Permit (37) CITY OF TIGARD MASTER PERMIT
111, •,41 COMMUNITY DEVELOPMENT Permit#: MST2016-00526
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2017
Parcel: 2S 106D B 11700
Jurisdiction: Tigard
Site address: 17416 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 117
Project: River Terrace Northwest, Lot 117
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 978 sf Basement: 814 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1251 sf Garage: 368 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3043 sf Value: $365,690.59 Rear: 10 1
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: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 4 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: 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
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 3043
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 2 Geotechnical Inspection
STE 1 Required before foundation
SCOTTSDALE,AZ 85258 3 One Hour Fire Rated Eaves
PHONE: PHONE: 360-695-7700 Required Bothe sides
FAX:
Total Fees: $34,125.62
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through AIR 95 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ 'Y
Issued B lr` �L»/ 1��'V.
By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
L_ 77 //
+es' na RECEIVED
Received //_ —•
City of Tigard 0 C T 11 2 016 Date/By:/��7//cy /l l 1 Permit No/' J%20/6 G0-5':2(n
13125 SW Hall Blvd.,Tigard,OR 97223 r,+
I Phone: 503.718.2439 Fax: 503.5 p, DateBy�eW��"�01. r j OtherPermif 49j6—4a9s/
Ins ection Line: 4 3.639.x: 5 T F. r i GAR D Date Read B 7 J.r;s. H See Page 2 for
R D p U LD N G DIVISION y y !�0� Supplemental Information
Internet: www.tigard-or.gov a✓ NotiSed/Method:�
•
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
,` .� work indicated on this application.lyt
Valuation3 bJ /9 v$
® 1-and 2-family dwelling 0 Commercial/industrial )b 4 1
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:**-2-.4. 3
t `�; ;& Total number of floors: 3 , )
Job site address:17(.41(./ SW Shadow Trail St New dwelling area: O square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 3C,,g square feet
Suite/bldg./apt.no.: I Project name:River Terrace Northwest Covered porch area: 1' 1 square feet J
Cross street/directions to job site: Deck area: I square feet
Other structure area: square feet 4
Subdivision:River Terrace Northwest I Lot no.:I 17 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
�q ° t� ,> '• " work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
e ;
JP, : 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:
;t: moi :
Business name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Angela Grajewski
FLS plan review fee(if applicable):
Address:109 East 13th Street
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Phone:(360)695-7700 I Fax::( ) Amount received
E-mail:Angela.Grajewski@polygonhomes.com
Commercial and residential prescriptive installation of
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 lic.:207247 Total fee due upon application: $201.60
Authorized signature: �j 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: /�K *Fee methodology set by Tri County Building Industry
/ Service Board.
'ermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
•
,
-% * ;#,.-
Mechanical Permit ApplientiRE('El tv t:,DIIIIIIIIIIIIIMIMIIIIIIIIIIM
City of Tigard ReceiVed' - Pennit NaMSV2Z ...
- -14 Ouuk- 2_1p ,
13 125 SW Hail Blvd.,Tigard,OR 97223 7016 UwelaY:
IJEC C 2 c _ Plan Review
Phone: 503.718.2439 Fax: 503398.1960 Datenr Other Polak.
Inspection Line: 503.639A175
CITY OF`11GAi-ID Doe RmulY/BY: !aria. Et Set rtge 2 far
Internet: www.tigard.or.gov otifiettivlethad: Supplemental lororeuniria
BUILDING 1:)IVIS;OE\i'l
-,,,,,,,,,t,,,,,,„,,--,;,,,,,,,,,,,-....,:74 4,...''*-t.i..;,;:4.'"',,y:thZ.1•;'14.):14--`;',6-.T.Z.4,\' LZ.:-'4,'"1-,:tF'-14,„,-';',+,.^..„,...-,,,,,-. . ;,:re',t.,`,t) ,e4:14,r,let:r9;;;,, ,,,,,itLe.,?..."e),:y el 44,%,,:k, •,..11,6,e.,,,..fii q+,,, ,,,...-.-
'a.i.e. i.v.,`-:-V: .; . ,=..
Mechanical permit fees*arc based on the value of the work
El New construction 0 Additionialterationitr,placement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other. mechanical materials.equipment,labor.overhead,and profit.
Value:S
-....34'W.'7r7.7t7E,'.7;:',4`.,,g-1:.FM,73.Y"F'41i.I;tc7-?"7-WiTiLKi57.-T:PF:Vg117,:g''''T: ----- -•''-°-'---'"Ft'• ''I' - 1-"&''''''''' • "T''''''''''''''''- ' ''' '
.7.1,m..,,..9..-;,-1:.'.1..z.'.4.-L-„4...;...=.22,-.1,f-'2iv...,;-,...-.=,%:,,Ye.,,:-..-.),i`1,:.. .i..:-.i,-.9..-,..LIer„,...k.,..,...-rfi,.. 1,:.-.:::i.. .,:-.:L.?:-.----;=,rs., r2-1:-...,,,,,....±,,,!.-.4,4*,'--'),,-?, I.',1 f;•.,r...1. -11;11,44, .1=-:..:*-,i,,,07!',„
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special&firsts:Wore axe checklist
Multi-family 0 Master builder 1:1 Other: Description I Qty. I Ea, j Total
I 46,73
i°b itc addreSS;n q 1 1, S‘N) Tr!nul Trail I St; Furnace 100.000 13TU fductsfyants) I 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100.000+BTU(duels/vents) 34.91 ,
Heal;lento 61.06
Suite/bldg./apt no.: 1 Project oarrcgiiitr Terrare.,ts)OrtiglAk-Ct Duct work 23.32
Cross streclfdirectiOns to job she: HYdmnic hot water system 23.32
Residential boiler(radiator or
hydronic) 2332
Unit heaters(fucl-type.%not electric),
in-wall,in-duct,suspended.etc. 46.75
Flueivent lot any of above I 23.32
n. Other:
Ubdivisidn KWer-Texrace_ Northutsi- I Lot no //3
Other filet appliances: 23.32
Tax map/parcel xi, •Water heater 23.32
Oas firePlacctiased 1 33,39
;,•..,....;4"„'::.._::1-1;:!'..".'j.;.f.'',7-`-',;1-`i.:..4.,22,',-,-.:4„:,,,.,..i,2„1-!,-Itg:.11-4."..5.,..t:_t.l.„Z...,5-1,:,1•;,6,„„I",4-1.,.,21„:„-..ei.s',..,,,f1.42t-;:,='; '-'4.i,5,:'_,-.: moo vor for wriror htoror or gra
fireplace 2332
Log liAlficr(stas) 23.32
Woodtpollet stove 33.39
Wood fireplace/insert 23.32 ,
Chlinneyrrinerifludvent , 23.32
23.32
f.-.,;,1,7;,,;, i.,-(,,;--,: ,i,i(;',.... .`'-,,, 'NMI':
.il_.......,-..,_,,,-..........,.1:...,-4.-::“..',....1,. ,_•;:.:-.,,r,:_-..al.,---,S'ag.1.::;',...:z-Sr,... .2-...,z1,q.Y',---‘t:41.<7-I.'', Envirimmental exhaustand ventilation:
Name:Polygon WL11,1..LO amigo Imodforher kitchen I,
,equipment 33.39
Address:109 East 1.1'k Street Ckalies dryer exhaust I 33.34
City/State/ZIP:Vancouver,WA 98660 Sinee-cluct exhaust(bathrooms.
Wet contpar,trnents,utility moms) 14 23.32
Phone:(360)69$-7700 Fax:( ) Aniefennyhmatte fans 23.32
"';'....:: Y-.?.-A,`: -.'',:l.-.;3,), Other 23
, , , Oth .32
• - - PIONS;
BUInilVeSS name:Polygon WIJI,LLC Fuel
$1436 for first four:S4.83 for each additional
Contact name:Angela Ontjewski Furnar,e.etc. i
Address:109 East 13th Street Gas heat mann
Wall/suspended/unit heater
City/StatetZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 I Fax::(360)693-4441 ' Fireplace i
Rano
E-mail:Angehr.Grajewsk eitpolygonhomes.som Barbecue .
-,' "., -,"":,,''-`- :-'-',-- ''':- . '-',1,`I','..'„‹.--,,,„-k-i.71,- --_„..,-.,:..--._,',-•;,,,1. ,,-,--.--,-_--.' I',..,) ,...„•,-* Clothes dryer(gas)
_.*_-.-:- •;,.......,-'L-,-1',6-----`Sn'..-..‘ -.171;7,44--,4.-.:: ....ilt12. ,...•3!,:2::.1:i.7-.4.1',',..,
. . —, . — ,
Other.
Business name:Apex Mr LLC
Address;18004 18404 NE 71'd Ave Subtotal
City/State/Z1P:Vancouver,WA 98686 - Minimum permit fee($90.00)
Plan review(25°4 of permit fee)
Phone:(3601342-8109 Fax:(360)326-1769 Stale surcharge(12%of permit fee)
CC8 lie.:203034 TOTAL PERMIT FEE
Authorized signature: °Thi:eePerrm leariolut 8"dalyrilistykalerst:41:"IT:tri-Cotanymbgenirdat":::::"In:1:":"Pryi8jettld wt
llIce:oar ..
Print name: 4^ /
.p_r_aez __
Date: 4-1/-/to.
lilimiktilerPgratieSIMEC_KnatitApp..9401 IS Sus 44a-46sTr(1Io2icommmt
Electrical Permit Applica FUR oFFICL tiSl'ONL1'
City of Tigard E r` 2 8t 2016Received
►. 'rj► l /'
ih13125 SW Hall Blvd..Tigard,OR 9727.._4' Plan Review
r�I Phone: 503.7182439 Fax 503.5 S, 6Q - ,�W y Ullte : El Pape Z for
Inspection Line: 503.639.4175 1 i Y E, F i 7.r'ti A�' Reedy1)atd&y. NM ePage2forormaaoa
1 C 'L Werner www tlgard or govSUILt g)y�3 g� 1 HotmedlMethod -
'T __ .:r ---- '. :ts-„.,1-? 5'r.•lV .<.-.";/T'-k"1 S-I.F .3^ -2::V -=t;.:Tc2' , ,-5 'i'' :tio.°' _ '�' 'C,,l=*�j 17.721^.r ;4":,>.�c` "2 c'.
®New oonstntction0Addition/alteration/replacement -Pleasecheekallthatapply(submitgsetsofpleasw/iteaacbecke
D Service or feeder 400 amps or more D Building over three sto'ries.
0 Demolition ❑Other •
where the available fault current D Marinas and boatyards.
4 > .� 1 n .+ F'�(e i tJ i 2' `. :' '° ., 4 exceeds 10,000 amps at 130 volts or [l Floating buildings.
�',�`-F�ar�,�O'S�i`� o fi+-�'�I'a.�yC�s:' Iy..,,�wd���. a).>��4�.[�___+. 9' ., , � .
less to ground,or exceeds 14,000 D Commercial-lase agricultural
®1-and 2-family dwelling 0 Commercial/iridustrial ❑Accessory building amps for an other installations. . baildioga.•
0 Multi-family El Master builder 0 Other: ❑Fire pump. D iasmuation oil 150 KVA or
L's^• " u o ' r r r9 7 ,S 'n %'' ` t ` DBde•geucy sYstem larger separately derived
` ` ria 1, j'0 " _,�AY ❑hdditioa of new motor load of system
Job#: Job site adtlres97 Ito SW Shacireurircuist. 100HP maims. Cl"A",s","1-2","1-3",
City/State/Z'IP:Tigard,OR 97224 0 Six or more residential snits. Recreoccupational
DHoalth-nate belittles. Cl Reaeadional vahvclAparks.
y D Ha hardens locations. 0 Supply voltage for more that
Suite/bldg./apt/apt#: Project name' w.e N )t' 1 D Servloe •
or feeder 600 amps tu more. 600 volts=mina
Cross street/directions to job site: •� " fN 'S ,`i F 4;atii3M 4."_1 l',.'4e :.=:,,e,",'4'3:
'ii.ription I Qty. Rath 'rout .
New residential single-or multi-family dwelling unit
Subdivision:Ri4tr Terrace Nnriloks - Lac t 1-1 Includes attached garage.
1,000 sq.ft.or less i 168.54 4
Tax map/parcel#: Ea add'!500 sq.ft.or portion 33.92 1
,:r.*> if-�_.^+^..•tfi1Ag..; . i`a i .. Y. c}�"s._�'_" r- Limited eoerey,residential
75.00 2
(with above sq.ft.)
Limited energy,mold.-family 75.00 2
residential(with above sq,ft.) .
Rene ble Energy D See Page 2
35,4-,, { F",�rl9,:t...P c,,c z a s,.. „V r. a4Z,E20-4'z 0 _' ''''F'7"- Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Moldings,LLC 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:7600 E Doubletree Ranch Road -
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 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or fevers installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or lens 59.36 112
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps I 125.08
Owner signature Date: 401 amps to 599 amps 168.54 2
: -Y,k, Branch circuits—new,alteration,or extension,, r panel
.'y ;: 3 ,,..fri.d!,Ir_;,pti�-A-4,9;'}0,7- ','°�,° `-1-�"2-„ ,V'kP �(E 3 a; t''';�' �r; A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name:Angela Graj ewskl B.Fee for brooch circuits wtthend
service or feeder fee.rust 56.18 2
Address:109 East 13th Street branch circuli
Bach addl branch circuit 7.42 2
City/Stabs/ZIP:Vancouver,WA 98660 Miscellaneous(service or feeder_not Included)
Phone:(360)695-7700 • . ' 1 Fax::(360)693-4442 Each act a' 67.84 2 and/ordwelling. ce
Email:Angela.Grajewslriepolygonholes.c0nl Reommect only 67.84 2
n ; .� y . ' -c) h"`R'°te,?,e a }' j_ > . ,:',F:-. 67.84 2
J.,-, ,,, Ptunp or irrigation circle
Business name:Garner Electric Washington,LLC Signor outline lighting 67.84 2
: Signal circuit(s)or limited-energy 0 See Page 2 2
Address:6101 NE St Johns Rd panel,alteration,or erdension. i
Each additional Inspection over allowable ho any of the above
City/State/ZIP:Vancouver WA 98661 Additional inspection(1 hr min) 6625/hr
E
Phone:(253)320-1657 I Fax:( ) Investigation(1 hr min) 90.00/br
Industrial plant(1 hr enin) • 78.18/hr ,
Email:bdaitiels(a3gwensa.eom inspections for which ao fee is 9000/lin
Electrical Lic.: 208174 Suprv.Lic.: 44965 listed %hrmm
CC13 Lia: C1158 .i'+” 1rM,e-TzW'04 P Liii7,1 i e-3.•,x '...' .;:
:r., elft'•4 .Y: k
Sum.Electrician signature,required: . Alii a,'.:+ �..
' _ Subtotal'
Print name: Joan P Albert Date: 4/26/2016 D Pian Review Required(25%of permit flee):
e. State surcharge(1294 of permit fee):
_,�-- =.:--- . TOTAL PERMIT'FEB:
., `•• Authorized signature:it` This penult app&cation expires Us parsattls not obtained within 160
r,,y`'" Print name: Bill Danielsdays after It has been accepted at complete.
h; ,.ti: Date: 4/26/2016 * t
s y,W::r,: Number of inspections allowed per permit -
V ; tit.'1B Rept Mo 46157111/ OM/WEB
--;., ,,.. u glYaroitelfiLc�asatllpp�f R BaB.dot o6n7/2ors
Plumbing Permit Annlicati , - 4-,,�
Building Fixtures F. n E°
MINIMEIBMEINII1111111
No. S
! C ity of HallTiTigard
Tigard,OR 97223 DEC 2 8 2016 Permit I� O �tp
ntemet www. gard . Plan Rev
iewPhone: 503.718.2439 Fax: 503.594f 10 t s DyOctant Permit No.:
r 'Inspection Lined: 503.4
r639go.4175 Inds: 0 See
Pagelfor BUILDING V =dd
Supplemental information
®New construction • Q Deanoliflon For spedal beforn erw' n sae' checklist.-
Description 1 Qty. j Ea. I Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft for each utility connection)
.. ••CATEGORY'OF CONSTRUCTION'' •• • SFR(1)bath 312.70
®1-and 2-family dwelling 0 Cornmerciaiii idustrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
0 Accessory building 0 Multi-finniiy Each additional bath/I itches 25.02
0 Master builder 0 Other: Fire sprinkler(`_.__sq.A•) Page 2
. • . . . '40111/SITE INFO,R, IATIO14rANO'LOCATION • ;'�;•, Site utilities:
Job site address:/7`"T/( SW Sxc.bw rtr�f..�,t.,i�1 ,
Catch basin or area drain 18.76
City/State/ZIP:Illgard,OR 97224 Dry►velf,leach lino,or trench drain I8,76
" Footing drain(no.linear ft.:,� Page 2
Suite/bldgJapt.no.: Project name: sJ ft-Te ffa� NGV t yfiv,./est, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear IL:_J Page 2
Ston sewer(no.linear R.:_ ) Page 2
y water service(no.linear ft: ) Page 2
Subdivision.),ivt r 9.i'YArt NI OY11.aleS 1y I Lot no.:l '1 Fixture or ltens:
Tax map/parcel no.: Backflow preventer { 31.27
DESCRIPTION OF WORK. Backwater valve 1 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejcctors/sump 25.02
.2'ROPERTY OWNER ' . ' I 1 TBJVANT Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixttue/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal • 25.02
City/State/JZIP:Scottsdale,AZ 85258 Hose bib 25,02
Phone(602)694-4031 I Fax:( ) Ice maker 12.51
4,...' 4.APP► CANF , [i COXTACI'PERSON• Interceptca•/8rease trap 25.02
Business name:William Lyon Hones,Inc Mediad gas(value:S_ ) Page 2 .
Pruner 12.51
Contact name:Angela Grajewaki Roof drain(commercial) 12.51
Address:109 East 13th Street Sink/basiidlavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)03-4442 Tubfshowcrlshower pan 12.51
E-mail:AngtdaGrajewski(>r�polygonbones.eom Urinal 25.02
Water closet 25.02
•
CONl3tACTOR • • Water hater _ 37.52
Business name:Malmedal Enterprises Inc. Water piptogFDWV 56.29
Address:PO Box 207 Other. 25.02
City/State/ZIP:Ranks,OR 97106 Subtotal
Phone:(503)3240759 Fax:(503-)324-0580 Minimum permit fee: 572.50
Plan review (2596 of permit fee)
' CCB Lic.:102535 "Plumbing tic,no.:34-276PR State surcharge(12%of pctt mit ibe)
Authorized signature: C_-- TOTAL PERMIT FEE
Print name:Carolina Matmedal Date:04/25/2016 This permit application expires if a permit Is not obtained within ISO days
after k has been=aphid es complete.
•Fee methodology set by Tri-County Building Industry Service Board.
L•1nundinePanitstPLMU.PenwitApp.doc 10/01/09 440.46161(1e(02JCOMMEB)
y r
ter`
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
II ■
T 1 G A R D Building Permit Review — Residential
,r.
Building Permit #: Cl S T / --00.5..2.G
Site Address: /417///p t) S'A hhk .--Tiail S/
Project Name: hej .e.-,- -rep ce A.)44 it i Lot #: //79-
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Na,( ) _-ie
Vi erify site address/suite#exists and active in permit stem.
Fri River Terrace Neighborhood: ❑ No I7 Yes,See River Terrace Review Addendum Attached
Sit/Plan Elements: A
Zree(3)copies of site plan : sting structures on site
C e plan must be on 8-1/2"x 11"or 11 x 17"paper IP: ootprint of new structure(including decks)with finished
Vrawn to scale(standard architect or engineer scale) or elevations
V .rth arrow IJd utility locations(required for new,may apply for additions)
��fte address,project or subdivision name and lot number 0' a cation of wells/septic systems
piirpplicant information(name and phone number) S •°,'sting trees to be retained with drip line,and tree
V t dimensions and building setback dimensions rotection measures
VJLot area,building coverage area,percentage of coverage and Vreet tree size,type and location
pervious 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)
i1ilean Water Services—Service Provider Lette of platted prior to 9/10/1995):
rtr Pequired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
ublic Faciliti s Improvement(PFI) Permit:
[jequired: Fig Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
and Use Case#: PAe.00,; ..� 00
LVjequired Setbacks: Front Rear /0 Side , Street Side Garage tQO
andscape Requirement: tit
0 Lot Coverage Maximum: TJ( .
Building Height: Maximum Height r `..Y4 Actual Height tQ3
/Ph" isual Clearance
I7 Easements
Vim'Jensitive Lands: ❑ Yes /No Type
Urban Forestry Plan
❑ Conditions "Met"prior to issuance/of buil g permit
�
Notes: 11Lt'/7nm. —Cho /J ,rxg:/- ` Fjy►,L /SS's lee-
WAPProved By Planning: ,i/r► _11111111
Date: A?Ar
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\BldgPennitRvwREs 091216.docx
w
i
Building Permit Submittal
Original Submittal Date: /C1 ///�
Site Plans: # 3'
Building Plans: # 3
Building Permit#: [g"-Enter building permit#above.
Workflow Routing: [ -Planning I -Engineering LJ Permit Coordinator R Siiilding
Workflow Sign-off: (Sign-off for Planning(include notes from planning review)
Route Application Documents: Ifr 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: „`'' Date: / /y../k,
Engineering Review
Slope at building pad: G��
❑ Conditions "Met"prior to issuance of building permit AC
Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 4' . 17 Date: a- ,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
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:
SDC Fees Entered: Wash Co Trans Dev Tax: 'Yes ❑ N/A
Tigard Trans SDC: C Yes ❑ N/A
Parks SDC: [ Yes ❑ N/A
OK to Issue Permit ( -
Approved by Permit Coordinator: Date: ) 21"112"49/
I:\Building\Fonns\BldgPermitRvw_RES_091216.docx
.
111 City of Tigard
e COMMUNITY DEVELOPMENT DEPARTMENT
m
r 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #:
r7_,5.i Tom-'C2 7‘? --��� �O.S"�G
Site Address: / / , -1 L) S .66A) 7a2-i/ L..
Project Name: River J cr it S/' Lot #: 1/"
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dist , t Design Standards (18.660.070.1.):
Is the project subject to the plan district design standards? VYes El 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 t. deep Balcony w/access 2 Window Projection Vertical Wall Offset a
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
❑ El ❑ El
2. Eyes on the street: a minimu,mr�of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: /c, S %
3. trances:At least one entrance must meet both of the foll ' g standards:
Mvi
ax. 8 ft. setback from Ion t street- facing wall Parallel to street, angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If e , all the following apply: sq.ft. min.
ne street facing entry '�' 2 ft.max.roof above floor of porch
5 ft. depth min. FI
min.porch roof coverage
. etailed Design:All buildings shall include a min. of five of e following elements on all street-facing facades:
overed porch min. 5 ft.wide x 5 ft. deepvp
Recessed entry area min. 5 ft.wide x 2 ft. deep
all offset min. 16 inches ❑9ormer min. 4 ft.wide
Roof eave min. 12 inch projection per .of offset min. of 2 ft.
❑ Roof shingles either tile or wood f/, Gable,hip or gambrel roof design
El Roof pitch oriented south min. 500 sq. ft. ❑ orizontal lap siding min. 3-7 inches wide
El Accent siding min. 40%of street façade Window trim min. 2 '/2"wide by 5/8"deep
El Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
El Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 350/s or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
N closer to front or side lot line, than longest street-facing wall. 1=1 Yes 4L� No. If No (Check one):
ay extend up to 5 ft.if there is a covered front porch and d garage does not extend beyond the front porch.
1
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)
Ely-foot wide garage door ❑ 40%max. of street facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: -- —��
� r Date:
I:\BuildingTomu\BldgPermitRvw_RES_RT_o62216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17416 SW SHADOW TRAIL ST, BEAVERTON, October 27, 2017 at
OR, 97007 1 :57:05 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00526
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17416 SW SHADOW TRAIL ST, BEAVERTON, October 27, 2017 at
OR, 97007 1 :56:18 PM
Record Type: Record ID:
Residential - Master Permit MST2016-00526
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 55 psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17416 SW SHADOW TRAIL ST, BEAVERTON, November 2, 2017 at
OR, 97007 10:00:38 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00526
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
A/C installed
Violation Summary:
Inspector Contractor