Permit CITY OF TIGARD ,r - MASTER PERMIT
- 't as
s COMMUNITY DEVELOPMENT --/-1,'..; z� Permit#: MST2016 00247
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2016
Parcel: 2S106DC03400
Site address: 13731 SW SILENT FOX TER Jurisdiction: Tigard
Subdivision: POLYGON AT WEST RIVER TERRACE Lot: 34
Project: Polygon at West River Terrace, Lot 34
Project Description: New SFA. Building/unit 4.1. 1/3/2017: REPRINT permit to correct plumbing fixture count(1 hose
bib).
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 344 sf Basement: 0
sf Left: 0 Parking Spaces: 0
Height: 30 Bathrooms: 4 Second: 646 sf Garage: 327 sf Front 12
Dwelling Units: 1Smoke
Third: 635 sf Right: 0 Detectors: Yes
Total: 1625 sf Value: $202,599.32 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 LaundryTrays: 0
Y Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100
Tubs/Showers: 3 SF Rain Storm Sewer: 100
Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0
Bckflw Prevntr: p
Footing Drain: 0 Ice Maker: 1 Catch Basins: 0
Hose Bib: 1 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 0 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
P W/Svc or Fdr: 0
Ea add'l 500 sf: 2 201-400 amp: 0 201-400 amp: 0
P 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: Y
Ecompasing:
BUILDING INFO
Class of Work: Type of Use:
NEW TYPe of Constr: Occupancy Group: Square Feet:
SFA VB R-3
1625
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
7600 EAST DOUBLETREE RANCH 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
RD,STE VANCOUVER,WA 98660
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $23,659.32
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•.R 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: -Ai ! L._ . C' f
G:-
Permittee Signature: 6/� 7/L If4-7G'dV
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.
Water Meter Fixture Unit Worksheet
Please complete the following information:
Contractor Name:
Billing Address:
Phone Number:
New Meter Address:
Subdivision Name: Lot#: j L.
Please fill in the number of each fixture as detailed on the plans. Multiply the quantity by the point value
to arrive at the point total. Add all point totals together for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer ) x 4 = 4
Dishwasher 1 x 1.5 = I . ..s.-
Hose bib ) x 2.5 = c)..5--
Hose
,5--
Hose bib, each additional x 1 =
Kitchen sink ) x 1.5 = I ..5-
Laundry
s"Laundry sink x 1.5 =
Lavatory S--- x 1 = fit"
Water closet, 1.6 GPF L}- x 2.5 = 1p
Bathtub/whirlpool x 4 =
Shower stall I x 2 = a
Bath/shower combo ca., x 4 = g
Irrigation(#of heads in largest zone) x 1 =
Total Fixture Unit Points: .3 9 ,S_.
Fixture Unit Points:
Up to 30= 5/8" Over37 = 1"
Up to 37=3/4"
Meter Size: Meter Cost: $
************************************* :***********************************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building(Master) Permit or Plumbing Permit: ❑Yes ❑ No n Other:
Meter#:
Receipt#:
Employee Name:
I:\Building\Forms\WaterMeters 070116.docx
CITY OF TIGARD MASTER PERMIT
fillii ..--..... COMMUNITY DEVELOPMENT Permit#: MST2016-00247
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2016
Parcel: 2S106DC03400
Jurisdiction: Tigard
Site address: 13731 SW SILENT FOX TER
Subdivision: POLYGON AT WEST RIVER TERRACE Lot: 34
Project: Polygon at West River Terrace, Lot 34
Project Description: New SFA. Building/unit 4.1
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 344 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 30 Bathrooms: 4 Second: 646 sf Garage: 327 sf Front: 12 Smoke
Dwelling Units: 1 Third: 635 sf Right: 0
Detectors: Yes
Total: 1625 sf Value: $202,599.32 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0
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: 0 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 2 201-400 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 SFA VB R-3 1625
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
7600 EAST DOUBLETREE RANCH 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
RD,STE VANCOUVER,WA 98660
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $23,342.79
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 -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.
)45
Issued By: mak- Permittee Signature: 'CI ✓74--/el���lC)
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 r 7j//
44311i11tis1 RECEIVE
FOR OFFICE l SE ON Ll
City of Tigard I Received -� ,r�
DateBy: 4�//�b �� Permit NWJ_ j/e"0Og 9
13125 SW Hall Blvd.,Tigard,OR 97223 JUN 01 2016 Plan Review,
8 ' Phone: 503.718.2439 Fax: 503.598.1960 �gy. 7 1 _' -I-) Other Perm �� ��:C�) ry!9
I-I(,\R 0 Inspection Line: 503.639.4175 CITY OF- I GAR D Nt .F//C 41 / jun'. H pSp�lemnea2lInformationInternet: www.tigard-or.gov
DIVISIO !'y /L- //&
'D i` 4 6 & E6 t '
®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 0 Other. equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
®1-and 2-family dwelling ❑Commercialfmdustrial Valuation: S194405 Ci
1 ,S G
i
ElAccessory building 0 Multi-family Number of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms' 5 -
m r t t ° t a s € Total number of floors: 3 j q S;-)--,
Job site address: 12513( SW Silent Fox Terrace New dwelling area: 1625 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 327 square feet (.13, -
Suite/bldg./apt.
