Permit (47) CITY MASTER PERMIT
s P' mOF TIGARD
, Permit#: MST2017-00183
g. ' COMMUNITY DEVELOPMENT
Date Issued: 09/21/2017
Tt G A Fk0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S106DB07500
Jurisdiction: Tigard
Site address: 17450 SW CLEMENTINE ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 75
Project: River Terrace Northwest, Lot 75
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1254 sf Basement: 735 sf Left: 3 Parking Spaces: 0
Height: 31 Bathrooms: 3 Second: 1655 sf Garage: 464 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors:
Total: 3644 sf Value: $438,503.56 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 Rain0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 2 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:
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: 6 201-400 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 Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3644
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660
STE 1
SCOTTSDALE,AZ 85258
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $35,774.59
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: i `OP Permittee Signature: ,. 1 qZ(4e-17ii-i
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.
i I',k( ' �a F x. Ste_
• Building Permit Application °, .�.. , , ,_, 7 v
Residential a FOR OFFICE I_SE ONLY
f k r i 1�3 iteceived r—f / Permit No' S vD!/}
City of Tlgard DateIBy: 5 / 4 l 7—
'� 13125 SW Hall Blvd.,Tigard,OR 97223 ,.h � � 4:y� ;�,� Plan Review � 1 -}� p��Pmt:�/��
I Pt
= Phone: 503.718.2439 Fax: 503.598.19 h r ''. 1 - d Date/By: 'j �7 J r` ✓"' / G
Date ReadylBy: Tuns: H See Page 2 for
T 1 G A F D Internet: Line: 503-or.go175 {,,t ' ''5 A' ..\'Notified/Method: ,17 Supplemental Information
Internet: www.tigard-or.gov . �Q.��'.��
- w...... _ � : Permit fees*are basedon„j .. _. .
®New construction ❑Demolition
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
work indicated on this application.
� „ .. Valuation: �,D. V�� � 17n3
8 ® 1-and 2-family dwelling IDCommercial/industrial
-11
Number of bedrooms:
❑Accessory building ❑Multi-family
0 Other Number of bathrooms:
e-% 0 Master builder ) 9- ) 0 O
LL.�s__ �.., � _ V _ I-� , � �l`�-�'�'���k �2"�� Total number of floors: Q
i^ �` ,ss k F�� Q � d E 4n'� Q,`. =e 4"° 4.r_n:S N.,, i,,+a.
■`I_ 6 v '� l,! e-,.i"ams`.,..r`.4..�,.1_....�s. .a..,.,/',,,,.
',r„r� ' , , New dwelling area: '�/Vl 1 quare feet
Job site address: 1� L
City/State/ZIP:Tigard,OR 97224 Garage/carport area: toll square feet
�' W Covered porch area: ^ V���
Suite/bldg./apt.no.: Project name:1�i,;.�� .6 • N l iW ;quare feet ,
Cross street/directions to job site: Deck area: , 60 square feet,as +
Other structure area: square feet/3C
Subdivision: `` ` Lot no.: Permit fees*are based on the value of the work performed.
v w Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
- .� �'' work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
-t a a 11 a tz Y 1 a_ . z w, k_t .. ,.." . Number of stories:
'�.. . ��=rte *� � <_ - , . _..
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:
r.� e' ' t �� _
S ➢ 5 � ' : 4
'_ tr, .i � '.,4 9 7:'-'W174;40
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)6954700 Fax::( ) . >- = - M` .,,-4 '..
crit .¢ tlrVi v ••,,,a'.4-
E-mail:Angela.Grajewski@polygonhomes.com Commercial and residential prescriptive installation of
g*arg gl _ k- _� ; roof-top mounted Photovoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:William Lyon Homes,Inc and fire department access,along with the 2010 Oregon
Address: 109 East 13th Street Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP:Vancouver WA 98660 and administrative fees): ,
d
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee):
CCB lic.:207247Total fee due upon application:
This permit application expires if a permit is not obtained
Authorized signature: al
�S ��' within 180 days after it has been accepted as complete.
r *Fee methodology set by Tri-County Building Industry
IPrint name: — Date: Service Board. '
I:1Building\Permits\BUP-RESPemutApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application`
I ()!{!i1 I( I I ,F r)\i 1
Received
City of Tigard r, , )I11 l t>�r r•
•
13125 SW Hall Blvd..Tigard.OR 9722j' PlanAerie+*° Other haunt:
503.7181439 Fax: 503.598_1960 rramH`:
Suri+ H See Pane I for
Inspection Line: 503.639.4175 !fie Ready BY Supplemental lafarmatioa
Internet: uww.tiprd-or.gov ...,'; NcxifcdMethod rrnnil bin
_ ' ' ... �,...c....7,0-+c jam+' �• •''''';%•";"7 1�.t vi-'''C';',�1,.. iw, �[fWy �;"
T,: ilii ••-
w -3,-4 , r ."`� ?'(,--':1.-.;'-,,* r " Mechanical permit fees*are based on the%slue of the wort:
®New construction 0 Addition/alterattonhpeptacerttent pert-mut I.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other
mechanical materials.
aterials equim>_nt,labo
r.ocrrcad.and morn.
:
WIT:'-',-4:41.-414 -4;S'r - �Ej4�� 4riF:�:o-; ���3 �� .x ,-t-r-,, , --:rrni,.7, - .�4-4
For sprt3al FirfortrraAat sae checklist
I-and 2-family d veiling 0 Commercial/industrial 0 Accessory building DescriptionQty Ea. Total
fold-family0 Master builder 0 Other
ds ':ar :, `a..a w� Hcatint=lcuolinE:
i'r r--" t xG: ,ttp/, P� * .'sem 1 ,4E 7 r1r ,} _. r e.,-_,-,± 46.75
�. =-t;.��r;.,:-,L.�f(�•.�r O fAe� .}�- Ait conditioni�
Job site address:
/7 Lico t J Si.) l�[3 1►e (\�e. k Furnace 100.000 BTU Cducas'•eaul 46.75
Furnace 100.0004 BTU(dtrctsjvemsl 54.91 I
City/State/ZIP:Tigard,OR 97224 Heat mann 61.06
Suite/bldg./apt.no.: ( Project name:R-t it r Texrace,N K- V3e s•1-D.«work 2332
llydronic hot water system 23.32
Cross street/directions to job site: Residential boiler(radiator or
hvdronic) 23.32
Unit heaters!fuel-type.not electric), 46.75
in-wall.in-duct,suspended.ete-
Fiue/vent for any of above I 2332 ,
Other. 23.32
Subdivision:p4vt(TGrraee,„ NOv1'Aujes}-- ' Lot n0-1c Other fuel appliance=
Water heater 2-23.32
Tax map/parcel no.: Gas fireplace/insert 3..39
t r.z 1 a..ra .i:5 t 4,a -r •t€ .ffi rte' - ', = 1
=�"..-; „„ . .,., .,. _ ... _ar-3 _. .. Flue vent for water heater or pas
fireplace 23.32
Log lighter(Res) 23.32
Wood/pellet syr 33.39
Wood fireplace/insert 23.32
Cltimaeyllinedbuehant 23.32
Otter 23.32
o-TiVi.- <r: l r:�i1 .:-1;: - e 'or - ' tk ` #
? 1-^ x ''t----. : n fl . .- Enviroameolai exhaust cud ventilation:
n W'L11,LLC Range hood(other kitchen 33.39
Name:Pnlygo equipment
Address:ln)Fast 13'1'Street Clothes dryer exhaust _I_ 33.39
Single-duct a haus=(bathrooms,
CitytStatcr7.IP:Vancouver,WA 98660 lotto compartments.utility rooms) 23,32
Phone: Fax ( ) -., AI
t oro lsp
acC fans
2332
Y ; ,� c � ==-_,73,...2---,%r-.....j- , . ; € Other23.32
s pFt,,€ �� a-,` , - �,(, ',h7 .2 rte '.�.,
Business name:Polygon WLH,LLC Fuel plpinC.
514.15 for fust four.$4.03 for each additional
Furnace.etc. � '
Contort nary:�lJ'inj �oGas heat pump
Address:109 East 13th Street Wallfsdspended/unit heater
CityiStatefZiP:Vancouver,WA 98660 Water heater I
Phone:(360) I Fax::(360)693-4442 Fireplace I
695-7700Range
E-mail:.4 A l t...`"14,_P 4°4,—1-�►n
1 Barbecue
' 0 _.44-44,*,ra„ --._ dnxr(fins)
Business namOther
e.Apex Air LLC Rs r', r i(r; _.t -;t -�
Subtotal
Address:111004 NE 72'4 Ave Minimum permit fix(u subtotal
City/StatrfZlP Vancouver,WA 98686 Plea review(25%of permit fee)
Phone:(36013424109 I Fax:(360)326-1769 Stale surcharge(12%of permit fee)
TOTAL PERMIT FEE
CCB Ifo 20303# This permit application expire*fid permit(s not obtrriant within ISO
days afterit has he=n acceptedas complete.
+ Fee methodology us byTri-County Building Industry Semi=Band
Authorized
,,si�gr�rat—ur-e:
IPrint name: i fe / I Date: 4,1'1,,it-- I
!Yluild7ajtJ4rndislMLT.Permithr+p 04d113 dee
44 461Trriu icon tai)
M
EIectrical Permit Application FOR OFFICE LSE 0\1,1
City o,f Tigard a�j y� I
, ed Puna 6:
II 13125 SW Hall Blvd.,Tigard,OR 97223, ,. Plan Review Related Permit Y:
Phone: 503.718.2439 Fax 503.59&.1§6( '. 2 Aae/B.
Inspection Line: 503.639.4175 Ready Da±e'0y hurts: El Sea Paget for
T1GAitD j� " \ \ `, ` , '.atofifred/Matbod: Supplemental Information
Internet wwtvttgarCl or.goV i,T
7 ?.S- _3 ' ,4;�__ 6v''� , ate:+. 11 . -.
_ � -,'�, ..., te. a a) � �__-'���_ .. �. - >�
®New construction 0 Addition/alteration/replacement Please check all that apply(submit I We of plans watems checked):
D Service or feeder 400 amps or more 0 Building over three strides.
Demolition Other: where the available fault current 10 Marinas and boatyards.
.7f,:---cr.,-,t.--f-f:', -.54- C 5 t4k-3 L al: ?i0ti'�t_ 11J 0)1?A '-- `-' '=-•1' =needs 10,000 amps at 150 volts or Q Floating buildings.
t t 1-and 2-family dwelling0 Cofnmercialfuidtistrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-„se agricultural
amps for all other installations. baidurgs.-
D Multi-family 0 Master builder 0 Other: ❑Fite pump. CI Installation of 150 KVAor
-. a Wo n tc,,-,yl •-z;q ,;*v.,- a-,,rec .,,,.-..-::-;,-.r;- r i
DEergaocr Weer& lar i s
hy derived Addition of new motor load of sY►eo�
Job#: Job site address:114 • SV" Hme, h�he S�
100HP or more. 0"A• B"•1-2-K-3"
0 Six or more residential units. occupancy.
City/State/71P:Tigard,OR 97224 ❑Bealtb-Dare facilities. ❑Reurationad vehicle pairs.
❑Hazardous locations. 0 Supply voltage for marc than
SuitrJbldgJapt#: ( Project name: ►vir�i'r-�rYbtte�� uJer600 voltsnominal.
I 1 I s 0 Savard or loader ns.amps or more.
Cross street/directions to job site. •:,,,3:---i",,,..4,- ,'Wit':•J ' a I4V-t'f _
.
Daarptlon I Qty. Each Total
•
New residential single-or multi-family dwelling unit.
Subdivision: MVor T( ro& tjoe (A}(,f 4- I Lot#:-lcc Includes attached garage. 1
I,000 sq.R or less t 168.54 4 I
Tax map/parcel# pa.add'l 500 sq33.92
�'
-, + r C,t f y p �t( .{f g �_ Limited wer83 acsidrntitportion 75.00
9 1
2
(with above sq.R) _
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
�1 ,,--r---,-,a' '7i' k` '` -' ` "`:
-, s .tlt � sr ----.7-',"E-1 +t' < _ =4i Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
201 amps to 400 amps 13336 2 -
Atidress:7600 E Doubletree Ranch Road 401 amps m 600 amps 20034 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 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 lessI 5936 1
intended for sale,lease,rant,or exchange,according to ORB 447,449,670,and 701. 201 amps to 400 amps 1 125.08 1 2
Owner signature:
Date: 401 amps to 599 amps 168.54 2
�r x Y r}f e+o,It>t ej ..-145,,,,,.__. ..„,...7.15-_,,,,,, Branch circuits-11 t;alteration,or extension,per panel
..__c,....„ > G aa� t ) A.Pec for branch circuits wfrh
Business name:William Lyon Homes,Inc. above service orfceder fee, 7A2 2
each branch circuit
Contact name:tivionokok pc B.Fee for branch circuits wirhmd
Y�• service or feeder fee,fust
18 2
Addresr.109 East 13th Street .. branch civet it 56.
