Permit (159) •
1, MASTER PERMIT
, 71 CITY OF TIGARD
2:' COMMUNITY DEVELOPMENT Permit#: MST2016-00467
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/17/2016 '
TIGARD Parcel: 2S106DB09900 ,
Jurisdiction: Tigard
Site address: 17434 SW AMELIA ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 99
Project: River Terrace Northwest, Lot 99
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 948 sf Basement: 799 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1130 sf Garage: 377 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2877 sf Value: $336,861.09 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain0 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: 1
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
I Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0 :
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr. 0
Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 j
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 2877 ,
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660
STE 1
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $33,620.96
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4".. /e/2 ' Permittee Signature: t'V ,97'.',7Z—,C*•977e1A1
/
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
�. or 7 7
• Building Permit Application ,
1 ResidentialRECEIVrD FOR OFFICE LSE ONLY •
City of Tigard y Received _ �y
II N g SEP 1 2 6 Date/By:0V. /4, Permit N g/ 0.4,_6 x96 7
1hone SW Hall Blvd.,Tigard,OR 97223 Plan Revi 9. enni ,�,�0f4j-OOS/
Phone: 503.71$.2439 Fax: 503.598.1960 D��By. ! j ( 11 Other P 1
11 G A R l7 Inspection Line: 503.639.4175 C i Y O f +,t 7 f\ VI Date Ready y: JAB: H See Page 2 for
Internet www.tigard-or.gov BUILDING i t `Ss,L` Notified/Method: i�� / i Supplemental Information
g/1.... Vii-/e-
2-'4
-a.;4l ,46*�'' `'4'„2i. `Y, '' '� #wr"� �0 r. i - t -' v„r rs k. ,,g 'er " ` M,1
.a:�s:.Y. .-wui«4%., , .a,,-. .v� '.@_ !.. xw 2`a;, 'mita;; � - . #,d - i':,'.Y :..:e' r li. s i. E @ . f ,:' € it
_.. _..- '� '..r;', :�w.�h`k'1... fi'€s-3E1���.KYi� f39�...w" ,k "P ,_'' a....'�i ..MaiYa..6arR_ � -.sa:n... � rpt
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all j
0 Addition/alteration/replacement 0 Other:
6s ',7§4-44,0t.
equipment,materials,labor,overhead,and the profit for the
1 < a, a '` t # g � � work indicated on this application.
® 1-and 2-family dwelling ❑Commercial/industrial Valuation3� <2c $
-
❑Accessory building 0 Multi-family Number of bedrooms: 1
❑Master builder 0 Other: Number of bathrooms: 3
Mt, -..*::::7',;,;(*MiNt:,4imfaP, �: a rgiT _.its ., Total number of floors: 3
Job site address: I 1 l.J 5\A' R,fy�p 1 ;/i New dwelling area: 2 e l square feet
City/State/ZIP:Tigard,OR 97224 v v l I lath A Garage/carport area: -311 square feet
Suite/bldg./apt.no.: I Project name:River Terrace Northwest Covered porch area:
{ 1 square feet
Cross street/directions to job site: Deck area: I L W square feet 9 U g
Other structure area: square feet 7 9 G!,
'g } :7,o 9P1 % #fit I 1wi'� k.
Subdivision:River Terrace Northwest I Lot no.: elg
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no .
# r e equipment,materials,labor,overhead,and the profit for the
}' ,. �1 �' /1 .4. ^. ' '1 E work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
i:+ t �a t- `q .; ��n�a�-"�*' if x.;, �
.,. +_..6 ..,, ��' �- Al ,.„:„.f„ Number of stories:
Name:ADVL Land Holdings,LLC Type of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/State/ZIP:Scottsdale,AZ 85258 Existing:
Phone:(602)694-4031 Fax:( ) New:
`:1%.1.,0,4 :4,. 4 i c „,,t4:,!at ` te> t*,t ,e°.0r k1 , .,I:Z SP a ti , a da t ”N` . ' kl -
`t4.1. aBusiness name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Angela Grajewski
FLS plan review fee(if applicable):
Address:109 East 13thStreet
1 City/State/ZIP:Vancouver WA 98660
Total fees due upon application:
Phone:(360)695-7700 I Fax::( ) Amount received
1 ' v ; M+' I
44 ° i " ;flE-mail:Angela.Grajewski@polygonhomes.com
- ir ) _..., SW r r are Commercial and residential prescriptive installation of, _ v,.