Suite/bldg.apt.no.: I Project name:Polygon at West River Ter Covered porch area: 6 square feet if Co
Cross street/directions to job site: Deck area: 96 square feet `)L
17 };L)--
Other structure area: Q ' 0....,c�� is uare feet q
Subdivision:Polygon at West River Terrace I Lot no.: 3I.4 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
' s r` t s t ` 7 ''' work indicated on this application.
E5 '$05 bin I,j.- : 4. 1 Valuation: $
Existing building area: square feet
New building area: square feet
� Number of stories:
Name:ADVL Land Holdings,LLC fype of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/State/ZIP:Scottsdale,AZ 85258 Existing:
Phone:(602)694-4031 Fax:( ) New:
Wt: , . ', t Eva ATa 1 °
Business name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Angela Grajewski
FLSplan review fee(if applicable):
Address:109 East 13th Street )'
City/State/ZIP:Vancouver WA 98660 Total fees due upon application:
Phone:(360)695-7700 I Fax::( ) Amount received:
E-mail:Angela.Grajewsk@polygonhomes.com . ,
,- - E 7 Commercial and residential prescriptive installation of
---' �� t 14:1: -. d .' roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 109 East 13th Street Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review
and administrative fees): $180.00
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247
/�J fr.4
Total fee due upon application: $201.60
Authorized signature: ��,ti , This permit application expires if a permit is not obtained
���/// ___ SLA' t within 180 days after it has been accepted as complete.
Print name:Angela Grajewski Date:5/20/16 *Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\Pernits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applica ' I
City of Tigard IIN 111 R ,�y
.1 in 13125 SW Hall Blvd.,Tigard,OR 97223 Date By:
Phone: 503.718.2439 Fax: 503598.196Q UN O 1 2016 Plan Review
f d G A I<to Inspection Line: 503.639.4175 Datt'BY: FOR t)LF1CF: 1'tiE ON l lOther Permit:
Internet: \41V44'.tl and-Ur. U4' {�.t rry t f 3 i r OatcReadyBv. Jurix_, Ed
€ S CITY O F' E I G.AR D Notified;MtJsod. See Nage 2 for
BUILDING DIVISION
hf Djy SIGN Supplemental Information
I TYPE OF WORK COMMERCLkL FEE* SCHEDULE —USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New conduction 0 Addition/alteration/replacement
performed,Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
I CATEGORY OF CONS IWC LION Value:S
® 1-and 2-family dwelling 0 C ommerciaUindusttialRESIDENTIAL EQUI MENT/SYSTEMS FEES*
0 Accessory building I For special injrrmarionuse checklist
❑Multi-family 0 Master builder
❑Other. Description I Qty. I Ea. I Total
I
JOB SITE INFORMATION AND LOCATION Heating/cooling:
JobQ Air conditioning 46.75
site address:
�� I �� t71��rs -Tog. Te rrQcs. Furnace 100,000 BTU(ducts vents) 1 46.75
City/State ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ductsvents) 54.91
Suite/bldg./apt.'no.: I Project name:Polygon at West River Ter Heat pump 61,06
Duct work 2332
Cross street/directions to job site:
Hydronic hot water system 133/
Residential boiler(radiator or
hydronic) I 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 West River Terrrace I Lot no.: 31.4 Other: 23.32
Tax map/parcelno.: Other fuel appliances:
Water heater 23.32
DESCRIPTION OF WORK;, Gas fireplace/insert 33.39
I
Complete rough of HVACFlue vent for water heater or gas
fireplace 1 23.32
1/k/W t/l n ; /4 ,1 Log lighter(gas) 23.32
v JE t '-) Wood/pellet stove 33.39
Wood fireplace/insert 2332
1 Chimney/liner/flue/vent ' 23.32
PZ OPERTYOWNER I 0 TENANT Other:Range 1 123.32
Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
Address:7600 Doubletree Ranch Road equipment I 33.39
$
Clothes dryer exhaust I 33.39
City/State/LIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:(602)694-4031 Fax:
( ) Attic/crawlspace fans 23.32
Ep APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:William Lyon Homes,Inc. Fuel piping:
Contact name:Angela Grajewski $14.15 for first four;S4.03 for each additional
Furnace,etc.
Address:109 East 13th Street Gas heat pump
City/State/ZIP:Vancouver,WA 98660 V4all/suspended/unitheeter
Water heater
Phone:(360)695-7700 I Fax::(360)693-4442 Fireplace
Range
E-mail:Angela.Grajewski ylpolygonhomes.com
Barbecue
I CONTRACTOR Clothes dryer(gas)
Business name:Andersen Heating,Inc Other:
Address:16285 SW 85th Ave ste 410 MECHANICAL PERMITFEES*
Subtotal
City/State/ZIP:Tigard,OR 97224 Minimum permit fee($90.00)
Phone:(503)992-6664 I Fax:(503)5364615 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:168214
TOTAL PERMIT FEE I
- This permit application expires if a permit is not obtained within 180
Authorized signet days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board
Print name: J Date:05/23/2016
J .
t•tBuitding Permitsysme Permr,App 040113 dac 446.46 tTr(I 1102 CCo 4,wEa)
W , _ . ,
Electrical PermitApplication RECEIV
City of Tigard vel Pet**II/� ...ST.20/a)-Oc.2 7
13123 SW Hall Blvd..Tigard,OR 97223JUN » :
Phone: 5031182439 Fax: 503.598.1960 -� Q 6 Dnu'Review Raked Permit a-
inspection Litre: 503.639.4175 a-x X81: AIM 0 See 2 far
Internet: www.tigard-or,gov i i A Cied�Ma.c S.pplementaI lafarmafiau
a ..' +.- • sir s a _ ..
t New construction 0 Additionfalterationfreplacement Remedied;all that apply(submit 2 sent. priors w ):
❑Demolition ❑Other: O Service or feeder 400 amps a mom 0 Building over three stales.
Vwhere tie available fault anent Cl Minus and boatyards.
. ..• ¢. _w,.2r'. `::7,....''''"' 72.1:,...:7:.;'- eacemds 10.000 asps at 1S0 volts or 0 Flodmi borldia8x•
< I-and 2-family dwelling T 0 Commercial/industrial 0 Accessory building lean to groundca 14.aoo O Commetrcial,rue a cultwal
tfor ail other mediations l
❑Multi-family 0 Master builder ❑Other ❑Fire p Installation of 150 KVA or
€� . . -.. . 77:-:+771 .�..� „�-T
0Emmlency>0 - larger scPmumaYderved
0 Addition motor load of sYmemJob : Job site address: l 2? If�t ► ��I �24 100HP re more.
City/StatealP:Tigard,OR 97224 O sire or more residential units, occupancy.
O Health-ewe facilities. 0 Recreational vehicle parks,
Suiteibldg./apt.N: I Project name:Polygon at West River Ter O narardoas locations. 0 Supply volas for mote dram
O Service or feeder 600 amps or more. 600 vote namimal.
Cross street/directions to job site: " ,a 4 .
Dewiness Qrr. tads - Total •
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at West River Terrrace I Lot 8:3,(4 Iseluda attached garage.
Tax tnaplparcel 8 1,000 sq.ft,or less I 168.54 L(0 (3l 4
''' -- �.` ., .x;, .` *+�. .17: ,-..;.1 , ...,... <'' - r�• ::" Ea.aad'ISOOsq.RaPurlieu
.Z 33.92 10'( I
0) k Limited energy,residential 75.00 2
(wilt above sq.ft_)
Limited energy,multi-family 75.00 2
resideatiai with above ft
Name;ADVL Land Holdings,LLC Renewable Energy 0 See Page 2
Address 7600 E Doubletree Ranch Road Services or faders installation,alteration,and/or relocation
City/State/ZIP:Scottsdale,AZ 85258 200 amps or less 100.70 2
Phone:(602)694-4031 I Fax:( ) 201 amps to 400 amps 133.36 2
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.
Owner signatu e: OverDateOvera 1,000 amps vola 55216 2
Temporary services or feeders installation,alteration,and/or
_ „ ,....,,...,,,._ , `,,...,..,,.,. •..a,• v-�, � . . «. _- .-,.-„....� tea,,, y relocation
Business name:William Lyon Homes,Inc. 200 amps or less 59.36 I
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-sew,alteration,or extension,per panel
Phone:(360)69S-7700 I Fax::(360)693-4442 A.Fee for branch circuits with
above service or feeder Fa' 7.42 2
Email:Angela.Grajewski®polygonbomes.com each branch circuit
. e_ .. .. .,_ �, B.Fee fa branch circuits witJroru
service or feeder fee,first
Business name:alameda electric ,,circuit56.is 2
Address:3415 ne 44th Each add'i branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:1NIE Rp p4 Artusere�O/z / 2.7--/3 Each manufactured err modular 61.84 2
_dwelling.service author feeder _
Phone:(503)3192192 Fax:( )
Reconnect«,y 67.84 ;
Email:solarpdx@me.com
Pump or irrigation circle 67.84 ' 2
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: y f7/ Sign or outline lighting 67.84 2
Suprv.Electrician signature,required:
Signal(mks/or limited-exrgy ❑Ser Page-2 2
Print name: k,k /2,0,0‘.,t, I Date: 5-1143/4( Panel.alienation,ore aanic
Each additional inspection over allowable in any of the above
Authorized si Additional inspection(1 hr min) 66.2511
AIR
I Print name: ( Date- 2,3 /•.,4 Investigation(1 hr min) 90.0()1 hr
tom _ t ,.._ELt..EAEdcc Rev 0HI?MI S 4404615mtmsecotucvsa / 1!1
i YYY!!!
ShXR atirchi rgt :211 2 3
r ,
Plumbing Permit Application
Building Fixtures I til. ,ii II( i 1 til t)q v
i3 25 Tigard JUN 01 2016 may: 1 trr14.:/ff /4 =I q
13125 SW Hall Blvd.,Tigard,OR 97223 earl Review
Phone:503.718.2439 Fax: 503.59 %0. Other Permit No.:
Inspection Line: 503.639.4175 1 1 T R �eR�'
Internet: www bgard or gos E�� � �/ .� 1 Neu Ready/By:C> !l eth d Page 2 for 1
Sap letnenta °
r�� ,�,ate �;� ` 7 � � �° r
- Information
®New construction 0 Demolition For special information use checklist.
Description i Qty. I Ea. I Total ,
❑Addition/alteration/neplacement 0 Other: New I-2-family dwellings(includes 100 it.for each utility connection)
4 :t is,F: ar, r:- �. SFR(1)bath 1 312.70 €
® 1-and 2-family dwelling 0 Commercial industrial SFR )' ' 437.78
I
0 Accessory building loMulti-family , SFR(3)bath 1 50032 50(3.32.!
❑Master builder Other Each additional bath/kitchen 1 25.02 ,r2�,QL.a
Fire sprinkler{ q.ft.) � Page 2 • Ia'
10=
:5111.W:#1KCI":7:117,CSZrzifi> t
Job site address: 137 3 1 5W 5 i Ie TTT, -circa C,Q, Catch basin or area drain 18.76
City/StatelZIP:Tigard,OR 97224 DrywetE leach line,or trench drain 18.76 !
Footing drain(no.linear ft.: ) Page 2 i
Suite/bldgJapt.no.: I Project name:Polygon at West River Ter 1Natuifarxure4 home utilities 50.03
Cross'street/directions to job site: Manholes 18.76 I
Rain drain connector 18.76 {
' Sanitary sewer(no.linear It: ) _ Page 2
Storm sewer(no.linear R:_) Page 2 :
Water service(no.linear IL: ) Page2 i
Subdivision:Polygon at'West River Tern-ace Lot no.: 34 Fixture or item: 1
Tax map/parcel no Backflow preventer 13127
`��£4 � ter , ��, ��- " Backwatervatve
�• 7
12.5.1 1t�.J( i
.... ��.� .. a.„ � 'ClOttfLS W$ShCT 25.02
S ,�a 1 n� { : 4.1 Dishwasher 25.02 t
Drinking fountain 25.02
Ejectors/sump 25.02
..,°,. : _`i , i',1; f Expansion tank 12.51
Name:ADVL;Land Holdings,LLC Fixture/sewer cap i 25.02
Floor drain/floor sinkihuo 25.02 ,
Address:7600 E Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax ( ) 12 51
Ica maker
�.i r ,„ o a n 5 Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Angela Grajewski
Roof drain(commercial) 12.51
Address:109 East 13th Street Srtklbasin/Iavatoiy 25.02
City/State/ZiP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail Angela.Grajewski®a polygonhomes.com anal 25.02
: Ze h �` " Water close 25:42
Watex heater 37:52
Business name:Alliance Plumbing LLC Wetterpiping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal (# 1 .024
Phone:(503)492-3490 Fax:(503)9124438 Minimum permit fee: $72.50 :i
CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review {23%of permit fee) 1
Authorized signature: — State surcharge(12%of permit fee) cl•eta,
TOTAL PERMIT FEE ..14.4
Print name:Robert Dishman Date:5/23/2016 This prrmtt apphrttion expires ifs permit is not obtained within 180 days
atter it ins been
accepted as comptetc
*Fee methodology set by Tri-County Building Industry Service Board
IAHuiidiagtPamitsiPi,MU-PervitAppdoe 10/01/09 440-4616T(10102/COMIWEB)
1
litf
City of Tigard
4 COMMUNITY DEVELOPMENT DEPARTMENT
111111
III
r 1 cAuo Building Permit Review — Residential
Building Permit #: / T1,20/6 -- 0 e),.:2 j 7
Site Address: 1 37 3 1 S w s►iex)i- , X Ti" re--
Project Name: Po 1 y Jc r, 01i- WeJ% 1-' Wi rt' rrr,c.4:_ Lot #: 34
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: PVW" cc e_
Verify site address/suite# exists and active in permit s stem.
River Terrace Neighborhood: 111No Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan 'Etrxisting structures on site
Fite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
North arrow ) 4tJtility locations(required for new,may apply for additions)
/Site address,project or subdivision name and lot number -0Lva.aiion of wells/septic systems
`Applicant information(name and phone number) Cxisting trees to be retained with drip line,and tree
JeLot dimensions and building setback dimensions protection measures
/Lot area,building coverage area,percentage of coverage and Ztreet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
/Property corner elevations(2 foot contour lines if more than
4 foot differential)
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
APublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
X Land Use Case#: �P_2,01S OQ0Z?�) fu02,24U 00006 , SIP.2.,CAS 00003
ie Zoning: P., 2
Setbacks: Front q ji sear i 0 Side 0 Street Side 3 Garage 1 9,S
Landscape Requirement: 2,0 % /
f6 Lot Coverage Maximum: 0 0 %
Building Height: Maximum Height 5s Actual Height (V/A
lV( Visual Clearance
,c2' Easements
jzr Sensitive Lands: ❑ Yes A No Type
6 Urban Forestry Plan
0 Conditions "Met"prior to issuance of building permit
Notes: ( n li ti j be vn pr t r v a.s .°c4 ii CZ 0t"- b I c c
N1 i -.
Approved l y Planning: ili 0 et r. Date: G j t I CG
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\B1dgPermitRvw_RES_060116.docx
„1
Building Permit Submittal
Original Submittal Date: ///A
Site Plans: #
Building Plans: #
Building Permit#: 0-"Enter building permit#above.
Workflow Routing: -Planning ^2 engineering a-Permit Coordinator ,[ .-Biilding
Workflow Sign-off: U.-Sign-off for Planning(include notes from planning review)
Route Application Documents: [g–Engineering: (1) copy of permit application,(1) site plan, (1) building plan and
original plan review routing form.
ffvBuilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
-'"$' 7'`7-(--1 e,/ //;;,
Engineering Review
Slope at building pad: a.,
❑ Conditions "Met”prior to issuance of buildingpermit
❑ Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes El No
Assess Water Quantity Fee in-lieu: El Yes El No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOTA prroov d by ngineering: Date:
Notes:Lir: �� 'Ale 40016E-4 /40r-8114-1--
Approved by Engineering: ./2Date: Z—,'?- _
Revisions(after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: El Approved El Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit /
pproved,NOT Released: 4IA2iiate: ! �4
ores: LAK c`fri
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: ':11_ es El N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes El N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_RES 060116.docx
V
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
II
T 1 G A RD River Terrace Building Permit Review Addendum
Building Permit #: /LIS 4 20/'67, -- 00,2V7
Site Address: I .51' I S VJ 5 len* X r-e.r,r.
Project Name: f o1y 90 C) cot 'V" i t' Zi'++ r rr-+ Lot #: `3 4
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.660.070.1.):
Is the project subject to the plan district design standards?%Yes ❑ No
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., ft.wide Gabled dormer
❑ ❑ ❑
2. Eyes on the street: a mmnim�of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: I Ri . b
3.Entrances:At least one entrance must meet both of the following standards:
Max. 8 ft. setback from longest 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 es,all the following ap y: 25 sq.ft. min.
One street facing entry 712 ft.max.roof above floor of porch
/5 ft. depth min. 730%min.porch roof coverage
4.Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
yag Covered porch min. 5 ft.wide x 5 ft.deep ecessed entry area min. 5 ft.wide x 2 ft. deep
Wall offset min. 16 inches � 1�-1, Dormer min. 4 ft.wide
Roof eave 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'/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: aux-f-9
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 porc IV/A-
0
J/n
'
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the secon story 1
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: /fr/l d yl j 13 i t Date: _
1:\Building\Forms\BldgPcrmitRvw_RES_RT_031416.docx
Plumbing Permit Applicatid>l •:, .~s
Site Utilities
FOR OFFICE FSE ONLY
City of Tigard , p- 11! 1 Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: lb Cal)) Permit No.: �xj/(Q-�a4I7
= Phone: 503.718.2439 Fax: 5035598'.•1960 Plan Review /
Inspection Line: 503.639.4175 Date/By: �(�.(�_jb Q Other Permit No.:
T 1 V A R D r Date Ready/By. luris:
Internet: www.ttgard or gov • / See Page 2 for
r __ d S plement l Information
Notified/Method ! �/��a ��'-f-j
®New constructiontl *'nSGHhf{JLE
Demolitionr special information use checklist t
❑
❑Addition/alteration/replacementDescription Qty. Ea. Total
0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
• ,. - rA ' T } Y a' 3e'Ot � �` SFR(1)bath
312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ®Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler(1,569 sq.ft.) Page 2
JOSITE'INFORMATION ANJ I AT1oNT Site utilities:
Job site address:13731 SW Silent Fox Terrace W Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: I Project name:West River Terrace Footing drain(no.linear ft.: _) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.:_) Page 2
.I Lot no.:34 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DE RIP1IQ g o I Backwater valve 12 51
Multipurpose Fire Sprinkler System Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
FRO R l n om,
'', � �; �� ,:,.. � „_:�. Expansion tank 12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Phone:( ) Hose bib 25.02
Fax ( ) Ice maker
12.51
• ® APPL ANT COI TTA 25.02
�, �" P �1 Interceptor/grease trap
Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name:Robert Dishman Primer 12.51
Address: 146 W Historic Columbia River Hwy Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale,OR 97060
Solar units(potable water) 62.54
Phone:(503)492-3490 I Fax::(503)912-6438 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:robert.dishman@allianceplumbing.net
0��� Water closet
25.02
Water heater
Business name:Alliance Plumbing,LLC 56 29
Address: 146 W Historic Columbia River Hwy Water piping/DWV 56.29
Other: 25.02
City/State/ZIP:Troutdale,OR 97060
Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lic.:184601 Plumbing Lic.no.:P13732 Plan review (25%of permit fee)
Authorized signature: C----( /Z____)
State surcharge(12%of permit fee)
ITOTAL PERMIT FEE
Print name:Gavin Thomes I Date:8/24/16 I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildinglPermits\PLMU-PermitApp.doc 10/01/09
440-46161110/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
_Fee Schedule: Residential Fire Suppression Systems:
Y.
Site Utftit es . ..- 0,t •; lett(ta) Totai :.: Sji1ar F`ootagl : . , _ tt .
0 to 2,000 $121.90
Footing drain-15'100' 50.03 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 ` -1 gar, - Permit ;'.> ,
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
I and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
90.00/hr
Additional plan review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantifiy by Fixture Type ..$cilli . w for to b i L.nstall*ti0IIS:
Replete/Fixture Type for RepPlan review is required for any of the following.
Capped Added Relocate
Work Performed: Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-DriveCupor as defined in OAR918-780-0040.
Dishwasher
her -Commercialo ❑ Medical gas and vacuum systems for health care facilities.
DishwasherD
-Domestic ® Any multipurpose fire sprinkler system.
0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2"
T I3Oinitr k.or.Riser ftagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestic-food related
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
\\up-dc2\home\gavin\My Documents\Fire Sprinklers\RT\City of Tigard Pgmit.doc
- - Vf
Electrical Permit Application (� FOR OFFICE USE ONLY
City of Tigard J l J V 1 0 2016 Received 1 ,
Date/13 . �,' Permit# 'u 1;1 n- Do
13125 SW Hall Blvd.,Tigard,OR 97223 p Review S W
Phone: 503.7182439 Fax: 503.598.196( ¢l�� l x 1(:'" t1 i' 3 ) Day.IN
Reacted Permit II:
Inspection Line: 503.639.4175 Rea Date/By: kris:
TIGARD , {re Ready Y: H SeePageZfor
Internet: www.tigard-or.gov BUILDING ,1S �� otified/htethod: Supplemental Information
:xr c al �'9,.f �
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other0 Service or feeder 400 amps or more ❑Building over three stdries.
� j_ where the available fault current 0 Marinas and boatyards.
'a fa•- ._; t+.4,..k. exceeds 10,000 amps at 150 volts or El Floating buildings.
®1-and 2-family dwelling 0 Commercial/industrial El Accessory building lass to groin or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family 0 Master builder ❑Otheramps for all other installations. buildings.
0 Fire pump. 0 Installation of 150 KVA or
..�-:�14V=tWgtaID!>1< Kt0.` 1,�Kal�` M5t �:tfi+r.:s.�:�_ - - --- ❑Emergency tem
n. � vg Y sYs larger separatelyderived
Job#: Job site address/3-131 S�n SI f\4..cox 1 ❑10IPAddition of new motor load of system.
{ 1, t1 11V111` l/1 ]00$P or more. ❑••A•>,••S","1_Z","J_3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: LA >, Project name:Polygon at West River Ter 0 Hazardous locations. ❑Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal.
3 Description l Qty. I Rath I Total
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at West River Terrrace Lot# l...k Includes attached garage.
Tax m arcel#: I,000 sq.R or less 168.54 4
p w Ea.add'l 500 sq.ft.or portion Z 33.92 1
,T= . 0E3 v. --'_..`O.4 : . _r z Limited energy,residential
1 75.00 2f rot/ 1the C,h ec (with above sq.R)
Limited
energy,multi-family 75.00 2
residential(with above sq.ft.)
'''';',:f-;"---. ' o-aitt i - Iteoewable Energy ❑ See Page 2
Q _ 1 _ � - '= Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E Doubletree Ranch Road 201 amps to 400 amps 133.56 2 -
401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over I,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or Iess 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
r �• � 0y m Branch circuits-new,alteration or extension per panel
A Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
each branch circuit 742 2
Contact name:Angela Grajewski B.Fee for branch circuits without
Address:109 East 13th Street service or feeder fee,first 56.I 8 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 . ' Fax::(360)693-4442 Each manufactured or modular
67.84 2
Email:Angela Grajewsln@polygonhomes corn dwelling service and/or feeder
_ Reconnect only 67.84 2
7-0c=.: . ? -=- Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
Address:6101 NE St Johns Rd Signalel,alteration,ti(s)or limited energy ❑ See Page 2 2
panel, or extension.
City/State/7.IP:Vancouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Entail:bdaniels@gweusa.com
Industrial plant(I hr min) 78.18/lir
Inspections for which no fee is
CCB Lic.: 01158 Electrical Lic.: 208174 Suprv.Lic.: 4496S .specific listed('f.hr min) 90.00/hr i
r�,� �� — _ ax D s . :. '.'.e '_ate: _
Suprv.Electrician signature,required: . r 1'.l l l'.r Subtotal:
Print name: Joan P Albert • Date: 4/26/2016 ❑Plan Review Required(25%of permit fee):
l— 1 _ __..- State surcharge(12%of permit fee):
Authorized signature: '�+` TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within I80
Print name: Bill Daniels Date: 4/26/2016 days after It has been accepted as complete.
* Number of inspections allowed per permit
:'1:1nufdinglPermittlELC PemitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
ll
Plumbing Permit Appli•catii;' 1 Ell"EU
Y
Site Utilities FOR OFFICE USE ONLY
City
NOV 1 1 Z 016 Received
Date/By: Permit No.:
Ile cp 411
ill . of Tigard
13125 SW Hall Blvd.,Tigard,OR 97223., 1 " +l` 1 Plan Review
S Phone: 503.718.2439 Fax: 503.50.11,6, I. - -` Date/By: Other Permit No.:
Inspection Line: 503.639.4175 INC JI 3ili
T 1 G A K D y , IS 113 1 4 Date Ready/By: luris: H See Page 2 for
Internet: www.tigard-or.gov i,� ..� Notified/Method: Supplemental Information
TYPE OF'WORK FEES SCH�LE .
®New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
, CA;TEGORY',OU COWILLctIf: - SFR(I)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building [E]Multi-family SFR `` 500.32
ach itional bath/kitchen 25.02
0 Master builder 0 Other:
're sprinkler(1,569 sq.ft.) Page 2
J SITE INF M TION AND LOCATION'. Site utilities:
Job site address: 13731 SW Silent Fox Terrace Catch basin or area n 18.76
Dr we ine,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no,linear ft.:_) Page 2 1
Suite/bldg./apt.no.: I Project name:West River Terrace Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.:34 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
, Backwater valve 12.51
W Clothes washer 25.02
MST2016-00247 Dishwasher 25.02
REVISED Multipurpose Fire Sprinkler System Drinking fountain 25.02
Ejectors/sump 25.02
0 PR EIT-Y O I 0 TENA Expansion tank 12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
C1.APPLICANT ❑:CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Robert Dishman
Roof drain(commercial) 12.51
Address: 146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale,OR 97060 Solar units(potable water) 62.54
Phone:(503)492-3490 Fax::(503)912-6438 Tub/shower/shower pan 12.51
E-mail:robert.dishman@allianceplumbing.net Urinal 25.02
Water closet 25.02
CONTRACTOR'.„ 4 .. . •' , ,,,... .' Water heater 37.52
Business name:Alliance Plumbing,LLC Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lic.: 184601 Plumbing Lic.no.:PB732
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ,„„,>_7 TOTAL PERMIT FEE
Print name:Gavin Thomes Date: 11/it I I b This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site.UtiIi Qty_ Yeetea) T46.1*.-, ,Square, alta e, !ermit +
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 uah ,
Storm&Rain Drain-1st 100' 62.54 ttfl!>l0 Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
' ie 'ek Total
Oti)er" >Itspectoii f1)t"•Feesand including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
QuantitybyFixture Type Plai R vit�*s�tlil•Piultmbiing
Fixture Type for Rep `cel
Work Performed, Capped AddedRelocate Plan review is required for any of the following.
'
Please check all that apply.
Baptistry/Font pp Y
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ® Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain = e metrie r RisDiagra �_.
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
\\up-dc2\home\gavin\My Documents\Fire Sprinklers\RT\City of Tigard Pgmit.doc
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: I D-�_ t. DATE :I MN ED
DEPT: BUILDING DIVISION
Nov 14 2016
FROM: 'Av►n1 T+4annES CITY OFTIGARD
BUILDING DIVISION
COMPANY: Apt &cE PWMBIN6
PHONE: (5o3) 442—349 0
RE: 13.131 Sw SILENT r--0X TERR-IKE MST2O1b - o Z4l
(Site Address) (Permit Number)
WES-r ROC g_ Te wizAc'E
(Project name or subdivision name and lot number,
ATTACHED ARE THE FOLLOWING '
Additional set(s) of plans. 2 Revisions: 'Rite SFR1roLEc
Cross section(s) and detai . Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: _ H o'D i , C A•a-i L v • o gX i tet, Pa-05
(0_6-km7-17-4;,. 0-4 t_:o... ---jT;5---j)
4
Routed to Permit Technician: Date: t->,'—_ l , Initials: IS
Fees Due: IN Yes • No Fee Descri stion: Amount Due:
$ S �=
Special
Instructions:
Re•rint Permit •er PE : ❑ Yes P No [g: D one
A• s licant Notified: Date: 0_, E ����
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
Plumbing Permit Applicati l• i
Site Utilities Nov4 FOR OFFICE USE ONLI'
1 2.016 Received
IIN - City of Tigard //P a144 7
13125 SW Hall Blvd.,Tigard,OR 97223r ,, y� Date/By: Permit No.:
Phone: 503.718.2439 Fax: 503.5 8. 6 1� i-3"1-"i *T Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G A R D g 1 SI(lit Date Ready/By: Juris: 0 See Pae 2 for
Internet: www.tigard-or.gov q ti i11vs g
Notified/Method: Supplemental Information
, TYPE OF WORK E* $
®New construction ❑Demolition For special information use checklist
Description Qty. Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATTt ORX OF COI�NST1 IJ TION SFR(1)bath
v., 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building ®Multi-family SFR .: �,�� ^i�1 500.32
❑Master builderach itional bath/kitchen 25.02
0 Other: 're sprinkler(1,569 sq.ft.) Page 2
1OEI ITE INFORMATI�I'
IOAgiJ LOC )I1+F3I I• Site utilities:
Job site address: 13731 SW Silent Fox Terrace Catch basin or area n 18.76
City/State/ZIP:Tigard,OR 97224 �)rywel ine,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:West River Terrace Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: f Lot no.:34 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
11 Backwater valve
Di�LC11ST OF Ave",' 12.51
Clothes washer
25.02
MST2016-00247
Dishwasher 25.02
REVISED Multipurpose Fire Sprinkler System Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER j :5Expansion tank
.,•0 TENANT P 12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
C,41,,.APPLICANT,,. ❑ CONTA T PERSON ,' Interceptor/grease trap 25.02
Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name:Robert Dishman
Primer 12.51
Roof drain(commercial) 12.51
Address: 146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale,OR 97060 Solar units(potable water) 62.54
Phone:(503)492-3490 Fax: :(503)912-6438 Tub/shower/shower pan 12.51
E-mail: robert.dishman@allianceplumbing.net Urinal 25.02
OISTIRACITA r Water closet 25.02
,a
F Water heater 37.52
Business name:Alliance Plumbing,LLC Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lic.: 184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: s��,.��Z----) TOTAL PERMIT FEE
Print name:Gavin Thomes Date: It/II 1 Ile This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
SltutlltFee eaTal. aax ° ntg, .