City/Statt/ZIP:Vancouver,WA 98660 Each add')Manch circuit 7.42 2
Mlacelltneous(service or feeder not included)
Phone:(360)695-7700 ' ' ' I Fax::(360)693-4442 Each manufactured or modular 67.84. 2
dwelling,service and/or feeder
Entail. / G s hi Al, /f I I s R_Al
Reconnect�y 67,84 2
_ k.e CI t . C. a t 1----,•37-7-----"--7'77:7-', - Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
4,:. Sigml cirwh(s)or limited-energy See Page 2 2
Address:6101 NE St Johns Rd panel,alteration,or extension. 0
Each additional Inspection over allowable in any of the above
City/State/ZIP:Vancouver WA 98661Additional inspection(1 lir min) 6625/hr
Phone:(253)320-1657 Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) • 78.18/hr
Email:hdaaials®gweusa.comInspections for winch no fee as 90.00/hr
CCB Lie.: C1158 Electrical Lic.: 208174 Suprv.Lie.: 4496S specifca(h'listed CA hr min
.t .'' ti„i pyJ(e..�if::C`?yCt4.11,'1.,'...,<)'.' 4.7-5;'..14.,!..---?:'''
-:-;
Suprv.Electrician signature,required: C / p; Suhwtal:
Print mune: Joan P Albert •- Date:(ef/`-4/26'/2016 0 Plan Review Required(25%of permit fee):
<----- State surcharge(12%ofpetmit feet
.-1S-.:',,y. - -- -�, TOTAL PERMIT FEE:
;1111'..Y:-: Authorized signature - _ This permit application expires ifa permit is not obtained within 180
:.!:.;
-�"•'; Print name: Bill Daniels Date: 4/26/2Q16 days after it has been accepted as complete.
Humber of inspections allowed per permit_
;dr3.1.!;la?°. MlW61ST(1l/oSACOM/WEB
„Z.y..,;;; iauadinsTeno'd+1tiLC PamttApp HCR EREdoc flay 0677/2015
4
Plumbing Permit Application
Building Fixtures ;n,
{i Z
City of Tigard D Received Pamir No.:
• 13125 SW Halt Blvd.,Tigard,OR 97223 a Play Review Other Ferrttit No
- Phone: 503.718.2439 Fax: 503/.59„8,1960 ,t t, DatrJBY.
Line: 503 639 4175 Date Ready$y, heir: H See Page 2 for
1 , t) Internet Inspection www ttgard or gov Notified/Method: S piameotal baf adios
r. a _ '- . r P Zy
7t- t t ( p�" ` `
te ~ ,, ="nT a:�t, - 6 `d.--* . ,-'---1v . � ... =,:-v,2 ., . �+.,.__i--+-xa=- -
For special inform:don use checklist
- Newconstraction 1 Demolition Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
, *- C"dc-- `c t tir€w eyc c r ' -;3> �' ,^,� ' SFR(1)bath 312.70
• 2 u e 4 ii k-.,,r }5� `, ,..3 43738
= SFR(2)bath
0 1 and 2-family dwelling il Commercial/industrial SFR(3)bath ' 500.32
0 Accessory biding ❑Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other. Fire sprinkler( sq.R.) Page 2
-'t`::117--",,,i7 'a a F -e ``r v;i t 1 .= 7111�.,; ` ; #
-;- F Site utilities:
5 i 3'Y'---t,..;.,-."-.2•-.,-,i-- , `^� Catch basin or area drain 18.76
Job site address: n, W C)Y V C.
(/Y1Q,Ydl(l,P.S Drywall,leach line,or trench dram 18.76
City/State/ZIN Tigard,OR.97224 Footing drain(no.Iinear it:: ) Page 2 1
Suitt:AddgJapt.no.: I Projectnamegltge/crGrrace. Npt({1rit0401` Manufactured borne utilities 50.03
Cross atrset/direc ions to job site:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear f:_) Page 2
Storm sewer(no.linear ft.:. ) Page 2
_Water service(no.Iinear ft.: ) Page 2
Subdivision:14/Gr 1 - .ct fa ac Vajef'f- I Lot no.: S' Fixture or item:
Backfowpruvcnter I 3127
Tax map/parcel Ito.: Bachomier nal 12.51
3
i`'+-+ t`a tJ-.'A e N/ � � --.' rt 25.02
_ � ' _.. • �-' -- .. �. i .;�� r `Clothes washer
Dlshviasber 25.02
Drinking fouOtain 25.02
Ejectors/sump 25.02
_ Ei:paasiaa tan& 12.51
c�a ',y °1 n, C:'-`-1.-;',.i.- r:r. •').,.”2,3,i- Erse dsew&csp 25.02
Names ADVL Land geldings,LLC Floor drain/tioor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal . 25.02 ,
City/Staic/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
'
Phone (602)694-4031 Fax ( ) Ice maker 12.51 r 4 ` ' "ts r„ .{ ' 4.13....-,-1`'�,f �" tor/grtase trap
22.5
1
,::--,,,;•- ., 1 '{}� .e',.1 -xis r ir ,. , J.r..,5 rMedicalgas{vatue:S ) Page
2
Business name:MR=Lyon Homes,Inc Primer 12.51
c-ontant P+j'GA (�VC
Roof drain(commercial) 12.51
Address:109 East Streetv. r
City/State/ZIP:Vancouver,WA 98660 SinkbbashlAavaiory LA-Gt. t/ 25.02
Solar balm(potable water) f 62-54
Phone {360)60470l Fare:(360)693-4442 Tub/shower/shower pas 12.51
25.02
Urinal
2431211;; .A b ,' . 11 1,E it ,-_ . ..-:7;. • a Tit
•k Water closet 25.02
� : r t-
Tai- . efRe .,:�� ._": 5-1.4 .firWater bnr37.52
Busidesiname:° G3 4, ' - 12l g Waterpiping/DWY 56.29
abo,
Other 25.02
Adm; p.d t �'oCt n^`''i'.vA�i Subtotal
Citiy/Siebe/ZlP: 5' e'�t act, 11131
Minimum permit fee: S72.50al
Rhine:;( �'! . ' 1411 Fax:{ 1 V'-141-1!J d ' Plan review(25%of permit fee)
CCIl Lie.: ff Plumbing Lie.ao.1b (�. State surcharge(12%of permit fee)
lt��
Authorized signature. Itiatt, TOTAL PPRWT FEE
/� s g / This permit application expires if a permit is pot abtatned within 150 days
Print n8naet. S. �,u'L +w I�e� ! Dei -,]l7-I[7 *iter it has been smtpted as complete.
� *Foe methodology set by Tri-Gowdy Betiding Industry Service Board.
1. .doe 10/01/09 44O.6I6Tt1e 2/LOM/P'F2i)
Plumbing Permit ApplicatifiECEIVEn
.,)
Building Fixtures
. City of Tigard MAY 1 7 2017 Rweived
Dewey.: PenitITNwf
,..
--_--• •' 13125 SWHallBlvd..,Tigard,OR 97.'gl• ..„, .,....„.,A,
, Plni Review.
N ... , phone; ko„.718,2109 Fax: 9$35gupsor OF i i Lamm.) .... r: oirceParnit 14::
-- ltayectiOn Line: 503439.4175 BUILDING DIVISION Dec RiadY/SY:. Jerk: fa Set 14*2 for
Internet Www.iigaid-or.gov .gottfredtmethew , •r• -••-•• Information .
•,. -.7'.:'-:•-"7:1:-..,,,',.:::.,F..!- -:::::,.--7,..*71.--7-W,,. ..,-4:-',- ,--,:F-:.':;':-Nr:;',Ir.-,-5,",zir.::.,,,,,.-:.QtT, !4,:ii:-..-;.z-..,.1:,,-..,A.i ,'AV'‘,.:." .,.7f.•: :'....;_;•..gly.t4:417,:elt.,'',`;:0;:.;tntit.:7;:i)t-IV.:Pq-1::: trAli4'4;j7.-*Sn.;j...
Air epeciel information Wee eheeldist
12 New critgfruction ,
•
ill Demolition Description I Ow. I Bs. I Total
0 A.ddition/altetatltintreplarattraent ID Other New 1-7.4atidly diielNegs(includes 100 ft for each utility connection)
312.70SFR(1)bath
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437.78
1,wad.2-frunitY dwelling IIII cornmereialruidistrial SFR(3)bat4. 500.32
El Aceessory building . .. 0 lkohilti,family Each additional baddkitchen 25.02
0 Master builder 0 Other. . , LFire egad'.der•Lsq.ft) Page 2
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. et .... _.. Odell basin or west drain 18.76
Job site address: P NM f..etrif-nll II NC '''‘
Drywall,leach line,or tray%drain 18.76
Chy/StatetEllit Tigard,OR 97224 - - Footing drain*.linear It:_j Page 2
SI4POWEAPt no.: • I Prrd°ct Itaraq4-i V..er 7Firraff Methwcsi Manufactured Nene*glides . 50.03
Cress strect/directiOnstp job site:. .Manholes . 18.76
• Rain drain connector 18:76
....... .
.. . .. , .. Sanitary atiWer(no.linear It.:'___._) Page 2
...
Storm sewer(no,linear it: ) Page 2
. . .. . . . •• . Water Service(no.linear It:____) Page 2
Fixture or item:
. .Subdbrisiq 124Ver"if rratt. Nornvotri- 1 r-t.itnolc _ .
1 Backflow premier 31.27
littiniVparechati.: , , . • _. .".
• • - -.--- ••..,•- = Backwater valve. 12.51
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1/rif.11 •A . o. . 0461.1 • LI-Cr -+ea fy- . . .DIA*6.1,ei . . .. . _ 25.02
, Drinking fountain 25132
'W•Ftetoridatunp 25.02
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• Fismre/sewer cap 25.02
'•
Name:MAI Leanilialdings,LLC
Fiber drain/110er alakilmib 25.02
Addreas:-7600 S.Dtiabletzie Ranch Road Garbage disposal. 25.02
City/StateilIP:teettadatei AZ 85258 Hose bib 25.02
. . ... -
l*C(6P)044011, Fax:i j Ice maker 12,51
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Medical gas(value:S ._) Page 2 .
,Business name:Nifillimnlywa Owes,Ilse PinPr 12.51
Contact name: WI tAq6krilfICKX- Itoot4raig(ParaMeniat) 12.51
•Addre)W.199 East 13th Street Sink/theft/lavatory 25.02 ,.
CR-Orate/21h Vancouver,WA 98660 Solar units(pow*water) 62.54
.11100;.000 6954746 Far:(360)693-4442 1121a/ibower/slower pan 12.51
a. Urinal 25,02_
311°Wi..._• 14,1 g4...._,. .4
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• -r-i.' i
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*IRO': .0, 6:,ogi Of A Other . 25.02
.00.1s44411: ST r e 44,4 art. 41151 . . sabtoto
_
krudwunt pennit fee; S72.50
1*.nel(ertd1.-,-844-' net I Fax:(ill iv--'191-11-PD - Platt review.(25%of permit SW)
•
CCB.l.4e. i:g1371D-. 1 PintOhig•Lie.wii.it .1101 . State trircharge(12%00010 h°)
Authorized sisn.Oure: ii .. • - . • 'TI)TAL r.ggi4T.Fg
• • • ." if a is riot abisivithiefibodays
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City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: 1/p CT;z0/7.-'0(�(��
Site Address: ii 145C s CA-E ,Et ' E 51.
Project Name: V-N ' T42rn(occ, N)1;) Lot #: 15
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review 9A97/7 /2 vi1 i o n✓S
Proposal: ne,,'ti.7 sf-2 Si /01:47‘i cd/EZL= ,9 7G'/ ic
[ Verify site address/suite#exists and active in permit ystem.
IR/River Terrace Neighborhood: ❑ No 5Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Rhree(3)copies of site plan £%` xisting structures on site
[ Site plan must be on 8-1/2"x 11"or 11 x 17"paper C Footprint of new structure(including decks)with finished
YDrawn to scale(standard architect or engineer scale) fl or elevations
'>orth arrow tility locations&easements (required for new and additions)
®Site address,project or subdivision name and lot number Sidewalk/driveway approach
pplicant information(name and phone number) ►P:ocation of wells/septic systems
4.4 of dimensions and building setback dimensions OVExisting trees to be retained with drip line,and tree
1!k.care footage of buildings to be demolished protection measures
J Lot area,building coverage area,percentage of coverage and treet tree size,type and location
iimpervious area(applicable if R-7,R-12,R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than Itorm water quality facility required if>1,000 sf of
4 foot differential) impervious area is created or replaced.
Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
V(Public Facilities Improvement(PFI) Permit: � A5-''(Xt12
Required: ❑ Yes,applicant was notified ❑ No Applied For: E Yes ❑ No,stop intake
V Land Use Case#: PO12-10i 5 —00Cor)
Er Zoning:
Front Rear Side Street Side F> Garage Required Setbacks: '� � �� ,� �� g 7C"i
,,�Landscape Requirement: 2°
LJ/Lot Coverage Maximum: 00
0/0
irlA Building Height: Maximum Height ', NiA Actual Height
I. Visual Clearance
1
2f/Sensitive Lands: Yes ❑ No Type LPw�;lr Q(\V Q. kic ,
PEri Urban Forestry Plan
V.Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: /� a , 3/,/ Date: 5/7 Z/ --)
Revisions (after Building Submittal only) Reviewer Date
Revision 1: / Approved ❑ Not Approved 11 A".�. i^ q! 1C7 1 1 1
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_051617.docx
i
Building Permit Submittal
Original Submittal Date: R,/kj l
7
Site Plans: #
Building Plans: # _I
Building Permit#: [ "Enter building permit#above.
Workflow Routing: {�•Planning1 Engineering Xt1 Permit Coordinator_„...-- Building
Workflow Sign-off: j2 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.
j7 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,9Date: S7j_,2-/,
Engineering Review f
< a Slope at building pad: / A , , 7
(di Conditions "Met"prior to issuance of building permit .! '' ,' --6
❑ 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
/;.r \ NOT Approved�by ] ngineer>< g: /4/ P Date: " „ ._ /
/
Notes•, - _, ' 1 .. (-i' -,7";;/' ..j , /
Approved by Engineering: Date:
Revisions (after uilding Submittal only) Review Date
Revision 1: pproved ❑ Not Approved 9 f
Revision 2: ❑ Approved CI Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit p
yB'Approved,NOT Released: ZZ--Vc`S7 *crl--, Date: s/ZC/ --.-
Notes: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:
7
SDC Fees Entered: Wash Co Trans Dev Tax: MAP es CI N/A
Tigard Trans SDC: %' Yes ❑ N/A
Parks SDC: yo Yes ❑ N/A
LIDA ❑ Yes N/A /lil /3----
K to Issue Permit
Approved by Permit Coordinator: Date: "T 47----
I:\Building\Forms\BldgPermitRvw_RES_051617.docx
7----I:\Building\Forms\BldgPermitRvw_RES_051617.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
II
T 1 GA It o River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 11'456 stO c &i 3— r
Project Name: Lot #: 7c
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.660.070.1.):
Is the project subject to the plan district design standards? ❑ Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 ft. deepBalcony w/access 2 Window Projection Vertical Wall Offset a
Gabled dormer
ft.deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide
❑ 12/ ❑
2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: le . r 6,,,
3. Entrances:At least one entrance must meet both of the folloying standards:
L"J Max. 8 ft. setback from longest street- facing wall
'Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: 'Yes ❑ No /,/
If yes,all the following apply: 2°725 sq.ft. min.
E(One street facing entry Er12 ft.max. roof above floor of porch
C,]�5 ft. depth min. V0%min.porch roof coverage
4. Detailed Design:All buildings shall include a min. of five of�iie 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
,,/Wall offset min. 16 inches ❑pormer min. 4 ft.wide
1.�Roof eave min. 12 inch projection Er 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
111 Accent siding min. 40%of street façade Window 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. Lf 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.
❑ 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 LK 40%max. of street façade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: X/ *0'4 i, Date: _____614.177_
I:\Building\Forms\B1dgPermitRvw REs RT o62216.docx