Permit CITY OF TIGARD MASTER PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MST2017-00038
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/14/2017
T[ ui� 9 Parcel: 2S106DB12800
Jurisdiction: Tigard
Site address: 17391 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 128
Project: River Terrace Northwest, Lot 128
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 948 sf Basement: 0 sf Left 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2078 sf Value: $252,028.18 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 Rain Storm Sewer: 100
0
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: 0 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types 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: 3 201-400 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 2078
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Fire Rated Eaves-Both
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 Sides
STE 1 2 Ersn Cntrl 503-639-4175
SCOTTSDALE,AZ 85258
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $31,740.25
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain as copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344./
Issued By: G/. Ae�../. y�L(/I(/�C Permittee Signature: 'C (/�-d /ece--- h
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/ /2-a
Building Permit Applicati + ��, :' 1; ?�
1 n FOR OFFICE l SL ONE)
City of Tigard C y� l i C Recei°�' !_ )
�J g E. 2 0 2 0 16 DateBy. l/Ace/f7 Permit No.:,�/ 7Aof7.', 00 37
li 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review /t/I
Other Permit:
Phone: 503.7182439 Fax: 503.59$.W ,, Date/By: .'30', 514441-017"
Tic, ,R D Inspection Line: 503.639.4175 r, °s ` " 1 t t a. Date ReadyBy: 42�G//7 Juris: 21 See Page 2 for
Internet www.tigard-or.gov g� 5 c i� Notified/Method Supplemental Information
>i/ d:1 L ?t-.1.6-
5.,: r7 Z "`i,. �:aa «3�
®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
" —,t1;.'"" - "ft ,'.-i` work indicated on this application. 35 a. d 3,5?)
® 1-and 2-family dwelling ❑Commerciallmdustrial +Valuation:
❑Accessory building 0 Multi-family Number of edrooms:
❑Master builder 0 Other: Number of bathrooms:
a
., '''''''371:7`; 774'
74 t-1„ €1 s`;t7 " � � s� € Total number of floors: 2 01.4 6 s
Job site address: Mil , iiik _ 1iAlMIIIIM New dwelling area: 2.15-1(21 square feet
no City/State/ZIP:Tigard,OR 97224 Garage/carport area: 38� square feet
Suite/bldg./apt.no.: Project name:R; .r^- ow Covered p. l a /, 1 quare feet 1 1 30
Cross street/directions to job site: Deck area: square feet q 4 g
Other structure area: square feet
Subdivision: / \) Lotno.: ` 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
� g : e-; : ' s f K t �� ,� 1 l� work indicated on this application.
,.»� � .;.,,,,,t.,,,,,tea
Valuation: $
Existing building area: square feet
New building area: square feet
'''';:e- � :Sig: i1, -� ;`` .; s as Number of stories:
.�..._.'�..'` �_ aid
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:
- � c..,"7------ . m.----`.. a3'7:'42-,`:777-71:`,--- ` 311..� ''''```'''''`.--L
as . z-«._ "�° ".
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
> .mn
�� �_ , —,, Commercial and residential prescriptive installation of
_ qct r_ .:C- y .'i,-':::-'41--, ,. L 7`-`4`&4",;7,-._:: "_; roof-top mounted Photo Voltaic 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):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee):
CCB lic.:207247
Total fee due upon application:
Authorized signature: This permit application expires if a permit is not obtained
115 {'if1 within 180 days after it has been accepted as complete.
_ Date *Fee methodology set by Tri-County Building Industry
Print name:
Service Board.
I:\Building\Pennits\BUP-RESPemtitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application Emnim
Cityof Tigard Received".
JAN 2017 may; r°°"11 N°1/14 ST.ttX?'-
13i15SWHall Bhrd.,Tigard,OR 97223 ��3�
Plan Review
Phone: 503.718 2439 Fax: 503.59 �i � �g Dr, maeor oil. rt.&
Inspection Linc: 503.639.4175 g`�1 gen
IUI 11�I VA Rif
pow a ,sy, ;wit• Ca See Paige 2 for
intunct: Wwv.figard•orpov BUILDING DIVISION Natified1)441°d Supplemental Information
's a,a r , ,,, ,, ,•� ..,, w ? `-t s s c• i .c r •.rte, 111 '4:.. , .. .;.
$k3 5 - . ,jf s. �:�F'-;Y^'r"�:"���, :J �?�;+?:j.7�n�i^5�t�� ^iesi� �_ �Y� ti ?.1h- R,`•:,.
L��' -:';:r.'
� �,o r G��,;.,... �,� n"4L'?,�'F
Ea New constructionMechanical permit fees"are based on the value of the work
0 Additiontalterationrrcplacement performed.Indicate the value(rounded to the!tartar dollar)of all
❑Demolition 0 Other: mcchanicat materials,equipment.labor,overhead.and profit.
'.474:434'1.47.1.,?;;—:1=: :.i
F� :eu t9t,y Y f ' w Y• ga.7.+�" z r.'7 rJ s4� _ . Value $ .. .... ,
z . „= r ;I.�se"k v� t f Y Y' r t''' a w
> 'i ...c a..a; ,ked k-•.cs�c..�.-.,e.. ,is s-F: 'la..r..c^ , r+. 1 v •t I ssbt. �l ..,„be,,)f as a rA..r z,. :k.;4,-A `�J,:!'.'; 14
❑ J and 2-family dwelling 0 Commercial/industrial 0 Accessory building Fur;pedal blioraKarton rise checklist w
El Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. 1 Total
'' r'' .c''4' (7-gY . ,� ' d r1 Y f 4...�k. t �i e ft4 i,. '' °v.J A tc4 r Nealingtakaitt:
^y q �` �j��� �w. r Air conditioning I 46x.75
Job she address: f I c? hobo nut Furnace 100.000 BTU(ducts/vents) I 46:75
City/State/ZIP:Tigard,OR 97224 Furnace 100.004+BTU.(duds+wets! 34.91
SuitclbMg'ept tto.: Project rtatn Beat pump 61.06
ROI •i.ery*rt f\Ia gloat Duct work • 23,32
Cross sucelfdirections to job site: )4ydnnic ltgt water system 23.32
Residential boiler(radiator or
hydrenic) 23.32
Unit heaters(fuel-type-not electric).
in-wall.in-duct suspended.mc. 46.75
Flue/vent for any of above 1 23.32
Subdivision:I2 a rT!gime!- �4/11Aw f 1' I Let no.: 2, OOtherOther
Z3.32
'�'� other•fact appliance=
fax map/parcel no.: Water heater f■ 23.32
x 7 ri 7 a 1.\r ttPtecafins rl • 33.39
''''.1"'-';', .:4-4:1.7;5f:.:'� a r''1�',:i� a11'Y r i}:.EJyv� 6 '€'� 'i� 4 E-t..+rc9k✓^v`Y. � Gas i1
1 t�..a J .._ >s,_ Flue vent for wider heater or gas
fireplace 2.3.32
Log lipliter(gas) 23.32
Woodittclletstove 33.39
Wood tt cplacdmscrt I 23.32
Chimneyflincdth ieM'zit 23.32
d y'ti..-� .t1f�.E xtiF j jCJ Uel t'' r� �P r'r »x>,rsa..4,� I Lk� ' „�2 o:. other: 23.32
:u• .�1.3, s.r.,.71,5'x. . ,,'_".r.::-��,.,k•`.:r.:Vt;Lit>tr��'�.5`�`:talr�+5+.': x�`..�_4, ��+... :fir;..,.'14!..{
lK.avitrtnareatat txhaust gad vt`a1lilatlon:
Name:Polygon WL/1,LLC Ranee hoodfother kitchen
Rddre�xs:109 East 13th Street cghiprneot , 33.39 ,
1 Clot esdryercxheust 1 33.3`?
City/State/ZIP:Vancouver,WA 98660 Sing‘-duct exhaust(bathrooms,
toilet compattrrtcets,utility rooms) �"'J 23.32
Phone:(360)695.9700 rye Fax;( ) Atlichauwispacc tans 23.32
�� r k , e t.!,." r �' ++_` ;.r f w« :7 1 ' 6`j .-�"4... Other 2332 ,
Business maim Polygon Ve 1.11,LLC Fuel pittitspt
Sla.1S for first four.54.03 for each additional
Contact nate:Angela Gr je rski Furnace.tic.
Address:109 East 13th Street Ctrs heat pump
. RECEIVED
WalUsuspendedfunit heater
CitylState/Z1P:Vancouver,WA 98660 Water Junta
Phone:(360)695-7700 I Fns::(360)693-4442 Fireplace !
Range
E-mail:A*gela,Grajewskl )palygatbomes.cam Barbecue
r
rt )
�_�.�. .. ..,m w � _a'� ��t �< > �n1�, � � a.�.: ..�., ti' Clothes dryer(gess
Business name:Apex Air LLCMare
Address:18004 NE 7r4 Ave Subtotal!
City/State/ZIP:Vancouver,WA 98686 Minimum permit.fee(5:90.00)
Phone:(360)342-8109 Fax:(360)326-1?69 Plan review iew(25%of permit fee)
State surcharge(1296 of permit 11x)
CCB 6c.:203034 TOTAL PERMIT FEE
Ibis permit eppticxtion aspires Ifa permit is natphtahted unities!Rpt
days after it has been accepted so complete.
IMlM
AItl7turiZcd signature,
'' Fee methodology set by Tel-Countyr!pudding industry Service Board
IPrint name r"n Date 4-1'?. f;,,, -
ll9uRcanstPomIlicl r_Permiillpp 001(..4ac 44O-1e,I7T(tH.o24a'Q3t%'tiS)
RECEIVE]) ...:,,,x,..,,: .;:....,:::.:.,
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard JAN 17 l 17 Reva
Datii/s Poona:AA ,r ♦ (>m3r
N..- 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503,7182439 Fax: 503598 NT OF TIGARD Datyg
Inspection line: 503.639.4175 i(} Ready Meaty: )ower: El See Page 2for
G:�
T1 :.I> un
intet: www.tigar&ar.gov BUILDING DI Yr7�ISIOt` 'ed/Method: Supplemental Information
_ r;,.:-: r.1 " ."::�'�, l'_s'_.r,�-?ry'-40,1;3�.,�''�Y<7�.`+f.ru,. * �5.-a ° ,r+,",4r,r -;2a: ��'w,,,*�•.,a.:,.. "v y iVi37'%i73:`iro.,-.. '�''vt7 ''�f:r:
G+New construction 0 Addition/alteration/replacement Please check all tlmt apply(suit 2 ata of plans w/iiems checked):
❑Service more or feeder 400 amps or ore ❑Building over three stades.
❑Demolition 0 Other
where the available fault errrtent D Marinas aad boatyards.
,:� ?:Y�a>,.�. ., 3.-.rri.<2r:i),j-tax 'tEx n�.,£B_ {�,. .-'S ,,::�',ti`,,:-<, �`� exceeds lO,UpO snips at ISO volts or CI Floating buildings.
23 and 2-family dwelling 0 Commercial/indlistiial ❑Accessory building fess to ground,or exceeds 14,000 Commercial-use agriculwral
O Multi-family - D Master builder 0 Other pa ucorer;asmna:;oes. baadug .
❑Pire pump.g. ❑]sutatiatiwr of 150 LCVAor
ti:6 r;i(-'0-1,'9 3,0,'';,-?-s-i.a l,[2) T. o: '.:, 8fi' X. ';';‘,1,V;7.:_' O Emcgeney system• larger separately derived
lob site addres f a, 0 Addition of new motor load of system.
Job#:
I-
7 S ! / y- sr IO0BP or more. 0"A","B","I.2".9.3",
CityrStaterLIP:Tigard,OR 972240 Six or more residential units. occupancy.
_
Oliestith-eare facilities. D Recreational vehicle parks.
Suite/bldg./apt#: Project name:fZ4j a,kif-lam„A/�K�Harardooak:cadons. El Supply voltage for more than
I,..'v i Q Service or feeder 600 amps or more. 600 vols nominal-
Cross street/directions to job site: 371"'?. NT, , k3_.exq�'55? :<T o- tit.F-V n }Z 4
Dascintifrn 1 Qtr. aisle Tomt *�
New residential single-or multi-family dwelling unit.
Subdivision: iWY Trill/AU (�/ �w0i•f— I Lot#:I7 Includes attached garage.
Tax map/parcel# ►` 1,000 sq.R.to less i 168.54 4
ri £ Ea add'1500 sq.ft,or portion 33.92 1
,=''''''--- .,--; :1 - r iC dar:re o €,-(.4 r� ,-),3`,. ;.r r ..»r - .ra�3 �; Limitedenarm resideartial
(with.above sq.R) 75.00 2
Limited energy,multi-family
75.01) 2
residential(with above sq.ft.)
f7 . - Ren
eSte Page
S' ., . .`'L1L.lC-ILIE. iTa6IJ "" , 1.£ _c.t;-Id: r-,--111',�!? '.� 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 scups 133.56 2
401 amps to 600 snips 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 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 less I 59,36 I 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 amts to 599 amps 16854 1 2
r mat ,,M „ r ti , , v .:�- Branch clrr:nits—new alteration,or pttension,per pane.
,�;� x '��:�-„>a:�����x�'� �*-r,`�� �k�.��� �;..1�„-��,i.�i�ir3'�YL��.a�ar��l,f° w�� A.Pexi for braacir cucuik with
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2 '
each branch circuit
Contact name:Angela Grajewski B.Pee for branch circuits without
e
Address:109 East 13th Street brbranchaach nch or feeder foe,fust 56,18 2
circuit %._
City/State/ZIP:Vancouver,WA 98660 Each addl branch rarcuit 7.42 2
llaacous(service or feeder not included)Phone:(360)695-7700 ' ' ' 1 Fax::(360)693-4442 Each or modular
dwelling,service and/or feeder 67.84 2
Email:AngelLGraj wsldC!.olygonhomes.com Reconnect only 67.84 2
� _r r .,. ') c E 4t r ...'4-7.1.- f • `a Purep or irngatson Clrcle 67.84 2
Business name:Garner Electric Washington,LLC Signor outline lighting 67.84 2
Address:6101rNE St Johns Rd Signet lterat(s)on or lctdend-energy
O See Page 2 2
panel,alteration,or tndansimt.
City/State/ZIPVancouver WA 98661 Each additional inspection over allowable In any of the above
Additional lemma=(1 hr min) 5625/hr
Phone:(253)320-1657 Fax:( ) Investigation(I irr niu0 90.001br
Finail:bdaaieis®gweasa.com
Industrie/plain(1 hr min) 78.18/hr
inspections for which no the is 90.00/hr
CCB Lc.: 01158 Electrical Lic.: 208174 rSuprv.Lie.: 4496S , listed l rmm
rit ^: r s ttk(
e ,�iL^ss `serane
� ,-1,3-:i.,,.:•;.- .1.- .;
=� • \
Suprv.Electrician signature,required- Pl ' Subtend:
Print name: loan PAlbert Date: y,-
4/26/2016 oPlan Review Required(25%ofpermitfee): i
C _ r, — — _--,_'y . State surcharge(12%ofpetmit fee):
", �y—� TOTAL PERMIT PEE:
Authorized signature: ! '�
..0%,!:.
l '
This parmlt application expires if a permit is not obtabted within ISO
i::r Print name: Bill Daniels Date: 4/25/2016daystemplate:
` :.\ After It has been accepted as
ix,-gt•; • Number ofI Inspections allowed per peemlt
'Tti't5°tattelletiegvermitdSLC?eaadtapp SLR ERRd°e Sev06/17/2013 4404613701/1=041794:13 -
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'tit•
Plumbing Permit Applies.'�t' GENE
Building Fixtures
City of Tigard J A 1 Dare/ft. Parole Ntwar, ��
■ 13125 SW Hall Blvd.,Tigard,OR "z
Phone: 503.718.2439 Fax: 503 3I9 0Ur' YIGAKU w OdterPermitNo.:
Inspection Line: 503.639.4175
Internet www.tigard or.gov BUILDING
DIVISION,
otctiedl abed: retie: 65 See 2 for
Supplemennttal Information
®New construction ' 0 Demolition For speial'fnJormoiian use checklist
Description 1 Qty. j Ea. l Total
1 ❑Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 It for each utility connection)
. ••CA;hGORY'OP CONSTRUCTION' . . SFR 0)bath 312.70
01-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath ` 500.32
❑Accessory building 0 Multi-family Each additional bathhitchen 25.02
0 Master builder 0 Other: Fire sprinkler(__sq.R.) Page 2
- ,., ' " ;oil SITE INFORMATION AND•LOCATION . ', , . ' Site utilities:
Job site address:/731/ sN ShidoW i rLIA I Sr Catch basin or area drain 18.96
City/State/ZIP:Titgard,OR 97224 Dryweli,leach lime,or trench drain 18.76
Footing drain(no.linear ft:_.) Page 2
Suit/bidgiapt.no.: 1 Project name: I2,Veor 10114X-e- N om'-- 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: I Page 2 _
Water service(no.linear ft.: I Page 2
Subdivision: Nom - Lot no.:/'28 Fixture or item:
Bacicaow preventer { 31.27
Tax map/parcel no.:
. DESCRIPTION OF WORK, • Backwater valve + 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/amp 25.02
.®:)ROPEHTV OWNER , j. 0 s�
TENANT Expanatank 12.51
Name:ADVL Land Holdings,LLC J. Fixture/ wee cap 25.02
Floor drain/floor sink/hub 25.02
Address:76001 Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
a; ®•A11'P;:ICANT C] CONTACI PERSON ceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical (` :S----) Paget
Primer 12.51
Contact name:Angela Grajeryskl 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 Tub/shower/shower pan 12.51
E-mail:Angeia.Grajewski@poiygonhomea.com Urinal 25.02
Water closet 25.02
CONZfItACTOR •
. Water heater 37.52
Business name:Maimedal Enterprises Inc. Waterr ' W 5629
p�P
V
Address;PO Box 207 Other 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)3244759 Fax:(503-)324-0580
Minimum permit fee: 872.50
CCB Lie.:102535 Plumbing Lie.no.:34-276P6 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: C � TOTAL PERMIT FEE
Print name:Carolina Malmedal 1 Date:04/2512016 j This permit application expires N a permit it not obtained within ISO days
1 after it bas been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:lialkfmsu4ahitestMU-0eaap*App.doc 10!03!09 4404616T(101O2/fAMIWEB)
A,
� V
City of Tigard
'I COMMUNITY DEVELOPMENT DEPARTMENT
T 1 cA R D Building Permit Review — Residential
Building Permit #: / 1t )/ 7 —000 3 r
Site Address: r ?cit S\ cCiYACAUN TrA t�
Project Name: Vim' Lot #: 1 j
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: iv)
. " Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
4IgLThree(3)copies of site plan , xisting •structures on site
.Site plan must be on 8-1/2"x 11"or 11 x 17"paper P. ootprint of new structure(including decks)with finished
'1 Drawn to scale(standard architect or engineer scale) floor elevations
A North arrow Utility locations(required for new,may apply for additions)
ite address,project or subdivision name and lot number N kLocation of wells/septic systems
Applicant information(name and phone number) Existing trees to be retained with drip line,and tree
f 4,ot dimensions and building setback dimensions %protection measures
of area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ►i Street names
Property corner elevations(2 foot contour lines if more than
4 foot differential)
XClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
ekr Land Use Case#: Pp(2-2ot5 ca;c0-5
Zoning: R_1 C PD1
Required Setbacks: Front Rear tO Side Street Side 1\y/‘ Garage j
Landscape Requirement:
VLot Coverage Maximum:
Building Height: Maximum Height tJ/A Actual Height •±7
X.Visual Clearance
'5k.Easements
Sensitive Lands: ❑ Yes ' No Type
X Urban Forestry Plan
.Conditions "Met"prior to issuance of building permit
Notes: C ;t liVlsC ,cv i j IX tS s�tCx✓Ir��P
Approved By Planning: 'Pry, 4 / Date:
Revisions (after Building Submitt.I only) Reviewer Date
Revision 1: ❑ Approved • Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPer mitRvw REs 091216.docx
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Building Permit Submittal
Original Submittal Date: `2,I,zo/7
Site Plans: # ,7
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: Planning La-Engineering , -Permit Coordinator 'Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: 'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
1;5-Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ' Date:
Engineering Review
__ Pone Slope at building pad: _ ....�,
Ceonditions "Met"prior to issuance of building permit ®1 /�
❑ 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: 11 j, Date: •-- 7--
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
pproved,NOT Released: 4/KI;ate: //7/1 �—
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:
)5•2SDC Fees Entered: Wash Co Trans Dev Tax: (es ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
'7613K to Issue Permit
pproved byPermit Coordinator: t //,/...-o Applic
I:\Building\Forms\BldgPermitRvw_RES_091216.docx
1r,
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City of Tigard
IN0
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: fl ( sv,i Shaelota 1 ra i I Si red A"-
Project Name: P-Ne,Y TOrreace No(ivieg+ Lot #: 122)
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.660.0701):
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.
Porch min. 5 ft. deepBalcony w/ access 2 Window Projection Vertical Wall Offset a
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
X ❑ ❑ ❑ ❑
2. Eyes on the street: a minimu of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: fi'=•'° , \a Yor`
3. Entrances:At least one entrance must meet both of the following standards: i ' i/� la.. u0��7
�'" Parallel to street,angle no more than 45° from street,
SI.Max. 8 ft. setback from longest street- facing wall
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes, all the following apply: k 25 sq.ft. min.
Ar One street facing entry ,► 12 ft.max.roof above floor of porch
, 5 ft. depth min. :1 30%min.porch roof coverage
4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
Covered porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
Wall offset min. 16 inches U Dormer min. 4 ft.wide
Woof 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 inches wide
❑ Accent siding min. 40%of street facade qUindow trim min. 2 1/2"wide by 5/8" deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35% or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
No closer to front or side lot line,than longest street-facing wall. ❑ Ye, No. If No (Check one):
, ❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ 12-foot-wide garage door ❑ 40%max. of street façade
*0%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: l` /' 46- Date I(44 7! —
I:\Building\Forms\B1dgPamitRvw_RES_RT_062216.docx