! rnait P
Footing drain-U'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
' �ilati(1n: PBlnft Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qt3• C'otal
each additional$100.00 or fraction thereof,to
QthelrXl #1121O1M11'. ' ` S Fee lea} and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour)
each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased'sewer fees*.
Quant tyby Fixture Tri.:' 'ilejanAeview tOiPlitubMg=Int tion
Fixture Type for R /
Plan review is required for any of the following.
Work l erfortned, Capped p Added Relocate,
Baptistry/Font Please check all that apply.
0 Any new commercial building with water service 2"and
Bath -Tub/Shower
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ® Any multipurpose fire sprinkler system.
Drinking Fountain El Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
I + mctt c orRiser( gram
4„
Car Wash Drain ❑ ti me
riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
\\up-dc2\home\gavin\My Documents\Fire Sprinklers\RT\City of Tigard Pdmit.doc
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
"IA If Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: I D- c. DATE I
DEPT: BUILDING DIVISION
NOV 14 2016
FROM: GQv1N Ti-I0AA CITY OFTIGARD
COMPANY: At-Lt PLUM B In)6 BUILDING D SION
PHONE: (503) 492-Vigo Y _J
RE: 13731 Sw SILi<rs7 'Fox TeggiNcE MSTLoU O - 002I-17. (Site Address) (Permit Number)
WES-r RIver_ TeNzAcE
(Project name or subdivision name and lot number,
ATTACHED ARE THE FOLLOWING ' M
Additional set(s)of plans. Z Revisions: 'Fig* sPrriniidt.st
Cross section(s)and detai . Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: Ho U , , A:7-i° • O EX 577/.1a ,2_E `d�,Q r rJ k -f P2. PLA-1..).
0-4
Routed to Permit Technician: Date: 1_k•_- Initials: 14
Fees Due: in Yes ■ No Fee Descri tion: Amount Due:
$ S o�
$
$
Special 1111111111111.11111111111111114.1.1.
Instructions:
41111111111
Re I rint Permit .er PE : ❑ Yes F�� No W i one
A. .licant Notified: Date: u , . # Etrtni1111
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
1111 Transmittal Letter
T t G;A R II) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIV
FROM: Angela Grajewski OCT 7 Z016
COF TIGRD
COMPANY: Polygon Northwest � �, A
BUi�� t� i�
PHONE: 971-212-2144 By:
RE: 13731, 13725, 13711,13705 SW Silent Fox Terrace MST2016-00247 �i X19, -30
(Building 4)
Site Addr- (Permit Number)
Polygon at West River Terrace Lots 34-37
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: ` yr/is 1 Copies: DescriptiC Ii.` i z
0 Additional set(s) of plans. 0 Revisions:
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.
3 Other(explain): Spaced deck detail as requested by field inspector
REMARKS: Please pay fees owed with Trust Account./�c= S ds,O fris;o/�- Z2 /?
;04% ONCE`jsKt „n
4:0,
Routed to Permit Technician: `�... .
Date: ,o / 9-- ) Initials:
Fees Due: E Yes ❑No Fee Description: Amount ue:
a3V.: A6' ,o N ��1/40 $ 90
$
$
zk ,,
Special CO 1-1.-E C7-- r S 0 Al t 1 S7cP-0/(c - )O, 1J 2
Instructions:
Reprint Permit(per PE): ❑ Yes S3No n Done
Applicant Notified:gA/ a Date: ///�1/4. Initials:,-�
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 /
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13731 SW SILENT FOX TER, SHERWOOD, OR, March 20, 2017 at 9:06:29 AM
97140
Record Type: Record ID:
Residential - Master Permit MST2016-00247
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Seal all penetrations in mechanical room, will check at building final.
Provide address on site for final inspection. R319.1
No AC installed for mechanical final inspection, new permit and inspections required at
time of installation.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13731 SW SILENT FOX TER, SHERWOOD, OR, March 20, 2017 at 9:07:52 AM
97140
Record Type: Record ID:
Residential - Master Permit MST2016-00247
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No AC installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13731 SW SILENT FOX TER, SHERWOOD, OR, March 23, 2017 at 12:34:45
97140 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00247
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certification received.
Moisture content form received.
High efficiency lighting form received.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor