Permit (46) CITY OF TIGARD MASTER PERMIT
IN
COMMUNITY DEVELOPMENT Permit#: MST2016-00529
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2017
Parcel: 2S106DB12000
Jurisdiction: Tigard
Site address: 17478 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 120
Project: River Terrace Northwest, Lot 120
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1259 sf Basement: 735 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1658 sf Garage: 464 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 3652 sf Value: $437,262.04 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 2 Water Lines: 100 Drains: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0
Drywell-Trench Drain: Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
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: 7 201-400 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 3652
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 Fire Rated Eave at fireplace
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $35,771.62
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 throug OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling Permittee Signature: 503.232.1987oor/1..800.332.2344.
Issued By:'�4 --"7--e //V g7/`Z-1(#1. 0
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
R `lding Permit Application !,Q l 2 ,
�t
R I
e; a�ent �'. /OR OFR( l sl,oNLI
14
City of Tigard OCT 1 1 ?_016 Date/By: /07/7 / ' C��o' Permit No S //---(90-5- 1
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 05�'S�c,
/ Other Permit:
Phone: 503.718.2439 Fax: 503.598.1460,1
1 DateBy: 0�7'I
Inspection Line: 503.639.4175 ° ° OF T I G A D Date Read B ° -1) J H See Page 2 for
T I G:RD t 1![ g s ti DIVISION
y y o
Internet: www.tigard-0r.gov . U f LD 114 G k s I t�1 S I O N Noti4d/Method:/ /9 /7 `tom Supplemental Information
/ i- ,�}/L '/4/& 1E
il±. ::< '' 77-Fit'-', ��
ti '': , . -i kt, : �X� € �,:3 1, tib?.F, ',,
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other equipment,materials,labor,overhead,and the profit for the
pry i t€ € -x . ., - 2
���, � �;'�����-�� � . �� � �jt���a �t��� ������ � �.�� � work indicated on this appl
�'»'F"v`ii�.
g:Z% Valuation:
' 1
l3?d '"1 2J 3
® 1-and 2-family dwelling 0 Commercial/industrial / 6 . $ Z
LP 0 Accessory building 0 Multi-family Number of bedrooms: y.
0 Master builder ❑Other. Number of bathrooms:
%� '; i : �--: 7 1:74;: Total number of floors: 3 Lf) i
Job site address/7y70 SW Shadow Trail St New dwelling area: 3 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: L{ square feet
Suite/bldg./apt.no.: I Project name:River Terrace Northwest Covered porch area: Li2 square feet )(.J'Q
Cross street/directions to job site: Deck area: square feetP„c
Other structure area: , 4 9 square feet -74„
T-- � s Kms ,i.,.
Subdivision:River Terrace Northwest I Lot no.: 110 Permit fees*are based on the value of the work performed.
value(rounded
Indicate
thelabor,to dollar)
all
Tax no.: materials, overhead,and the profit the
�
L- � � . t, t � e . _
work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
q _ ' a 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:
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
Amount received:
Phone:(360)695-7700 Fax::( )
E-mail:Angela.Grajewski@polygonhomes.com � t �t € at�f air
' a �� ,' -'::',7t.,,' -•— n Commercial and residential prescriptive installation of
,L 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 lip.:207247 Total fee due upon application: $201.60
Authorized signature: L...... 4/1/:„..7Z i I 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: ijag"1 *Fee rvicmete Bohodoard.logy set by Tri-County Building Industry
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
t
Mechanical Permit Applicata
I, r,JIIIIIIIIIIIIIIIIIIPIIIIIIIIIIIIIIIIMI
City of Tigard
Dste/Br re'll N°MST2-1)1V-602f1
13125 SW Halt Blvd..Tigard,OR 97223
• 'hone: 503.7182439 Fax: 501591L1960 DEA: 2 ea lt-nulcsu Dogailan RVew Other Pcnriin
inspection Line: 503.639.4175 lath' sti See Pour 2 for
internett www.tigard-or.gov _ r i r-.; t'l l'')1:1=8;
GayUt--....) ,,, ___., ,, Supplemental leforntatien
is, lk h. ci,n it.I1F.:0 C44
•^; r:-,t,.,,.,..v.--,:ry...,,-,-,,,-v,...._:-.4,,,,,,,,.;.-,,,,,,*?,,,,,,,I.-.-1.7; -.9%,..-z,..'"').-i',..,,..,,v.s- ..-i,<;,ft.k,.,............:,,...ffv,p..."'z.:-",-,.4s..F.-. :"..''''.:,:rs!..;..1...;.±..,......04 ,,,,Li..,,,..1-.,..11•...',1,-.. .”4"-'''4,,-144 va, -'1,,,s.,....s
_,,l'''''''''''''' '''''I'''''''" -c"- -- -----—"s"--'"-'------'``.- Mechanical permit tees*are based on the value of the work
123 New construction U Additionialterationfreplacement performed.indicate the value(rotrnded to the nearest dollar)of all
El Demolition 0 Other. ,mechanical materials.equipment labor.overhead,and profit
Value:S
..;1',i.:``,:...K''''-,-*`.-'"-q..''.-.7.-!•Yil..7;;.7-74,1Z:,:',1".-.,R72,'21;:rii'•73.-','=z,11,Fraf-,=..4"-.;"-ai',;"--4,.,,F,. ,-,-,74',7f.'M.7.0.:.5:711",-17„-C -f,-. _ ,,,, . . ,. _ ,.,, ,,,, _ „ .... _ ._ _., . ,
:,-_,1:1:4.3.....4'4.21=-",i,..:.%.41.41f:II,:..,-...n.Z,::,,_!.-,,,i4h... ..--,.!4;Stiml,:::,:t1.0.-',:a`Alir'...1..;:'it.:31":?: ..:.-:i.,,:412-,:fi-...,:-.11Za f,.„..4.4.,,,..;:f:',47.1i7s,VS.v,r.;,;Iit.4'j:I.L.,:,',n•,,3;-,11,...,.,..;t .:',/7,2,i:,'Llt-r.N:,..;f;:.A
fi(1.and 2-family dwelling 0 Conenercialtindustrial 0 Accessory building Fe r special ktfromeniut sae checklist
Multi-faTily 0 Master builder 0 Other: Description I Qty. I Ea.. I Total
...,,...,,,.-...:,„,2...,:,-,,.,,,,...„.,...i,,,,,,,,, .2.,,.-,4,,..,!,z,l,i.--',„.i-;.,,k..,:,-;_;,4,7,L.-.2,,,---f,,,.... , ,441,t,-,-, s,, Zs,,,,--,,,-,.. ne*OPWCOOring:
-....-,,,,' ''•-.,'A-.-c-f•'1.1.-.-- . - •
Air conditiestune 1 46,75
Job site addrassl 7 7A s S s . buITtrali St: Furnace 100.000 BTU Nuerstvoset I 46,75
City/StateRIP:Tigard,OR 97224 Furnace 100.000+BTU(dectsivena) 54.91
Hest puny 61.06
Suite/bldg./apt.no.: I Project muncgAr itxrcige.0 orktruki'r Duct work 23.32
Cross streetfdircctions to jab site: ilydronie hot water system 23.32
• Residential boiler(radiator or
hydronie) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct suspended,etc. 46.75
Flueivent far any of above , I 23.32
Other:
Subdivisiw RiVer"TexraCe- Northuve--I-s Lot no.:i lb
.. Qther fitol itonlianceat 2332
TeX mop/parcel no,: Water heater 23.32
i.IT2,...;y3i-,79...i2,:;,N;„'ro .-t.,:.:;.:.,*-.'.:.7.,..-,;*,:;`,..::..'4,..-1=;:,* Gas fireplace/insert 1 33.39
'-'-'- " '' -' --'" - -- • Flue vent for water heater or gas
fireplace 2132
Log lighter(gas) 23,32
Woodipaet stove . , 33.39
Wood tirepfaceinsert 2132
Cbirrtneyninerilluervent _ 23.32
23.32
y.:...., .,1.it, ._.),i,:-f . o.4.1-,-.4-.,,, 2-4 -;.j.. .1,...4.4:--,,,i;.T.?rf,:f.,41: -.. ,4:, :1,4,,,,1. .:,,,.-
1-- -.. ‘ ----- .- - - ,- -' ..•---' - -- -F- :- -.-- .--' - ,- "-' -----, Environmental exbaustand ventilation:
Name:Polygon W1,41,:LLC Range hood/other kitchen t,
ettuipment 33.39
Address: 109.East 13'1*Street 'Clothes dryer exhaust I 33,39
City/State/LIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
r toilet eompartments,utility rooms) 4 23.32
Phone:(360)695-7700 Fax:( ) AtticknovIspaec Fans , 23.32
''-''''-';;';' •-':''-?1:-'". --1•'''..•'.-,f•-l':-'2.zTA'-"-''',.;:,...,; 't:.-1 i s--s,,,.,-,,,:,t,,,,c..,t r.., ..!..,':,,,,.?...i.,;,,-,-',..:,-,:,-:, ' 23.32
'het pinkie:
Business name:Polygon WL11,LLC $14.15 for first four:54.03 for each additional
Contact vamp:Angtht Grsjtwski Furnace.etc. 1• ,._.
Address)109 East 13th Street Go heat Pump
Wallistisperidedtunit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phonez(360)695-774)0 I Fax:(360)693-4442 Fireplace i
Raw 1
E-mail:Angela.Grajewsltl@PolY14941bifineLto9 Oarbecut .
' Other,
Easiness name:Apex Mr LLC . , ...-:-.:7,,,:'''''''''''.>:'-''. .:.:Cri;"741-77',,'. .'.:..E-t.;•::'',.'.:':'''',. ..--.4.-.,..‘'..,-,••:,_,
...... _ . .... _
Address: 18004 NE 7Z Ave Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fec($90.00)
Plan review(23%of permit fee)
Phone:(360)3424109 I Fax:(360)326-1769 State surcharge(12%of permit nee)
CCS lie.:20034
...•.........04 TOTAL PERMIT FEE
This permit egmlicatiets eeptres ire permit is net obtained Aida ISO
dayseiterit bats been accepted os complete.
Authorized signature: s' Fes methodology set by Tri-County Building Industry Service Beaid
'Print name: • I te1/4 • I Date: 4-11-14.
ilkokkomtito.usr....ft.itm,,t940113d. 449-16471.(I 11000NSAY1E
Electrical Permit Applicatiol t I — F::; S
ra.11t orr��c�t�_E ONLY
INI„:„( Kitts Sw Tigard
Blvd., OR 97223 DEC,' 2 8" ?_Q 16 n h.i * t 1!,• '
Phone: 503.7182439 Fax 503.598.1960 ReviewPlea ,
l..
resp Line: 503.639.4175 r a/ �� � pDatHi= 121n
Date/Br �See Pa :for
T 1GARiil met we w.tigard-or.gov s I c" r't iF1
" 1 Supplemental Information
e 4 - :;24:-.V.-)Z4' -.-t.0.:` -. -. 4a_ hTia.:-'"y4i?'E ''c^a �f, , :.?.,r}.,.. .4 ,,5S f ' ",r -'4""1.'1',' err- tr c"i .54,. 4; &
®New construction 0 Addition/alteration/replacement Please check all that apply(submit isms of plans widens obsebd):
D Service or feeder eon amps or more 0 Building over throe atones.
❑Demolition ❑Other
vinare the available holt current D'Afarinas and boatyards.
'7 .,r `"4$_ -.4. !g,fti i.r V4.0 . I) ' ilc..IN5).;_...- ''.. "y.`r -'? exceeds 10,000 ampsatISO veal or 0Fioatu*gbuildings.
at 1-and 2-family dwelling 0 Commercia]/iridtistrial 0 Accessory building less to ground,or exceeds 14,000 D Commercial-use agricultural
amps for all other installations. bmydings.•
❑Multi-family - 0 Master builder 0 Other. UFire pump. D installation of 150 KVA.or
a * ::::.,t,"RQ 4�_ i":,;,-tZ•r rZ 0 ,,..t t.`,I! rte.., E n i..r" c ?= 'ti-,_,, zit"• 0 Bmeageae'syatem, larger sepsnioly derived
Job#: Job site address!71478 S',J ShL1dku—rye 1 S�'-, 0 Addition of new motor load of system
LJ I00I.1P a more.
D"A","B","1-2',"I-3",
City/State/ZIP:Tigard,OR 97224 D Six or morn residential nails. occuPencY.
DHealtt-ogre facilities. 0 Recreational vehicle parlcs.
Suite/bldg./apt#: Project name'Rivt r"`race N b - OI4am does iocatians. D Sugrlrty voltage far more than
❑Service or feeder coo amps or moth, 600 V°112naminal.
Cross street/directions to job site: Pt_ .XAK' s J a1 6� r l fili*1 u'-4- t 14 {
Arsednaon Qty. I rhea I Toni
New residential single-or multi-family dwelling unit.
Subdivision:R,l(erTr,he to Nnriilukir Lot#:pi) includes attached garage.
Tax map/parcel#: 1,000 sq.R or less 168.54 4
Ea.add
a01-0W-.1'111,..--'--4
�+ F 'I 500 sq.R.or portion IL p 3392 1
=' ,, _ !,at o.1.I'1:170--, .a ha? u , �.. 1.In � 1 r Lmuted entugY,residential
(with above sq.R) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
, ' t ' ` ''`V.',.%-7,,,, ,,7,51=';;•24k-1`.' J'�-;' -' Renewable Entry ❑See Page 2
: .A.' mss) c ` . ; "w. ` ,^-F
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 •
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 55226 2
Temporary services or feeders installation,alteration,and/or
Email: •
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or lags59.36 1 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. - 201 amps to 400 amps 125.08 12
Owner signature: Date
401 amps to 599 amps I 168.54 2
' » se.2 E rte" �.� "``2-� ri-�` s Yll�� -. �_ Branch circuits-nesr�,alteration,or extension, panel
- - A.Fee for brancG circuits wlrh
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name:Angela Grajewski B.Fee for branch circuits without
Address:109 East 13th Street service or feeder fee,fust
56
branch circuit .18 2
City/Stat/ZIP:Vancouver,WA 98660 Bach add'i branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695"7700 - ' ' I Fax::(360)693-9442 Eachmanufagaaed or modular
dwelling,service and/or feeder 67.84 2
Email:Angela.Grajewsid®polygonhomes.com Reconnect only 6714 2
` 'et--,07.1::31d-.- c S t£ hs.:= x:- y, �n Pump or irrigation curare 67.84 2
-
Business name:Garner Electric Washington,LLC ' Signor outline lighting 67.84 2
aria Signal circnit(s)or limited-energy
Address:6101 NE St Johns Rd panel,alteration,or extension. D See Page 2 2
City/StatelZlP:Vancouver WA 98661 Each additional Inspection over allowable in any of the above
Additional inspection(1 brittle) 6625/hr
Phone:(253)320-1657 ( Fax:( ) investigation(i brink) 90.0W hr
Email:bdanielsQgweusa.com
Industrial plant(1 firman) - 78.18/hr
t inspections for which no fee is 9000/hr
CCB Lic.: C1158 Electrical Lic.: 208174 ___.I Suprv.Lie.: 44963 s `1'listed hunk
f A_ h f! Subtotal:'
Suprv.Electrician signature,required:
Print name: Joan P Albert • Date: 446/2016 D Plan Review Required(25%of permit fee):
:j c�L Slate surcharge(12%of permit fee):
t'°
e',77
' -^� —� TOTAL PERMI-FEE:
:i;;`. Authorized signature: -
.:'.,`,q.-•:'::: This permit application expires if a permit is not obtained within 180
.r:•- Print name: Bill Daniels Date: 4/26/2016 days after it has been accepted as complete.
04v*: • Numberofinspeotions allowed perpennit -
4:1;;,.:118rdidingll'enoitaLC'„RmaBApyi{, R6,doe Rev 06/17/2015 4464615111A/WM/writt
•
J
Plumbing Permit Application
Building Fixtures , Vit.- 1()12 <11 1 1( 1 i 'r 0v1 2
C125 W Hof all Blvd.,Tigard,OR 97223 A�E r. g. 7 Q�� W Permit No.)/�Sp.D i(p_O�-rj ci
Received
1,1_,_
• • Phone: 503.7182439 Fax: 503.598.1960 :Y: Other Permit No.:
1 1•,-,i<r, Inspection Line: 503.634.4175 - d ®1 {„ reds: 0 See
Internet: wwwugard.or,gov 9,�y `9 > g Page for
`a.,. :-147. .,017..y,,010(43:0�t.°pE c`I e��J1 't ,etb°d' Pptememalnformation
IN New construction 0 Dem tion For special t�flrrrtur>yon use deeckt'
0 Addi<ioNalteratialt/repiaeement Q Other Descxlptioa ( Qty. ! Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
. .. 'CATEGORY'OF CONSTR1ICTIOTI•• .. , . SFR(1)bath 31Z70
®1-and 2-family dwelling Q Commerciabmdustrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 50032 .
0 Master builderEach additional bath/kitchen 25.02 •
0Other The sprinkler(_sq.ft) Page 2
. ., '1lOB SITE INFORMATION'AND'1.00ATION . • _ Site utilities:
Job site address: S , Catch basin or area dram 18.76 f
City/State/ZIP:Tigard,OR 97224 Drywelt,leach lite,or trenchdrain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project"me'RiVtritrakce Noetiogst Manufactured home utilities 50.03
Cross sheet/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:„•_„„) Page 2
Storm sewer(no.linear 8: ) Page 2
Water service(no.linear R: ) Page 2
Subdivision'R1uP.rTie•rvAe.e NOrtvjcS-I-- I Lot no.iil"t✓) D Fixture or item:
Tax map/parcel no.: Backflow per' 1 31.27
,'• . . • ' DESCRIPTION OF.WORK .
Backwater valve ) 12.51
Clothes washer 25.02
Dishwasher 25,02
• Drinking fountain 25,02
Ejectors/sump 25.02
.:0.2ROPERTY,OWNER • . ' 1, • Q TENANT Expansion tank
12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Address:7600 E Doubletree lunch Road Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hale bib 25,02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
:•.'®.APP CANT . . Q CONTACT PERSON: Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(value;$_) Page 2
Contact name:Angela Grajewski Primer • 12.51
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
Phone:(360)695-7700 Fax::(360)693-4442 Tublsboworlsbower pan 12.51
E-mail:Angela.Grajewski®polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
. Water heater 37,52
Business name:Mahnedal Enterprises Inc. Water piping/DWV 56.29
Address:PO Box 207 Other
25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324.8759 I Fax:(503-)324-0580 Minimum permit fee: $72.50
CCB Lie.:102535 "PlumbingLic.no.:34-276PB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:
TOTALALPERMIT FEE
I Print name:Carolina Malmedal ( Date:04/25/2016 This permit applicationIt
expires pi an accepted not obtained within 180 days
after Pled as complete.
"Fee methodology set by Tri-County Building Industry Service Board. _
1:1auidiraPendts1PLMU,PenattAyy.doe 10/0U09 440.4616T(10A7/COM/WE9)
City of Tigard
® COMMUNITY DEVELOPMENT DEPARTMENT
11111I
TIG ARI) Building Permit Review — Residential
1. .: .t.:`.... .n„„# i..„.. _y,, ,„, ."e»... _. a.T..„.it .xet� � sx>c _ ..+EF•- . ;:3 fi ”:S'y7a.41 Tt.1.A
F rises::�:�;eai_
Building Permit #: /7s77,2,/& e)(5...5"...2 J
Site Address: /44: e a() cA3ibt ---770/i 34
Project Name: ii4P,-- marc,I 4)14,4142 2- Lot #: _/QC)
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: ail,,)
... --,e.
Vi erify site address/suite#exists and active in permit stem.
i? River Terrace Neighborhood: ❑ No Yes,See River Ten-ace Review Addendum Attached
SiVPlan Elements:
ree(3)copies of site plan C ; sting structures on site
tpe plan must be on 8-1/2"x 11"or 11 x 17"paper II, ootprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) or elevations
V .rth arrow Ittility locations(required for new,may apply for additions)
r:T�fte address,project or subdivision name and lot number io,%cation of wells/septic systems
Vplicant information(name and phone number) 0 !A-sting trees to be retained with drip line,and tree
t dimensions and building setback dimensions , otection measures
11Lot area,building coverage area,percentage of coverage and 1,4 eet 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)
)itlean Water Services—Service Provider Lette of platted prior to 9/10/1995):
�equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
ublic Facili�ti s Improvement(PFI)Permit:
equired: VJ Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stopintake
;s�
and Use Case#: /64bROC)/57-0000 j ��'� G,l�_ . 93
IV/Zoning: (Pb)
Landsequired Setbacks: Front Rear /D Side 3 Street Side / �('? Garage
cape Requirement: *. % d `�r"Z ��
Landscape
Coverage Maximum:
V.Building Height: Maximum Height �/� Actual Height �i it
l'CiY''•isual Clearance
n 'asements
IS I ensitive Lands: 0 Yes 1ZNo Type
FA Urban Forestry Plan
❑ Conditions "Met"prior��� to issuance of buil • g permit
Notes: �s1Lf/77v1? ce S' I i JI /0/71-r— 7?) 'Oh'J Al-c4-f ICL
Approved By Planning: (z=== �-,< Date: i,R
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
1:\Building\Forms\BldgPermitRvw RES 091216.docx
Building Permit Submittal
Original Submittal Date: # 5'/e//%
Site Plans:
Building Plans: # 3
Building Permit#: E(Enter building permit#above.
Workflow Routing: Planning engineering ❑'`Permit Coordinator E tsuilding
Workflow Sign-off: 2'"Sign-off for Planning(include notes from planning review)
Route Application Documents: 0--Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
yriginal plan revirouting form.
Building: original
ew permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 6(::C2447
r1L___,._ Date: 7,,,,.../.?///,h...---,, __—_ ve, !, .. , - .-. e . ., .,. . �xF2 m..,4}. 1 ..; ..__f..'
Engineering Review
Slope at building pad: .9d "-A'
■� onditions "Met"prior to issuance of building permit Nal /4f,
❑ 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: WI Date: __Z_2—>
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
mamirmazszam
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:
DC Fees Entered: Wash Co Trans Dev Tax: Li... es ❑ N/A
Tigard Trans SDC: 7. Yes ❑ N/A
Parks SDC: p Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: //7 /›NA-?4,47
I:\Building\Forms\B1dgPermitRvw_RES_091216.docx
y
City of Tigard
p COMMUNITY DEVELOPMENT DEPARTMENT
I
•
T l G A R o River Terrace Building Permit Review Addendum
Building Permit #: --(/- 2er/c -05 5,
Site Address: / 1./` -e. a) ?%dl ) —Mid .'ST.'
Project Name:
/2/17er iii oe /17LLot #: j
(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? rr Yes El No
1.Articulation: a minimum of 1 element per each street-facing façade 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 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
LiGIICI ❑
2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: / 3 L'%
3. trances:At least one entrance must m/eet both of the folio , g standards:
Max. 8 ft. setback from Ion s !r. Parallel to street,angle no more than 4 °
t street- facing wall g 5 from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
IVs,all the following apply: 25 sq.ft.min.
VIA ne street facing entry 12 ft. max.roof above floor of porch
5 ft. depth min. ❑ 30%min.porch roof coverage
4. etailed Design:All buildings shall include a min. of five of e following elements on all street-facing façades:
overed porch min:5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
all offset min. 16 inches ❑
ormer min. 4 ft.wide
I' Roof eave min. 12 inch projection Vyoof offset min. of 2 ft.
❑ Roof shingles either tile or wood VGable,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ❑ orizontal lap siding min. 3-7 inches wide
CI Accent siding min.40%of street façade 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:
N closer to front or side lot line,than longest street-facing wall. GIYes [ No. If No (Check one):
ay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
V?C/I
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: _ Date: �J� �
/2,.,m /�
I:\ _ _Building\Pomis\B1dgPermitRvw RES RT 062216.docx `�
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17478 SW SHADOW TRAIL ST, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2016-00529
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:
17478 SW SHADOW TRAIL ST, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2016-00529
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17478 SW SHADOW TRAIL ST, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2016-00529
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:
17478 SW SHADOW TRAIL ST, BEAVERTON, October 25, 2017 at
OR, 97007 10:55:55 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00529
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - CofO
Comments:
Corrections completed.
Final erosion control passed
Street tree certificate received
Moisture content form received
Moisture barrier acknowledgement form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor