37uid not water systm 23:32 hv. - � / ) boder(ra3imor or 232 �. - - U>aiibe»ts ia= aoLvll(l_*W4mdq4 Cie. 4675 FYpefroiit.fat .' of abaft 7332- " - At6rr3nd a- ce#: 2333 - -- _laccTaise� 3339 F4=ventfoar-walar fieytaorgns J.X332 2332 .. : a3.39 Wctid tiisc3. 2332 am 23:32 _ Toifvameatal txmua Spa vcmututiattc NPlot�wat ilenechooilloiher I 33.39 r4ss lD9ET36&t Qothverau�t 1 33.39 s' vtr, i'1: 1 � t - 'tcr7cL: .rotinis 4 2332. i'loaic3d@}Si�G-7$9fl' Fax 3" fau 23.3.? ' 2332 :. -1 "09me- 1 ttl>mC P�ygoa I±iort rPe t SId35[ur first tomr"$4.0 W.eaeti aa1t11fiosal .-. Gas: M&Fss lD4 EpSt" : .. _.... lip'a� .. ia►i2b C lStataZl i?xoo0aver,?�YA98661 viciUM&I - (3FD)&llrr' Faac-T ) 1 Ids aairic tiirt�an Hestiug,ine Oibm A167$5_�:W five.�k'�10 �'athtotal _ "t ) Cry I3g ir3,QX97MA .Pian reviim(2S%ofpmv*166)- 'C F=(50)536-"u Sute sttirlt W lz%of*nwt foo) i�1ic.•.1LSZi4 '7'OT�L.p,�bIIT:�. *w-k p a�ri'eicpsr ipa�risaa..1 ca+e,rklain daps suer 1t�:lx�q d as eoaopTaetz Authoriztd *: Fx m�tbodolosy setirx rri-Gotmtp 8w'fding irn sxrice Boyd l�"ta .�idtAtiderEcti I7xktr 7.II3tA+2013 I--L AP_ 'tlS:dac ocW4i7'I{13td:'dCOmmEB? Plumbing Permit Application i Building Fixtures • City of Tigard } Fermin un ~- .3 G 13125 SW Hall Blvd,Tigatdr OR / t} Phone: 503"7182439 Fax: 503- 98.!960 �s�}��J DDacday eco Otho Parrs[No.: Inspection Line: 503.639.4175 e� Die g� 3uix 0 See Page 2 for Intemet www-tigm-d-or guy ,^e N Natisedwailwd: svpplemmfal wormation 1 For speduf information use checklist New oonsttvction letuo)ition a Dasaa-t lion I Qty. Ea Total ❑Addiitionfalterationhcplacctnent ❑Other: New I-2•-family dwellings(includes 100 R for each utility connection) Maw SFR(l)bath 31270 1-and 2-fatm"ly dwelling C1 Commarciatfindusfrial SFR(2)bath 437-78 SFR(3)bath 50032 ❑Accessory building ❑Muth-family 5 t3 Each additional baBVkitchen 25.02 ❑Master builder ❑Odlc= Fin sprinkler[__sq-fQ Page 2 _ Site af0itirs- area /lobstte addr>Sc Catch basin or ea drain 18.76 City/Stateaw: ��}(' V.9�,C�3 _ ` T I�^1� ��1']tach loll, thenen!drain 18.76 Footing drain(no.linea ar R: � Pahge 2 SuiWWdgJapL no-: Project name: Manufactured honor utilities 50.03 Cress stivWdiirertixhs m job site: J awkf-'C_1 Manholes 18.76 3.)� �. Rain drain connector 18.76 Sanitary sewer(no-linear fL:__ ) Page 2 Storm sewer(no-linear fL:_) Page 2 Water service(no.linear fL:_) Page 2 ShlbtliYtSie7n: Lot no_: q Fzturt or item- Tax!m>Ip/parnocl no.: - l3ackflowpmvcntcr ( 31:27 Baccvater valve 1251 Clod=Was6a 25.02 a .� Disi washer 25.02 ,L) Drinking fountain 25.02 EjectorslsuXM 25.02 Expansion tank 1251 Name �� l F"rxtnrdsewercap 25.02 n Floor drmn/floor sink/hub 25.02 AddzLss: ` 't'► ' Gwbap disposal 25-02 City/Stateim: Bose bib 25.02 Phoo Q Fthx ( ) Ice cock=' 1251 2 Interceptodl;rem hV 25-02 Business umnc Medical gas(value-S ) Page 2 Prig 12.51 Contict hhemc Roof drain(commercial) 12.51 A t SiamashAnvadory . 25.02 Clty)SMWZEF- Solar units(potable wator) 62.54 prone ) — d F=:( ) TubJshower/stwwerpcn. 1251 2 (7 Urinal 25"02 E-mail: lei VK_ Waterraosct 25.02 Water heater 37.52 . $usahtss scene Water piping/DW V 5629 Adder f4 Other 25"DZ Citylstaftan- subtotal Phone: F=( ) Minimum permit fee: S72S0 CCB 1 Lit Plumbing Lic. Plan review (2s%of permit fee) State srrchatge(I2%of permit fa) Authorized signahm -TOTAL PERMIT FEE This permit application expires if*permit is not obtained witkin 180 days Print name= �- - ('----- :iter it ons been accepted as complete -Fee methodology set by TrWourrty Build-mg Industry Service Boatel L- pAm 1010Ga9 Ma-d6I6T(!db>JI:OM/tVFB) City of Tigard ~ COMMUNITY DEVELOPMENT DEPARTMENT i Building Permit Review — Residential TIGARD Building Permit#: Site Address: 13 84 q S , Y1-11 0 V e. . Project Name: PO/yOC;/1 (0 weJf J?(Vrr -T e--r iCe_ Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: /y0'A.r & C_1 m od-O Ito Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: Yes ❑ No Site Plan Elements: /Three(3)copies of site plan -94E-iisting structures on site to plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished /Drawn to scale (standard architect or engineer scale) floor elevations North arrow J21Utility locations(required for new,may apply for additions) f�ite address,project or subdivision name and lot number ocation of wells/septic systems /��pplicant information(name and phone number) Erosion control(including drainage-way protection,silt fence XLot dimensions and building setback dimensions design,location of catch basin,etc.) C�Lot area,building coverage area,percentage of coverage and Street names impervious area(applicable if R-7,R-12,R-25&R-40) 2treet tree size,type and location /Property corner elevations (2 foot contour lines if more than sting trees to be retained with drip line,and tree 4 foot differentialprotection measures Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑. Yes ❑ No Public Facilities Improvement(PFI) Permit: /� Required: El Yes,applicant was notified El No ' Applied For: JOYes El No,stop intake Land Use Case #: 1 D� �� ' �000`/t ��6 -2,0 /- 00006 Zoning: — V Setbacks: Front I '2 Rear 1 Side -7 Street Side _ e Garage Landscape Requirement: IV % )21 Lot Coverage Maximum: C 0 % 1 �7 / 6 Building Height: Maximum Height _5S Actual Height � /7 Visual Clearance 1 Easements Sensitive Lands: /Yes ❑ No Type Urban Forestry Plan onditionss "Met"prior to issuance of building permit otes: I U,-n 6110 1 Cl) W n d_r,t_70 0 J r V IJ n o c+ (SS S (10H �rii �f Li e-C'( Approved By Planning: 114 a V? 1�� iLo G�_Ltiu Date: G�/J Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Fonns\BldgPennitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: i� 3/ h 5 Site Plans: # 'z Building Plans: # Building Permit#: n r building permit# ove. � ' Workflow Routing: Planning gineering - ermit Coordinator g-1 uilding Workflow Sign-off C,Sign-off for Planning(include notes from planning review) Route Application Documents: Qigineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. wilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: Engineering Review Slope at building pad: ❑ 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 eNo Assess Water Quantity Fee in-lieu: ❑ Yes Ef'No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: k(fib" )40"4 Approved by Engineering: y C, W14 TF, Date: 6 f Z Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ 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: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: [ Yes ❑ N/A Parks SDC: 1�3 Yes ❑ N/A OK to Issue Permit /� pproved by Permit Coordinator: lWi Date:A / ` 1:\Building\Forms\B1dgPennitRvw RES 070915.doex Mechanical Permit Anplicatioit SI HEcEivED ,/,Re,,,,.„„ City of Tigard 13125 SW Hall Blvd..Tigard,OR 97223 Phone: 501718.2439 Fax: 503.598.1960 Inspection ine639A175: 503. Internet wow.tigard-orgov Man Res iew e y. SEP 2 2 2016 L1)20 14 CITY OF rICIARD "eduld' EzdeBy ,... * I PI ir OBI ti Othei Permit, Date.Not,Rtady)By furs, iii st„,pate 2 for Supplemental information „ ,,,,,,--, —or,: ,„ 1 1 Nci,I VI,§111.‘,-, ,, '',1•u :4 •L:,-..',...,--,‘,,,)•'-... -.'.%,'"..%,,,,,;,;,,t, ..›..-,,,,/.—, ;,'...7 ,.„ .,,,,,,::';,,,,,,.,,,41,'•••0'.:.,,..t94,*:. ,......:.., ---..-,..?,.... ...,,,,,a,„ ,,:54;1/„...s,. , ,„...,,e, , , ,, , . , ., „.•,,,,,, , ,, .,`S.',., ;:e,''1A*SPW/::Or#1.'7,40416418,4/'''-' ..'''''°;it'')g,::::;1,i';',',< -a'',V',Zt',i&:,',::,';',0,T,',,,i, Mechanical permit feesare based on the value of the work I New construction 0 Addition/alteration/replacement performed,Indicate the value(rounded to the nearest dollar).of alt 0 Dentolition 0 Other: mechanical materials.equipment,labor.overhead,and profit ,' ,,,,w- 4.,.:?-:,,,-;',,,,°,'„',,-,i;,C,,i,'„-,51.4:..,:t,',..1"; „;:'; ':°4,,Lit:;11&:',...;:t,-, ), -,1,,,,,, ',•:12,,f5!,f,,,,‘,.',,,' ',7* -',- ' •.•,,,,y!g4.,‘,. ''',.!'.,4,1"gg=gg.trr",s,:•!--,,,,,•:.•°4 •;g,::...'•''',:,' :,%•.,, 't, Ei I-and 2-family dwelling 0 f7ontrocrciallindustrial 0 building Accessory „ g Fa,spedal information am cheattitt i Multi-family 0 Master builder 0 Other: Desertption 1 Qty. f En. 1 Total '''''''• 441,-7.'-.MF64%;'',.'."1.'4.-,i'';',P t''i'•'r,:',''' '''''g' 10.Ci.", *;,,,.,• Ljtatiperooung: '.s.. Job site address:BC:52- SV\I 115* Pat, Air eandituming 46.75 Furnace 1001810 BTUdutts'gentg) ( 1 46 7 6 City/State/7.1P:Tigard,OR 97224 Furnace 100,0004 BTU iductsiveragr 54,91 pm jea name: A t,,_...ii Oa_ ilea,pump 6L06 Statelbldglapt.no.... A(nu itiect-14,/,), r ..et,ork 2332 Cross streelidireetions to job site: 1 tvdronic hot water system 2332 Residential boiler(radiator or Iwdronk), 23,32 , Unit heaters(fuel-type.not electric), imwall induct,suspended.etc. 46,75 Flue/vent for any of above I 23,3' Subdivision: iii -on 4,i- 1.in,t Po 9 Other 101/f4 A,V.€4e-1-eArate_ I Lot Other fuel appliances: 2332 Fax thapiparcel no.. Water beater 2332 I 33,39 Me vent bur water heater or gas , D if\Araf,t1)( CAACLAI.P fireplace 2332 Log lighter(east 23,32 Woodtpellet stove 3339 Wood fireplacelasert 2332 Cbitnnevlinertflue'vent 2332 , • -•gi. %.f.4981'"- •-•-, -:„r...4!„,,•!•.:•:-••.,/, ..,-.1.,...:,,,TC. YF ,•K''','.<,--,r,-,'' ••,,,,",:,.., jtr i.,',•-• ' (E)nthveiyronmntal exhaust and ventilaion: 23,32 Name:Polygon W1,1l,1,1,C Range hoodfother kitchen .......... equipment I 33,39 Address, 109 East 13° Street Clothes dryer exhaust 1 33,39 City.'StineiZIP:Vancouver,WA 911440 Single.duct exhaust(bathrooms, LI toilet companments,utility rigouts) —I 2132 Phone:(340)69$-7700 Fax:( 3 Attic/crawls ,.., fans 2332 1gt",..-,,,01,..•1'.,--,..,: ':,, ',,,t.,,,,,,- .,f,fogr:' '72:,T- :,,, ' 4,...t'''-',':' .-•• ',:'-',-,,'''''''' ''''''''',,, ,''''', ' Other 2332 Tik.!"4 -"- ' "741-'4414-44:.\- ''''''':' le---t : ,' t - i .: .4 .,' : _ el Business name"Polygon WLH,LEL' Fupiping: $14.1S for first foot;S4.03 for curb additional Contact name:Angela Grajewski Furnace.etc. I Address: 109 East 13th Street Gas heat pump WaRisuspendediunit heater , City/State/ZIP:Vancouver,WA 90660 Water heater Phone:(3410)6954700 [ Fax::.(3601693-4442 Firepbee I Range I E-mail;Angelt.Grajewsk4polygonhontes.com Barbecue clothes dryer 10001 -- '---- Busumss name:Apex Air EEC Othec , vo-v„..,,,/„:0vvv...0',-,.)!.;,. :., i t, - ', :,) -'"i i•1;1E% ,-,-... V., ..- Address; 10004 NE 72"Ave Subtotal Cir)/5latefZIP:Vancouver,WA 98606 ' , Minimum permit fee;$90.001 „ • Plan review(25%of permit fee) Phone:(36013424109 Fax:(360)326-1769 State surcharge 112%of permit fee) CCB lie.:203034 , TOTAL PERMIT FEE 1 This permit application expires if a mann is not obtained within lad days*tarn has bean accepted as complete. Authorized signature Fs• Fee methodology get by Tri-Couray Buildrue Industry Sersiet Beard nr.......-..."-- Print name: f teN .1 Date. 4./.1.it. ... 