Permit (14) CITY OF TIGARDMASTER PERMIT
r � ` it,,
'' COMMUNITY DEVELOPMENT 'IN
# Y` Permit#: MST2016 00042
/JAM Date Issued: 04/13/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1080001506
Jurisdiction: Tigard
Site address: 15378 SW THAMES LN
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 65
Project Description: New SF. 6/13/2016: Reduce bathrooms from 4 to 3,and add 166 sq ft of covered deck.8/25/16:
Add 2nd water heater. 10/21/2016:Add NC.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1589 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 2167 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3756 sf Value: $468,270.52 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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: 2 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
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 add9 500 sf: 7 201-400 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 3756
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
109 E 13TH ST,STE 200 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 A Geotechnical report is
required before the footing
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $35,583.44
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuo4f'AR�11-1090. You may obtain a copy of the rules or direct questions to OUNC by calling 50013.232.1987 or 1.800.332.2344.
Issued By: J / Permittee Signature: ,/ .0G / 6i(./
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Alban' 1 ec 'ea P erm'iI
' APPlicalRECEIVE rt u()R(}Futi L 1 SL()NIA
, ,
a ky of Tigard
IN- Dawftr, /0/0„1 4 414, PMnit NO/Cic,';21,f;6
. 7 )312$SW Hall Blvd,,Tigard,OR 97223
Plan;Review
Phone: 501718.2439 Fax: 503.598.1960 SEP 2 0 2016
Other Permit:
Dated4y. .,
T I GA RD Inspeclion tine: 503,639,4175
CITY OF TIGARD Dat..R..1:-`11!,
.i.calet: www,tigard-or,g0x NotifiedUethed: Suppliuneetat Information,
BUILDING DivisIrm.•
. . *rm OF WORK ' -' COMME0CJ4'-F-E8*SC11004'''.,ISE C11 (ICLST
Mechanical pen fees*arc baced on the value of the work
•tatl New construction 0 Additionialterationlreplagexnent perfumed.,Indicate the value(rcatnded to the nearest dollar/610
0 Demolition 0 Other, mechanical materials.equipment,falvar overhead and profit
Woe:S
. . ... . . ..
CATEGORY OF CONSTRUCTION, ' • 4_4-
REsiDENTIAL EQUIPMENT/SiSTEMS rtE,S*
0 1-and 2-family dwelling 0 Coctrullerciallindostrial 0 Accessory building 1 For special kfht-matiori/die chechtia
2 Multi-family 0 Master builder 0 Other; 1 r.. criplion Total
4011 SITE INFORMATION ANO L(1ATION tingl-" ing: ,
.
Air conditioning , 46..75 —1
Job site address:1 531 e sv\i 11150e-s. taint. Putnam lOtt,000 tirDuinetiiveato 1 46..f.''
City/Stater2/P:Tkvaril,OR 97224 Furnace 100.000+BTU kinetahTatin 5491
Heatmaw
Suite/bldg./apt.no.: Projectm
name:Polygon at Roll Nfountairt
/hid'wadi
I 2332
Cross street/directions to joh site: flydranie hot water a:extern 2132
Resideatial boiler(radiator er
hydronio) 23 12
Huh heaters(fuel-type,not rietatic),
..
, 411-Witil in.ilita grispeneted e 4 .7tc
Pluekent for nay of above • 7332
...., ,
Other 23.32
Subdivision:Polygon at Hull Nionotain Lot no.:IS
00kr.r1(0 APPliancm
Tax amp/parcel lit.", Water fluter 2332
. . , .
DESCRIPTION OF WORK Gas firorkizellosen ' 3339
Flue veal for water beater ot nas
CO.ntraChir tho' A rutploce
. . , .
A C(G( •7n,C# Wood/Log liaftkr OW)
pa lat stave
2332
la 19
Wood fireoltteelinsert 23.321
Chiontexilineefluchrent 2337
_
. . .
, 1. , a Other
-' ...t-PROPERTY OWNER all TENANT I I 2332
• frivirrinineaul exhaust A xitt ventilation: -
Name:Polygon WLH,LLC ; Range hood'other kitchen
—.....-.---
t I ,u/ mem 33,39 1-
Adkins:109 East le Sim(
Ii Clothes iirver exhaus _t 33,39
_.,.........._
City/SlateIZIP:Vancouver,WA 906 ,60 I Single-duct exhaust(halhotonis,
1 toilet own gartmouts.,wild towns) LI 111 I
Phone:(360)69$-7700 Fax:( ) Atikkrau Is -et fans 2332
0 AFTL1CANT' ,- . r a CONTACT PERSON Other: 2332 111111.
Fuel ,i,in.:
Business name:Polygon WI,H,LLC .
51415 12w first form 03red earn atininouat
Contact nate Angela Grajetvski Furnace.cle. 1 I I
Address;109 East 13th Street Gas heal pump
Wall..-..4e.,ndetitilnit beater
City1StateiZIP:VatICOUTVZ,WA M60 Water heater
. , .
Phone:(360)695-7700 Fax::(360)6934442 Fireplace
B-mail:4ngela.GrajewskiI3p1lygnahumes.tein -
Barb/woe .
CONTRACTOR ' Clothes 'Cr(MOS-
13usiness name:Apex Air LLC Other
,
. , •
141ECIIANICAL PERIttirfEES*
,
Address:18004 NE 724 Ave Subtotal
City/StateZIP:Vancouver,WA 986116 Miniunon permit fee(590.0(1)
review(25%orpmniit ree) I
phone.;(366)342-8109 I Far.(360)326-1769 Stale surcharge(12%of permIt ke)
...
CCB lie,:203(134 TOTAL PERMIT FEE i
This permit oPplicatiou expires Ka permit k net Adtlaiarti within Igt
days afterit has betit autptat as rem-00r.
Authorized signature: *- Fee methodology K:i by 111-Counly Building:hatunry Sersiot Rood
ron mine. (^ Ar.
Dale: 4.Pi A•it,,-
10,41,,,;,.5..rt,,,,-.Mrt_NtritApp2.40.1 13 44.x: 4*,',4(+17/{il.,i,24`04A1113).
F.Aicstricajrermit Applicatil7:(''',F.--; •\I.:--.R 1 ()1(“111( 1
City of Tigard Reetwed
patsy 1 EIPISVPrilMI
13125 SW Hall Blvd,Tigard,OR 97223 SE j 1 b 2016 Km Review
Phone 503 7182439 Fax 501598,1%0 Dangs Related Penen e
InSpection Line' 503.6394 175 c iTy 0 F: -p:3.,,'..\pil,) no*poesy
11111111 -. Sel P*St 2 r*r
Internet www.tiprd-Or gov Notified/Method Supplemental labretation
In;':,:Fri':.F.'::...: ' ;7;2!:';':1::,.,:'-':
) New.construction 0 Addition/alteration/replacement Please... °back all that 41814y(mibmit 2mns i . ,..written c*zchent'
UService or feeder 400 amps or more 0 ginktum over three stones
0 Demolition 0 Other: where the available fault cumin 0 Mamas and boatyards
exceeds 10,000 amps at 150'oh or 0""mg bu-
4 I.and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to arrow,or excels&14,000 0 Commercial agricultural
amps for all other installations builduip
0 Multi-family 0 Master builder 0 Other: 0Rn Plane 0 Installation of 150 KVA or
..,,.. t4.-4,714.:AP Rig70 0 Emergency system huger sepermely derived
, 0 Addition of new motor load of sYstem
Job#: Job site address: 1 5 5 ( ) -ThaAt.& , k 100HP Of more 0"A","E","1-2","1-3",
0 Si, m more residential units 00Q415neY
City/State/ZIP:Tigard,OR 97224 0 Recreational vehicle prark,s.
0 Herdth-care facilities
SUitetidgdapt.#: Project name:Polygon at Woo‘Riti'ton-Tor 0 Hazardous locations 0 sutmly vat for more thee
0 Service Or feeder 600 amps or more 600 volts amnia
Cross street/directions to job site: ittwli (Ain Ptifq:::r,Zigi;;ZitZi:'' ":.'S'-' :-‘7,r1:--TI;AiliniNor
Orwripties Qty. Each Total .
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at ihissidianuxiliinemilise littk%Atm . Lot#: (05 Includes attached garage.
1,000 sq..fl or less 168.54 4
Tax map/parcel#:
;i1::,j7 .,, .!-!'1Z!r.,7i:77,„.., . -,L1::: .71,±j ,:.1:1*.:::‘,:7,1....:: ‘1L1Tii!;.4:::,..: :::7;;i-.2:7-!..:.. ,47Z::Q::''' Ea.addi 500 sq.ft.or portion 33.92 1
60 Ole I C/1=1,196C, Limited energy,residential
(with above sq.ft.) 75,00 .
2
Limited energy,multi-family 75.00 2
-2:-" ;: 7.-,. ; - '..:: ,".--711,7111, ;T;; ; :: .„, -; 7 -: . / r ,...:::,, ,,,:,. residential(with above sq.It)
Name:ADVL Land Holdings, LC Stift/1E Pis Renewable Energy 0 See Page 2
Address:7600 E Dou et nch Road Pr A P 1-10kOT Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70
City/State/ZIP:Scotts ,AZ 85258 2
201 amps to 400 amps 133.56 2
Phone:(602A94 1 Fax:( )
Email: 401 amps to 600 amps 200.34 2
Owner installation:This installation is being made on property that I own which is not 601 amps to 1,000 amps 301 04 2
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701.
Over 1,000 amps or volts 552 26 2
Owner signature: Date:
Temporary services or feeders installation,alteration,and/or
relocation
Business name:Wilfirm-L-yurrliunresrine. #jA0 VI Wi-jf i /....1.1.-- 200 amps or less 59.36 1
Contact name:Angela Grajewski
201 amps to 400 amps 125.08 2
Address: 109 East 13th Street
401 amps to 599 amps 168.54 2
City/State/ZIP:Vancouver,WA 98660
Branch circuits-new,alteration,or extension,i panel
Phone:(360)695-7700 i Fax: :(360)693-4442 A Fee for branch circuits with
7 42 2
above service or feeder fee,
Email:Angela.Grajewski@polygonhomes.com each branch circuit
..'. -..;-":, ..1„,.....,:,,,L„., :,,,;.,,;.:2 ',..'''''F'i,:.1;7:7.:''.!.).E.1721:: ral.7:'::.:KV.:711-TANA B Feeserfic''re lovrfanch e:ffeeuelirwsitlia°41
Vbranch circuit 56.18 2
Business name:alameda electric
Each addl branch circuit 7.42 2
Address:3415 ne 44th
Miscellaneous(service or feeder not included)
City/State/ZIP:allOR /37,-.1 jobve 21/2, /4" 7 02-, /3 Each manufactured or modular
2
dwelling,service and/or feeder 67 84
Plume:(503)3192192 Fax:( ) ...
Reconnect only 67 84 2 .
Email:solarpdx@me.com
,,, Pomp or irrigation circle 67 84 2
CCB Lie.: 199188 Electrical Lie.: c923 Suprv.Lic.: /f7/...>
Sign or outline lighting 67 84 2
Suprv.Electrician signature,required:
if j panel,Litrecrua'tt,orrirliemxtiendsIneM 0 See Page 2 2
Print mune: ,/c, 4_ /2 ..t. Date: _CA3d- ,Air
Each additional inspection over allowable in any of the above
Authorized sign,tw;e: Additional inspection 1.1 hr mm) 1 6625 hr 1 I
,,,, -
IPrint name: .:ii" , fr. ...„,,,e -2-- Datc....5---/43///4 Investigation(.I hrmin) 90 00'hr
ianaineateermitnew_einnaintek.eut_EitEduc Rev 06/1 MA IS 440-46.15T(I I MS/COM/WES
CITY OF TIGARD MASTER PERMIT
:. I 't COMMUNITY DEVELOPMENT Permit#: MST2016-00042
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016
Parcel: 2S1080001506
Jurisdiction: Tigard
Site address: 15378 SW THAMES LN
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 65
Project Description: New SF. 6/13/2016: REPRINT permit to reduce bathrooms from 4 to 3, and add 166 sq ft of
covered deck. 8/25/16 ADD 2nd water heater
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1589 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 2167 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3756 sf Value: $468,270.52 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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: 2 Water Lines: 100 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: 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: 7 201-400 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 3756
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
109 E 13TH ST,STE 200 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 A Geotechnical report is
required before the footing
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $35,441.08
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: Permittee Signature:
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.
Plunibin Permit A Head - .
Building Fixtures- .AELICG
016
1E6IV2 ED — -
FOR OFFICE t SE
.. . . _ .
City;iir Tiga.rci ..gePPiv'eE! (.7
40'' Pe*t.'N'}.'
13125 SW Half Blvd.,Tigard"OR 722AUG
I,1". • phone: 501718.2439 Fax 563:011.„,r, tiatail.iy: Other RermieNci:
•
.. ,
_ . inspeetion Liiie: 502.6394175 pi ‘"11-- i/GARD Date Reudyipy: Rais. I RI Sae Pap 2 for
i I GAR D Internet wwrictigtrd,or,gov r""'LJILDfNir DLV
i :is,r,h i Nodim
titieutbod; Supplemental Information
••:''•: ••-., nl;'•''..-,.-',1;-",`"2'""r":-.t"''''' 'FITE-•-OF WORIC-7:-. •:•'.--i''• ' •11I.,• ,:.....,-',rt :,....,:;:.•,,,i-:::', :.?: •:-•' ,'14,-z.'it.i. ',!--FEE*SCHEDULE,,•;.,--,;:"*:-,-•.!11ilt•-•',:n*I.2,.
.• •• • 1For special information use efiecklist • •
0 New constntetion i 0 Derneilion ,
. - -
Description .. . . i -Qty. 1 Ea. [ Total
0 Additionlaiteration/repla(.ement 0:Other: . l'iew 1-2 family dwellings Ofeltides 101)ftfor each utility connection)
... ... ...
:47,•-:,•?..,: lF.:.:-,,Ir.,..,--, -,••... :.:....:-.;:' CATEGORV-Of,CONSTRUCT1Olk,1;,],‘• -•-a-qt,:,•'•'•-:!-:•'',..,31:-.:•:.-•.•:.,..,i,,, • (0-bath 31270
D.1-and 2-family dwelling 0 Crimmereiallindlistrial .SFR:(2).1tath . 437:78
•• ••• .:SFR(3)bath 50032.
0 AcceSsory building. 0,Malti4atni13., - .
•• - Each-additional bathikitchen. . . 25%02
_
0 Muster builder aCtiliPt. - Fire sprinkler( s9...ft) .PUgd,2
.ii2iit',41.7Eitiiiii.-ioiii,.,.-iiiirLoOktiaiN' :1-5- ,'.,-,.'' -':'':iH Site utilities:
...„ ..,, . .. ...,_....,.. . ._ ...._...
-
Joh site addressJ . Catchr basin or area drain 18.76
..
'. ii.al ' • -
. ... nt-
. - Diyweir,Teackbile,or trench drain 18.76. MK
City/State/ZIP.Tigard,OR 97224 . • . .-• Footing drain(no,linear 11:;:, 1 Page 2 '
Sidte/bIdg./apt:An,: :vrajact nalae:IPal)ga0 at Bull Mountain Manufactured home utilities. • .51)s01. . .
. . . . .
•CrOss:Streeldirectiont to-job site: . . ..,' Manholes 18.76
Rain drain connector 18.76
. . .. . . . .-. . ' •
- -. . . • . Sanitary sewer(no.linear R.: y Page,2
.. ._ ..
. ., . . .
.-Stern sewer(no.linear It.:.. . ) I P2 i
. ..
. -Water ser ice(0.linear ft.; ) Page2
Subdivision;Po4,7gort,atlitillikliantain •LOt no v5- FiXtare fir item; - ..
. ..... . .
..._
. Backflow tiityeiner 3127 .
Tax map/parcel no,: - -
. ... . . .
. ... .. .. .
:•.,..,..:.„...„:- - .,:c„,„ :J.::,,,,,,.--,.:-. ,i,s.,1.•,-.;. '...: '..,- - --.,,..,0..., .:ti,...,.--._L,...:.2:,:•.....,.. :::_.:,. .•."‘-•:„?..77-,74.1to,-;:.A-,...:::;:-.i4.;:. Backwater valve • 12.5..!
.:-,.-",i:. •i..:„•:•:.- -.,.,' ..,-..,,i•., --,:-.,;:,,-,•••••'..--.7..DESE-RIPT10.1%:UOF,WORw.- , ,.....•.„ J]:, ,y...:,::.,,-.•.„„yr,...„4.,, .
... 25.02
.. .
.. . . ••••• . .. .
Dishwasher .25.02:.
. . •
Prinking fountain ... 25,42
- • •
. . . - . . . ..
EjectorSisump 25.02
• --,4:4. -....:-.• • •- ,.'• ••• -,1*, ••--,;::.!--v: •g-'1.: :: r-t'''' -'"'" •'''''' :!"''''''' , , Expansion tank 12.51
••-••••,-,..,-,-.::,..-: EayRUPERTY OWNER -,,,f4f...,Wg-: ,,.,:'"•:';:...,:-.•,:.'1,:L,Crg.NANT`!,F• ::.%;.:,.,,i, , ., •
. . . i
• _ Fixture/sewer cap. 1 25,.02
Nam:Polygon Vv'LILLLC .
- • - . . .. • • • Floor.drain/floctr.sink/rab 2502 i
Address:109 fast 136 Street • - - - - • i
, • :-. Garbane disposal : 25.02 - •
•
.C.ityi.ttatit/ZIPI Vancouver,WA 98660 . Hose bib . .. Ear/2
.. .... . ..._
. ... . . . ...
Phone:(360)095-7706 Fa,-,.g.( ) Ice tnaker ...1251
_ , 1
• --. .• •-'•••.- • ' • • ,C- - -it 6,- •-- li
tgi-Apttreipur• :...4.11,; :,,,,,-.. ,z,,,, •coNTA,• r••_,p_F.. S 1- ,..„,,,,,,„: nerceptpri:gfaa...5a trap 25.02
.--."' '-'-' ' ' :''' •- '' '''• ''-' ' - '- ' - ' ... -'- • .•Medieat gas(value$ -.) • Ntle 7..•: . :
Business name:Polygon W1L14 LLC
Printer - 12.51 •
-Contact name:AogelA.OrajcwSki , — - - • •
• Rodf,drain(commereiel, 12,$1
,.
Address:109 EaSt1,: th Street- •Sink/basintlavViir .. 25.02
. .
--City/,StateMP:Vancouver,WA•98660 . . .Solar units(potable watery 62..54
Phone(360'695-7700 Fax;T060).60-4442 ..Ttilt/showe-rishower pan , '12,51.
" • - Urine .25,02
F mail Angea.Orajewskiapolygpithomps.cont . - . ,. ,..•.. .. , .
• • ,,,---,aimwt:s7:-.J. ...„*•,.2, ;.Water eoset • 25.02
. •-..-- ...
"-1;••;'::•• :'-•"•'s• ::•-72'•;•' 1:::::' ' •'•-'•---:••-'• •: :•toN i'lltACTOHRA,•-"'•;••".••• :1-•--AfT-W1:21, ..,,tott:',. : „..., • .
•••••,:t.,i•-•-F:•.•-•':::::1,--', ....:•',.'--.;•:‘,.'-t'•.::- '-"-:'-' .,:-,•• - ---- ,---- • ''', ''' -'-:• -":'•'-1.----^.... ,••‘• og'''''''' ' 'Water heater ., 1. . ...41..5.2 'S1•ea)
Business name:1311L Plumbing LLe ' .:.Water:piping/DWV $6,29.
. . . .. ...
Address:PO 130X.85 . other .25..0l
.... .
,.. . .. .. .
•
City/State/ZIP:Corbett OR 97019 \, Stitttotat ..
•• • . . - - -.- . .. • - • ' - . . ... . .
•Winne(503)151,3903.... Fax ( , ) Minimum" '
. ... . permit fee; $7150.
. ... .
— ...... ... . . . .
Plan review (25%of permil fee
CCB Lie 1800 ... . - Pluntbjeg Lie:no,.:,P.131582 . . . .
. .
... State surobarce(1-2%Of permit fuel ..
. .
Authorized signature: 6,2 . tikerii,„04#0..," TOTAL PERMIT FEE
• •• • " 1--• o I t •iit:,• -I • This pernikappheatiors expires if a permit iS aal.4falned:ssithiri 180 days --.
Print garnaBraidnn Lanier - paw 8 I ., after if:haaliagn'accepted as toniplefe. .
*F6 MeihadOp6 sat by Tri-CeinityBailding Indusiry Service Bahl_
.
1....EiailitiniiierraiisMaitisReiraitAppxlaa-10141/09 44M6.15T(.002COMTNEB) •
i31 .. MASTER PERMIT
CITY OF TIGARD
4) /3 /6 ./."ilIll. tt . COMMUNITY DEVELOPMENT Permit#: MST2016 00042
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016
TIGARD Parcel: 251080001506
Jurisdiction: Tigard
Site address: 15378 SW THAMES LN
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 65
Project Description: New SF. 6/13/2016: REPRINT permit to reduce bathrooms from 4 to 3, and add 166 sq ft of
covered deck.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 1589 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 2167 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3756 sf Value: $468,270.52 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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: 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: 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: 7 201-400 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 3756
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
109 E 13TH ST,STE 200 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 A Geotechnical report is
required before the footing
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $35,354.06
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 0 R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 550 ,i - '503.232.1987 or 1.800.332.2344. /
Issued By: ZPermittee Signature: IA/ ` r1Cl OPV'
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 MASTER PERMIT
1111 s'a COMMUNITY DEVELOPMENT Permit#: MST2016-00042
Date Issued: 04/13/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S1080001506
Jurisdiction: Tigard
Site address: 15378 SW THAMES LN
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 65
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1589 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 4 Second: 2167 sf Garage: 661 sf Front: 20 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 3756 sf Value: $461,076.08 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100
Tubs/Showers: 4 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: N Vent Fans: 7 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'500 sf: 7 201-400 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 3756
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
109 E 13TH ST,STE 200 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $35,255.94
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 throug - 1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19877,// ),oror1.800.332.2344.
Issued By: Permittee Signature: dAr e—/e1-770/\/
Call 603.639.4176 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.
� } / ar 6 �
Buildilr i4rn it Application Z__ Q//e /4o
itz:,-4-ffardri
FOR OF FIC l S( 0Nl.\ I
City of Tigard �� J I V L' N°/11-.57--e/6Ai
g
Date/By: 7 �� / Permit �j�B(/7
1111 a "I 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 1 8 2016 Plan Review, Nf /�4
3 I /i6 - erPermit4w1e,�a/6 Pet a9
Phone: 503.718.2439 Fax: 503.598.1960 DateBy:
c t:t Inspection Line: 503.639.4175 Date Ready/By: � See Page 2 for
g y:
Internet: www.tigard or.gov CITY OF TlGIRL Notified/Method: Supplemental Information
BUILDING DIVISION
,ae��;'� k e 2V , addg ¢2w,ag;;‘,.,0- 1,,,,,,,J r , 4 -vhb �b< [
®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
f _ work indicated on this application.
' Valuation/.t�J • 7♦ S F .��.�
® 1-and 2-family dwelling ❑Commercial/industrial 1�
ElAccessory building 0 Multi-family Number of bedrooms: 4
❑Master builder 0 Other
Number of bathrooms: : . 111111111=111
n-
Total number of floors: 2 4 4 43
Job site address: 3� 5t� t � New dwelling area: S 52 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: /(.0 square feet
Strite/bl t no.: � Project name: Poly gin ' � ��r\ rrNrn Covered
porch area: Gsquare feet
__ -
Cross street/directions to job site: Deck area: J 9 V 0 square feet JE • •
Other structure area: y, square feet '
,.tea.',,-,:--,,,--7_;-fa a cc ' �;� ,: ck, w� $:4L ,,
Subdivision:Polygon at Bull Mountain I Lot no.: US 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
work indicated on this •..lication-
ne� 1�. .,\"�n 1tt��\.. > . ' Valuation: $
1 ' y Existing building area: square feet
New building area: square feet
� s c o wx ' f7. Number of stories:
Name:Polygon R'LH,LLC Type of construction: I
Address:109 E 136 Street Occupancy groups:
City/State/ZIP:Vancouver,CA 98660 Existing:
Phone:(360)695.7700 Fax:(360)693.4442 New,-
Business '-
BUS
s name: �/ '..J L r\C
Structural plan review fee(or deposit):
Contact name: 1_1 a • ‘ ,-e. (orc 0--im
FLS plan review fee(if applicable):
Address: 1 01(A - 7-)44Th Total fees due upon application: _.
City/State/ZIP: V 10a JK)or W pt C\s 0
Phone:3tpt)) �9 C 5 ---41-DO I Fax::No )) U -U222 Amount received
E-mail:maggie.gordon@polygonhomes.com
Commercial and residential prescriptive installation of
, ` « roof-to mounted Photovoltaic Solar Panel System.
P Y
Business name: , ,1 v L1 , Submit two(2)sets of roof plan with connection details
I �� W `1 \n C. and fire department access,along with the 2010 Oregon
Address: \9 a — '3 Solar Installation S,ecial Code checklist_
City/State/ZIP: V Qf)ea,(0 W J Q gl0(00 Permit Fee(includes plan review $180.00
Phone:c6igD) b a5 N-31-C)0 Fax:(3v0) 4
3 . L.\222_
and administrative fees :
State surcharge(12%of permit fee): $21.60
CCB lic.:204238
Total fee due upon application: $201.60
Authorized signature: /ice I This permit application expires if a permit is not obtained
• within 180 days after it has been accepted as complete.
Print name: Date• I —Z1 71.0 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
7
,Elettrliql • .ical Permit Application FOR OFFICE t Si;' ONE
dry of Tigard
Permit NM
13125 SW I tall d.,'Tigard,OR 972 Plan Review
Phone 503.718.2439 Fax: 503.598.1960
DalentyOther Pernut
:
I I c, \t;I) Inspection Line: 503.639.4175 FEB 1 8 2016 Date Itcady/ity: tubs 121 See Page 2 for
Internet www.tigard-or.gov Notified/Method: Supplemental Information
1 1 c ...-` 7q. 4 .r.,• ;TSE ttj;F {{LL.,lt-fe:-,.,.....,.,-.,-.4:.,..:....4.;:,..,:,;,%,, ,,..( ^^ 3PLA'1 .REVIEW
®New construction 0Addition/alle'fadO'n/TLp1t cement Plc ice check all that apply(submit 2 sets of plans u'itcnts checked belosv).
0 Service or feeder 400 amps or more 0 Building user three stories
0 Demolition 0 Other: ..here the available fault current 0 Marinas and booms aids
CATEGORY OF':CONSTRIJCTI N exceeds 10.000 amps at 150 volts or ❑Floating buildings
a+;.� ..x. ..< .....x. ..r . . Icss Inround.or exceeds I a 000
g 0 C'onuneretal-use act
® I and 2-family dwelling 0 Commercial/industrial 0 Accessory building :mops for all outer installations buildings I
0 Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 75 K V:\or
)
❑I:mer genes,systemlarger sepuaicl s denser'ss stem
rt 4 ) , *B SITS oRMATIfON.AND LOPA'T1ON,
['Addition of nese motor load of ❑"n 'I.. -1-2" 1-?'.
Job no.: Job site address: 1537-S 5\A/ -11-04,4_326 ta, .c 1001IP or more. uccupamcv
�j/'�L ❑Six or more residential units ❑Recreational sehtcle parks
City/State/ZIP: �)9( OR G1LL ❑Health-care facilities ❑Supply snhage lin mote than
J ❑I I v uJ>uti locations 600 s tilts nominal
Suite/bldg./apt. no.: Project name:p t 9,� o- B. \� m4,-� ❑Service or feeder 600 amps or inure
F*C$0.IIEPIA+E: .. .
Cross street/directions to job SI le: Description I Qty. I Err. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
I.ono sy Ii.or less 1 168 54
Subdivision: Lot no.'�9b
^I a.add.'500 sq.ft or pon)on 7 33 92 I
Tax map/parcel no.: _ Limited encrey.residential
...,..,-,4.-x
. •.,..:,,..,,,
.7 ,tB.� • 1•,---
_�--•,-------,
�'eR jQ V d*i (with above sq.ft) 7i 01) ?
• - . Limited energy.multi-family 7,00 , I
New electrical service and wiring residential(with above sc.] It)
Services or feeders installation,alteration,and/or relocation
200 amps or less I IX)70 ,
` ��PRpY�n 'r s� ER- '- - •,^.,0T!✓yANT :; 201 amps to 400 amps 133 56
Pt) 401 amps to 600 amps 2(10.34
Name: Y 1 . ,
`' 601 amps to 1.000 amps 301 04
Address: ` b a ',�� ` Over 1.000 amps or volts 552 26 _
acke Temporary services or feeders installation.alteration.and/orCit)/State%/I : \.)^ roDwU fA q relocation
Phone: D) 6 (15'�qP. fax: D ) u2q��}_4 200 amps or less 59 36 l 1
P . ry "w tit"i LLL 201 amps to 400 amps 125 03 ,
Owner installation: This installation is being made on property that 1 own which is not - (
intended for sale, lease.rent,or exchange.according to ORS 447,449. 670. and 701. 401 amps to 599 amps 168 54 2 '
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
above ah(we service or feeder lee. 1
® ,I oTiltAAc f't'IPFJ�tSON each branch circuit 7 42
Business name: (i..7)------, ' 13 Fee for branch circuits without
service or feeder fee.lirst ib 18 ,
Contact name: m . i ive. C--)ore branch circuit
P
Each add'I branch circuit 7 42
Address:
1 Miscellaneous(service or feeder not included)
City/Stale/ZIP: Qirl CCU ' : ` , 1 le * Each manufactured or modular I
VAJC dwelling,service and/or feeder 67 84 1
Phone: 67 54 ,Reconnect onl 1
( ) Fax: :( ) > -
t � ` �� Pump or irrigation circle 67 Sr' { ,
E-mail: a.69Yt. rW�^` p Sign or outline lighting 67 84 ,
"'` " O_ Signal circuit(s)or limited-energy
Business name:Simply Electric panel,alteration,or extension Pair 2 ,
Each additional inspection over allowable in any of the above li
Address: PO Box 822408 Additional Inspection(I hr min) 66 25/hr
City/State/ZIP:Vancouver,WA.98682 Investigation(I hr mint 66 25/hr
Industrial plant(I hr min) 78 I X/hr
Phone:(503)849-8202 Fax:(360)314-4945 Inspections for which no fee is 9q.00/hr
specifically listed(%z hr min)
CCB laic.: 204615 Electrical I.ic.: ', 067 Suprv. I.ic.: 4394S •-- - * • �EL'ECTRiC:3L'1'E'RA71T7FEl~S;'
O Subtotal
Suprv.Electrician signature. required: �fG4t f5)
r �'`f flan revien (25%ofpermit fee)
' Print name: Victor Zarzhitsky Date: 11)17/2015 State surcharge(12%ofpermit fee) r
TOTAI.PERMIT HA.:
Authorized signature: ,
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I)aIC: ` Number of inspections allowed per permit
1 Hwldmc'Pcrmitc\\Iu.C.Pcrmil\pp doe 07,01;10 .Wu..t615 ft I I.os(•OnL1NGtt
Mechanical Permit APPlicaho
ECEIVE'
Ft/110111C L 1 st csNlri
City Of Tigard Received
FEB 18 2016 't ' 9S��p/b- 00��
13125 SW Haff Bivd.,Tteard,OR,97223 Plan Review PeravG.
• Phbntr 5Oi118.2439 Fax: .0.3 5981964 ry x
Inspection r, ane s03639.4175
CITY OF T�t3A , «�►r�rSoppg .t�.
Internet m�ww tlgara-or.gov 3 E f k�. DIVIS. .
pa ,t 3 r, :
�"w .3yi`och±micsl permit ties are bstsedon the value of the weak' at'ton 0 tidditiortalteraiioitireplactri performed.Indicate the value(rounded to the nearest dollar)of all
O I+em Clition mechanical materials.equipment labor.overhead,and profit _.
0 T3espalrtr� Yam'$
AccessoryForspedalIn�formation use eliec lint
®1-.and z-fateilydvi�euin$ 0 Commercial/industrialo building Dcsa,p6dm I �''- 1 � 1 TaAat
CI family 0 Master builder 0 Other
Hea
6ae essol ng:
< ,4" y s ®'.?'i Z,e,r:° ne r'3 nAir e° :ditioning. 36.7
Job site address. 1 .-7.)---1-e6 J,,,L) I . yVt / '`.0 Fumact loo,fi00 BRUa
(lodms) 1 4635
Famaca 100.000+BTU(dams/was) 34:91
�l� G�ZZu 61,16
�� 'rl C.' � ,, Q 'BO
`' r�pmnp.
Suitt/bldg./apt no. ( Project.namc PO\y J � BO\\ Mid Duet work 2332
�J Rydronic hot water system2332
(dogs 5tt�t/diitc2ioais to.job site: g,�td�ial boiler(radiator or
lay c) 2132
U*.beattts(fuel-type,tint electric),
iti.w�at iii-,dux,suspended.etc.
46.75
gm/wit foram of above 23.32
t1tlzcr ..
2332
Si m; _ Lana..
j
O{trertfiad*when— test.
'Wiucrhesier
Tax loo csas fareplacclinsert .39 "
23
3333
" = � Fjnevertt for water fierier or gas
Ftepteec 23.32
l li tit Cgs) 23.32
Woe' 3339
1cad:fuepiacstrawt ,
33.32
t iiinncf/lioefiluevent2132 ,
_ a ` 73:32
€"-§ , 7 •'4 ° , ';, "_ . -4,-:::13'.,-,.4,f!..-1 -„,,,,r::-.. ;,,,:q._*"4 Easironi Cental exhaust and ventilation:
hood/otterkitchen
Name Northwest 'Range .- 1 3339.
Ott :
Address:.109 E,23u St tlotba dtuar.exbatisa
I .3339
Single-duet exhaust(6a horns,
4;itg/3�lef:LlP:Kaacauxer,�V.'-1..98661 'toileiranetis,:id7ity.roonss) 4 23.32.
Plioth 6- Fax.( ) Otlieferawlspaee fans 2132
2332
-fnd Opttag:'
Bi00mc Polygon Northwest S1.is for first four;54.03 for ads additional
Furnace.etc:
1
Contactisathe
fstrs:beat:p mD
Address:40 E 136 St WiiWsuspeodedhinit heater
. . . '
Cty/State/Z.IP;'V:�fconver,WA:98661 Wier heater I
Fax::( ) Fireplspe
rl t (aw)816-7800 >s 1
Bather=
Oilim
L! Dane Andersen Heating,late..... .A. 3 ,.7,i k�..,...,-_d.S.t.' " 4 a� ,.'5' k r':'"
Rosiness x, , � v.
A .14285 SW8S"Ave >fie 410 Subtotal
Maim=permit tee(59D 00)
City!$tandZlPi Ttpid,QR 97224 Plata review(23%of permit fee)
Phone;{$03)9924.664 ( Far(503)536-6615. State.sur (12%of permit fee)
TOTAL PERMIT FEECCB Iia-:168214 This pined applicatian acpiroit Ili permit is net obtained within 180
days atter it has band accepted at sniespkte.
*, Fee methodology s by Tri-CountyBoitding Indestry Service Rood
Authorized sigaauus:
Print ruin=Art AIda ter , Dot=11)20/2013
akaiocansti 'slteft3 owiai.dar 44o461rr(timco aa)
1
Plumbing Permit Application
r" r" FOR OFFICE I_SF o�L�
Building Fixtures EC
Received Permit No- f /1 i/_ ..eOpve
1 City S Tigard FEB ( fir ���G
i 13125 SW Hall Blvd_,Tigard,OR 97223 FEB 1 8 tPkhd Revia+v Other Permit Na:
Phone: 503.7182439 Fax 503.598.1960 r� x��Y y,� ( ® Page 2 for Inspection Line: 503.639.4175 CITY OF ) J 61 See Page 2 forormation
I L' Internet W W W hgard•or gov r r<`S . ?-"„.. ;Y._:3' l. .. &,_:-- - _
-----.'-`,•••- _ R ----. For special information use check/6i
• my1 New construction ❑Demolition Description I Qty. I Ea_ I Total
0 Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft for each utility connection)
r ,-- -= f a-,. SFR(1)bath 31270
2 T. -, =da 1 E(C .- -, .:. •- �:'' _as-"`" 437.78
SFR(2)bath
T1-and 2-family dwelling 0 Comtnercialfuidushia1 SFR(3)bath i 50032 5 t-51.._
O Accessory build'mg 0 Multi-family Each additional bath/kitchen 25.02 •
❑Master builder 0 Other. Fire sprinkler L_sq.ft) . Page 2
.a^ . -,,,,, -q.:,- -s Site utilities:
-- ;,,.r ' ,3:,""45,1,'; ',m-- x;t - , .. 18.76
vi:.:ems-,_ ilei ess: s' i ca-
0� ` / Catch basin or arca drain
- Job site address: 18.76
/� Q G��//� Drywell,leach line,or trench drain
City/State L1P: T ��r� ► \ l ` (�( � Footing drain(no.linear R:__ Page 2
Suite/bldgJapt no.: cJ I.Project name: Yo\' B C(� t J\ '" '1' ' Manufactured home utilities 50.03
7 Manholes 18.76
Cross street/directions to job site: 18.76
Rain drain connector
Sanitary sewer(no.linear ft:_J Page 2
Storm sewer(no.linear ft.:__ • Page 2
' Water service(no.linear ft:_ ) Page 2
Subdivision: • I Lot no.: U .') Fixtureor item:
r--- Backflow peeve rater 1 3127
- -` � '.1'
Tax map/parcel no.: ,) r
7 r _Arse Backwater 12.5`\
c--------4.',-,---,, =•i 4 . „ :
, _ _, y__ _ �,, c - rClothes washes i 2502 5,O
Z
Dishwasher 1 25.02 ac);0 2
NW,/ f 4 0 iV kL *iDrinking fountain 25.02
X� Ejectors/sump 25.02
1 Expansion tank 12.51
y j r ..1Z-:::-.7-7:7--- h 25.02
•,:,,.. .t._ - f ' - _. . FFxturdscwer caP
1Jame: 3 p oN 9 ;~ ` Floor drain/floor sink/hub 25.02
Address: C ` 1"'t l S-\-' Garbage disposal t 25.02 2S,eYL
Jq Hose bib 1 25.02 Z G?,Ofi,
Cfty/S...gap: of,0 0\/
Pho +O Fax ( ) Ice makes' ` 12.51 i'2. \
t` \/ L151.4
_ Interceptor/grease trap 25.02
;F �'� -5..--:-..... .-4_,•-,-..„,,._'- Medical gas(value:S ) Page 2
Business metre: 3DL u. ,bi-vis j Primer 12.51
nemCgoVriAaCon (_( ` Roof drain(commercial) 12.51
Address `t/ 67 Sink/basin/lavatcry 25.02 ,
`
City/State ZIP: 06 16/9 Solar[mils(potable water) 62.54
a 12.51 Z5.0z.„Tub/shower/shower pan.
Phare: j) 3�'b3 Fax:( ) Urinal 25.02
E-mail: I) N'(Gi..! Nom- Water closet 25.02
-- •�J2
•'-;',:2-,;:--,... y 1 . - -�,_ _ ‘-----,----.,--- _� Water heat= 1 3752 y�'
Business name:�Z 'MS Li.e_, Water ptpmglDW V 5629
Other. 25.02
City/State/ZIP:
("be f J Cl_ 61' Subtotal
fee: 57230
Pbane$' - • Minimum permit
' 7) .:.7 I 3 /�+ F ( ) Plan review (25%of permit fee) _
CCB Lie: t$b3 Plumbing Lic.r 158-7- State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signahu>w
I Date:///7/5-1
This permit application expires if a permit is not obtained within 180 days
Print Italile % / /SI after it has been accepted as complete_ •
*Fee methodology set by Tri-Corady Building Industry Service Board.
lAButdinePetmeAPLMU-P'ermilAPP-doc 10#D IX* 440-46]6T(IWQZJCOM/WEB)
. City . and
ofTi g
r COMMUNITY DEVELOPMENT DEPARTMENT
s
T l G RD Building Permit Review — Residential
Building Permit #: rix1,,20/6 r dpp�.2.
Site Address: /S-3,-.!gSjv g 1n.2/l z
Project Name: // l Lot #:
(New d ;= subdivision name;.Addition or.Aiteration= last name of owner)
Planning Review VVV
Proposal: A/et) SjfC'
erify site address/suite# exists and active ' permit system.
R ver Terrace Neighborhood: [No ❑ Yes,See RiverTerraie Review Addendum Attached
Sit Ian Elements:
P ree (3)copies of site plan 111 $ 'sting structures on site
175,ite plan mus be on 8-1/2"x 11"or 11 x 17"paper ii ootprint of new structure(including decks)with finished
3/ awn to scale (standard architect or engineer scale)•
or elevations
rth arrow tility locations (required for new,may apply for additions)
itt
address,project or subdivision name and lot number . cation of wells/septic systems
plicant information (name and phone number) IT. rosion control(including drainage-way protection, silt fence
AL.t dimensions and building setback dimensions d gn,location of catch basin,etc.)
01 : area,building coverage area,percentage of coverage and eet names
(pervious area (applicable if R-7,R-12,R-25&R-40) treet tree size,type and location
VProperty corner elevations (2 foot contour lines if more than 0 sting trees to be retained with drip line,and tree
4 foot differential) protection measures
(p)klean Water Services—Service Provider Lette (lot platted prior to 9/10/1995):
It/equired: ❑ Yes,applicant was notified V No Received: ❑ Yes E No
Public Faciliti Improvement (PFI) Permit:
R uired: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intakend Use Case#: S�� Qdts— ( oo
oning: g-1-4s--
II.
Setbacks: Front ,Q0 Rear I Side s Street Side N/Garage '?D
t 11 Pi,andscape Requirement:
Iii of Coverage Maximum:
A Building Height: Maximum Height Actual Height so
itCli P isual Clearance
JAI asements
ensitive Lands: Yes ❑ Nola •
Type LGG3--1/ro/uj
Er Urban Forestry Plan
❑ Conditions "Met" rior tc)issuance of building permit
Notes: C"rl1/03bii e /y,jj ,L he 1 , ,L r r?r /0 f C.cm2./ted'
Approved By Pl nning: — - _...e, �_ Date: eQ/�' !' j(.,
Revisions (after Building Submittal only) Reviewer / Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B ldgPennit R vw_R ES_O 12 116.docx
1
Building Permit Submittal
Original Submittal Date: .//�-/fo
Site Plans: # 3
Building Plans: # 3
Building Permit#: E" Enter building permit#above.
Workflow Routing: -Planning E Engineering Permit Coordinator Building
Workflow Sign-off: Er-Sign-off for Planning(include notes from planning review)
Route Application Documents: 0-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
riginal plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: cQA.a/jpv
Engineering Review q�
Slope at building pad: .
/❑ onditions "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: E Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approve• by gineering: Date:
Notes: .i. _ 141_f____.....• .... i.gr'l' it� sr C" -_/. ,./
Approved by Engineering: � 6�� Date:
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: ...?-772-41/47Notes: /yL�
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: J.%ires E N/A
Tigard Trans SDC: es El N/A
Parks SDC: Yes ❑ N/A
154 OK to Issue Permit
Approved by Permit Coordinator: ea...,,,,.., Date: —( 3 -1 6
1:ABuilding\Fonns\BldgPennitRvw_RES_0121 16.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
i Ill
1114 ■
T I G A R D River Terrace Building Permit Review Addendum
Building Permit #: /f.5��/& - c'QQ y.2__
Site Address: /s--3?-3 Ls3/0 "j;7kGatzLt
Project Name: ,aZw-on . 2.7L , ll JP � ;Z Lot #: 1p(Neg=subdivision name;.Addition or.Alteration=last name of owner)
Planning Review River Terrace Plan District Design Standards (18.660.070.1.):
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/ access 2 Window Projection Vertical Wall Offset a
Porch min. 5 f�. deep Gabled dormer
/ ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6 wide
❑ ❑ ❑
2. Eyes on the street: a minimu of 12°o offach street facing facade must include windows or entrance doors.
Percentage Shown: 23.3 e/c
3. E trances: At least one entrance must meet both of the folio mg standards:
Max. 8 ft. setback from long t 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 • s, all the following apply: 5 sq.ft. min.
�ne street facing entry ft. max. roof height above porch
ItQ 5 ft. depth min. 0% mm. porch roof coverage
4. etailed Design: All buildings shall include a min. of five of e following elements on all street-facing facades:
overed porch min. 5 ft.wide x 5 ft. deep
RRecessed entry area min. 5 ft.wide x 2 ft. deep
V /all offset min. 16 inches
Vormer min. 4 ft.wide
L14 Roof eave min. 12 inch projection of offset min. of 2 ft.
❑ Roof shingles either tile or wood Gable, hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. Horizontal lap siding min. 3-7 ft.wide
in
❑ Accent siding m . 400/0 of street facade L►dWindow trim min. 2 '/"wide by 5/8" deep
❑ Window recess min. 3 inches for all street facing ❑ window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft. wide x 3 ft. deep with inside access Attached garage is 35% or less of street facade
5. Garages and Carports: May face the front or side lot line on a corner lot.
Setbacks:
diZcloser to front or side lot line,than longest street-facing wall. ❑ Yes ❑ No. If No (Check one):
ay extend up to 5 ft. if there is a covered front porch and garage does not extend beyond the front porch.
ay 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 the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ 12-foot-wide garage door 40% max. of street facade
❑ 50% max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: '-------,.-:j,A Date: „,77/AA,
I:ABuilding\Forms\BldgPennitRvw_RES_RT 012116.docx
Albert Shields
From: Albert Shields
Sent: Wednesday, February 24, 2016 2:51 PM
To: 'Maggie Gordon (Maggie.Gordon@polygonhomes.com)'
Subject: RE: MST2016-00038, -00039, -00040, -00041 & -00042
Attachments: Conditions-02-24-2016.pdf
Maggie, various of the Conditions of Approval under SUB2015-00002, highlighted on the attached conditions list, remain
to be Met before we can release these 5 permit applications, meanwhile we will put them on Hold marked "Approved
but Not Released." Please let me know when the conditions have been met. Thanks, Albert.
1
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
g ' Transmittal Letter
T GA R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
g g ov g g
TO: Tom H. DATE IR A
DEPT: BUILDING DIVISION
MAY 177016
FROM: Angela Grajewski/Chris Walther CITY OF TIGAR1D
COMPANY: Polygon Northwest BUILDING DIVISION
PHONE: 503-312-6213 By:
RE: X5518 SW Thames Lane MST2016-00042 155-u,
(Site Address) (Permit Number)
Polygon at Bull Mountain LOT (05
(Project name or subdivision name and lot number)
ATTACHED ARE TILE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
0 Additional set(s) of plans. 3 Revisions: WIC/4t bath change
0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 0 Engineer's calculations.
0 Other(explain):
REMARKS: Removal of 4t Bedroom bathroom into Walk-in Closet
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: 6 / (,, /) 6 Initials: .--
Fees Due: 41 Yes ❑No Fee Description: Amount Due:
r plc.v rev $ G? o
y-AM/4/ `e- $ vS:ri)
s, � . $
$
Special
Instructions:
Reprint Permit(per PE): Yes ❑No ❑ Done
Applicant Notified: ,"9-,V6/6" Date: 0/, // • 67`14/i___ Initials: --
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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
T,c;;\l?n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:` I
DEPT: BUILDING DIVISION RECEIVED
MAY 24 2016
FROM: Angela Grajewski/Chris Walther CITY OF TIGARD
BUILDING DIVISION
COMPANY: Polygon Northwest
PHONE: 503-312-6213 By.__
RE: 15378 SW Thames Lane MST2016-00042
(Site Address) (Permit Number)
Polygon at Bull Mountain LOT 65
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies:r;. Description: {9. , Copies: Description:
0 Additional set(s) of plans. 3 Revisions: change from patio to deck
0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 2 Engineer's calculations.
0 Other(explain):
REMARKS: Terrain makes a deck necessary
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: I a6 ) J .0 Initials:
Fees Due: [2j Yes ❑No Fee Description: Amount D e:
.,c N r Pi c.v. ✓'cv; c'.✓ $ ys
r /),Erie_._ $
nen/#J r , $ X .5, X7
Special , 1"64 7 ) V97..../,09-770i✓ C 9-L.ect.c1T7r 2_
Instructions: /2- ----e..4-z_C 'EA p Al 1 7' /� S
Reprint Permit (per PE): [Yes ❑No [1] Done
Applicant Notified: ,1-/66/g— ate: V3//, iy,9 it_ Initials: $
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
n J
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
FAIL
November 3, 2016 at 11:08:11
AM
MST2016-00042
David Young
Remove non pt wood from concrete contact at garage man door landing. R317
Fix grade to slope away from house under back deck and around corner from deck.
R406
Window in upper level main bath does not appear to be tempered. R308.4
Breaker for smoke detectors off.
Switch cover not installed in kitchen.
Not ready for final inspection.
Violation Summary:
Inspector Contractor
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
199 Electrical final
PASS
MST2016-00042
Jeff Grove
Entry hanging fixture not working
Will check at building final
Violation Summary:
Inspector Contractor
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.
IL City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
a
Transmittal Letter
T i G A I I'1 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: Tom H. DATE RE E
DEPT: BUILDING DIVISION r41:7,121
1
Li
kOG222.016
FROM: Angela Grajewski410 .� �
COMPANY: Polygon Northwest B�JILD1 "i
i-1/4stori\‘
PHONE: 971-212-2144 I: ' -=
cay OF-RE: iS3 e sw ThaMST201
(Site Address)
Sne' (� e
(Permit Numer) 0004/2_
Polygon at Bull Mountain
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
0 Additional set(s) of plans. A
0 Cross section(s)and details. 0 Revisions:
0 Wall bracing and/or lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 0 Engineer's
3 Other(explain): Additional 2 eck details requested by inspectorcalculations.
REMARKS:
Routed to Permit Techni. an: Date: 2 - �� - i .
Fees Due ] Yes No FeeDescription: Initials: ,
Amount Due:
bt � . .S ✓ • - • - ; W $
,�- -- - $
ry o $
Special $
Instructions:
Reprint Permit(per PE): ❑Yes I �No
Applicant Notified: I Date: [I]Done
Initials:
IABuildingTormslTransmittalLetter-Revisions.doc 05/25/2012
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
199 Electrical final
CNCL
October 28, 2016 at 12:05:35
PM
MST2016-00042
David Young
Not ready for inspection, work not complete.
Violation Summary:
Inspector Contractor
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
November 3, 2016 at 11:10:18
AM
MST2016-00042
David Young
Violation Summary:
Inspector Contractor
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
399 Plumbing final
PASS
November 1, 2016 at 11:04:43
AM
MST2016-00042
Don Sylvester
Corrections complete
Violation Summary:
Inspector Contractor
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
15378 SW THAMES LN, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
PASS - C of O
November 8, 2016 at 5:01:14
PM
MST2016-00042
David Young
Final erosion control approved.
Street tree certification received.
Moisture content form received.
Vapor barrier verification received.
High efficiency lighting form received.
Blower door test report received.
Insulation certification checked.
Violation Summary:
Inspector Contractor