Permit (87) IIICITY OF TIGARD MASTER PERMIT
• COMMUNITY DEVELOPMENT Permit#: MST2018-00341
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2019
T I C.A 1,Cr g Parcel: 2S107AA01700
Jurisdiction: Tigard
Site address: 14471 SW 168TH AVE
Subdivision: ROSHAK RIDGE Lot: 17
Project: Polygon at Roshak Ridge, Lot 17
Project Description: New SF.-Model Home
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1109 sf Basement: 140 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1059 sf Garage: 422 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2308 sf Value: $293,554.20 Rear: 5
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 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: 3
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'500 sf: 4 201-400 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 2308
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Required Prior To
Pour
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $34,812.29
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: e ��e� �l!�GI.� -1Y Permittee Signature: tr %�/'� �pG�
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.
---)
'—.. g Permit Application RECEIVE
. ,,_
LCAT \ -
Residential FOR OFFICE USE ONLY
Received Permit No , N'R.-
City of Tigard DEC 11 2018 R Date/By:
I - a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i3 ' �� Other Permi � j-
Phone: 503.718.2439 Fax: 503.598.19 n DateBy: 7uris: ® See Page 2 for
' OFG Date Ready/By: /� I Supplemental Information
TIGARD Internet: wwn w.: 503.639.4175 N. 'fied/Method /,
Internet: www.tigazd or gov OUTI MNG IMV1SIO / ,/
�.7 It I�+
. n44j15,411?.I, -44�,, X21 AI Y'1 4 L '1*P
TYP i]." Oled
�, 6=, .�. Permit fees*are based on the value of the work performed.
7,112 New • , ■ Demolition Indicate the value(rounded to the nearest dollar)of all
■ Other: equipment,materials,labor,overhead,and the profit for the
■ Addition/alteration/replacement % work indicated on this application. �j
Valuation:
94
g 1-and 2-family dwelling ❑Commercial/industrial
Number of bedrooms:
■ Accessory building ❑Multi-family
Number of bathrooms:
0 Master builder 0 Other: �y ���]�
, ' Total number of floors: /l/ ✓"
f JOB S TE 1NF RMA l"IONANDAOCAT-ION F
New dwelling area: g�,�leb square feet ' b'�ii
Job site address: square feet ' /
Garage/carport area: 11 q '
City/State/ZIP: `��� �� � � � // square feet
Project name: V ` r / / ' Covered porch area: q
Suite/bldg./apt.no.: J � , � ���' ��� � �/ Deck area: square feet
Cross street/directions to job site: rect.`1l
Other structure area: square feet
'REQU11E D DATA SCO II RCJ rI16 0 C `l"'
������� ��� Gun.,(}- ) Lot no.: Permit fees*are based on the value of the work performed.
Subdivision: a) Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no J I `� equipment,materials,labor,overhead,and the profit for the
- K - ,' v ' j ,j work indicated on this application.
'� pN
,. Valuation: $
01... r � i Existing building area: square feet
.)\,N SVCL \ I\ODt,/
v,.....401.114•� square feet
4 h,- _
New building area:
'f 'it*AN / a
Number of stories:
Y1tOPETtTY OWNS � �=
Name: ?o 6 ovt WON U,v Type of construction:
Address: U I A •a A k A LA v '
Occupancy groups:
City/State/ZIP: \10‘111,(j0 A i A b 191. / i 1
Phone: ) 1t201S—ell 0 Fax 0)(00�e•"1UL2'
y'. y '1!,,
SC ,y, 1 1
Aixl iy , f y, " j { PElft4
� � C(�I�IT�
Business name: 1 A IA% A `t U� plan ,
Contact name: 2i (1yk, p�1,n�� ,n1 yG p t plan
Address: 1097 i/Y `M&Vv ✓` p�C.ft�n1 I�n • . -
upon application:
City/State/ZIP: V l W'11,v �� 0\ f W0 • '
Phone:( Fax::( ) I1�• X T E� �
E-mail �1 1 1 t11 ✓„ 7W k 9 5 0\A ��i. VlX ��Y UV, /. Commercial and residential prescnptive installation of
ON7`KCT
Submit
with connection details
Business name:
W kI1OM
with the 2010 Oregon
department , .
Address: 10� fbYbotAWf SAT S1D , . Installation Specialty
n C/�n'^h •• pnistrative fees): :1 1
City/State/ZIP: V/h lLv4� Pc �? \JG\►I v
V� �1
Fax:(�(�0) ��LI� State surcharge(12%of
Phone:(�a)��S'��U� ✓�v
[CB lie.: $1)1 211Total fee due upon application:7 $201.60
This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
,A„,, l/1 V V/` ('nat/1,pv Date: Service Board.
L Print name:
I:\Building\Permits\B1JP-RESPermitApp.doc 02/24/2011
440-4613T(11/02/COM/WEB)
1
I
„-_-...,---
. Mechanical Permit Api)licatiR_ECEINTE 1 FOR OFFICE USE OL
City of Tigard R=erved )
Permit Na2
, .1
25 SHll Bld.,
131W avTigatd.OR 97223
' Phone: 503_71g/439 Fax: 50.3598-1900 14 DEC 1 1 2018
Pion k'eview
Daiml,3y: Oliva Peralitn-v\-- cjis&...(.1.._-,.,17,50(
Insp=riort Liu= 513...-09.4175 Date Reac.b..,,,13v: .1t.IN 0$ee Pne Z far
TIGARD CITY OF TIGARD Netified,t-ied;od,
haterupt: www-tiaard-ornav ' Supplemental Information 1
$1111,11INGTIVISIO.N -
. ---..------ '...- -,..---.-.------------- •',---.CONL4EidArTiiiSetiEDVIV: VSirCliEtt(E-1S'i7 ti
7.. . .A, ::: -:.::-:•::(.1.ililit.,":.!(W:i:::8V,010:ii.,:;',;:::, 3":.. :0;:,;:-N; 1.2,:.-,.::!F- -:: :::-;.:-..'.. ''-” ..r. - - ' :::=.- . .-." `-- '-...
, Mecltanil permit fees*are based on the value of the work 1
New caustrudion 0 Additionfattenninntreplacernent 1 pcifoaned.indicate the Table(rounded-to the nearest dol1ar1 of iill 1
El Dermafitlin 0 Other: • mechanical materials.CMIMPIMIL tabor.medical and profit.
Value:$
, .,,ii,z,:...,„,---,,,:,:.;.,.,, „,•:,,,,..-;n:•CATEGQ417,-:-:Or,!.-ct;Iy.t.,,ASICTUIPN:2,.:,7:,-7.7.-707gz:_,',T7:::::„ :*'-:-',:-.: •1,1!7:':?';:. ....::i'::::'.-i7-,,,,!,ItittiftSIVAIAQViliN(Ctifagii,:_lijitOttSt:::::,,:::. .....,...•
0 i-and 2-family dwelling 0 Comanerciallindus•trial 0 Accesscay building ror speciul infirrnatiart use citEridist .
Multi-faanity 0 kt/swr Nader 0 Other. ' De$criinion 1 Q . 1 .Ep_ I Teml
-,-- --._. - •-, •:. .-...:,--- ::, -,,--,.,. -!:.-_,.., ...::4 1:.:.,•.-.7'.'T,.,:,'-',._ 14eAtilit;COOtilta:
. jiiE::,Stik.:-*T0*14AITIO*:00:,..0e,..:441€ ::,,,7--,i ,'-1 .:::":-::::::'::::-.! . A_ ,. .
i P COMMPPIPg 1 I 46.75
Job six adthesst 1 Li ull 1 G-.)\A.) 1 u) 31-.1/1 PQ.) . Fortnum 100_000 B11.1(decuiAe.e..wl I
- City/State/MP:Tigard OR 97P...4. Furnace 1010004 13Th(ductiFYents) - 54.91•
„
lima pump 61.06 1 1
SunatIdgivt.no.:
Project IMMTO t 1#1 0 vi.R-- - Or _.slm\4.,. Duct work
. 23.32
Cros street/directions to jtib site: 1 ) -16.(7. 0 l'f a q- livdrunic hot water system 73.31
Residential boiler(radiator or
laycic) 23,32 f
. „
'QUA IIPIPPIP trIMMYPC,not cli=trk).
in-wall.in-duct sow-aided,etc, 46 75 IF
Fliteveru for my a gMlie_ 1 7,3,32
: 23.32
Subthvisim utr- Terrue_e :Er....s Lot rto. I : Other:
Otber fad appriances: - '
Tax mactipamel no.: 'Aram-heater 23_32
iitgititiptio*,bt.-rwijilik.....-.4.. ,..:-,:-.. .yr-..-,....!. OW fireplacefirixil ,_ 33.39 I
.
fireplace 23.32 4
---
_Log lighter(gas) 1 23.32 I
Wooepellet stove 3339
Wood fireplacennsat 23.32
. . . . - .
Chininevilincriflui..-'vent . . 23.32 I
-•- . . Other: ' 113)
:Tcli.:.****01::'0.:**4;t477?-!'.:,•':,'',i.l'fl:.::7i:i.i'!':::.,A:rtt.N.- t.'.. :": i''!-E''''s. I Environmental nth.-aunt and ventilation:
‘2 0 1.,U CO V.,VklUk-aL I Resign hoodnither kitchen '
1 1
i milt-meet I I 2-139
,,Address;.'' .1 02,i
voa_k.K) A 11„f I Ctotb. drver exhaust 1 1 3339
3 I '
1 City/State-ID? ; \)CA,A4 W.Uk.Vet(' V f '9 z(p() I Siriale-duct exhau.s1(bathrooms.,
3 tott;t compartments,.utility moins1 1 13.32
1 Pix'ne. 0 VC4 '1'1 OD _ 'F2';( 00)tO°114114'fb I Atikkraulspax fans I 23.32
tlA:1*thicA.,.*i.l.T.:t.:-•:,.1::;::::-..,.-I:,:::,.::i:-,...:iR.,,.;:1;,.;-,,-,:Cl.CONTACT; 'likijict.W .::,::::-E-.-:....:::•r':::: I Other 2.3..32
1 Fuel*intr.
1 Business name:.Polygon NS,L.1-1,LLC
5 far first foam SALO far each add:I...Vous!.
Conn14V. ' \8(1rY\riAltafiti Cla,v(AA. ) : Furnace,etc. 1
Gas heat mum
Addres: 1 0 S Ryi-CO.ISLO C:l_ *- * t Ske. 510.
I
- WaThisuspetidedlunit heftier 1
CState:FM?Vancouver,WA 96660 • Waterhemer 1
Phone:(360)695-7700 i Fat:(360)693-102 - Fireplace
Ranee I ,
E-rrieffRericY\,A-sk.k.b"Ty;,4a.I.sropRol.. sor,v‘trre5.ex rn .1 Barbecue 1 I
; t 1
'.....:.„ ',.1.7 .:,'-;,.:::7'- 1:.'.- 5.:':85':;. ,:Z:-.;::,:.'.-fi.5:... 9; 17034c7171-- :', :7=ii,--,i,-- . -:-..;.?..... -..,-.,-::::::'.4.1::.-:". ':'---;:-.'',
,
Ioat=Apex LLC I I .Busintss Air
'Other.,.•'. .!;:t;:',: "!, iC;Et.pit.p4.-tOiLNIFT-..TX.W:-.Ti!T.::,:-:. ,..!.:.-•••,.::::-.:..-.!-:',
' .
Address:18004 NE 72”Ave
'Subtotal
.., _
City/StaieZIP:Vancouver,WA 98686 1 Minimum permit fee a9e,o(y) , 1
Phut.revicw(25%of PL:1.Ei iii fee) I
Km=-(3601342410 . I Fax;(360)324470
.Sintr,surcharge(12%of permit fee.) ,
CC13 tic::213634 ..t4___ ._._..._,_
. .. ...... 1 ThisTOTAL PERMIT FEE
..
Ipertnis appiicatr
tion ...pirt*if a fieratit is not ubtwithin is(1
days after ir tam kett argulketi as-,20noptotc.
Authorized signature: • * Pee niethadok,gy set-by Tri-Cemay Bufalief_,Induslry Ser ..e Stard
• '--... .
. Prial Bar= 1 t" . I B*21 lai(ALiw
,..,..„6..„.t.N...„..„,,,,,..cfi..„.doc 410-4077 fli,432('6‘AVS11
• --
Electrical Permit Application "� E1 4 : ' -- --
I. _ � FOR OFFICE USE ONLY
City®f Tigard 111:( Received
- - °t 13125 SW HaII Blvd.,Tigard,OR 97223 2018 DatelBy: Permit 6:
Phone: 503.718.2439 Fax: 503.598 Plan Review
q� ti Related Permit
Inspection Line: 503.639.4175 d � � ReadyeaBy: �"� Page .���.d���
TIGARD DateBy: Juris: Q See Page 2 for
e Internet: www tigard or goo f �j NoLfied/Metllod
t ILDIN j DIVISION►( Supplemental Information
®New construction 4 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked).
0 Service or feeder 400 amps or more 0 Building over three stdries-
❑Demolition ❑Other:x ,,z." where the available fault current 0 Marinas and boatyards.
_- _ ::: c cr i -ORdr s ? g-mi _ tio _ exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling ❑Cornmercial/nidustrial ❑Accessory building less to ground,or exceeds I4,000 0 Commercial-use agricultural
11Multifamily JD Master builderamps for all other installations. buildings.
❑Other: 0 Fire pump. ❑Installation of 150 KVA or
_ JOB tilt INF'ORMA`I ION i?b LOCATION; 0 Emergency system. larger separately derived
Job#: ❑Addition of new motor load of m.
Job site address: U U✓'� S �
' � ' 1 1 1 1 J V� I Ul ��'"' ��f-K./ 1001iP or more. ❑••A•,,<.E„<.J_2»
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt,#: Project name::.Vol a -I- vo('/1 r ❑Hazardous locations ❑Supply voltage for more than
V ) `/' ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site:
i Description I Qty. Each 1 f ..
Total_ I
.s_
\it V1-„ Y , n q/KNew residential single-or multi-family dwelling unit.
Subdivision: / Lot#: Includes attached garage.
Tax map/parcel#; 1.000 sq.ft or less 2 168.54 4
DESCRW'ON OE W)RIC 100
Y add' S sq.ft.or portion i 33.92
-.-- . ..__ _ ..,_ . . , . _ Limited energy,residential
(with above sq.ft_) 75.00
Limited energy,multi-famiiy
residential(with above sq.ft.) 75.00 2
_. la PIiO ERT rfl VER Renewable Energy ❑ See Page 2
{ - "" " AM Services or feeders installation,alteration,and/or relocation
Name:A / A 1 ,
y 1 100.70 i 2
4 200 amps or less
Address:' 1 b '' IfUC( t I 1� ¶5h Skt SID 201 amps to 400 amps 133.56 2
VO Y 1� V V t v-[/I V 1 t ( l��lY V 401 amps to 1,0 amps
am 301.04 2
Ciry/State/ZIP:
60]amps to 1,000 amps 301.04 2
Phone: pt.)( �1 ) Fax:( q)(D C1',44, e7 Over 1,000 amps or volts 552.26 2
Email: b�//I I�(�� ! LI
porary services or feeders installation,alteration,and/or
!/t v ��a YVS tJ elo cation
Owner installation: is installation is being mad on pr. e $ that I own which is not 200 amps or less 5936 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
;,;,T e--„_ amyry l r c o d Z; O Branch circuits-new,alteration,or extension,per panel�~ .-�. �".N '"�`" """_ A.Fee for branch circuits with
Business name: pv I )n/O +�, IA t,4, 11 J above service or feeder fee,
Contact name: m 11��V J\M/ (l/i Vt_�t each branch circuit 7.42 2
1 t Ill B.Fee for branch circuits without
Address 102) V O O/� + l'� C c 1 Il service or feeder fee,first 56.18 2
Y V v 47 V VlJ ���///���/// V branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Phone:(360)695-7700Miscellaneous(service or feeder not included)
Fax::(360)693-4442 lnA n( Each manufactured or modular
1 f ��� 7 $. �OtVLIG) �O* 67.84 2
Email 1/1 vii t-tt t'�/l dwelling,service and/or feeder
�,��� :W <.v /1:, Y Y W���Weirliraitir C.1 Y� Reconnect on1Y 67.84 2
.- E__, Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
Address:6101 NE St Johns Rd Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension. .
City/State/Za Vancouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr E
Email:bdaniels@gweusa.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is90 00/
CCB Lie.: C1158 Electrical Lie.: 208174 _J Suprv.Lie,: 4496S specifically listed(A ht min) hr
`. >:, ELE R eAN-t1 B'Ii'C its
Suprv.Electrician signature,required: ,op 1 7 . .. - a _
Subtotal:
Print name: Joan P Albert 1 Date: )'21(AI I y3 ❑Plan Review Required(25%of permit fee):
r- - --- -- State surcharge(12%of permit fee):
Authorized signature: - a —_- TOTAL PERMIT FEE:
This permit application expires if a permitis not obtained within 180
Print name: Bill Daniels Date: 194 .41[1:3, days after it has been accepted as complete.
����iiii * Number of inspections allowed per permit
Ir Building4PeratitslEl.0 PermitApp_Et.R ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
I ,• • .
Plumbing Permit Application RECEIVE I
. : Building Fixtures
City of Tigard Li EC I 1 2018 Received
Pemdt No.:
: qi 13125 SW Hall Blvd,Tigard,OR 97223
' '4 Phone: 503.718.2439 Fax: 503.598.1t1Ty fliti."
1,1Date/By:
Plan Review
V.P! f IGAR i Daresy: Other Pemit No."‘"Ncy.3T cjA(fs-a:1"..:....-)4.1
RD Inspection Line: 503£39.4175 e,,,, .•. Ready/By: Reis: lil See Page 2 for
T1GAR- Internet yvviw.tigard-or-gnv BUILDING DIVLM lip'6edtMethod: Saaptemeittat information
TYPE-OF WORK , ,. `, : -„ -:- FEE* scHEnuLE,
For special information use checklist.
PI New construction E3 Demolition
Description I Qty. I Ea, I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGt3RY-OF CONSTRUCTION - SFR(1)bath 312.70
SFR(2)bath 437.78
A 1-and 2-family dwelling Ei Commercial/industrial
0
SFR(3)bath I 500.32
Accessory building E.]Multi-family
. Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION , ; Site utilities:
Job site address: t4 tAl S W t V(/ç'1 Av
tehukt, Catch basin or area drain 18.76
Drywell,leach line,or trench drain
38.76
City/State/ZIP:Tigard,OR.97224
Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt.no.: Project name: )0y)yvt.k- V...ockik,10 Manufactured borne utilities 50.03
Cross street/directions to job site: ff Irea I.-- Manholes 18.76
Rain drain connector 1836
Sanitary sewer(no,linear ft,:_____) Page 2
Storm sewer(no. 'linear ft.: ) Page 2
Water service(no,linear ft.: ) Page 2
Subdivision: 4V,IlLjk_Vikkialkit Lot no.:n Fixture or item.:
Tax map/parcel no.: Backflow preventer 1 31.27
I 12.51
ilESCRWII°1 OF WORK Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROI'FiliY OWNER- ' -, fl TENANT - ' Expansion tank 12.51
, . ,
Fixture/sewer cap 25.02
Name:./ V010
0
0\ 1 .1 liNott0 ,LC) Floor drain/floor sink/hub 25.02
Address: "1(4 , Y7 y() \AXUA ski) cl D Garbage disposal 25.02
City/State/ZiP:' 110 Vt cO(kv-eir \AR' 01Wta(0(). Hose bib 25.02
Phone:'3f°0 /Cis'T1 o() Fax:( /I)V 0117 114+14 2.- Ice maker 12.51
APPLICANT. , - ' El CONTACT PERSONIntercernorigrease trap 75.02
Business name: ?Ol Vori -%4 i, ,() Medical gas(value:$
Primer ) Page 2
12.51
Contact name: R
v Roof drain(commercial) 12.51
Address qui.) vock,A)o(AA'I' ''-1* s(o
w
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
25.02
, Unit' al
E-mail: Ve V'vift.t. inlowitttnie?@poiv(k1401/1#26)144, Water 25.02
3752
Business name: G.,+4 ii 4,,,,,,„\),),Lc - , , it4,,,,e____ Water piping/DWV 56.29
Address: .,ei. 1!)-0K4 CIA Other: 25.02
City/State/ZIP: 5T. eg..4 arc, ci i is/ Subtotal .
Minimum pemtit fee: $72.,50
Phone:(363...-is&tt-, 1(411 Fax:(411i t .0-7a1-47 ir-po
Plan review (25Voof permit fee)
CCB Lie.: ig• i 3-72_ Plumbing Lie.no.f)t) ( 3q
State surcharge(12%of permit fee)
Authorized signature: 1,..tiL)jt .1-Cito.b0"-•-.......,_ TOTAL PERMIT FEE
Print name: ,s+f„vt_ (7" W14,. Date,1--) 1.„1 i ilo 1 This permit applicationafteritnexpires ifa pezlisnisionntmobptained within 180 days
*Fee methodology set by Tn-County Buildingtry IndusService Board.
VauildmaNamitrAPLMII-PennitApp.we 10/01/09 44046t6T(tonacowvatin
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
IIIIII
T l c A h n Building Permit Review — Residential
Building Permit #: �C•A- CC 4t
Site Address: I LN ?l -L' !6R A-
vc
Project Name: i f rr At- kiki Cir- Lot #: 17
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Reviewj�
Proposal: Ito 141. 01,t,n0 0-44 j- b - i
-10Pr7 s J J r e-
56Verify site address/suite# exists and active in permit stem.
13 River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached
Site lan Elements:
ree(3)copies of site plan [ Existing structures on site
S' e plan must be on 8-1/2"x 11"or 11 x 17"paper [footprint of new structure(including decks)with finished
awn to scale(standard architect or engineer scale) floor elevations
rth arrow L7U ty locations&easements(required for new and additions)
Lite address,project or subdivision name and lot number L 'idewtalk/driveway approach
r�pplicant information(name and phone number) l'iii cation of wells/septic systems
21,ot dimensions and building setback dimensions N xisting trees to be retained with drip line,and tree
_, are footage of buildings to be demolished protection measures
11@fot area,building coverage area,percentage of coverage and eet tree size,type and location
/impervious area(applicable if R-7,R-12,R-25&R-40) L'Ia'Street names
BI Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? L`7Yes ❑No
4 fpot differential) If yes,is a storm water quality facility shown? Etettst
lNo
L,U2 Clean Water Services—Service Provider Lettertt (lot platted prior to 9/10/1995): 11m/4( J
,equired: ❑ Yes,applicant was notified Lid' No Received: ❑ Yes ❑ No
[ Public Faciliti Improvement(PFI)Permit: l (RI_
equired: U Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
21/Eand Use Case#: POk2 O6-0OOOZuPio' �} ,
,,
oning: f(-Ii. CPO) .1
L' Required Setbacks: Front ' Rear 5 Side Street Side Garage
andscape Requirement: Lo
of Coverage Maximum:
Vdisual
Building Height: Maximum Height 1uActual Height 2S
Clearance
nsitive Lands: ❑ Yes CD
' No Type
r ,\
- ban Forestry Plan
L. onditions "Met"prior to issuance of building permit 4
-'.tes:
t i, 1 r1\-- J 6 i4,1- p pi,- ItI -0 1- i s4 1.?--,, ...
'Approved By Planning: ,fl
� v,,.,.1 l / Date: f LH-IF
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:13uilding\Forms\BldgPennitRvw RES 061417.docx
Building Permit Submittal
Original Submittal Date: «t 1t‘15{
Site Plans: # _
Building Plans: # 3�
Building Permit#: Enter building permit#above.
Workflow Routing: [ "Planning Eq"/Engineering 2/Permit Coordinator ('Building
Workflow Sign-off: Er 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.
Q'Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: .......34‘...A.),...„._
,- Date i.;\t ,.k
Engineering Review
Slope at building pad: 76)
0 Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Zr No
Assess Water Quantity Fee in-lieu: ❑ Yes 4CJ No
LIDA Facility on lot: ❑ Yes /6 No
/ErFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
p-Approved by Engineering: A t ICe7,. (.(' , Date: /2- ..2--/(e)
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Ootidmons "Met"prior to issuanc- : _-.• • • •-•••
•
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
*SDC Fees Entered: Wash Co Trans Dev Tax: yYes ❑ N/A
Tigard Trans SDC: NX Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes RN/A
156 OK to Issue Permit
Approved by Permit Coordinator: A61N'°
Date: 1'2-J 1''Z 't E
I:\Building\Forms\BldgPermitRvw_REs_010118.docx
r
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
!PI II
TIGARD River Terrace Building Permit Review Addendum
Building Permit #: mS-+a€ - (0?L 1
Site Address: 14',1 71 S I68 /
Project Name: � r l7,.. ,z_e 144 a.14� Lot #: 1 7-
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dist' t Design Standards (18.640.070.L):
Is the project subject to the plan district design standards? L�Yes El No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 ft. deep Balcony w/access 2 Window Projection Vertical Wall Offset a
/ ft. deep min. 2ft., 5 ft.wide min. 2 ft.,6ft.wide Gabled dormer
L�/ CI ❑ ❑
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 2-6,S `
3. Entrances:At least one entrance must meet both of the follog standards:
❑ Max. 8 ft. setback from long t street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes,all the following apply: q.ft.min.
ne street facing entry 112 ft.max.roof above floor of porch
5 ft. depth min. L1Y30%min. porch roof coverage
Vctailed Design:All buildings shall include a min. of five of jfe following elements on all street-facing facades:
overed porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
,❑l /W/all offset min. 16 inches ❑ Dormer min. 4 ft.wide
Loof eave min. 12 inch projection �❑ of offset min. of 2 ft.
❑ Roof shingles either tile or wood 11yGable,hip or gambrel roof design
❑ : .of pitch oriented south min. 500 sq. ft. El Horizontal lap siding min. 3-7 inches wide
fr Accent siding min. 40%of street façade ❑ Window trim min. 2 1/2"wide by 5/8"deep
El Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
0 Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade
p
. Garages and Carports:May face the front or side lot line on a corner lot.
Iv$, Setbacks:
No closer to front or side lot line,than longest street-facing wall. ❑ Yes ❑ No. If No (Check one):
Gkekje ❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
El 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.
fir Width: (Check one)
441 ❑ 12-foot-wide garage door ❑ 40%max. of street facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: S-0•Adj- LpJL.
_ Date: l Z—(I-11
I:\Building\Forms\BIdgPermitRvw RES RT 121417.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information. -1
Please 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
rit
1111112 Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
i
TO: AI t b U Uv V'Ilr � pvi DATE RECEIVED:
DEPT: BUILRE-
ING DIVISION
vniAV &�, (-,rptvtUl. JANFROM:
COMPANY: -Yom o O� N )0 \_s BUrL, ,, .e;� ic. N
PHONE: (2,1O 01S -1100 By:
RE: 114141
r7 PV V i lX V k , 2. 1 - Do `T I
} 'ermit I um.er
Pi 1 I C r. , ' V-1 \)e VTCTe v rot.(t ot Ir€a 40
rod c i. e or su.a tviston name an. of num.er
ATTACHED ARE THE FOLLOWING ITEMS:
LCopies: Description: Copies: Description:
Additional set(s) of plans. j` Revisions:Ardil-r (A(, Y'a1 5V
Cross section(s)and details. Wall bracing and/or lateral analysi . A_l i ; f73
Floor/roof framing. Basement and retaining walls. I styuci
Beam calculations. NfAil Engineer's calculations.
7( Other(explain): 'I` SS a r vo(V- /SV I o 2S
REMARKS:
FO O FICE USE ONLY
Routed to Pe it Techni 'an: Date: \ 46 (I Initials:
Fees Due: Ye No Fee Des iption: Amount Due:
$ 1c2,......„/
ib relvc,%) $ LISC1G-C)
l� $
$
Special
Instructions: /
Reprint Permit(per PE): n Yes NoL/ ❑Done 7fkA_____
Applicant Notified: Date: r 4 3 X vl Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012