1,,B.44-dal5farr.m...MET,PestratApp:401 I 3 doe 4,W451-77.( t11.2,1`04 wui ECEI Electrical Permit Applicatidn` VE FOR OFFICE USE ONLY' 11 - City of Tigard/ SEP 2 2 2016 Received 1 • 13125 SW Hall Blvd.,Tigard,OR 97223Plan eB `2�� V �� L� / Phone; 503.718.2439 Fax: 503.59'1 fy OF TIGARD Date/B vi Datem : Related Permit ii: TiGARD Inspection Line: 503.639.4175 ��®'�� DIVISION Ready Date/By: loris. IZI.See Page 2 for Internet www.ttgard or.gov Notified/Method: l, _� Supplemental Information ,. '` � "� .. � -ice- -.- ®New construction 0 Addition/alteration/re lacement Please check all that apply �`- ie`` Addition/alteration/replacement pp y(submrt 2 sets of plans Wilms checked): ❑DemOlItiOn OtheC: 0 Service or feeder 400 amps or more 0 Building over three stories. sa t x ismr0 where the available fault current ❑Marinas and boatyards. F .a. r• � x.c — exceeds 10,000 amps at 150 volts or ®1-and 2-family dwelling 0 Commercial/industrialless to ❑Floating buildings. 0 Accessory building ground,or exceeds 14,000 ❑Commercial-use agricultural ❑Multi-family 0 Master builder Other: amps for all other installations. boitdiugs- . Fire pump. ❑installation of 150 KVA or s.:,.�n -»,,s.;._.,-Jt)B 5I ORW.tas i1t1 6'L(ij2'L' toN -' ❑Emergency system. larger separately derived // Job# Job site address:/3835 SIN 17� /o ❑Addition of new motor load of system. ✓ J I ,'`/L 100HP or more. [l system. City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name:Polygon at West River Ter 0 Ilazardons locations. 0 Supply voltage for more than Cross street/directions to job site: tea. .❑service or feeder 600 ampsmpar.�m"ore. 600 volts nominal. . :.:.'Feet ' W4g-g-:-. f x+ .. Deactiption I Qty. I Each I Total I :.: New residential single-or multi-family dwelling unit. Subdivision:Polygon at West River Terrrace I Lot#:9(p Includes attached garage. Tax map/parcel#: W 1,000 sq.ft.or less 1 168.54 4 llEJ Oti Ea.add'1500 sq.ft.or portion 33.92 CAAtrattiirC _�A-� _•._ .. -,.,- Limited energy,residential '� 1 (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 '�`- _"r Q ER fergI O. i-a _ Renewable En ❑ See Page 2 �'7>NA1 fi Services or feeders installation,alteration,and/or relocation Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2 Address:7600 E Doubletree Ranch Road 201 amps to 400 amps 133.56 2 City/State/ZIP:Scottsdale,AZ 85258 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:(602)694-4031 I Fax:( ) Over 1,000 amps or volts i 552.26 2 Email: 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 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 aftOwner signature: Date: 401 amps to 599 amps 168.54 2 r [ L)�rrACT ? QNCC0 Branch circuits—new,alteration,or extension,per panel Business name:William Lyon Homes,Inc. A.above for brvneh rifeede fee, 9 above service or feeder fee, 1 Contact name:Angela Grajewski each branch circuit 7.42 2 i B.Fee for branch circuits without Address:109 East 13th Street service or feeder fee,fust 1 branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add'I branch circuit 7.42 2 Phone:(360)695-7700Miscellaneous(service or feeder not included) Fax::(360)693-4442 Each manufactured or modular Email:Angela.Grajewsld@polygonhomes-com dwelling,service and/or feeder 67.84 2 - VrtAIItGI] Reconnect only 67.84 2 -. " i ,n.. (1F�,` r � ,�` = Pump or irrigation •on circle 67.84 2 Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2 Address:6101 NE St Johns Rd Signal circuit(s)or/united energy l=1 See Page 2 2 panel,alteration,or extension. City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable in any of the above Additional inspection(I lir min) 66.25/hr Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr Email:bdaniels@gweusa.com Industrial plant{1 hr min} 78.18/hr Inspections for which no fee is CCB Lie.: C1158 Electrical Lie.: 208174 I Suprv.Lie.: 44965 specifically listed('h hr min) 90.00/!u mK Ir >� - Suprv.Electrician signature,required: heti - -_ Subtotal: Print name: Joan P Albert Date: 4/26/2016 ❑Plan Review Required(25%of permit fee): e----- _ ----- --- State surcharge(12%of permit fee): Authorized signature: .- ______----------- 1 ____.�---.:.."" — --'1',---- TOTAL PERMIT FEE: Print name: Bill Daniels This permit application expires if a permit is not obtained within 180 I Date: 4/26/2016 I days after it has been accepted as complete IIII • Number of inspections allowed per permit. - `.:I:11Euildigg1Permits\ELC-PermitApp_ELR ERE.doc Rev 06/17/2015 446g615T(11/O5/COMtWER Plumbing Permit Application BuildingFixtures `r s " t , I out ()I II( l: 1 SF t)\1.1 City of Tigard Received +A 13125 SW Hall Blvd.,Tigard,OR 97223 L� 1 `� 016 Plate/By: i12.7/fC Permit No.:1`4 20(S-ODZ'b Phone: 503.718.2439 Fax: 503.59 . p, Plan Revie 1�4J1 J I I,t� Inspection Line: 503.639.41758 jr'�#'{ ) Date/By: Other Permit No.: Internet: www.tigard-or.gov U t L1� •-•N Date ReadyBy: tuns: ® See Page 2 for Ni?S Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist Description Qty. 1 Ea. Total 0 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 ® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory building 0 Multi-family SFR(3)bath 500.32 0 Masterbuilder Each additional bath/kitchen 25.02 ❑Other: IFire sprinkler( sq.ft.) Page 2 3,3 JOBSITE INFORMATION AND LOCATION Site utilities: ss: --# L CQ- . VlJ I I_ -75.W.1p� Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 � CDrywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 1 Project name:Polygon at West River Ter 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 West River Terrrace l Lot no.: /(to, Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �y,{j�� r/_ Clothes washer 25.02 (fit/ v(�� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER ! 0 TENANT Expansion tank 12.51 Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:7600 E Doubletree Ranch Road Garbage disposal 25.02 City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02 Phone:(602)694-4031 Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2 Contact name:Angela Grajewski Primer 12.51 Roof drain(commercial) 12.51 Address:109 East 13th Street 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:Angela.Grajewski@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:Malmedal Enterprises Inc. Water pipinglDWV 56.29 Address:PO Box 207 Other: 25.02 City/State/ZIP:Banks,OR 97106 Subtotal Phone:(503)324-0759 Fax:(503-)324-0580 Minimum permit fee: $72.50 CCB Lic.:102535 Plumbing Lic.no.:34-276PB Plan review (25%of permit fee) C....------_{. �\ State surcharge(12%of permit fee) ( Authorized signature: TOTAL PERMIT FEE Print name:Carolina Malmedal Date:04/25/2016 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU•PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13835 SW 175TH AVE, SHERWOOD, OR, 97140 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00316 David Young Final erosion control approved. Street tree certiﬁcation received. Moisture content form received. High efﬁciency lighting form received. Vapor barrier acknowledgement form received. Blower door test report received. Insulation certiﬁcation checked. C of O to be left on site 10/6/16. Violation Summary: Inspector Contractor