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 $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lie.:207247
Total fee due upon application: $201.60
Authorized signature: ��+ ' This permit application expires if a permit is not obtained
�' ( within 180 days after it has been accepted as complete.
Print name:Angela Grajewski Date: *Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applica ' tr— FOR 01.1 It. l SE O\Ll
City of Tigard - `. �"ezVID
Permit No
Date/By: i?- Y�e.vey—�P lt`7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960S E F 1 2016Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 _ Date Ready/By: Juno: ® See Page 2 for
Internet: www.tigard-or.gov CITY E- i 3/ . �,r Noti&ed/Method:
iy^�� e.,�,„s'S. ,��, Supplemental Information
i 1
x C ! T: 1 7 `4 .^' '1 gw.v 3 ,': :u. c, $ .,c
.., 't� , ' : , 'r.9 e s `,` . ,vim i�r a a � ter f 1Fe ti- , e3f i, -
,,,.:. ,,,,_ .,r+ ,. w .�£��?.,,,..,�� ,.a,-.,c�. ,.. . .,� ..�,..�....a >4�._....� ..-x,....,� oma.,._ �._. _ _S'¢h.,am �.-�s..>
' New constructionMechanical permit fees*are based on the value of the work
0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other. mechanical materials,equipment,labor,overhead,and profit
alu
_ S
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description l_Qty. 1 Ea. ( Total
. v x s [i , € r r�' a t 5.,, d b £a e, Aeating/COOling:
n a3 ,a C7 ,.�M r /� Air conditioning 1 46.75
Job site address. SW et() lA St Furnace 100,000 BTU(ducts/vents) I 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(duets/vents) 54.91
Heat pump 61.06
Suite/bldgJapt.no.: 1 Project name:River Terrace Northwest Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
1 Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75 _
Flue/vent for any of above I 2332
Subdivision:River Terrace Northwest ( Lot no.:et Other: 23.32
i
_Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
'.- ...,,,...,..ui _ ..._ ,6htw. i,`` .___..!�.�..., Gas fireplace/insert33.39
- Flue vent for water heater or gas
New construction HVAC system fireplace 23.32 1
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other 23.32
-.„-° . -- ` '°•-��� � - ,,t� � � Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen 1
Address:7600 E Doubletree Ranch Road equipment 33.39
Clothes dryer exhaust I 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, U.
toilet compartments,utility rooms) 23.32
Phone:(602)694-4031 Fax:( ) Attic/crawlspace fans 23.32
i
e 71.', Other: 23.32
Fuel piping:
Business name:William Lyon Homes,Inc. S14.15 for first four,$4.03 for each additional
Contact name:Angela Grajewski Furnace,etc. I
Address:109 East 13th Street heatpump
WalL/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 l Fax::(360)693-4442 Fireplace i
Range
E-mail:Angela.Grajewski®polygonhomes.com Barbecue
h es dryer(gas)
Business name:Apex Air LLC ' '
Address:18004 NE 72•d Ave
Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Plan review(25%of permit fee) 1
Phone:(360)342-8109 Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lie.:203034 TOTAL PERMIT FEE
11
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: �Alaff446 * Fee methodology set by Tri-County Building Industry Service Board i
Print name:Angela Grajewski Date:8/22/16
i
I:\Buildi°g\PmnitAMEC_PermitApp_040113.doc 440-4617-(t 1/02/COM/WEB)
Electrical .Permit A lica (P \/ :`: FOR OFFICE USE ONLY
13125 SW Sy wHallTTigard,OR 97473 r 1 2 016 Received P S`7 /6 - r&
Plan Review
3 Phone: 503.718.2439 Fax 503,„,.598.1960 Date/BY: Related Permit 8:
Inspection Line: 503.639.4175 C FT'Y (if- F l E <5 u/. Reedy may: bait H See Page 2 for
T I GA R D Inlet ty,R,n,.tigard-orgov 1 ;G 0 c v v,0, ' Notified/Method: I Supplemental Information
.�� 1a
®New construction 0 Addition/alteration/replacement Please'heck Sit that apply(submit 2 sets of plans wfnems checked):
❑Demolition 0 Other: ❑Service or feeder 400 amps or more ❑Building over throe stories.
where the available fault current 0 Marinas and boatyards.
