Permit Support Document (20) CITY OF TIGARDe MASTER PERMIT
it COMMUNITY DEVELOPMENT ; A®1 Permit#: MST2017-00388
TIGGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2017
Parcel: 2S106DA04800
Jurisdiction: Tigard
Site address: 16854 SW FRIENDLY LN
Subdivision: RIVER TERRACE EAST Lot: 48
Project: River Terrace East, Lot 48
Project Description: New SF. 12/5/2017: REPRINT permit for reversed plans.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 1248 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1666 sf Garage: 464 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 2914 sf Value: $353,724.58 Rear: 3
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: 0 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: 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 2914
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: $34,035.99
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. f
"'� _ g eVAr /`'r/C' Gn'a't!
Issued By: ' Permittee Si nature:
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.
11
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT 1111
Permit#: MST2017-00388
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2017
Parcel: 2S 106DA04800
Jurisdiction: Tigard
Site address: 16854 SW FRIENDLY LN
Subdivision: RIVER TERRACE EAST Lot: 48
Project: River Terrace East, Lot 48
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1248 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1666 sf Garage: 464 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 2914 sf Value: $353,724.58 Rear: 3
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: 0 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: 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 2914
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: $33,945.99
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 R 9 (01-1090. 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: - // `�r Permittee Signature: e,7AI (/P7 A l %%t!All
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.
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III •
Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
NOV 2 0 2017
FROM: Nichole Thorpe CITY OF TIGARD
BUILDING DIVISION
COMPANY: Polygon Northwest
PHONE: 360-989-4204 By: 6, .
RE: 16854 SW Friendly Lane MST2017-00388
(Site Address) (Permit Number)
River Terrace East Lot 48
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: j; Description: Copies:'' Description:
0 Additional set(s) of plans. 3 Revisions: Plan Sets
0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 0 Engineer's calculations.
0 Other(explain):
REMARKS: Please pay fees owed with Trust Account.
The original plans were wrong. They were the non reversed.
FOR OFFICE USE ONLY
Routed to Permit Technician: Date:
) a7 — 1-2 Initials:
Fees Due: ❑ Yes ItNo Fee Description: Amount Due:
/4):64 ,0694/-9"-,1 /2"e Circ ) $ 2e , cr)
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No ❑ Done
Applicant Notified: Date: Initials:
I:\BuildingTorms\TransmittalLetter-Revisions.doc 05/25/2012
'`Building Permit Application
L. 0 7 �'
� 4t
® � t & FOR OFFICE L SE O\Ll
V Received Permit No
City of Tigard JUN ,,i, Dateiny: f O If)//? �'Lj<
pop
_a)3'Yf''
IN . 13125hnSW Hall Blvd.,Tigard,OR 98223.19 PlC Dae/By: el �6— 17 -4 Other Permit:CG a` /, .DORT-
Phone: 503.718.2439 Fax: 503.598.1960 (1 r W(���`D Date/
By:
Date Rea By: Juris: H See Page 2 for
j t ,I.�� Inspection Line: 503.639.4175 B(�(Li�((`v DIVISION
Internet www.tigard-or.gov Notified/Method: Supplemental Information
PP
M� sl ❑Demolition Permit fees*are based on the value of the work performed.
®New construction 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.
t'4.••- r ':-`.�. ','s-s r 1:a � ,19 ' ,;� POS At .:��, " a ►y
s -,Y ,,..... ,. .: , tz1'4'.*' . ' Valuation: $ vyr (",•�T/7
® 1-and 2-family dwelling 0 Commercial/industrial 1 ...3,t-31 7�-
Number of bedrooms: `
❑Accessory building 0 Multi-family
❑Master builder 0
Other Number of bathrooms: 3
• 3 tx•• s v 'Csl s t/ ,g 3i r 9 Ef- ,a Total number of floors 3 378
Job site address: � � so Fri cI a I Lane, New dwelling area: 42.9 14 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 40
l square feet
Suite/bldgJapt.no.: Project name:River TerraceEast Covered porch area: I4')quare feet j ,�6
Cross street/directions to job site:
p , d a1 7 1 square feet ayg
Other structure area: square feet
Subdivision:River Terrace East Lot no.:4e, 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
work indicated on this application.
, ms Valuation: $
Existing building area: square feet
New building area: square feet
< Wf # g ; q Number of stories:
Name:ADVL L nd Holdings, z
LLC Type of construction:
Address:7600 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:Nichole Thorpe 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 I Fax::( ) a
Email Nichole Thorpe "� "` � " ,.� �t
,, ', - Commercial and residential prescriptive installation of
, : `'� , . �1• 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 $180.00
City/State/ZIP:Vancouver WA 98660 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
This permit application expires if a permit is not obtained
Authorized signature: 047 .-- *
within 180 days after it has been accepted as complete.
Date:06/16/2017 Fee methodology set by Tri-County Building Industry
-int name:Nichole Thorpe Service Board.
iding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
.,
-. . .
Afeehattical.Penhit Applicathiti ' FOR 011:1(fr. 1_SE(/N1.1.
City of Tigard
- I beieftly:
,., f 1
- -'' 1 i; 1 Pci/1131Ntk"z/A/Sreai 7-oolea?.
.• I 3125.SW Plait Blvd.,Tigard.OR.9724 •?t t & - plan Review .
- .
. -
Phone: 503 118.2439:F ux:,--1015981960
,. Other.Permit;
...1 1 6 A It D 'Itispectiort Line: $03.639.4 115 4--',.'1'''",‘-' ''...',!.';.r."..Il("4. ,‘si't.''.:•-) -tip'4-lat:tali(ytily,
-,, ii * -_ -
Intarat WWW.Sigifid.OrrgOi
'-NotifiedIdetliod-. repple:ent)121:frail:Indian
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•
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• •
- -- - - '
Mechanical permit fees*are'based on the value of the work
0-' New construction El Additiontihoratiorfireplacomefft. performed...Indicate the value(rounded to the nearest dollar)dell
13 Demolition 0 Other: ',ferniest nutteria. ls.equip- meta,labor.overhead.and Profit
met-
. .........• . ..„ . ..,......... :. . ,,.,..... ...„ . _ . ...,..... . .,.,... •--•. .. .- .. ., r" " Value:$
:....L.; -•,.-,:#...--•••:•i..,••, :-...-...-.•-:.•-•- .C4 -7.— -..... 7...-,....-- ..---:,---.----'''.--'..''-:'- ---...'...-..•-•--. ''.-- '':',2,,,,,11.-Ff.4.,..g?•$IPPi..0.4:Kq.1.1PMPF,F-./..4.MXtVlk..:FXM...!J•:•':- ..;. .
and 2-family dwelling 0 CornmerciaVinaustrial 0 Accessory building For special informution use eh ea4list.
., ..
Witiiii- MPy. 0 Master builder 0 OtItcr: Description _Qty. I Ea. Tot
al
.--.•--1•..4--.--."-:---c--..- ..' ' 1T O ilirA 1 'Arco LOCA1101's .-,--,-,...---...:1,.,... ..:.. Itooltflt
- ''
Air conditioning - 46.75
JO iti,address.' ki922Cial 5k0 51h tnCtill 1--.44f\ . .
Furnace 100,000 BTU nittetskents) , 46.75 ,
City/Stale/ZIP•'Figfirdt.OR 91224-
..... . . _.„ Foulke•100.00(0.4n(deers/v=0 54.9'1
tiiiiehidgii,,r,ito,:, Heat pump 61.06
Pril°6t.hathe: - .. . - 23.32
Cross street/directions to job site: flydrortic hor water system
. . , . . .
Resideaati1 boiler(radiator or
h3xironkl ' . . 23.32
' .23.32
Unit heaters(fuel-type,not electric),
.. . „... .. . ... in-Wail.iAuctsuspended.etc.
46.73
•
Pt cut for any of above , 1 23.32
.
•
SOther. _2332.
ubdivision:. iv
giVe Te.tntrc:. ec,c 17-. Lot tat:Liii5
-- Oilier filet appflantai .. . _ .
Tax map/parcel no.:
Water heater _ _ ._ 23.32
.;:..,c,i.•,•.','..-,,:-.:,?•-;!.•.,,'...,-..i..,!,,'.--•,,‘....,2„-F..,',.:,. ..,st.:.-i ..-Y...:,-t .',..,DESCItlitrdfiN14ir.v.NVOitION',;;Y'll'i'4;(•'',.:),•±',4;f;;A*0-4?-::`:f4:'!.::':,-:::: . Gas plSCCIjflSCftI 3339
...
Flue vent for water:heater or gas
IASI-LOD•••1r)31.jEla) (Imola= 2132
Log lifghter(gas) 23,32
Woo pellet stove • 33.39
Wood facolacchnsert 23)2
Cbitnneyiliner/fInelverit 2332 •
2 .
...i•'-;.:.,..:..:iA.1.i:4 ..1.,..II.r,.)!....?qr-.0.)*04 ;340
'.i.,i,:r;i;!•::::...: .r..;;;;.1.1*"af..,r-6441i1r.0::•.•ii:f..4Other 233
.f:ffi'.::..'-'47.',!..::-4:c • Eiwiromeeittmhtn,i And„notation:
Nathe:'PI"D V L .L-Zitirt (ll))cjiry45 ,LLC, . Range lloOdfothor kitchen- ,.
f equipment 1 33.39
Addlesa::•1 to OD. 6 °DIA/Lott:114e. (Z<Lhck P-4n4 Clothes dryer eXhaust I 33.39
City/S •ized:41P: • ;,.-J L A,• rx--,c.a . Singledtzt exhaust thadrooms,
i■ fi.w.e./..F-tn.1.... 1:)- L-:')ki •
toilet compartments.uulity rooms) , 2332'
Phone: 1 i 01_ (I/( H. 463 ) Fox:( ). • AnicknotisPace fans 23.32
:•: ....'.;-. .."....:-..-1';-C-0:4 -*.j:4:4' . .:1.::::,i -!:::1:::.1!i:::::: :,..,:','7:4;'. :E .itli.tt:$)iic:,--4:0:i::#.:::titso* -. .. :-..:':.:: Other 2132
piping:
Business name '110 i l•i i avyl VAiny tki-INci vS Mr\C-- $14.15 far 16t four 54.03 far each additional
,.Fuel, . .. , ...
Contact name:. k .% ,..At I A q,c....., Furnace„etc, I
1 Gas heat pump_
Address: IL \ a 0#?„ • . II
,
Walltsuspendeilittnii heater
City/State/ZIP:Vancouver,WA 98660
Phone:(360)695.7700 Fax:,:(360)6934442 V4htiheater
tt.
Fireplace 1
• . Range
6411nik 1 ' 4..' i li ib !Lit Pit .oiliniyyxs czno Barheette
•-•.!;„.....,74.:.,i...;.,..,',,„. ..„.,n :.5....4....,...2,•..p.,:t.,,;:h.,. .!,,fit,.,..4,-.-,...4. , -, ;..---...50;it,:,-.3...-7,.:i..""J.-.7:t_r_ItIrc.,T.;.,,..r-t'ii-',.:'''('-;:T.:'1"-''1.,,-4:-:-. :.' Cknhcs drYor(gra)
Other:
Business mum Alien Air LLC •
_ . ...., ..,..,.._-... ,. ..., • . . ...... .... , ,
... •
• ' ICALPERMIT LES''''..-"-'•:,------.',
.. ,-',:-:.,:_:::.z, 4Pf.i.VN
Address;18004 NE 12na Ave
Subtotal
•
City/State/ZIP:Vancottver,WA 98686 Minimum()emit le(S90,00) _.
,
Plan review 125%of pennit fee)
Phone:(360)3424109 Fax:(360)326-1769
, State surcharge(12%of permit fee)
... .. .. . _. ,
CCB lie.:203034 TOTAL PER.1,V11T FEE
Authorized Signature' • - ' °:VisFeepeartemthodoil IdP'*1:51:afirt.tetr"tfYitr;btri.Cottarislietn't2ty1c°173n-Pmilsedand tpasklat ic 6:h I f+t monbpiariSnuse:rrimet'iti:Boarin Id"
I Print namer170 Apt . Date: 4./1. ...
4
,........„.,..........,...„..A.,,p.„,13 duo 444-w17()liTtectrAlwrzi
Electrical Permit Applicatiohf° , O•:,
roiz OFFICE USE oir[.Y.
Ci o Tigard �, Received
• r i
13125 S Hall Blvd.,Tigard,OR 972 l t
Date/13 : ,
:) II Plan Review
Phone: 503.718.2439 Fax: 503.598 1960s .,.{ t Date/B Related Permit It:
TIGARD Inspection Line: 503.639.4175 x jF y t s 4 4 '�'` ReadyDate/By: holy 10 SeePage2for
Internet www.tigard-or.gov , %-*t;,^ NotiEedMehod:
•
Supplemental Information
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/uoms checked):
0 Service or feeder 400 amps or more 0 Building over three stdries.
El Demolition ❑011ier:
. z -:r
where the available fault current ❑Marinas and boatyards.asl�G qt.,uE-,, ��?1���ii h`c4�. -J 8.�: `�2. s�.t,a � r
"coeds 10,000 amps at 150 volts or J;(Floating buildings.
®1-and 2-family dwelling 0 Commercial/iridtistrial 0 Accessory building less to mound.or exceeds 14,000 0 commercial-use agricultural
ID Multi-family ❑Mester builder 0 Other amps far all other installations. buildings.•
.sm ��� o :. � d i�• e o z • ❑Fire pump. ❑installation of I50 KVA or
: .174-""11°
11 , a ,P Fa v, t @ y a , "? '1.:: 'TM ❑Bmergeocy system. larger separately derived
Job#: Job site address k// i C's' ❑Addition of naw motor load of system.
0654 ,4 �i enail LQ Ine . 100lP or more. 0•'A,•,•E,•,"1-2;X13,',
City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Reoreationat vehicle pants.
Suite/bldg./apt,#: I Project name:gives- T ❑
-�*1 ❑Hazardous locations. it Supply voltage fur more tbau
�"� Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: -; _ a _
DescriptionI
DIY. t Each Total R
New residential single-or multi-family dwelling unit.
Subdivision: tf Lot#:�g Includes attached garage.
r'��� T��1'YGtc�- �u.S'"
Tax map/parcel#: 1.000 sq.@ or less I 168.54 4
--•-•:,V----.-,''n .i- - ?t<I.4�t ATAT: .� i 1;4:x., s,4• rLimited ener sq. i../ 33.921
Ea /
�/�(+ ).s`)j� tl-�7�t,,"�? energy residential
J v i J l L/V'7 Ck es3 (with,above sq.ft) 75.fl0 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
��t" --DCi�,J `i..�+ ��� !, ?� ?1''a�. 5 ;, -.�.7�,-fw-d aE? 1-°t. r =*s�„<a`� Renewable Energy 0 SeePage 2
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 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 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 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 amps to 599 amps 168.54 2
it; t. c€ illItZt€ 2 T,„;:t -fes ,, Di- pk 4i c �:7 j y ,, 1:, Branch circuits-new,alteration,or extension,per panel
'".'" A,1 ea for breach quits with
Business name:William Lyon Homes,Inc. above servranchicecircuit or feeder fee,
/ eaait b7.42 2
Contact name; N i c h 016-T11 fl B.Pee for branch circuits without
feeder fee,fastAddress: 1D3 �nr,�Ca^ L S- l, c`V branch 56.18 2
City/State/ZIP:Vancouver,WA 986604
Each add'l branch circuit 7.42 2
Phone:(360)695-7700 • ' ' I Fax::(360)693-4442 . Miscellaneous or(service r not included)
Each mamtfactured Email;
dwelling,service and/or feeder 67.84 2
illk
ct
67.84 2
- .; "?- r, i ` ` 0 i�tl',Fs.3'7:1r :� `"' -f3,, mP �. , 44, pts irrigatiyon circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:l4 OZ. \I a`1 n , ` r��C,e l panel,alteration,ore tension. ❑See Page 2 2
F1 t �J1 ' ," WJ
City/State/ZIP;'p Lk t ']J' Each additional Inspection over allowable in arty of the above
y au J will, Additional inspection(I hr min) 6625/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:bdaniels@gweitsa.com Industrial plant(]humin) 78.18/hr
Inspections for whichno fee is 90
CCB Lie.: C1158 Electrical Lic.: 208174 Suprv.Lic,: 44965 s ..00. listed('4 hr min)
Suprv.Electrician signature,required: /1 Subtotal:
Print name: Joan P Albert .• Date: 4/26/2016 ❑Plan Review Required(25%of permit fee):
•
',A �__ State surcharge(12.4 of permit fee):
Authorized signature: /r-�` ---�= TOTAL PERMIT FEE:
Print name: Bill Daniels Date: 4/26/2016 This permit application
d ys after It lies been if a pp not p eie. within 180
daysaccepted as complete
!if! * Number of inspections allowed per permit
°r(iBaitdlopTermitilliX PemsitApp H[.1>r BRE.doe Rev 06/17/2018
icurt osismtrosn owe
Plumbing Permit Applicatib[
Building Fixtures °,(_: 2 `;or 1F
OR OF II( 1 SI 0v.1.v
City of Tigard ?, 1By: Permit NS % eCd'
1111 W 13125 SW Hall Blvd.,Tigard,OR 973; ' Eew
Phone: 503.718.2439 Fax 50 59 960,t Other Permit No.:
Inspection Line: 503.639 4175 Yi,, k _ . "f' ' ` i i iitReady/By: Juts: BI See Page 2 for
Internet: www.tigard-or, ov
g Notified/Method: Supplemental Information
®New construction' ❑Demolition For special information use checklist
Description I Qty. I 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 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
•: '.OB SITE INFORMATION AND-LOCATION Site utilities:
Job site address: j 0 BE)1.J �� ' , `t t LnAe. Catch basin or area drain 18.76
City/State/ZlP:Tigard,iOR 97224 ".3 D►Ywelt,leach line,or trench drain 18.76
e� ' Footing drain(no.linear ft.:____,) Page 2
Suite/bldg./apt.no.: Project name: J2jder Te, aee+"C1- 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 It: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1240X �. rra ce_. f.s _ I Lot no.:4.4!) Fixture or item:
Tax map/parcel no.: Backflow preventer1 31.27
' . • • DESCRIPTION OF WORK: • Backwater valve 12.51
• M�1�')�.. ��� � Clothes washer 25.02
1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
®.PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker _ 12.51
®.APPLICANT . 0 CONTACT PERSON Interceptor/grease trap _ 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Contact name:/J e Il lb�1
Primer 12.51
7 v�t.��v I� i! 1 U Roof drain(commercial) 12.51
Address: `1 Q'5 (00, a Sti 510 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/sbower/shower pan 12.51
`�`-'r tUrinal 25.02
E- �: '"i ��e-' '`s ``"' '1�' 'lei �L� ? � ��5'`lm Water closet 25.02
CONTRACTOR-MCfO Water heater 37.52
Business name:Malmedal Enterprises Inc. Water piping/DWV 56.29
Address:PO Box 207 Other. 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324-0759 Fax:(503-)324-0580 Minimum permit fee: $72.50
• CCB Lie.:102535 Plumbing Lic.no.:34-276PB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: r:: TOTAL PERMIT FEE r
Print name:Carolina Malmedal Date:0425/2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
IABuilding\PermitstPLMU-PermitApp.doc 10101/09 440.4616T(I0/02/COM/WEB)
I.
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
11111 i
T1cARD Building Permit Review — Residential
0
Building Permit #: 1`2s.�0 ' / O2 FF
Site Address: I QgS4 SW Erre/nal y Lr)
Project Name: 1 WVe r Terra EAST- Lot #: 4g
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review il��r�7/46-Vii ON 71) C ail—-�
Proposal: N AN S c-� /Arks 6 7-'4,1"1 Dszs E-,,., .vo,,i (>A1
..5 i 7-E— A--9---,../ rf 1 7-6-/4e4"") is a."4-)/2-e--5e-r--
% Verify site address/suite# exists and active in permit system.
7 River Terrace Neighborhood: E No %Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
,Three(3) copies of site plan Xxisting structures on site
/Site plan must be on 8-1/2"x 11"or 11 x 17"paper .Footprint of new structure(including decks)with finished
/Drawn to scale(standard architect or engineer scale) floor elevations
North arrow
{{�� ,,�Utility locations&easements(required for new and additions)
Z Site address,project or subdivision name and lot number SCJ Sidewalk/driveway approach
2Applicant information(name and phone number) ❑Lu.aiiuii bf wells/septic systems
Lot dimensions and building setback dimensions ❑E dng trees to be retained with drip line,and tree
Square footage of buildings to be demolished rotection measures
,ILot area,building coverage area .ercentage of coverage and Street tree size,type and location
impervious area(applicable i 0%R-12,R-25&R-40) treet names
%Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑ - RINo N/A
4 foot differential) If yes,is a storm water quality facility shown? !� es 0.No
%Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
% Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: $'Yes ❑ No,stop intake
V_Land Use Case#: ?D e:W I G —0 0 0 01 SUB soli, - 0 000 4
Zoning: Q ,
ZRequired Setbacks: Front . 12 Rear 3 Side 3 Street Side 8 Garage Zo
%Landscape Requirement: 2 CI %
% Lot Coverage Maximum: 8 0 % Ai/ Actual Height
z Building Height: Maximum Height ?s-
,e-Visual Clearance
�,,c
, Sensitive Lands: El Yes /21/No Type
in Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: M :,.. {tip Date: 10/ 1 l 1 I 1
Revisions (after Bding Submittal only) ` n Reviewer Date
E El 1: Approved Not Approved . 01,-,k.
y 1 I-71-
CA II-
Revision 2: ❑ Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
L•\Building\Forms\BldgPermitRvw RES 061417.docx
V
P
Building Permit Submittal / '
Original Submittal Date: _ 64,07
Site Plans: ## I
Building Plans:
Building Permit#: Enter buildi ermit#above.
Workflow Routing: Planning Engineeringermit Coordinator wilding
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.
Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: / /
- / _ ,
By Permit Technician: � ALL w,/�, a/ Date:
Engineering Review 7
Slope at building pad: 2- /0
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
0 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes Zit No
Assess Water Quantity Fee in-lieu: ❑ Yes ,if No
LIDA Facility on lot: ❑ Yes V No
Y
❑ NOT Approved by Engineering: Date:
Notes:
1
Approved by Engineering: /i1,( /}--' . Date: /O/I/ 7 /7
Revisions (after Building Submittal only) Reviewer ate
Revision 1: "Approved CINot Approved GVH,k t4Qi w . I t 1 [Z
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved El Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
'M/Approved,NOT Released: Date: /V/12' 3,/i
'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: - "es El N/A
Tigard Trans SDC: ► Yes ❑ N/A
Parks SDC: - -Yes ❑ N/A
LIDA IllYes N/A
A.,. y
to Issue Permite0K
roved by Permit Coordinator: Ma Date: // y i
'I) PA--- 1[ (2`-t(t 7
I:\Building\Forms\BldgPermitRvw_RES 061417.docx
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 1 (0$41 s W i CX?d l y LIn•
Project Name: iIVLr- Terrot ce_ eats+- Lot #: 9Qj
(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
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
❑ ❑ .2 ❑
2. Eyes on the street: a minimumoQf 12% of each street facing facade must include windows or entrance doors.
Percentage Shown: 141
3. Entrances:At least one entrance must meet both of the following standards:
/Max. 8 ft. setback from longest street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: "Yes ❑ No
illall the following apply: "25 sq.ft. min.
1One street facing entry g12 ft. max. roof above floor of porch
1CJ 5 ft. depth min. '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 ❑ Dormer min. 4 ft.wide
'Roof eave min. 12 inch projection ❑ Roof offset min. of 2 ft.
❑ Roof shingles either tile or wood 2tiGable,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 jer 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. ❑ Yes,No. If No (Check one):
C '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 /C40%max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: /1/1` LOA^ 11/N Date: )0 J ( I J
1:\Building\Forms\BldgPermitRvw_RES_RT_062216.docx
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
= •11
Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Owner
Check(✓)one ❑ Applicant Contractor 0City Staff
REFUND OR Name: /00 c-,/ el/k/ 4-I-
INVOICE TO: (Business or Individual) 43/G G/.9"i L D.�/ ,7
y
Mailing Address: 703 ,e/ 9- et/,q y s/ 7-E- _570
City/State/Zip: Vff-A/C Cru �/L- 9c- ,
Phone No.: 6 r3"- 7`7 )
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
= k -- VOID PERMIT APPLICATION.
0`r REFUND tERMIT FEES (attach copy of original receipt and provide explanation below).
II I• CE FOR FEES DUE (attach case fee schedule and provide explanation below).
0 REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: /f/S-7,2/7 —6D 3II
Site Address or Parcel#: /F-57 / /Ec7v2S
Project Name: A/� 7-L- LS-7
Subdivision Name:
Lot#:
EXPLANATION: E-M 6//C� //E/77-ex_.
Signature: Date: 70/
Print Name: jNw
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to S s Admin: Date B Route to Records: Date Wig_
Refund Processed: Date �' �`� B •1 �-
�- B t!+a Invoice Processed: Date B
Permit Canceled: Date it/ B I
I:\Building\Forms\RegPennitAction_0 2314.doc Parcel Ta:Added: Date B
ED
Plumbing Permit Appli/3EG
Building Fixtures NOV 2 2 2017 alit 01 i it i t ,;c (,vI ,
City of Tigardp� TIGN1 D :eaived/.2 S./7 G
• 13125 SW Hall Blvd.,Tigard,tit nardBy Pt ioil No��T�l/7'-OD
a Phone: 503.7182439 Fax$ G Dl v i t r Plan Review ' '
E) Inspection Line: 503.639.4175 Date/By Other Permit No.:
Internet www.tigard or gov
No6DateRte'/By: 1 I Id See Page 2 for
fied/metlwd
_ Supplemental
Information
...*-'Yr'.n.r0g ,....2.„........ ... . _ ,.a,'c: ~;. _ -• ••:..:.+miidirbi,. ;'-r;.. YY.,
i
®New construction 0 DemolitionFor special allAlaraa0(onaerJieptit
❑Addition/alteration/replacement Description Qb
(]Other: New 1-2-family dwellings(includes 1008.for eachEs utility co>necion)
;..-.-`` - : ''CATEGORY OF CONSTRUCTION.' .' . . SFR(I)bath 312.70
®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
13Accessory building 0 Multi-family SFR(3)bath 500.32
0 Masten builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler
•
.. •..'JOB SITE INFORMATION ND-LOCATION ft) Page 2
- � Site ud7ities:
Job site address: /496S-7-1 ,SW 6, .-_ _IIy /4- lli
Drywall,
basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 C�'Yi rywa ,leach line.,or trench drain 18.76
_
J _
Suite/bldg./apt Footing drain(no.linear ft.:_,) Pa$e 2
dgJapt.no.: I Project name: / /...,,„
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear 8.:___) Pa$e 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: Water service(no.linear ft:_) Page 2
irApiretCe. ELM- _I Lot no.:L.415 Fixture or Item:
Tax map/parcel no.: Backflow preventer
31.27 111111
DFSCRIl770N OF.WORK: Backwater valve 12.51 i
�j ,/. Clothes washer
1/' ' / WQ far halter DEA 190,1711t W Dishwasher 25.02
(VW 1)11I tri �Uy.5th I, Drinking fountain _ 25.02.
�S�G)17 !�D Ejectors/sump ■ 25.02 -
®.i'ROPERTY OWNER - . ' p TENANT - Expansion tank
• 12.51
11
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Address:7600E Doubled Ranch Road Floor draiNftoor sink/hub 25.02
City/State/ZIP:Scottsdale,AZ 85258 Garbage disposal 25.02
Phone:(602)694-4031 Hose bib 25.02
Fax:( ) ice maker
12.51_
t: ®-APPL!(CANT . . In CONTACT PERSON• Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(value:S ) Page 2
Contact name: Af�eitie_ Primer 12.51
Address: IIrr__ri Roof drain(commercial) 12.51
1 t d . r,,, , ,, r l i Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 9;, i •
Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Thb/showcr/shower pan 12.51
EynaikNiillok.7-h0 �J�O y�haetler.1- Urinal 25.02
• . CONTilACTOT{ Water closet 25.02
Business name:Malmedal Enterprises Inc. Water heater 37.52
Waterpiping/DWV 56.29
Address:PO Box 207
Other 25.02
City/State/ZIP:Banks,OR 97106
Subtotal
Phone:(503)324-0759 I Fax:(503-)324-0580 Minimum permit fee: $72.50
CCB Lic.:102535 'Plumbing Lic.no.:34-276PB Plan review (25%of permit fee)
Authorized signature: State surcharge(12%of pennit fee)
TOTAL PERMIT FEE
I Print name:Carolina Malmedal I Date:04/25/2016 I This permit application expires Na permit is not obtained within 1S0 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L•lawldioglPam6s1PLMU-PermitApp.doe 10101109 44046161110102/COMMEB)
a
TIGARD
January 18, 2018 City of Tigard
Polygon WLH,LLC
Attn: Angela Grajewski
703 Broadway St, Suite 510
Vancouver,WA 98660
Re: Permit No. MST2017-00388
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 16854 SW Friendly Ln
Project Name: River Terrace East,Lot 48
Job No.: N/A
Refund: ® Check#227200 in the amount of$68.14.
0 Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
0 credited to your account by the company that issued your card.
Trust account"deposit"receipt in the amount of$
Comments: Per applicant's request to remove 2°`'water heater from permit.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
IN q
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Polygon WLH,LLC DATE:
703 Broadway St,Suite 510 12/28/2017
Vancouver,WA 98660 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 413631 Case#:
Date: 10/31/2017 MST2017-00388
Address/Parcel: 16854 SW Friendly Ln
Pay Method: Check Project Name: River Terrace East,Lot 48
EXPLANATION: Per applicant's request to remove 2nd water heater from permit.
o ".'ani°€ a;! K' x
n, '_-7'i;•-:4;-:'::;,;
e r �
s'-� � " �i,z§ ,'s \ -7,'g p F' i. :9ra, !' Mfr;.,,„�' cZ i>,,' 74
v q,.' i " , rr': 'P ' dS S m .r : ` = °°.� ssPlumbing Permit
Mechanical Permit 230-0000-43101 $37.52
12%State Surcharge 230-0000-43102 23.32
100-0000-24001 7.30
TOTAL REFUND: $68.14
APPROVALS: SIG TURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
CaseI ��b/%
Refund Processed: I Date: /� ��
I By: I
I.\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD
RECEIPT
Iii,____
. . 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: River Terrace East, Lot 48
Site Address: 16854 SW FRIENDLY LN
IReceipt Number: 416592 - 04/06/2018 I
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
MST2017-00388
$-68.14
Total: $-68.14
PAYMENT METHOD CHECK# CC AUTH.CODE
Check ACCT ID
CASHIER ID RECEIPT DATE RECEIPT AMT
227200
DROWSE
Payor: Polygon WLR, LLC 04/06/2018 $-68.14
Total Payments: $-68.14
Balance Due: $68.14
Page 1 of 1
u
CITY OF TIGARD RECEIPT
11 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: River Terrace East, Lot 48
Site Address: 16854 SW FRIENDLY LN Xr/G fA d I-
1 Receipt Number: 413631 - 10/31/2017 I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER
PAID
MST2017-00388 Building Permit-New Construction
MST2017-00388 230-0000-43104 $1,990.22
Plan Review 230-0000-43106
MST2017-00388 12%State Surcharge-Building $751.34$238.83
MST2017-00388 DC Provision Review, SF-Ping100-0000-4311224001 00
MST2017-00388 100-0000-43112 $90.00
Info Process/Archiving-Lg$2.00(over 230-0000-43135
11x17) $36.00
MST2017-00388 Info Process/Archiving-Sm$0.50(up to 230-0000-43135
11x17) $60.50
MST2017-00388 Metro Const. Excise Tax
230-0000-24010 $424.47
MST2017-00388
Beaverton School CET-Residential 230-0000-24101
MST2017-00388 Permit Fee-Elect(per dwelling unit) 220-0000-43103 $3$338.24
MST2017-00388 Limited Energy $335.00
MST2017-00388 12% 220-0000-43103 $75.00
State Surcharge-Electrical 100-0000-24001
MST2017-00388 Air Conditioning $46.55
MST2017-00388 Furnaces< 100K BTU 230-0000-43102 $46.75
230-0000-43102 $46.75
MST2017-00388
Water Heater 230-0000-43102
YZ of $33.39
MST2017-00388 Gas Fireplace 230-0000-43102 $33.39
MST2017-00388
Range Hood/Other Kitchen 230-0000-43102
MST2017-00388 Clothes Dryer Exhaust $33.39
230-0000-43102
MST2017-00388 Single Duct Exhaust(Bathrooms,Toilet, 230-0000-43102 $1$33.3916.60
Utility Rooms)
MST2017-00388 Fuel Piping
230-0000-43102 $14.15
MST2017-00388
12%State Surcharge-Mechanical 100-0000-24001
MST2017-00388 SFR-Baths $44.53 ¢-
M 230-0000-43101 $500.32
ST2017-00388
Laundry Tray 230-0000-43101
MST2017-00388 Water Heater $25.02
MST2017-00388 12%State Surcharge-Plumbing 230-0000-43101 $37.52 4.-
MST2017-00388 Erosion Control w/Development 100-0000-43134001 $6
100-0000-43134
7.54
MST2017-00388 Plan Review
$386.40
230-0000-43106
MST2017-00388 Wash Co Trans Dev Tax-SF Detached $542.30
MST2017-00388 Tigard Trans SDC Improvement-SF 405-0000-433201 $5,48 88.000
Detached 415-0000 43300 $5,488.00
MST2017-00388 Tigard Trans SDC Reimbursement-SF
Detached 415-0000-43301 $317.00
MST2017-00388 Tigard Trans SDC River Terrace-SF
Detached 415-0000-43302 $2,684.00
MST2017-00388 Parks SDC Improvement-SF Dwelling 425-0000-43300 $4,356.00
(detached/attached)
MST2017-00388 Parks SDC Reimbursement-SF
Dwelling(detached/attached) 425-0000-43301 $1,207.00
MST2017-00388 Parks SDC River Terrace-SF Dwelling 425-0000-43302 $2,003.00
(detached/attached)
Total: $33,945.99
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IA CITY OF TIGARD i MASTER PERMIT
iff4074.
-- COMMUNITY DEVELOPMENT �� Permit#: MST2017-00388
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2017
Parcel: 2S 106DA04800
Jurisdiction: Tigard
Site address: 16854 SW FRIENDLY LN
Subdivision: RIVER TERRACE EAST Lot: 48
Project: River Terrace East, Lot 48
Project Description: New SF. 12/5/2017: REPRINT permit for reversed plans. )2/5/2017: REPRINT permit to
remove 2nd water heater.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1248 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1666 sf Garage: 464 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2914 sf Value: $353,724.58 Rear: 3
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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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: 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
p
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 2914
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: $34,035.99
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 thro • • 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: Permittee Signature: /U( /4)Z-f77 )
Call 603.639.4175 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.
Plumbing Permit Appli S)EIVEr
Building Fixtures NOV 2 2 2017
City of Tigard Receive: -? S/? A«Y Permit No/f5j i1/7-,e
IIII • 13125 SW Hall Blvd.,Tigard,tia°�1 I�t �+ r^• Dat�y:/Phone: 503.7182439 Fax� t►OtG D VI�7,v D e/By: W
II. Other Permit No.:
� I c�n I t n Inspection Line: 503.639.4175 Date Ready/By: lurk 0 See Page 2 for
Internet www.tigard-or.gov Notified/Method: Supplemental Information
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... ..:':i:::,.
. l'ili/Vl;'RLiIIC"i ...'.'. . . :I :S�DI0..,.'. �?,.c-«:'4.:•
-:
tEl New construction • ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 it for each utility connection)
CATEGORY OF CONSTRUCTION'• ' . . SFR(I)bath 312.70
®1-and 2-family dwelling ❑Comme rcial/ndustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkles( sq.ft.) Page 2
-. :`
JOB SITE INFORMATION°AND LOCATION Site utilities:
ICatvest/ Sill i _ _ _tj I fV_ Dryw basin ch area drain 18.76
Job site address: GF'Yil ( Drywall,leach lisle,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.near ft: ) Page 2
Suite/bldg./apt.no.: Project name:.'g4164,0' reify-ate east- 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 It:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: f2. k r refteleatt E_GtS'{- Lot no.:L46 Fixture or item:
Tax map/parcel no.: Bacldlow preventer 31.27
.' • DESCRIPTION OF.WORK. : . Backwater valve 12.51
" ;.. r� D Clothes washer 25.02
I/t1''JJ� I M/�f(r heater'i9A pe i1 we Dishwasher 25.02
Win 04!ty 15/, List n I , Drinking fountain 25.02
/'14511017' oo 1) Ejectors/sump 25.02
®.PROPERTY OWNER • . • ❑ 'TENANT Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694.4031 I Fax:( ) Ice maker 12.51
®,APPLICANT .. 0 CONTACT PERSON Interceptor/grease trap 25.02 :
Medical gas(value:S ) Page 2
Business name:William Lyon Homes,Inc
Contact name: 11lie,h te_-a'Ya Primer 12.51
Roof drain(commercial) 12.51
Address:-7/ A11 I_- .., i , r 7 . Sinklasin/lavatory 25.02 •
City/State/ZIP:Vancouver,WA 9866 i Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
. Urinal 25.02
E-mailW i1oe.1norp 'OcilO/ hi, i r.l� Water closet 25.02! CO
-
Water heater 37.52 r
Business name:Malmedal Enterprises Inc Water piping/DWV 56.29
Address:PO Box 207 Other: 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324-0759 Fax:(503-)324-0580 Minimum permit fee: 572.50
CCB Lic.:102535 'Plumbing Lie.no.:34-276PPlan review (25%of permit fee)
B
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Carolina Malmedal Date:04/25/2016 This Permit application expires I a permit is not obtained within 180 days
after it has bees accepted as complete
'Fee methodology set by Tri-County Building Industry Service Board. j
l:1BuNdinalPensitsPLMU•PamitApp.doa 10!01/09 440.4616T(1e/02KOM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16854 SW FRIENDLY LN, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2017-00388
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:
16854 SW FRIENDLY LN, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2017-00388
Inspection Type: Inspector:
299 Final inspection Allyson Armstrong
Result:
PASS - CofO
Comments:
Collected
Moisture content acknowledgement form
Moisture barrier acknowledgement form
High efficiency lighting form
Air leakage test report
Left C of 0 on the counter
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16854 SW FRIENDLY LN, BEAVERTON, April 25, 2018 at 9:56:34 AM
OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2017-00388
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Previous corrections completed.
Water pressure = 64 psi
Violation Summary:
Inspector Contractor