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Permit (36) CITY OF TIGARD j MASTER PERMIT r ' c ' • 11 . '` COMMUNITY DEVELOPMENT Wiara Permit#: MST2016-00133 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2016 Parcel: 2S 108DB07600 Jurisdiction: Tigard Site address: 15227 SW SEINE DR Subdivision: POLYGON AT BULL MOUNTAIN Lot: 74 Project: Polygon at Bull Mountain, Lot 74 Project Description: New SF. 10/21/2016:Add NC and 2nd water heater. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1103 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height 32 Bathrooms: 3 Second: 1306 sf Garage: 400 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2409 sf Value: $289,633.36 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: 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: 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 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'I 500 sf: 4 201-400 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 2409 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: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $31,906.95 - 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 '090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1997 or 1.800.332.2344. 11 Issued By: 4 --- — _.a _ Permittee Signature: ' `/ -,''...6, /e'.-977-70/x.,/ 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. RECEIVE( _ . .. .g c i..4 I Permit_Application , ' loft 0I1-I 1.t 4l.f tl.l CIty Of Tigard SEP 2 0 2016 ,E®� >xy:r� w 13125 S Hail Blvd..Tigard,OR 9 Plan Rav Phone: 5)3.7/&2439 Fax: 5I) .t -t SJU I%. Mfl'D Plan•Ravi Relases3l mit d Inx tionLige: 333.63+1.4173 a 'MU DMS nn gettlyi l Rrady I�a1aS": RI sot Page 2 fvr Internet: www.tigard-or.gov NordiedNeihod: yappl mra:at informatfosa ,, .. T'.PE:. WOE New construction 0 Addition/alteration/replacement 1r'�l,e check all that apply isvt mit 2 sets 0plans w,,Eems cheekedl. ` Demolition [�Other; Awe or feeder 40 amps or more ll8uildingoverthree stories, . - where the avert able fault current 0 Mariu4s and boatyards, L'V TEG RY' FCO RJj 3())1.1._ exceeds 10,000 amps at 150 oohs or 0 Floating btttldings. ►;e I-and 2-family dwelling 0 Commerciallindustrial Li Accessary building less to ground,or exceeds 14;000 0Coanncrei5 use agrkerraritl amps for all other installations. buildings. 0 Multi-farrlily° 0 Master builder 0 Other: 0 Fire pump. ®Installation of 1501 VA or - TICHitiS117.f t3R' AflON"A LOCAT1t3N °Emergency system. larger.separately derived Job#: Job site address] ,1 SVQ Seo t t OrN 0 10010 an more,f new motor load of system, 100HParmtre. ©••A'. 12'."t-J", 97224 0Six ormore residential.units, occupancy. 19 City State/ZIP:Tigard, ©#lealtlnt art fxc�l ties. 1 aecreational vehicle parks. Suite/bldg,apt.#: Project name:�i y )- r ©lfararda is lteatians, 0 Supply voltage far mart than J �r� d,' -d -� ��,, } U?� . 6°0 oltsnomtnaf, �Ssr,�ce or feeder amps or more. Cross street/directions to job site: neecri icn 1 Qts, 1 bell I 7'atal. New residential single-or multi-family dwelling unit Subdivision )WD err es fl lu IfLkad U� ' �. Lot#: includes attached garage. Tax Map/parcel t: 1,000 sq.R.or less I 168.54 4 • s, — YYI tR1P' ION t F 3 O Ea add'1500 sq.ft,or portion 3 33.92 I C vs oy/tr" 1'fl r C/ ?- Limited energy,residential 75.00 . 2 '+ ]with above sq.f) Limited energy,multi-family t3;$- r:_<_ O -_aW it '; residential(with above sq.II,) �S.Ofl 2 Name:AD.VL Land Holdings,LLC Renewable Energy 0 See Page 2 Address:7600 E Doubletree Ranch Road Servicesor feeders installation,alteration,and/or relocation City/State/ZIP:Scottsdale,AZ 85258 200 amps arless 100.70 2 201 amps to 400 amps 133.56 2 Phone:(602)694-4031 I Fax;( Email: 401 amps to 600 amps 200.34 2 Owner installation:This installation i$being made dirt property that I own which is not 601 amps to 1,000 amps 301.04 2 intended for sate,lease,rent,or exchange,according to ORS€47,449,670,and 701. Over 1,000 amps or volts 552.26 . 2 Owner signature: Date .. Temporary services or feeders installation,alteration,and/or r - s,,40#70.604...-..=:,-- ...,:t tY9Itt7'AGP PEI S{#39i; relocation Business name:William Lyon Homes,Inc. 200amps.orless 5936 1 . Contact name:Angela Grajewski 201 amps to 400 arttps I 1 125.08• t Address:109 East 13th Street . . 401 amps to 599 amps 168.54 2 City/State/ZIP:Vancouver,WA 98660 j tt Branch circuits-new.alteration,or extension, er panel Phone:(360)695-7700 1 Fax:;(360)693-4442 A Fee for branch circuits with above service or feeder fee, 7.42 ? Email:Angela.Grajewski®polygonhomes.com each branch circuit t B.Fee far branch circnitswithout _.., - . ..'-_ :,. y.. ._ F service or feeder foe,first 56.18 2 Business name:alameda electric branch circuit Each add'/branch circuit. 7;4'r . 2_ Address:3415 ne 44th A Ja ./i►/Z / / 2 /3 .. ETh manufactured to(service or feeder not included) 2 City'l5taieI21P: � Each manafsclured ar modular 67.84 dwelling•service andior feeder Phone:(503)3192192 I Fax:( ) Reconnect only 67.84 __ 2:: Email:solarpdxf®rrte.cvatt Pump or irrigation circle CC11 Lic.: 199188 Electrical Le,: c923• 5uprv.Lie.: Y? ,j Signor outline lighting 67.84 2 Suprv,Electrician signature,required: Signal circuii(s)or limited-energy / panel,alteration,or sion. 0 See'Pagr' Print name; t � �` Dots: � Each additional inspection over allonable in alive-of the abo e Authorized signature: Additional inspection(1 hr min) 66?3s hr' ' ,. .. ,. , .. . Print name; ��'" ,,.. ::. ^- 1 Date63/2„3 /I ,I Investigation(l lir min) 1 90 O0 fir t'' sit4iNtr eamMIEt,C Ptsmitdpp EI.RERE.d>s Rel WA70015 440-4615T(i Laa51C0WWan - : Me-CE1it-A flea CEIV El . FOR(iFF1(E I. SE(YN1.V y of Tigard . SEP 2 0 2016 D444r le '2-f /6 Prm":'4*(t7f7-2C1/t-'00/,,F, eiki Plan Rovietv .... . : 46 13125 SW Bad Blvd-,Tiaank OR 97223 .-':: Pit-one: 501718.2439 got: 503,598.1960 - <alba Penni!, :` i-•• Defeat e, F TibiAti I-) ... . . ..11Bpection Line: 603,630,4175 CITY 0. - 1 c tr,, Imo Readvity; tone- -121, See Page 2 foe Internet: slcww,tinard-or,gov BUILDING ors/ NotidettNicitioa: Supplemental Information • - . - • COMMERCIAL FEE*SCHEDULE- LSE CitECK-LIST TYPE OF 'IA Olth Mechanical permit fees*are based on the value of the work .tgl NII"construction 0 A dditiorilultorationfreplacement perhirtneil„Indicate the value Bounded to Alio nearest dollar)elan 0 Demolition 0 Other inechanitel materials...equipment.fultat,overhead-and pmt, . Vattle:$ . CATEGORY OF CONSTRUCTION ' .. . .,,-.....--.....-_____,:.,.......__....„ - ' • ,RESIDENTIAL EQI.tarraex ri SI SAtms pttz 0 I-and 2-family repine 0 emrtmercialliodusfrial 0 Accessoly butiding I For special Information Rye checAtim •r Multi-family 0 Master builder 0 Other 1 Deseription Qty. la 1......Toal . • - . - ,. ,.., .,....,, tauf.tonitnet: -•• JOB SITE INFORMATION AND LOALTIont at --I Air eanditionina 46.75 lob site taidi&ss: 5 6 , . Furnace.100100.831361nets'velas) i 46;78 Cit,y/Statv2iF:Tigard,OR 97224 Paream 100,000+BTU'ditersivenis1 54,91 1 Beat pump Suite/bldg./0Di no.: Project name:Pulygon at Bull:Mountain punt work . 23,32 cross strecedircotions to job site: livdninie hoi.water system 2332 - Residential botter(radiator or • hyilronie) 23,32 * Unit beaters(Fuel-typo.not decide), suspended„etc. 46,75 Fluakein tor am.of above 23.32 2332 11111111 Subdivision:Polygon ut.Bull Mountain Lot no,: , _ Ot y Futil appliances: Tax mapipared no: Voter heater- 2332 i DEscorrioir OF*ORR. • ' - Gas ructilacciqusen 33_39 I • . : • Flue vent kir water heater at gas C 6 ntraCilir £/1W ti-, tylace _ 23.32 I .libiner easi 2132 , . • 11 f I i Wcaall) let stinve 3339 Wood fi 4,,,laeotinsert ion 2332 ---1 Chintwalinallittarltent 2132 . . „ 2132 PROPRTY-OWNER" 0 TENANT Environmental-exhaust and vetttilation: - Name:Polygon WL3E•1,4,,C i Ranee bend'other kitchen I i. ,,,,,at mcia 33,39 , i Address.:109 East 13th Street I Clothe'diver exhaust 1 33,39 1 • CityiStare,erP:Vaineutwer,WA 98660 I Slog duct cabalist(bathrooms- --- antct mutpatimedis„,utility moms) I-1 2132• Phone:(360695-7700 • Fmc( 3 Attiekrawls ate Fans • _ 2332 • .I . . - . . • •• ' t 4 ArritcANT: - . 0 copittc-i iEnsos.--- '.-. , Other: 1132 Fuel t i tine; Business name:Polygon WEE,LLC • -• . $14.1 4• 1hr first four S4-6,3 for each ad• ditional Contact name:Angela Grajewski . • Furnace,.et.e . , . , I Addreexas.hort pump ss:109 East 1316 Street .. . . wawsurpentledlinnt heater 4 as CitylState/ZIP:Vancouver,WA 98660 Water h • eater Mame:(360)698-7700 Fax::(360)693-4442 Fireplace • . Raw -111 E-mail:Angela-Grajewskilt)ptilygorthunies.tom Barbecat al CONTRACTOR - ' Clothes d.'et,eas)- - 13tisiness name:Apes Air LLC • 'Other • 111111111111 • • SIECHANICAL PERior FEES* - • ' • Address:1801,4 NT 12d AveAvg Subtotal ....... CityiState.'qlF:Vancouver,WA 98686 • ... . .. Minimum pennitfee(890.0th . • Plan reviiew(25%tir permit Fee) I Pbotio:(360)342-8109 Fax.:(360)326-4769 CCB fie::203034 Statcs•tnehatge 02%Of patted fen) 1 TOTAL PERMIT FEE I • Thke permit applicatinet moires ila permit is not obtain ed-within itte days.ante-0 has been-accepted as carapietr, Authorized signature: '• • * Fee inelbadolev set by Tli-Colaint Pailiiing tt0113try Spkvit4 iItI.Vd I,Print riuntel #0‘ iv../ _ , I Moe: 4-/././t,..---1 lmpp N.41 I:1 4ftle 44:146'17T g.i L'o2-COIt111,X. Plumbing Permit Application „:.,i': .::,„ Building Fixtures FOR OFFICE ( SE °\I.\ City of Tigard ,)e:.1' I o ,u 1‘, Received l " -0til -00/33 . 4 ,Oirt 'If °21 ' PerP1977- e.* , it13125 SW Hall BlVd„Tigard OR 97223, , ,... ,„,-•:,:,. plan R.evie„ IliPhone: 503.718.2439 Fax: 503.59000'' '-,•'"' :•,,,'' ,',:.',..1-..., •06-t.e..13;,,:- Other P.ermit No.: Inspection Line: 503.639.4175 .,:' :;•, :,, ' ' , . '''• - Ready/by:TIGAR D Dote IktrIt,. VI See Page 2 for Internet: www . Notified Mothod: Supplemental Information '..;'• *KIP.:*::04Xl ::41-''11:':: 4iT'4::; t:;4 .:1114:1 ,,;;1T'.•gki''':'''IN-kq;::! *jitfti* :r,:,'A:;-,'''?''s..ti.j--:"'-'::':75'j.:' Da New construction I El Demolition For special information use cliecklist Description I Qty. I Ea. I Total 0 Addition/alteration/replacement 0 Other;: New I-2.-Tamily dwellings(includes 100,11.for each utility connection) Aiii.aiitiikik.rai*I.i,a14,4'.407,*E;!.:11?-',*.P):.: 7,:t! SFR(I)bath 312.70 IZI 1-and 2-family dwelling 0 Commercial/Industrial ,SFR(2)bath 437.78 SFR(3)bath 500,32 , 0 Accessory building 0 Mniti4innily Each additional bath/kitchen 25,02 ' 0 Master builder 0 Other: Fire sprinkler( sq.ft) Page 2 ;,it*gttt4Aji:iakrgv.•--ieiitoE:ireAtioi*':-:zt-.s,;lP,:: o!:.,.::,: Site utilities: Job site address: IS 12:1 5oj ',', i(it v 1 z_, : Catch basin or'area drain 111 8' 6 MEI DrywelL leach line:or trench drain 18.76 1111111. City/State/ZIP Tigard,OR 97224 Footing dram(no,linear It:: ) Page 2 r Suite/bldg./apt'.rit).: Project name:Polygon at Bull Mountain Manufactured home utilities 50,03 ... • Cross street/directions to job site: Manholes 18.76 Rain drain connector 111111 18.76 ....„.._ _ Sanitary sewer(no,linear ft.: ) Page 2 ------'-"---- •Storm sewer(no,linear IL: ) Page 2 Water service(nc.linear IL: ) Page 2 SubdiYision:Polygon at Bull Mountain Lot no.: 7L Fixture or item: 'f ax map/parcel no.: Backflow preventer 31,27 . 1 '...e. ',.,j;•-/Ir.'•,.W:1;•?,g:Ir...-',, :t,•:,-'•,.Iv ...i.iir •-.4.„t,..-4;„wo.,-„iic.,,- ./3.1v.,,,-:. -.F.:,,lttfei,!,...,,,,A,:t:,-,:4,... Backwater valve 12.51 i,:•:,, L ',..7.,... „:,,,..,,:-,•*,':41i--,.'.-,.-x.,g2..r•L,:71 ... `.. , ,;P tv., `..7”7:741,..:, : ,,:lnt,-- .1t,.:.:•-y‹,-,4;f-t::-.:. .,.,::.,-:.:,.., ,,-;,,4.J,F cloilie•s washer 25.02 4:25.2, 41.-1- A/9-77: -. "igE-17-76/e---- • Dishwasher 25.02 Drinking fountain /5.02 Ejectors/sump 25.02 i •,-,-.,.4c.":,:.4y.1 ,;'..0:1,,ii.iii*0 TV 4:41Nailt.,.f,in:-,'i-,;;;, -,:. ht,...,.-_•,:,y;,,,,,;c1.;..toust,,,,,,.:,. ...,.::;:::,,,„.-, Expansion tank 1 12.51 Fixture/sewer cap ' 25.02 Name:PolygonWLII,LLC _ Floor drain/floor sink/hub 25:02 Address:109 East 136 Street Garbage disposal : 25.02 city/StaterZlpi Vancouver,WA 98660 Hose bib 25.02 -7-- Phone:(360)695-7700 Fax;( ) lee Maker • . 12.51 1 -1 tr,tZ. ."?-4,ROIJI:4****#:t;C::: ,*:',1‘71,- .:,,,,-N,I=F0131SfattigkiiStiii.:,,:iti-:: 1nterceptor/grease trap25,02 _....... Medical gas(value:$ ) Page 2 Business name:Polygon WEB,LLC Primer - 12.51 Contact name:Angela Grajewski Roof drain(commercial) 12.51 Address:109 East 13th Street Sink,basindayatory - 25.02 City/State/Z1P:Vancouver,WA 98660 Solar Unita(potable water). 62.54 Phone:(300)6,5-77.00 Fax::(360)693,4442 Tub/shower/shower pan 12.51 . Urinal 25.02 E-mail:Angeht.qrajetv*Mt@polygonhomesicom t•„4:w*.•..;,'-' ,'-jX, 1S'..--.l,•• • w : : V r closet 25.02 44 &: r : ,::Y.T4.,:ei',;i141,-..r.:,,,,,-Titc,i4ke::;',..T.-It,,,,..4i.".'.,:,,.•,.;im! ater beater I 37.52 -V-7,5 Business name:SDI Plumbing LLc • Water piping/DWV 56.29 . Address:PO Box.85 Other: 25.02. City/State/ZIP:Corbett OR 97019 . _ Subtotal Phone:(503)351-3903 Fax:( ) Minimum permit fee: $72.59 Plan review (25%cif permit fee) [ CCB tic.;180345 Plumbing Lie,n0,-.P111582 :State snreharge(12%of permit lee) Authorized signature: ill, • ,idoie..0,z,„,„. TOTAL PERMIT FEE . 1.00mtt: Print name:.Brandon'Linter Date ' ' 8 I I ii 1 c, 1 This permit application expires if a permit is not obtained within ISO days i after it has been accepted as complete. *Fee methodology set by Tri-County Building:Industry Service Board. ElhOldinevrrriitAPLNIIi-PermitApp.doc 10101/04 440,4616I(10.%02./C0MAVEB) CITY OF TIGARD MASTER PERMIT lik =~. COMMUNITY DEVELOPMENT Permit#: MST2016-00133 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2016 Parcel: 2S108DB07600 Jurisdiction: Tigard Site address: 15227 SW SEINE DR Subdivision: POLYGON AT BULL MOUNTAIN Lot: 74 Project: Polygon at Bull Mountain, Lot 74 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1103 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 1306 sf Garage: 400 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2409 sf Value: $289,633.36 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: 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: 4 201-400 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 2409 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: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $31,741.45 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 952-00. 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: ,C �� r/ Permittee Signature: '4/ t 7-,,,e_i(g7-7U Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. " Building Permit Application W 7V i RC; RECEIVED FOR OFFICE I SE om. City of Tigard ReceiDate/By: 3 Jr i 6 4h PermitNo.: H57-.3-0/(0-co(33 IN ■ 13125 SW Hall Blvd.,Tigard,OR 9722M4R 3 / U ■ g 4 2016 Plan Review Other Permit: 1IOI�p-l7O Q 1 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: i J Io 8 a t-i , RI, Inspection Line: 503.639.4175 CITY OF TIG ry RR Date Ready/By: J� H See Page 2 for Internet: www.tigard-or.gov BUILDING DM/'1S Notifed/Method: Supplemental Information . a.... sw�€.' �m ''� ..::�?t [ },.:, , , .';'f"t "���� .., � �. k• ,`�i ;;i,Yom.,,,,€,, • .�„ �.. s am ' s ,Fay, ..., .._�. .•_.�� ���. �P �a��,�.���m :e_�:� `�.... _W- ,��a... � ,� �� ,,.�, .�: �.�;,��� ���F— � :� .............e.....,„,-.¢-,,,,,, ®El 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 k -, > work indicated on this application. - ' ,� � �.,-..."1:(F.'<-toss , s �, ''..., �' ca �,., as i .i € . •s� .., %T`�«..`*+n ..s.'.a,. xtw„_2`..tt✓r uE.u3.�nxa» ,K �. ® I-and 2-family dwelling ❑Commercial/industrial Valuation:ac c $ El Accessory building ❑Multi-family Number of bedrooms: 4 1 ❑Master builder ❑Other: Number of bathrooms 53 -,- -<,r;-,-ht,", a7 -.;-',.;:;-,'..;<:,,;-F,::,(1,-:..,,( sem i .-S1 r- � � �'� � ' � �� j �s Total number of floors: 29 OS Job site address: � New dwelling area: 91/4_0 '''.";1 square feet i 522 5 � � Dr. City/State/ZIP:Tigard,OR 97224 Garage/carport area: `I Q() square feet Suite/bldg./apt.no.: I Project name:PO\\i(31Jn C;t.C )1` rain in Covered porch area: u square feet)3 0.G Cross street/directions to job site: J Deck area: square feet) )03 Other structure area: 0 square feet t '',L`• ':ka , a 7s . iii, - Subdivision:Polygon at Bun Mountain I Lot no.: 31._.\ 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 �.,<, - <_-., �.�-i'-'," ",-l "`z``,"N-: �" :J '''.".::`1'.:^'-''-r-: �' 'r�>amwork indicated on this application. neV \ o - Valuation: $ Existing building area: square feet New building area: square feet „ `".. . ,..,,,, y, 'ta •+ a ;g ,�..--< • t.t �a • '41" yk :°' 5 Number of stories: Name:Polygon WLH,LLC Type of construction: Address:109 E 136 Street Occupancy groups: City/State/ZIP:Vancouver,CA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: Business name: l L n CM t Structural plan review fee(or deposit): Contact name: M 0 8 '‘_e, &Orc\Cr) FLS plan review fee(if applicable): Address: I 0 Qi 4 h 3- Total fees due upon application: City/SMte/ZIP: q a_n owv ei f\ c,Gc to 0 Phone:kpD) V 01( ` • OD I Fax::('j oD) (6-ua2Z g Amount received E-mail:maggie.gordon@polygonhomes.com . t a Commercial and residential prescriptive installation of ; _ - Panel�; � , � ��h,��.,��,._ ,��•?`_ ._;a4� , roof top mounted Photovoltaic Solar P System. Business name: V �. Submit two(2)sets of roof plan with connection details n "f�� "" L' `' and fire department access,along with the 2010 Oregon Address: t 9"1 3 1 Solar Installation Specialty Code checklist. � I City )/State/ZIP: V a_5(-)S(1 CcUoer ,b Q Solo 0 Permit Fee(includes plan review $180.00 Phone:(jip J) to(I5 '41-CIO Fax:(300) �Q3 . 1\�2 and administrative fees): State surcharge(12/o of permit fee): $21.60 CCB lic.:204238 Total fee due upon application: $201.60 Authorized signature:- /!" I This permit application expires if a permit is not obtained a within 180 days after it has been accepted as complete. Print name: Date- 21._ L° *Fee methodology set by Tri-County Building Industry Service Board. I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) i ' DIVED i:C3itoi 11CL l SL C? Ll city afTlgar L l Rtp48 fitpail No.: " ' - N....., ., 13125 SW,fiail Bird.;Tiaard,*1 1 1 2016 - Ishii > Flippe 543.71&2439.Far 5Q3398..[_ .. I?attd$y rw,,; H Sec 2a¢e'far IltOrpcvnLmt g*dr3ncr'P fl'I"Y OF�`lGARD edjl atEed: SnpPiemaatatinroxuts£oa: • i Internet:v•itw tiger rt 'UILDING DIVISION �,� vcoa. �t�a�r �� �sE�t: alsr; ; � � • ... E-o , lyfcohanical permitfees*are beam on the v ue of the'. t- 1146*cmistntation ,0 Add'ttaonialtera iottirepiiicement :,performed_ladicatt the-value(rounded w the nearest dollar)oat mechanical materials.ttiuiliiin.ut.labor overhead.and profit .. [j.i}exnolitton 0yalilt::5 f °f }� 'CA-GDR3Q Si8f " Mi ' - � "`'' _ . .. : *. TP *iPPi3t'.s3 A/:' S# " _ B ®t an2fs14 ItIWTIliqg sec 0 A#4$siity biitldtng for"spoda in csniratfoa use.theckiist []Multi-faitiil 0 Master builder 0 Other Descnplon QtY; Ba. Total ", fl ib nricoois • t?B 5IT£ Il�IFOR�►11tii }� 1�II!3 aan 4635 Job.site :_: 15,93.1- �J1,3 ��� -�Q .� . Fuoraec 100,1100 B1 J td i. ) I 1 46.75 �. :... :F3irsiAea 100:000+.3W tdactsventi) '4:9I ctyilarGtz -rt c�c��d G22 PSP 67.06 • ,, Poly 3 ? J\\ M�Yl 13uct w,>i z StiiteibldgJapt rad Prolect.aatne livdronic hot wafts system tis stt?xxJditiet figas to.job site: Residential,boiler(radiator or hviliobic) 3:332 : Unrt2,010.'s Mitt t ; .11.t Ctectric), iii-svali,i lur,susper der,etc. 46.75 Fluefvetti Emir any of above I 2332. $ttbt€rvrsion: I, uo.: � Qflrertnei applliii6v s 2332 Ta?t�l nn 1+airLegiii , .. . 2332.... . _ t-6l CSF"l:4'Cl iki ...�.,,. . �'<` ` 59 . was 11I P1acelmsrrt ; 33 ,� r 3}tESIGRii'3 . Poe for:VTter#t*::rcor, f 2332 • • Ibj+li `r:( ) .2132 . .. ... Wiiodfpclietstoye 33,39 __. _. alraad;freplace/lpsat, 2132._ . .. iiQiiii glliriesyfludvent 2332. 6�P11i'E$ ,t , k � ` ��'`? E ronmental ezlraast and .. ,i `"3 32 •hangs booillather lutchen *m0,64700.irortirweat -egiiitititeht' 1 3339 Ardd ess:3l39Efi3°St •tlpihes.d ;:athsttsi 1 3339 _..___ ._...._. _ Si 3orbamst(hatbsooins, cii ngto.du . . y kanc�irvt r,S4' 98661 . tors) . 4 23.32. ' Fax ( 3 •amr3ixavvlspaee iia Pliatnc 171 r . 2323322 riatric P on.Norttrwst 514:15 for fast four.$4,03 for each additional Ba&mess Contac uaiue : .Earns I etas - :Gttluisty uitii-. : .. :s.1.04 E 1:)°i St : : .. WaAlsusptndeiliisiit hearts GtytStatdZlP—1L100aver,WA.8661 LY�tsr;licatei I Fa :( ) Vvepl 1 Pl oit :(360)8101800 -.- _ y- t,s" S.. ,p..^ 'P a ,rku . ::%l c 9 :_t°f�iaP„.4e. x:«`..,...._.,..,�a,.-e, '1 ,,15_._".,:., Iiitiinesi t!ffitic,Andersen$ilii ugr IncO then' a ,t: -!M i+r' ;atldirss lass•8'7 8.r 4ate Stt:410 ... Subtotal. - .:. .. 1�Tmiimrm prxinit fee(S9D�0) �+;�./� [}11:97224 e CAA ............ _ plffi['t7tttW(23Jnof:pt3lititlix) Mae*:$03)X924664 l Fait(563)536461S Sts .suit ar&(12°%afpciatitfop). TOTAL PERMIT FEE C tiC 1b 114 ' a tion irs permit is'netnbtataed within ISO • is pcimd pplxa" acpdrxs.' dui atter itlush! sctcyitedmScompiefz *. Etc.iaai+odoiegy saby Td-CountyBr'iding lndn sorciee Board Authvrtzdi si�tatzae: �riti, ��rA�aeri 1: p .pp owi 1.3:doc 44o4irr{;t1mxis.4/W 8) 'uEl'ectrical Permit A licati FOR OFFICE I SF ONLI City of Tigard CEI V Received Peened No u 13125 SW I lall Blvd..Tigard,OR 97223 Dam 13y: TAR 31 2016 Dan Reviess. IIIll Photic'. 503.718.2439 Fax: 503598.1 Daie/ny: Other Penna: I I C ,\K U Inspection Line: 503.639.4175 Date Rcady.13y: Juris ID See Page 2 for Internet: www.tigard-or.gov ' OF T�GARD Notified/Method: Supplemental Infunnatiun sw a az y i .. -" �' ,TAPE i t 11 15 ViSlOt�l P..LAI4.REVIE •• ®New construction 0 Addition/alteration/replacement •,!lease check all that apply(submit 2 sets of plans sv'items checked below). 0 Service or(ceder 400 amps or more 0 Building user three stories 0 DemolitionO Other: where the available : odi current� t Marinas and 0 boat anis r`lt r CATEGORY OFI:CONSTRN ., {fCTI :: exceeds 10.000 amps at 150 volts Sr 0 Floating buildings �' '. •. r less toround.or exceeds 14.000 g 0 Commercial-use agricultural ® I-and 2-family'dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations buildings I 0 Multi-family 0 Master builder 0 Other: ❑Fire pump 0 Installation of 75 K VA or t.4.-•"' + ) �+ sr. - ..i.,�, +.+ 0 lunergency system larger scparuelc Jens ed a-stem r i 7.4e.. ., ,S ,cE'''''-.&46-7R10' TIIOONeAND , ,.,l.ATIOTt.. . . i'(�',-. 0 Addition of newmotor load of ❑..n.. ,L.. ..I �.. .I ,. Job no.: Job site address: 1�JZZ� `J0 L .1 .17 1 • Ioolu'or nmre. occupancy ❑Six or more residential units 0 Recreational.chicle parts City/State/ZIP: 'T\CiOLCA O ci�-ZZ� ❑health-care facilities 0 Supply sottace fix more than J ❑I I z rduus locations 600 s ohs nominal Suite/bldg./apt. no.: Project name:tib a ,.)\1 m4-) ❑Sersiceorfeeder600 trip or inure ✓�� CA-- F, - 'FF,..r'€ SO4E0.*JLE .. is ; Cross street/directions to job site: Description I QMI errs I total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: -1--L\ L(xx)sy It or less 168 54 4 ^Iia.add'(500 sq.ft nr porton 4 33 92 I Tax map/pate el no.: tinted encrey.residential r Y 4. 1� ..r < `1 SCi'RIPTIQ$ i•V161iWt. '''''''..;?''''.5.-'''''' _ (with above sq.It) 75 00 2 Limited energy.multi-family 75 00 2 i New electrical service and wiring residential(with above sq 11) Services or feeders installation,alteration,and/or relocation nr- 2(8)amps or less 100 70 2 ** 0*-1l<te 4i$IER ;U TENA 201 amps to 400 amps 133.56 2 � 401 amps to 600 amps 200.34 (��� Name: r `'y-� 601 amps to 1,(100 amps ;0104 2 Address: ' b a �,� ` - ,�y Over 1.000 amps or volts 552 26 - City/Slate%/._IP: )w'�V.x.��..el.1e,� —i ay./14 C) relocation services or feeders installation,alteration,and/or , �7 relocation Phone: D) I„ a5_, D Fax: D ) I^/Y.>`�1 II Q� B / 3(x)amps or less 59 36 I 1 CCCC��r���illllVVfffIJJJJJJ v y that I which`1 C-/ • 201 amps to 400 amps 125 08 , I Owner installation: This installation is being made on property that I own wis not - I intended for sale, lease.rent,or exchange..according to ORS 447,449.670.and 701. 401 amps to 599 amps 168 54 - ' Branch circuits—new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits will. p;j, above service or feeder lee. ,_� .V ar �-(� iCONTAC3' Pt, 591 7 42 , each branch circuit Business name: P—$ tip B.Fee for branch circuits mithoui service or feeder fee.first Contact name: m a 1 i - s , branch circuit 'r' I x Each add'I branch circuit 7 42 3 Address: Ili 1 '' j _ Miscellaneous(service or feeder not included) City/Slate/IIP: � 1 u (^ . dwel manufactured or modular I �lC dwelling.service and/or feeder 67 84 1 Phone:( ) Fax: :( ) Reconnect only 67 84 4. 3 Pump or Irrigation circle 67 84F.-mail- .." YD. 9pr J^1 1.1 ( V ' Sign or outline hghline 67 84 2 ..'.. . . " .. r.. C© CT-0 _ _ - Sienal circuit(s)or limited-energy Business name:Simply Electric panel.alteration.or extension Page 2 j 2 Each additional inspection over allowable in any of the above Address:PO Box 822408 Additional inspection(I hr min) 66 25/hr City/State/ZIP:Vancouver,WA.98682 Investigation(I hr min) 66 25/hr Industrial plant(1 hr min) 78 18/hr Phone:(503)849-8202 Fax:(360)314-4945 Inspections for which no fee is 90.00/11r specifically listed('Y:hr non) CCB Lie.: 204615 Electrical Lie.: : 067 Suprv. Lie.: 43945 •ELECTRICAL"PE•RJl1ITFEES ' / Subtotal: Supr'.Electrician signature. required: &traci fs Plan review(25%of permit fee) Print name: Victor Larzhitsky Oate: I 1 17/2015 State surcharge(12%ofpennit lee). Authorized signature: IOTA!.PERMIT fl-.1.: This permit application expires if a permit is not obtained within 180 Print name: days after it has been accepted as complete. Date: ` Number olinspecliuns allowed per pet nut I ninidmcil'crmii,n4,I.0-Perm it App dm:07,01;10 -1411-45,l 5ill I.It s 50xIAF'La Plumbing Permit Application n Building Fixtures RECEIVED FOR OFFICE FSi: ONLI Permit No..: d Date/By: II 3125 of Hall Bl d.,Tigard,OR 97A R 3 1 2 016 Plan evie oma Permit No.:Phone: 503.7182439 Fare: 503.598.1960 Date/BY J it See Page 2 for Inspection Line: 503.639.4175 CITY OF TIGARD DateReady/Bx T f L Internet www.tigard-or.gov • ' w R Notified/Method SaPd�`n _sem -71.-- t '.... T„•c7-• , r�.-g .F 71] E 2'�'�-� .-L: .T-" .z-c` z "' C E ~�.f.-• i=.- -_- ?=� -r x"e'� 7 'c`. '-'-tea i-_ _r.]-` " • s _�F,..7.-',... ..:•_,-,-;--.1-.- --,,--7-•=•,,,,,,,`"--:; "_" .+:-� .+?.1 '' -0i� +_.•.. i_i9. Ne ,._ For special information use checklist 1 New construction 0 Demolition • Description I Qty I Ea Total 0 Ade ibpn/alterationh cplacetnent ❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection) - `�" +=. SFR(1)bath 1 312.70 ;a�Y 1--- 7 City of Tigard IIICOMMUNITY DEVELOPMENT DEPARTMENT T 1 G A Il D Building Permit Review — Residential Building Permit #: 115-r o20 l tv - 00 ! 3 3 Site Address: S 5221 5W Selo e tY . Project Name: Po�� pn OA' ZuAl Mout}-al,n Lot #: I LI (New ]ling=subdivision name;.Addition or Alteration=last name of owner) Planning Review Proposal: nevj 3F ❑ Verify site address/suite# exists and active in permit_ s�/stem. River Terrace Neighborhood: ❑ No E Yes,See RiverTenace ReviewAddendum Attached Site Plan Elements: 9>hree (3) copies of site plan casting structures on site 'pLYS to plan must be on 8-1/2"x 11"or 11 x 17"paper L�Footprint of new structure (including decks)with finished rawn to scale (standard architect or engineer scale) floor elevations LSA North arrow OOUtility locations(required for new,may apply for additions) LYS to address,project or subdivision name and lot number ()cation of wells/septic systems ®/ plicant information(name and phone number) Erosion control(including drainage way protection, silt fence t dimensions and building setback dimensions esign,location of catch basin,etc.) Lot area,building coverage area,percentage of coverage and reet names Pmpervious area (applicable if R-7,R-12,R-25&R-40) Street tree size,type and location roperty corner elevations(2 foot contour lines if more than -DE'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): �1Required: ❑ Yes,applicant was notified K No Received: ❑ Yes ❑ No l J Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No , Applied For: Yes ❑ No,stop intake 4mnd Use Case #: SU52015-00002 /A2o\ 00104 oning: R_ 1.�,5 Setbacks: Front I 5 t Rear 15' Side 5 Street Side Garage 2 0' Sif Landscape Requirement: � °A) A. of Coverage Maximum: �1 NI/Visual//Building I height: Maximum Height 30 Actual Height Z Clearance M Easements Sensitive Lands: ❑ Yes 12r. No Type Ri jUrban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: -(irn LehrbaehIC Date: .34412 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Forms\BldgPermitRvw_RES_012116.docx 1 Building Permit Submittal l Original Submittal Date: Z/g1 4Site Plans: # Building Plans: # Building Permit#: 2'Enter building permit#above. Workflow Routing: ❑'Planning ngineering ELI-15- erinit Coordinator - itilding Workflow Sign-off: 'Sign-off for Planning(include notes from planning review) Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: \ " V ( esd, , 4 Date: (54//h Engineering Review Z' Slope at building pad: 4p 0 Conditions "Met"prior to issuance of building permit Easements (encroachments) per engineering conditions of approval and plat 4 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 E No ❑ NOT Appr ve by Engineerin : Date: moi Notes: �q�l� 4 d,„e„'r_. '7 l 4l-r' Approved by Engineering: #(_Z__,P 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: C;�'`"""7_ ea, t,,,,p,) Date: 4 7-1 (o 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: EA SDC Fees Entered: Wash Co Trans Dev Tax: cif Yes ❑ N/A Tigard Trans SDC: Ix Yes ❑ N/A Parks SDC: Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: M4-- C-,, Date: S - '4 -( c I: Building'.Fonns'\\BldgPennitRvw_RES_0121 16.docx City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT T 1 G n li n River Terrace Building Permit Review Addendum Building Permit #: I`l 5Tc - Site Address: 152277 5'J Sri br• Project Name: PoIys ea' 1,cll Nlourrl-altn Lot #: (New welling= subdivision name;.Addition or.Aiteration= last name of owner) Planning Review River Terrace Plan District andards (18.660.070.1): Is the project subject to the plan district design standards? ❑ Yes 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 ft. deep ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft. wide Gabled dormer ❑ ❑ ❑ ❑ ❑ 2. Eyes on the street: a minimum of 12% of each street facing facade must include windows or entrance doors. Percentage Shown: 3. Entrances: At least one entrance must meet both of the following standards: 111 Parallel to street, angle no more than 45° from street, ❑ Max. 8 ft. setback from longest street- facing wall or open onto porch Entrance opens to a porch: ❑ Yes ❑ No If yes, all the following apply: ❑ 25 sq.ft. min. ❑ One street facing entry ❑ 12 ft. max. roof above floor of porch ❑ 5 ft. depth min. ❑ 30%min. porch roof coverage 4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades: ❑ Covered porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep ❑ Wall offset min. 16 inches ❑ Dormer min. 4 ft. wide ❑ Roof cave min. 12 inch projection ❑ Roof 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 ❑ Accent siding min. 40% of street facade ❑ Window trim min. 2 1/2"wide by 5/8" deep ❑ Window recess min. 3 inches for all street facing ❑ Bay 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: No closer to front or side lot line, than longest street-facing wall. ❑ Yes ❑ No. If No (Check one): ❑ May extend up to 5 ft. if there is a covered front porch and garage does not extend beyond the front porch. ❑ May extend up to 5 ft. where the garage is part of a two-story building and there is a window at the second story above 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 m lehrbacir, Date: 3131 1b I:Building Forms BldgPermitRvsc_RES RT 031416.docs 1 // '7 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ,111 Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www ti_ar •A fl TO: CITY OF TIGARD Building Division . 017 13125 SW Hall Blvd.,Tigard,OR 97223 X2 0'`//, Ill /,r l� ( x, Pho : 503 718 2439 Fax: 503-598-1960 TigardBuildingPermits 1., i_x ego FROM: [OwnerAContractor Check(✓)one pplicant D ❑ City Staff REFUND OR Name: ` ' INVOICE TO: (Business or Individual) PO 1110K tJ L\ LLC Mailing Address: I t Eat 1-�h S+ City/State/Zip: Va'CI IA Ve,r V V e 9Sie(p0 Phone No.: 360- (0q5-T)D b PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): FAL E CANCEL/VOID PERMIT APPLICATION. ResAhrri 117r1� rteplan REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). {pp 0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). AQ�,t) pta 4S 0 REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: MST-201 (0 -- O0 1 /-5a-/X-02-0/{o'610/O( Site Address or Parcel#: LOT- 'ILI (Poli Son Wil r 'it 15 -a--4. s w S.e Subdivision Name: Lot#: EXPLANATION: _ !( #- u! I +ra ! 1 Signature: if ` / Date: i a'q/i Print Name: raj •SkJ Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date /2 B J Refund Processed: Date e2/.2v//7 BA7 Invoice Processed: Date By Permit Canceled: Date .i)/)y//? B 1:. ,. -Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_092314.doc TIGARD City of Tigard February 9,2017 Polygon WLH,LLC Attn: Angela Grajewski 109 East 13th St. Vancouver,WA 98660 Re: Permit No. MST2016-00133/SWR2016-00108 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15227 SW Seine Dr Project Name: Polygon at Bull Mountain,Lot 74 Job No.: N/A Refund Method: ® Check#223765 in the amount of$27,597.68. ❑ Credit card"return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ Comment(s): Per applicant's request as they changed house plans. Refund 100% of permit and SDC fees;retain all plan review fees as plan review was completed prior to request to cancel permit. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 1111 H City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Polygon WLH,LLC DATE: 2/3/2017 Attn: Angie Grajewski 109 East 13th St. REQUESTED BY: Dianna Howse Vancouver,WA 98660 TRANSACTION INFORMATION: Receipt#: Various Case#: MST2016-00133/SWR2016-00108 Date: Various Address/Parcel: 15227 SW Seine Dr Pay Method: Check/Trust Account Project Name: Polygon at Bull Mountain EXPLANATION: Per applications request as they changed house plans.Refund 100% of permit fees. , ®. r . .,� 5 x:' '4 dam' N`l.:* c e-d .� 4 z y 8 f 9 e v. a x rte-. �- 0 e s se 0, e � 4'1 4 4'C '� o. : ® -0' ",�"' ,1,,.c-171,,91,,,,,,,'7144•N "' Ot *"� , w �e 3„3,!.3.3_4..1,-1 Building Permit 230-0000-43104 $1,707.34 Mechanical Permit 230-0000-43102 371.06 Electrical Permit 220-0000-43103 379.22 Plumbing Permit 230-0000-43101 537.84 12%State Surcharge 100-0000-24001 359.46 Metro Construction Excise Tax 230-0000-24010 347.56 Tig-Tual School CET—Residential 230-0000-24102 2,890.80 Erosion Control w/Development 100-0000-43134 311.40 Tigard Trans SDC Improvement—SF 415-0000-43300 5,402.00 Tigard Trans SDC Reimbursement—SF 415-0000-43301 312.00 Tigard Trans SDC River Terrace—SF 415-0000-43302 2,642.00 --- --• 2 8 Parks SDC Reimbursement 425-0000-43301 1,001.00 Parks SDC River Terrace 425-0000-43302 1,953.00 Sewer Connection Fee 500-0000-25500 5,100.00 Sewer Inspection Fee 230-0000-43118 35.00 TOTAL REFUND: $27,597.68 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager I_ If under$50,000 City Manager l �r ���/ If over$50,000 Local Contract Review Board N.', L1111E- Per-R, /%72,7/7-ger--zr 416 44,4- ,,,,,:1,3,A- x ; _ EOR,TIDiE IARK SYSTEM ADM1$ISTRTIOI'+T.U'SE.ONi s_, . , „ ,. Case Refund Processed: Date: ,,2/02.07 By: „.../r/Y: I:\Building\Refunds\RefundRequest.doc x 12/21/2016