_-a =4Sri -1 .^
'' - r .'( a.-rp %. _.' re .,f8)y,- g' - '- _ exceeds 10,000 amps at 150 volts or ❑Floating buildings.
®1-and 2-family dwelling 0 Commercial/itidtistrial 0 Accessory building loss to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps❑Multifamily 0 Master builder 0 Other pump. other installations. In buildings.
_ ❑Fire Cl]retsdlatioa of I50 KVA or
,.': f''s Vg ;o ::: " . r earT5 y .`.,--_?i .-ta* Q F.mergeacY system. !arms separately derived
Job#: 1 Job site address:17 y .5 V Y f ahyj/�/J�•et SI 0 Addition mom,f new motor load of
f y d�t��rr-��vv�t c7 100fIP or mora ❑"A:^5;`I-Z;"1-3".
City/State/71P:Tigard,OR 97224 ❑Six or more residential volts. occuParaY•
0 Health-4am facilities. 0 Recreational vehicle parks.
Suitebldg./apt#: Project name:./4/0.--
/ jl� /� /a�n��/fA/ �}w�r IJ Hazardous Hazardous locations. Q Supply voltage for more than
I '+• 'r J ❑Service or feeder 600 amps or more. 600 w16 200011-
Cross street/directions to'ob site:
� ��t Win �r--.c��Ji: �T".ai ri .- w'' �'-r -,-,•;-z.::
Description 1 Qty. I Earn Total
New residential single-or multi-family dwelling unit.
Subdivision:Po-7 y 1— Lot II: Includes attached garage.
_
1V/fir �s 1.000sq.ft.orJess i 168.54 4
Tax map/parcel#:
Fa add'1 500 sq.R or portion 4.4 3392 1
-f _ n-... m-i fa1.a0a A.t 9 f1'l?'S�.x`�te-wz'y--fir...--v4-' ""''
Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family '
75.09 2
residential(with above sq,ft)
Renewable Energy 0 See Page 2
-4i-0 T - Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600E Doubletree Ranch Road 201 amps to 400 amps 133.56 2
city/stawz�:Scottsdale,AZ 85258 401 amps to 600 amps 200.34 2
60]amps to 1,000 amps 301.04 2
• Phone:(602)694-4031 TFax:( ) Over 1,000 amps orvolts `55226 2
- Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This inctatiation is being made on property that I own which is not 200 amps or less 59.36 1 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: Dare: • 401 amus to 599 amps 168.54 2
Vii,>a e J6$0€F'c;a ., .z rt . , o'® tr �,s6, o l0,01,,,t41.:,::
1 4 ,1.,, Branch circuits-new alteration,or extension, er panel A.Fce for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
- each blanch circuit 7.42 2
Contact name:Angela Grajewsld B.Fee for branch circuits without
service orfeeder fee,that
Address:109 East 13th Street branch circuit 56.18 2
City/State/21P:Vancouver,WA 98660 Bath add'!branch circuit 7.42 2
Phone:(360)695-7700 • Fax::(360)693-4442
Miscellaneous
ormceodulaz feeder or rat Included)
dwelling,service and/or feeder 67.84 2
Email:Angela.Grajewsid®polygonhomes.cotn
Reconnect only 67.84 2
,12„? 4.,;-,,-' -,12_::',":":".::-. - -L eU a._i - }9.... , <_. =t " -s_" .t,--2-:,1,:t--- pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LW • Signor outline lighting 67.84 2
-f-, Signal circuit(s)or limited-energy
Address:6101 NE St Johns Rd penal,alteration,or extension. Q See Page 2 2
City/Stata21P:Vancouver WA 98661 Each additional inspection over allowable in soy of the above
Additional inspection(I hr titin) 6625/br
Phone:(253)320-1657 Fax:( ) Investigation(I hr min) 90.00/hr
Email:bdanieh@gweusa.com Industrial plant(1 hr min) • 78.18/hr
Inspections for which no fee is
CO3 Lic.: C1158 Electrical Lic.: 208174 ___1 Suprv.Lic.: 4496S s ]fie• listed 54 hr min 90 00/hr
' - M e4I''..11'al
Suprv.Electrician signature,required: ... -.. Subtotal.. -
Print name: Joan P Albert •_ Date: 4/26/2016 ❑Plan Review Required(25%of permit fee):
'. C — State surcharge(12%of permit fee):
�s- TOTAL PERMIT FEE:
Authorized signature: -
Thispermit application expires Ile permit's not obtained within 180
r..,','':1. Print name: Bill Daniels Date: 4/26/2016 days after it has been accepted as complete.
:`rim`.-�i
— * Number of inspections allowed per permit
cit' likdldieggPecmits\61.Q,PemeApp ELtilitKeec Ray 06/17/1015 440-4615T(]7I05/COM/WFa
i
Plumbing Permit Applicatia Ej C
Building Fixtures 1(,R OlIl( I I <I 11)\I1
City of Tigard NOV2016 !herrn.
114 I)stuBy. Permit Not/S%e2G//-44f,q6 7
.i■ 13125 SW Hall Blvd.,Tigard,OR 97223Plan Review
I Phone: 503.7182439 Fax: 50359 -4v m GARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175 11 I l' 151
I1 r . Ready/Ety: Z.
Sae for
Internet: www.tigard-or.gov Ip11T^'I, rs DIi SO otiaed/Mabod Suppkm Information
FFki!.SC .
®New construction ' 0 Demolition For special information was ckeckkst
0 Addition/alteration/replacement Description Qty. 1 Ea 1_ Total
/al
to ation/replacement 0 Other: New 1-2-familydwel
lings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIONSFR(I)bath 312.70
®1-and 2-family dwelling 0 Commercial industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)b ' 500.32
0 Master bulkierEach additional bath/totchen _ 25.02
, 0Other. Fire sprinkler(„_sq.ft) Page 2
JOB SITE INFORMATION'AND LOCATION Site utilities:
Job site address: `7(� ./ Catch basin or area drain
(�(l S � Yry�
Drywell,leach line,or trench drain 18.76
18.76
'T •igard,gard.OR 97224 Footing drain(no.linear ft.: ) Page 2
Suite/bldgJapt•no.: Project name: W T-' tvvr/e-e,N W( 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 It: ) Page 2
Subdivision: Agorf f . R N`krnw.4'j Lot no.:q, Fixture or item:
Tax map/parcel no.: BeckBow preventer 31.27
. . ' DESCRIPTION OF.WORK. • Backwater valve 12.51
Clothes washer 25.02
Ur nit ctA/Vt
Dishwasher 25.02
Drinking fountain 25.02
Ejector/sump 25.02
O.:PROPEgry OWNER • i. 0 TENANT Expansion tank , 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) lee maker 12.51
.. ® APPLICANT ' C] CONTACT PERSON Interceptor/Ipease trap 25.02
•
' Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Contact name:Angela Grajewski Primer 12.51
Roof drain(commercial) 12.51
Address:109 East 13th Street Sink/basin/lavatory _ 25.02
, City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
I Phone:(360)695-7700 Fax::(360)693-4442 Tab/shower/shower pan 12.51
E-mail:Angela.Grejewski(a3polygoabomea.com Urinal 25.02
•. CONTRACTOR
Water closet 25.02
•
• • Water heater 37.52
Business name:Mabxsedal Enterprises Inc. Water piping/DWV 56.29
Address:PO Boa 207 Other. 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324-0759 'Fax:(503-)324-0580 Minimum permit fee: $72.50
Plan review (25%of permit fee)
' CCB Lie.:102535 PiumbingLic.no.:34-276PB
State surcharge(12%of permit fee)
Authorized signature: ---c , TOTAL PERMIT FEE
Print name:Carolina Maimedal Date:04/25/2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l BuildiglPanc[dPLMU.pvmitApp doe 10/01/09 440.4616T(l002/COMHVEa)
City of Tigard
° COMMUNITY DEVELOPMENT DEPARTMENT
T l c nn Building Permit Review — Residential
Building Permit #: iS 7 20 6, - Qom,/ 7
Site Address: _ 174 3'j S'W A x'12 h Cis S f A
Project Name: (1 V e r TeAr-rcAc.>Z fV Q(T We i,i- Lot #: C)9
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Plannirsg Review
Proposal: Nem & F R
Vf. Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: 0 No Xi Yes,See River Terracr Review Addendum Attached
Site Plan Elements:
/Three(3) copies of site plan €4Existing structures on site
Site plan must hg 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 iFilltility locations(required fox new,may apply for additions)
,'Site address,project or subdivision name and lot number dation of wells/septic systems
Applicant information(name and phone number) Ening trees to be retained with drip line,and tree
,Lot dimensions and building setback dimensions protection measures
, Lot area,building coverage area,percentage of coverage and XStreet 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)
fd Clean Water Services–Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes 0 No
/1 Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
, Land Use Case#: PPR 00005 , Su62.,OJs -.000013
LI zoning P
eel Required Setbacks: Front ( • . Rear (0 Side 3 Street Side g Garage z et
0 Landscape Requirement: ZO
,1I Lot Coverage Maximum: S~ %
,2rBuilding Height: Maximum Height Ni Actual Height 2
Visual Clearance
,fd'Easements
Sensitive Lands: ❑ Yes ❑ No Type
,I Urban Forestry Plan
Xr Conditi ns "Met"prior to issuance of building permit
Notes: on c1:1,1112 n J to b.e me f" f,it) -+a i S S(CJ n.t� a f-
a o i CL1 n 9 p r-m 1-i-3 .
Approved By Planning: MO r1-,Zc.. /3 t 1 ol_a 4AA- Date: 10// Z // 6
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
l:\Building\Forms\BldgPermitRvw_RES_091216.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: # 2
Building Permit#: EQ.-Enter building permit#above.
Workflow Routing: 0-Planning 9--Engineering [3 Permit Coordinator -E3-"Building
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: fr 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: ®'git, Date: /7/_3".
Engineering Review
-Slope at building pad: /
.2:A_
onditions"Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 Yes 0 No
O NOT Approv-d • Engine ' : Date:
Notes: y 1/..00%iS! ,.► .!_.di • of!
Approved by Engineering: ,2— Date:/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
'!� 1 C Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: Yes 0 N/A
rOK to Issue Permit
Approved by Permit Coordinator: if T ate: "/
-/irY
1:\Building\Forms\BldgPenuitRvw_RES_091216.docx
r4
City of Tigard
1111111
q COMMUNITY DEVELOPMENT DEPARTMENT
■ •
TIGARD River Terrace Building Permit Review Addendum
Building Permit #: /V.S j /G -_- coG/6 2
Site Address: 174 311 S W A m e i i el S'+.
Project Name: 2 N' ' rerr-c-4 Le Iv 0 r i-v)W e..s}- Lot#: 9 01
(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 0 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.
Porch min. 5 ft.deepBalcony w/access 2 Window Projection Vertical Wall Offset a
ft. deep min.2ft.,5 ft.wide min.2 ft.,y6 .wide Gabled dormer
0 0 " ❑
2.Eyes on the street:a minimum pfd%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:
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 0 No
Ifes,all the following apply: '25 sq.ft.min.
yiOne street facing entry g 12 ft.max.roof above floor of porch
5 ft. depth min. X30%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.deep0
Recessed entry area min.5 ft.wide x 2 ft.deep
Wall offset min. 16 inches 0 Dormer min.4 ft wide
iil Roof eave min. 12 inch projection (Roof offset min.of 2 ft.
0 Roof shingles either tile or wood 21 Gable,hip or gambrel roof design
0 Roof pitch oriented south min. 500 sq. ft. ig Horizontal lap siding min.3-7 ft.wide
❑Accent siding min.40%of street façade all Window trim min.2'/"wide by 5/8"deep
❑Window recess min.3 inches for all street facing 0 Bay window min.5 ft.wide by 2 ft.deep
0 Balcony min. 5 ft.wide x 3 ft.deep with inside access 0 Attached garage is 35%or less of street façade
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. 0 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.
Vi 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 0 40%max. of street facade
�50 %max.of street facade with 7 detailed design elements
Notes:
Approved By Planning: M gn.0 ._ 0 f/O 1,--,61/1/L Date: 10/1 L f f (a
I:\Building\Fonts\BldgPermitRvw_RES_RT_031416.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17434 SW AMELIA ST, BEAVERTON, OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2016-00467
Inspection Type: Inspector:
699 Mechanical final Chip Barnett
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17434 SW AMELIA ST, BEAVERTON, OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2016-00467
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor