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Permit (10) r 4: CITY OF TIGARD h ,4. MASTER PERMIT :. ''- COMMUNITY DEVELOPMENT ��l� Permit#: MST2016 00025 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016 Parcel: 2S1080001504 Jurisdiction: Tigard Site address: 15402 SW SEINE CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 52 Project Description: New SF. 6/13/2016: REPRINT permit to reduce bathrooms from 4 to 3. 8/4/2016: ADD sump pump for storm water. 8/25/16:Add heat pump. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1518 sf Basement: 826 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 2144 sf Garage: 735 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 4488 sf Value: $548,864.77 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: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 1 Other Fixture Units: Sump pump for storm water 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: 8 201-400 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 4488 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 repor is required before the footing PHONE: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $37,315.52 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 952-001-00 dough OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin. : .232.1987 or 1.800.332.23444.. Issued (N_ 9 Ce....C,CeL--ViA—ALL.../ Permittee Signature: "A' ail 0!/ 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 Ain tliccati®tit • IVEDFOR OFFICE USE ONLY ! eW . l ® 1gs1 C � PermitNo.: IIIIw 13125 SW Hall Blvd.,Tigard,OR 9 Phone: 503.7182439 Fax: 503.598.Ac6¢, Other Permit: IIJJ(7Date/By: TIGARD Inspection Line: 503.639.4175 2 2 Q�6 Date Ready/By: Jas: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGARD . ,- .11n I VI IO ,1. COl CLAL 1AE. SC 11U1 -U C.Etiad=ST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. $Fi '4" gam_ ,...,,,'-'''',t.-'ik iO_ v . Value ufes. ,.. ,M.s :� , - �.4_.«� _;._, f :SIDENTIALE UIPMKa'T/SYsLkMS ESQ ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist 0 Multi-family 0 Master builder ❑Other: Description Qty. I Ea, I Total f _.c . l Heating/cooling: 4 r- ,-K wore .19813E:lrIFOl ATA:c4 .Artfiq 4,13cAT1p Air conditioning 46.75 Job site address: 194 U.2_ s4) SCAA nicLt Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 1 61.06 61.06 Suite/bldg./apt.no.: I Project name:Polygon at Bull Mountain Duct work 2332 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision:Polygon at Bull Mountain Lot no.: SZ Other. 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPSiION OF;;WORK �: fireplace/insert 3339 _ _ Gas " Flue vent for water heater or gas Change 2"furance for basement to Heat Pump fireplace 2332 Log lighter(gas) 23.32 Wood/pellet stove 3339 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 - Other: 23.32 _ UP TENAN__- _ _. .------ . __ ..---- ._ . .. : .N.,:._.__ Environmental exhaust and ventilation: Name:Polygon WLH,LLC Range hood/other kitchen equipment 33.39 Address:109 East 13th Street Clothes dryer exhaust 33.39 City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(360)695-7700 Fax ( ) Attic/crawlspace fans 23.32 6( a i�€ ❑ CONTACTPERSOIY4 Other: 2332 _ . . Business name:Polygon WLH,LLC Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Angela Grajewski Furnace,etc. Address:109 East 13th Street Gas heat pump Wall/suspended/unit heater City/State/ZIP:Vancouver,WA 98660 Water heater Phone:(360)695-7700 Fax::(360)693-4442 Fireplace Range • E-mail:Angela.Grajewski@polygonhomes.com Barbecue ^t't;.i%ti-Z-K ... .,4r;,.•.k 4 a 4 Clothes dryer(gas) Business name:Apex Air LLC Other 'i " 1f:'a u� CAI.PERl1 ) B mob ... Address:18004 NE 72nd 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 days after it has been accepted as complete. Authorized signaturji .. f * Fee methodology set by Tri-County Building Industry Service Board Print name: I Date:8/22/16 I I:\Building\Permits\MEC PemiltApp_040I 3. oc 440-4617T(11/02/COM/W1313) 0" CITY OF TIGARD .� MASTER PERMIT COMMUNITY DEVELOPMENT ©® Permit#: MST2016-00025 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016 Parcel: 251080001504 Jurisdiction: Tigard Site address: 15402 SW SEINE CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 52 Project Description: New SF. 6/13/2016: REPRINT permit to reduce bathrooms from 4 to 3. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1518 sf Basement: 826 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 2144 sf Garage: 735 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 4488 sf Value: $548,864.77 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: 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: 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'l 500 sf: 8 201-400 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 4488 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 repor is required before the footing PHONE PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $37,174.11 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 1.9877 or 1.800.332.2344. '/ Issued By: �k/� 447,471e._..* 7 Permittee Signature: 'N j// / � e �ON 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. 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 I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Tom H. DATEVED i DEPT: BUILDING DIVISION MAY 17 ?016 FROM: Angela Grajewski/Chris Walther CITY OF TIGARD BUILDING DIVISION COMPANY: Polygon Northwest PHONE: 503-312-6213 By: A:-��r RE: 15402. SW Seined}. MST2016-000 2_5 /Sctc 0 (Site Address) (Permit Number) Polygon at Bull Mountain LOT 52 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description:.t,; - ' Copies: I Description: 0 Additional set(s) of plans. 3 Revisions: WIC/4th 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 4th Bedroom bathroom into Walk-in Closet FOR OFFICE USE ONLY Routed to Permit Technician: Date: (p/!P//(o Initials: � Fees Due: Yes [1] No Fee Description: Amount Due: / l #72 ' sem!//.) $ 9a, Iry ,9 Mid Esc=-' $ y-;at $ $ Special (3) e4-Th.too MSS �S_) Lr9-t//, (3J Tlr3 s-,,,,,,,,-.,/ (�)Lf9zc, .,,2y- Instructions: T72,4y ('S) �- G�S e---73/ (SJ //b- �- 2- ,9•v_S Reprint Permit(per PE): ' 4.)e-7--e4.)e-7--e-74Yes El No one Applicant Notified: Date: 67/.9//,6 /,c//6. 71...c oma/ Initials:4 I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 q CITY OF TIGARD MASTER PERMIT III _ COMMUNITY DEVELOPMENT Permit#: MST2016-00025 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 04/13/2016 TIGARD Parcel: 2S1080001504 Jurisdiction: Tigard Site address: 15402 SW SEINE CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 52 Project Description: New SF. BUILDING Floor Areas Reaulred Setbacks Required Stories: 3 Bedrooms: 4 First: 1518 sf Basement: 826 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 2144 sf Garage: 735 sf Front: 20 Smoke 1 Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 4488 sf Value: $548,864.77 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 Rain0 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 Times Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum>=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: 8 201-400 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 4488 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 repor is required before the footing PHONE: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $37,062.43 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through••- • 001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. "FM Issued By: • Permittee Signature: /7AI 9i/'..( 977& Call 603.639.4176 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection. . y— az 0 7- Building Permit Application 77 6— n��;ltmsl' ,' ��� FOR OF FI( ltik n\l.l City of Tigard �y y �j '� ar4)/1 ved �G �O Permit No.: T t , � / 13125 SW Hall Blvd.,Ti ard,OR 97223 \L! plan Revie.71 L Other Permit: yyg / i lr'"Phone: 503.718.2439 Fax 503.598.19 Date/By: C 5 //6 4 Inspection Line: 503.639.4175 � pQ'ZO$ Date Readye/Bo:d: Juju: H See Page 2 for � 1:, Internet: www.tigard-or.gov .1c, Supplemental Information rmation i� 1' cl r..- '. �. � 'd. �t• � C � k� °*�'§^Y d I y try , R 3 '.4:...c. ..::.:,.i. .... >..v ......_.:.:'�.. .n........_. ....v..... ........r...a..r.:..... ...i..x...... .. ........ ._e ,.....aa.,.,n..va.mic . .. _ ... .. .... »_a ..... a✓. ®New construction Permit fees*are based on the value of the work performed. ❑De� •1 Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. . . Valuation: A 8 86T' 55 a ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑Multi-family Number of bedrooms: 4 ❑Master builder ❑Other: Number of bathrooms: ' , ,� Total number of floors: Job site address: ,p, �}eL,I\_Q �� � New dwelling area: 1.4 5\_\ d square feet •8 -, City/State/Z P:Tigard,OR 97224 15 ' 0a-' Garage/carport area imp square feet Suite/bldgJapt.no.: 1 Project name: PD\(3-on (,;t , 15 V r\ rr)i-n Covered porch area: 5 1 square feet,, 4 • Cross street/directions to job site: J Deck area: / • square feet f Other structure area: ,' square feet 1 ail Subdivision:Polygon at Bull Mountain Lot no.: 2 Permit fees*are based on the value of the work performed Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the :- r a� aS"" ,- r work indicated on this a..lication. ne�,J LnC�� � S , . orn �_.,. �.��: � .. �3 __ � _ Valuation: $ Existing building area: square feet New building area: square feet 4 C Number of stones. Name:Polygon WLH,LLC Type of construction: Address:109 E 13"Street Occupancy groups: City/State/ZIP:Vancouver,CA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: Business name: pe� it k.1.)L \n C Structural plan review fee(or deposit): Contact name: a f y� (occ or\ Address: I O` }Q V3"4-177\ \)i (� f FLS plan review fee(if applicable): �j��OCUQ el� W p, r(�1 to Total fees due upon application: City/State/ZIP: ;-•� /� Amount received Phone: D) et ` �1-0V I Fax:(JVD) U`'13.U222 E-mail:maggie.gordon@polygonhomes.com s Commercial and residential prescriptivevmstallati on of roof-top mounted PhotoVoltaic Solar Panel System. Business name: V b I (fW�� 'n c Submit two(2)sets of roof plan with connection details Jand fire department access,along with the 2010 Oregon Address: t 0 Cl i '31/4-4.o �Tf _ Solar Installation S.-cial Code checklist City/State/ZIP: Van CQUo( A Q Tj V/lo 0 Permit Fee(includes plan review $180.00 and administrative fees : Phone:coli)) b Q 5.11-0O Fax:(%D) 0Q3 • 1—\222 State surcharge(12%of permit fee): $21.60 CCB lic.:204238 Total fee due upon application: $201.60 Authorized signature: .8f. $ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date �] *Fee methodology set by Tri-County Building Industry 7 -_i_..0Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) J I Electrical Permit Application ReceivedIOR orrfc-t, I sh: O.\I.i City of Tigard `±Cut4S) Datealy: Permd NO L,M' 0 u 7.7as. ;t • 13125 SW!fall 131vd.,Tigard,OR 97 flan Review Datcrliy: Phone. 503.718.2439 Fax: 5063.598. 60 Il 1�\ (Aber Permit. _ 1 I( \I:I) Inspection Line: 503.639 4175 C(a `Date Ready/11y: huis O See Page 2 for `` Internet: www Ugard or uw (.� �+„ b tuUMctho(I Supplemental Information � �YQIrV T..: PI1�I R1FrV1E�Y t� �j Please check,all that apply(submit 2 sett of plans s.itms checked below) ®Nov construction 0 Addition/alteration/rt. 1) ❑Semac or feeder 400 amps or more ❑'holding ' uddoer three stones Demolition ❑Other: % service the available fault current 0 Marina;and boatyards i tr' CAq'E6©R`Ym OP }111.CONsr.it . exceeds 10.000 amps at 150 volts or 0 I loaf nig building; i., °.;. less toround.or exceeds 14.000 g ❑Commercial-use agncultural 10 I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps fir all other installations buildings 0 Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 751:VA or .: y.+�ryr) .. g, n moo.:. �,• - ❑Emergency system larger separately den,cd systenm -•-'i. 'o,. ca`, .f.,,, ; !,cGa Q-RMA 6N y (.,O -, ' _- ^•-•'.•i:`. ❑Addition or new motor loin!of 0..A.. -,I.. ..1_'.. 1 Job no.: Job site address:,, Se i c' .A Itx)or or more. occupancy • --r-%e mrd OR G1ZZtA 15yo l ❑Six or more faclitiresidential units 0 RecSupply anal e lin c purls Cit '/State/-LIP' ( �-- ❑lia,ir oure facilities ❑Supply ynitage lire more than J ❑I I mrardouti locations 600,ul(s nonnnal Suite/bldg./apt. no.: Project name:p b ..3 3 -' 0,....4r \' 111-1-n ❑Ser,ice.or feeder 600 amps oor more Cross street/directions to job size: Description ) Qty. J Fen sI Total I • New residential single-or multi-family dwelling unit. Includes attached garage. ^(.000 sq a or less 1 168 54 4 Subdivision: Lot no.: 52 Ea.add')500 sq.II or portion q 33 92 I Tax map/parcel no. h Limited energy.residential 1 75 00 2 •* ]�E ottitioo; eiRK r (with above sq.II) New electrical service and wirfn Limitedenergy.multi-family 75 00 residential(with above sy 11) 2 1 Services or feeders installation,alteration,and/or relocation N, zR<(1P ryR,, 201 amps or ess I(NL 70 11 r :fE1HA�1T `T amps to 400 amps 133.56 Name P0\1/4,1 401 amps to 600 amps 2(8).34 -, 601 amps to 1,000 amps 301 04 2 Address: ` b a `,o4rN Over 1.000 amps or volts 552 26 , qoo, `e Temporary services or feeders installation.alteration,and/or City/State/ZIP: v)� �(�Jt,,� W /�/` relocation Phone: D) h "t5. e7. Fax:aD ) 1.tL"FC/ 5-sl 2(x)amps or less 5936 I ry "`"'"lul����LLLL 201 amps to 400 amps 125 08 , Owner installation: This installation is being made on property that I own which is not intended for sale, (case.rent,or exchange.according to ORS 447,449,670.and 701. 401 amps to 599 amps 168 54 , Branch circuits—new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits with i .X T ,.? I `" F, © '0-01.4:j'AC1''4PE SONt above service or feeder tee. 7 42 , each branch circuit Business name: 2-6K70.ig I3.Fee for branch circuits rruhour service or lecder rec.first 56 18 , Contact name: m . 0, e rli branch circuit -)ord. Each add'I branch circuit 7 42 , Address: s 0 1 _ Miscellaneous(service or feeder not included) modular City/Slate/ . Bach manufactured orCity/State/ZIP: an COU ( I dwelling.service and/or feeder 67 84 ` Phone:( ) Fax: :( ) Reconnect only 67 84 2 1 D .ab r `^� /,•�,� Pump or irrigauon circle 67 84 j , E-mail: Y�. �I I \.C/ ' 2 Sign or outline lighting 67 84 :nil '. ,'._.. "V Signal circuit(s)or limited-energy Business name:Simply Electric panel.alteration.or extension Page 2 j . 2 Each additional inspection over allow able in any of the above Address:PO Box 822408 Additional Inspection(I hr min) 6625/hr City/State/LIP:Vancouver,WA.98682 Investigation(I hr mini 66 23/hr Industrial plant(I hr min) 78 I8/hr Phone:(503)849-8202 Fax:(360)314-4945 Inspections(fir which no Ice is 90.00/lu specifically listed(V:hr min) CCB Lie.: 204615 [F lectrical Lie.: , 067 Suprv. Lie.: 4394S •ELECTRIC; L+ERI►7IT' .FEES ' O ecf� Subtotal Suprv.Electrician signature. required: Hca,_, f$ Plan rcvictc (25%ofpermit Ice) Print name: Victor%arzhitsky Date: I 1 17/2015 State surcharge(12%of permit fee) Authorized signature: TOTAL.PERMIT 1:1.1:. 'this permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print namc. Date: • Number of inspcciiuns allowed per permit. l lirddmgd'ccmmi0ki.C-Pcrmim.t pp doc 07,01;10 4.40-41,15T(I I,OS'('Q5LWEli J I • PlumbinPer g mit Application roll ori lc1 l F. ON L1 Building Fixtures Permit Nc.:0\ �/le-00-0a,5- 711 �00-0 City of Tigard 0e 13125 SW Hall Blvd.,Tigard,OR 9�6h ,6 Pfau Review Otho Permit No.: __A- Phone: 503.7182439 Fax 503.598. .DrO Date/By: 4175 4 Ready/By hid= El See Page 2 for l nemct Line: 503 639 dhoti: Supplemental information www h gov r.i. � _ `.a_.�?_. ' E*G' 0.,-4.--;;;:""4---',.:::-..-2, ser,o y .t +----'"-=,.- `" . 'y i•-e-k�....sti I-°t r,--,_ ,•.4 - - _ Cy •'p.•=)_::- -�... � _ ; __y�a o/ ormaaion use checklist c _ t_ w r For sped 'af New construction 0O �1�1G Description Q . i Es. 1 Total `i` New 1-2-family dwellings(includes 100 ft_for each utility connection) Addttao/sltaationlreplacement ❑ �• 11' - 312.70 kZ= r-;` ra>a '� ' SFR(1)bath F.s=' ri ,�� -ie.-.L-1` ..�.� ._.. . S FR a)bath 437.78 F.:-.,..--7,-,_.---..-.:,..-:,-,..4.,_2'..... ❑Commercial/industrial 43738 5�h32 1-and 2-family dwelling SFR(3)bath ❑Accessory building • 0 Multi-family Each additional bath/kitchen 25.02 . 0 Master budder /S 0.- 0 Other: Fire sprinkler(__sq.ft) . Page 2 • �, , - - _ 'S -r .�. -s Site utt'lities. - -�rir , it:>,,it..,;;. ;--4 1�.I.,4-;��r.(jr - ._ 18.76 • "- ry ` -c`�C \"` Catch basin or arca drain Job site address: Q J Q G?�� Catch ,leach line,or trench drain 18.76 City/StatrJLiP \ �X-� , ` _ ` Footing drain(no.linear R: ) Page 2 Yo Ca'ley 11150.03 Project name: \1� tom" Manufactured home utilities Suite/bldgJalpt-no.: Cross street/street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(rho.linear ft:____) Page 2 Storm sewer(no.linear ft.: ) Page 2 • • Water service(no.linear fL:__. ) Page 2 • Subdivision I Lot no: )Zxturowe or item: - - g eo p enter 1 3127 �`;11- Tax map/paucd no Backwater valve ( 1231 1►2-eJ` -:-.7:-.7-.. .--- s' r ...-:_..7. ...,--::-, . =h Cioshes washer i 25.02 , 5,()Z Dishwalsher 1 25.02 0917.0 2 Ne,t,0 /.0v1�K t►'Vs-1..r e v in rPI tit Drinking fountain 25.02 LXJ Ejectors/sump 25.02 -- - Expansion tank 1251 ,�-��_-" >- -.:....-'-.174-7.--;-::-.- --7-="---r----‘1,- --'.,,., ....�- ___ •_.-�:7--.',-,.=:-.-7,-...2..:7 -_-.="_5, ---- u =.. . _ Fixture/sewer car - � � 25.02 Name: oH 9l Floor chain/floor sink/hub 25.02 Address: C 1 Yr I 5Garbage 25.02 2Gj,dL R q Hose bib 1 . Z�' 2s.1n 0`L City/State/ZIP: (j�,jr�C�1,Q 1261 �� GJ to,!, II + Fac( ) r maker 1 -; tar/ hap 25.02 f•-:--, :, r 2 ,>.,� � _� 7 ��. �•_' r�= �=�-A- .��_-..1,---'--- •--- -.-.. Medical gas(value:S ) Page:-"-----,----- Business canter 3DL r,i,�M,I vtS ( Primer 1251 Contact namlx ��� n ,t..„,.. Roof drain(commercial) 12.51 Address: Sittk/basin/lavata' 25.02 ++`D` L6? 1 62.54 City/State/ZIP: 'cl Solar units(potable water) 2� T Fax :( ) ub/siwwer/showerpan a 1251 -2,5.02_. = �JJ l 3�b3 25.02 E-mail: f -, Vbta-1 '•► - Wane closd 25.02 '` z -- y t-,, s - -�- water heater 37.52 Business name: '-13,1) ? i�S l.UL Water piping/DWV 56.29 Address: � r Other. 25.02 , Ci /SlatrLlP: t} ei ( -F VE9 Subtotal Phone) I -39b3 Fax ( ) - Minimum fee: 57230 Plan review f25%of permit fee) - CCB Ute. r Q�� Plumbing Lic.I ' Z State surcharge(12%of permit fee) L / L j,` TOTAL PERMIT FEE Authorized signahat~ . - --- This permit application expires if a permit is not obtained within 180 days Print (v // �� l Date:�` / /Sl after it has been acceptedyBuilding ng Industry Service Board. ��~. - �-/_�� J ` as complete. • Fm methodology set by Tri-Comity t:1BuldmPambt LdU-PvmiIAPP-doer 10/01/09 440-4636T(IW02FCOM/WEB) 1 Mechanical Permit Application �� FOR OFFIC l_ I �1_O\L\ l xe City.of Tigard ()-i Reached ley (�5Te)Of<i cLdS .. 13125SW:Ha•llBivd:,Tigard,03 97.L?3 iiPias Review. p�her?cwt. 11 Phone: 503 7183439 Fax 503398.t�G�,,i}j�`� n%\15 DsdBr.- lnspcdion Linc: 503:639.4175 % t- . Ready/By: �: H.See Page 2,for Itemet www.figard-or.gov Snpplemsatd Info rmatina 0 - -.,.a..r,. "' Je ^r.�t 3+ �,e ` L . i f. ._tv:.d j..-.:1.4,:t ill,w y*4-. A Y '.'k.:1 6$•8&0.N tib,. 'k: ''-' e it^-FF " +t� *� g,: rzr - - �,aY' `' "` e �� i- • "� lytcchanlcei I� fees*are based on the value Of t'he work- El''Nei/ge W sction .❑Addition/altcratiortr"rrp performed_truncate Ste"value(rounded to the nearest dollar)of all U mccbanleal materials,taauipmcnt.labor.„overhead,and profit .. • ❑P f9r.lrtion 0 Otho. v Value:5 Teae rye e @ 4s': ^c, y. ii t-a s i,iv,i..: o � s" nr3 ®i *lid 24arriilydwelling ❑Cornnterciallmdustnal 0Accessorybuilding - For at trionstation xst clierk/1sY. y ISy Master builder 0 Other D�ptii n Qty' { .a+lntti faattl 0�0 OEL Total ? `a -off.-"t l',,.20 . if i,c% i :T E:4 tf`t ` •,,,� ;'- •• liwdsgJrooiiuS: 4635 Job stte addr+css: �,,L� SeUIN D C- �Flrmaee' �BTU(ductslsaK) 1 4635 C --r; Jox `o C 7 � .. Furnace 100.000+BTU of cto ads) 5491 ,01 SuiJkilii$Japl `J Pmt . 01�Cf30y, (; 711 1l'1Heat puinp �Y1 Duct2332 Otos -s tnect/diret�ons to.job site: J HYdronic hot water system 2332 Residential.boiler(radiator or hydcdnic) 2332 Unit heaters(fuel-type,twat electric), in wall, ln-duct,'susPendcd.mac. 46.75 Flue/vent nt for key above 2332 _._ Z Udici: _ 23.32 St vzttaa: ... Lot na: Other eetapplia ices ,�,�,,_... 233? Tax Y"` no , r,: a. . a„ ; a - Y, ..' Gas fbep 3339 . : ,4?._ ,?e^'e tt.axt, fir? - Flue vmt.for water bait=Or gas firerilace 2332 lig Ight (_gas) 2332 Wood/pclletstove 3339 'Wood:fireplaceruis Yt 2332 Cliiiooe}lineuifhWve m 2132 ;� -» .. x3.32 . t .�� � __-� vend ..�.., ��;� � `Eavtros�tntal ez6aast acid 'btriort: Nam.Polygon Northwest Hangs:hood/otherkitchen - eml 1 3339 Address:109 E'I36 St Clothes dryer-exhaust 1 3339 Single-dila exhaust(bathtoomris, f tyY3taoeifiZlP KaaCoirvci,PYA 98661 toiletcompaMtents,ulrlity.rooms) 4 2332 fltaac g8i6-7800 Fax:( ) Anidcrtwlspace farts 2332 , ...s 4 • r � t i:,...71,..-7-!n-,-----,—..::,,,..? 2332 FrielpiPINV. li smess name:Po on Northwest .. $1425 for Etrat four,54,03 for eadi tial aided risme. -._ Tuniaoe.etc. 1 ' Addreas;109 E 134 St • Gas.heiirpunIP WaU(suspeodedhata heater Vaut ower,WA-9/3661 liVaw itteatra Plio (360)816-7800 [ Fax::( ) Aseplaoe I Range 1 E-co ' -': it Ryx r. •I'''--$i;-:-.44-,..;.`- s � ; L3otbesdrve.(gas).. l business nine:Andersen Reatins, Other .. ` inc Yt Z� ": F f�.w ilii f�(bar Lf �,6i6 51 6:.''fT =�-E.'.4 Address 16235 5W'83°Ave.Ste 410 Subtotal Nt'mimnm permit Lee(590.00) Gityl$tatdT;IP:T3pid,OR 97224 Plan review(25%of permit Lee) Phony:503)992-6664 Fara(503)536-6615 :State Sumba:Re(12%ofPenult fee) . CYC.lie.:168'i14 TOTAL PERMIT FEE ibis penult application tic**Oa permit is not.sbtaiaed within IBC days alter it has been acted as immplete. Authorized ' Fee methodology tit by Tri-County Building Industry Service Board Printneme ActAodersen . Date;11/20/2015 tte .-. t_poaianav_eirn ir.dx 4404617T LAr.CONMEB) City of Tigard 11 COMMUNITY DEVELOPMENT DEPARTMENT 0 T 1 G n k D Building Permit Review — Residential Building Permit #: rr),57a0 Ito Site Address: /.5''yo.3-- ' - t Si.J Se_ , Pyr Project Name: Poli 9 0 n �+ a )( M vu.4a;•- Lot #: 5a (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Ne,,J SF CZ. AM Verify site address/suite# exists and active in permit system. N--River Terrace Neighborhood: Al Yes ❑ No ,, Site Plan Elements: Nthree(3) copies of site plan Existing structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure (including decks)with finished lk"Drawn to scale(standard architect or engineer scale) floor elevations North arrow YUtility locations(required for new,may apply for additions) .Site address,project or subdivision name and lot number Xocation of wells/septic systems i Applicant information (name and phone number) krErosion control (including drainage-way protection,silt fence BLot dimensions and building setback dimensions design,location of catch basin,etc.) tKot area,building coverage area,percentage of coverage and Street 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 ,xisting 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 R"No Received: ❑ Yes ❑ No ,T Public Facilities Improvement (PFI) Permit: Required: kYes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake .`-. Land Use Case#: 5u-.B01o(5— UU 00 D. Zoning: Q& R _ . 5 Setbacks: Front AO Rear ‘5 Side 5 Street Side -- Garage c2 o )Z Landscape Requirement: '— ozo tI p`/11of Coverage Maximum: Building Height: Maximum I'eight (SO Actual Height )7 Visual Clearance K o'-c `4.set " I u F c c+ �.47i-e e -.c_a_ ,,i 1,4- (-,-.,1 f -4-. b e cic-. Easements Sensitive Lands: E Yes ,1 No Type Urban Forestry Plan E Conditions "Met"prior to issuance of building permit Notes: IA e e 4- e o d;.}; u,_) ,. 0,- -{b ak 1 d; n) pc, y,,,4- . Approved By Planning: C t,c (-- RevisionsDate: a - -I (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPennitRvw_RES_070915.docx 1 Building Permit Submittal Original Submittal Date: / Site Plans: # 3 Building Plans: # 3 Building Permit#: nnterbuilding permit-#above. Workflow Routing: Tanning E r;ngineering E1rmit Coordinator IfriCilding Workflow Sign-off: Zr5rggn-off for Planning(include notes from planning review) Route Application Documents: L ngineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Z--1351-ding: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: c-r��, - is` Date:02.10//(, E6ngineering Review / r Slope at building pad: f a4" i _ ma�_�� Conditions "Met"prior to issuance of building p- 't je Easements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes 4 No ❑ NOT Approved by Engineering: Date: Approved by Engineering: 4' if' Date: _Z,.....42,-147 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 'p Approved, NOT Released: ge- Date: .22/ 3J/4 Notes: Lam,fr '` ` 6`1'�' / 444 P-.ic4ce-, 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: 1n SDC Fees Entered: Wash Co Trans Dev Tax: 'es ❑ N/A Tigard Trans SDC: Pio Yes ❑ N/A Parks SDC: }Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: ac a.,(in-w Date: q - /2 - / I:`Building\Fonns\BldgPennitRvw_RES_0709I 5.docx