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Permit (85) 14 p CITY OF TIGARD MASTER PERMIT I = COMMUNITY DEVELOPMENT . , ,`'t,' ; Permit#: MST2018-00336 Date Issued: 02/06/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 4' '.. ' ,, �� �CSS Parcel: 2S107AA08600 Jurisdiction: Tigard Site address: 14479 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 86 Project: Polygon at Roshak Ridge, Lot 86 Project Description: New SFA. Model Home. 9/19/2019: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 80 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 670 sf Garage: 532 sf Front: 8 Smoke Dwelling Units: 1 Third: 634 sf Right: 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Fire sprinkler system 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'I 500 sf: 2 201-400 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 SFA VB R-3 1384 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 1 Hour Fire Rated Eaves PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,213.07 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 OR 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: ‘4-....._‘4-....._ ),Z\--/N0,__}L-A... , Permittee Signature: 1 �� � 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. Plumbing Permit Application Building Fixtures ' o'"'°i s a � 'r° , 1,,. ,.. FOR OFFICE t SF ()NIA City of Tigard Received , j u 6 1' Date/By: `-.1 M.5,-I\CA �1� Permit No.;�Cs"c ,�\ C.�-Q... 11,1 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 1 - 1`= 7�� = Plan Review Phone: 503.718.2439 Fax: 503.598.1960 t Otter Permit No.: y , Date/By: '/C! I 466 T 1 c,.h K D Inspection Line: 503.639.4175 ��Ready/By: Page 2 for Internet: www tigard-or gov Notified/Method: Supplemental Information'' ff, , � x p ��,� V i,..{ ''',5k'u 4 %, AY " +;_b gyyq V41 New construction 0 Demolition For special information use checklist - Description .1 Qty. .1 Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ' e;•4.:.:';°bra rt �c4%.ta `( t�` � : .' SFR(1)bath 312.70 .s. ..kN � P . � - � ❑1-and 2-family dwelling 0 Commercial/tnd ----r 11! 1a. SFR(2)bath 437.78 ❑Accessory building 0 Multi-family E SFR(3)bath 500.32 f C \'- Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(/3$ ft.)Ys1• ) Page 2 -,�R�.�;� ,�'� *,�:e` "'� ° ����� �,�„'-e � t `�, �{ ,�-� '`; Site utilities: Job site address: / y7 9s� �f7/./i ,44,/e-- Catch basin or area drain 18.76 / / 7 Diywell,leach line,or trench drain 18.76 City/State/ZIP: + �( ii �` 2- Footing drain(no.linear ft.: ) Page 2 --_ Suite/bldg./apt.no.: t>- I Project name: /_e'd7 , ,L( le- Manufactured home utilities 50.03 __ Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 (� Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: (J(7 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 -, ;,1 ' t : Backwater valve 12.51it Clothes washer 25.02 _____ nr 71)v12I-61h-S ' ? Sp)k4ae, .5V , Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 1 7 ' ;- X�y , � s a "% " rx '€ < c` , Expansion ansion tank 12.51S�::_ v. ''L t_ _.. ::: :;�6 " .._� �" x� ��� s_. vLr " 5'4v Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 I Garbage disposal 25.02 _- City/State/ZIP: Hose bib 25.02 Phone:( ) Fax ( ) Ice maker _ 12.51 i .� �.' A � �. �:-. Interceptor/grease trap 25.02 I Business name: --AS gas(value:$ ) Page 2 Primer 12.51 I Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 1 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 i s ce .� x Y�E"° v ' �" 7 y ,� Water closet 25.02 --- „ �Y,: !', ;�, ,,-,: � _ ,U `..* _ vi . ?' 15 Water heater 37.52 - Business name: AO � L L 0144,1/V-g- / 41- m p p C Water r Address: /'6 $J)( 86 Other: ✓ /� � 25.022 City/State/ZIP: `o/`'?e rr t ee-, q 7 617 Subtotal Phone:(`171) 23$ OSO ii Vff'' Fax:(l ) Minimum permit fee: $72.50 CCB Lic.: I V / Q2 Plan review (25%ofpermit 86 3C.5 Plumbing Lic.no.: 5' fee) _. � State surcharge(12%of permit fee) {I Authorized signature: TOTAL PERMIT FEE Print name: ,,„,,i,,,,,,.....„ Date:51,4 This permit application expires if a permit is not obtained within 180 days Y, ` r after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font LI Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacn77i/Whirlpool Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. LIDishwasher: Commercial Any multipurpose fire sprinkler system. Domestic 0 Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4„ LI Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Maeh./Rerrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:ABuilding\Permits\PLMF_PermitApp.doc 08/04/2011 2 CITY OF TIGARD MASTER PERMIT IN---1-- , COMMUNITY DEVELOPMENT Permit#: MST2018-00336 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2019 T t r..; It.t: 9 Parcel: 2S107AA08600 Jurisdiction: Tigard Site address: 14479 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 86 Project: Polygon at Roshak Ridge, Lot 86 Project Description: New SFA. Model Home. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 80 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 670 sf Garage: 532 sf Front: 8 Smoke Dwelling Units: 1 Third: 634 sf Right: 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 2 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 Drywell-Trench Drain: 0 Other Fixtures: 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: 2 201-400 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 SFA VB R-3 1384 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 1 Hour Fire Rated Eaves PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $22,715.70 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. Yo may obtain aaccopy of the rules or direct questions to OUNC by calling 503.232.1987 or 11-.8800.332.2344. Issued By: �/� i � '{"'2� ��� Permittee Signature: :'(� - //(tG /j 7 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. . t Building Permit Application L-0T �J V, R . , esidential RECEIVE , ' FOR OFFICE USE ONLY l _ City of Tigard Received -r r igr 13125 SW Hall Blvd.,Tigard,OR 97223 Ol r {.i f li 1 i Date/B : i Permit No ti *„\ t Plan Review --111^ Phone: 503.718.2439 Fax: 503.598.196 -;(Iry OF � $ 4 Other Permi. •\ tU' �-I r O.r TIGAR DateB r }.��L1,� T I GA R D Inspection Line: 503.639.4175 % Date ReadyBy: 7u s: H See Page 2 for Internet: www.tigard-or.ggoiv BUILDING lM Y 1S i Notified/Method: Supplemental Information 'Li✓" �,.,>." �/;" _yq ,,,_, �., �/% ,:�.. y� e✓;;,: �'QL1IREll I1'�"1C`A 1,A1�7b 2 lE<' '1'b�LLTI+�C .. ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other ,e ui mentmaterials,labor,overhead,and theprofit p t , pro tt f or the // /�# %/ -,04-- j." y,% r y GA 9ogy:pP cos,,A JcT pN work indicated on this application. ® 1-and 2-family dwelling IDCommercial/industrial Valuation: $ I � (j� El Accessory building ElMulti-familyNumber of bedrooms: ` 0 ❑Master builder ❑Other: Number of bathrooms: I04 s1E i...1 *I Al * I •.Lo 'IUN ' y '✓: Total number of floors: 1 t z rte. ( �\ Job site address: `LI U-10 iy I+n l -- J1/ t`.�NO-I t- New dwelling area: `�ic/ square feet ( „ City/State/ZIP: fi1�OtAr �0\i t-itAN-V p^ Garage/carport area: 59A square feet `( 7 Q Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Avrot I Covered porch area: square feet cs 6 Cross street/directions to job site: Deck area: square feet v Other structure area: square feet EQU0I A C)MM `RC1MA1SR ECIa T Subdivision:Polygon at Roshak Ridge Lot no.: n Permit fees*are based on the value of the work performed. Tax map/parcel no.: Wl Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the Z 12i- itijr 1 s C1,:#'*€ [ ..,G ,i work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet A'PRE? EIt OWNER t%`TEI�1�1' Number of stories: Name:Polygon WLH LLC ,� Type of construction: Address:703 Broadway Street }p StV Occupancy groups: City/State/ZIP:Vancouver,WA 98660 Existing: Phone:(360)695-7700 Fax:(360)693-4442 New: �21 PL CAJ j , : ; / CUN PEO1 y rte � ,r,.,. .,y` /t� r� y,.;, i3O ;. ,,, ��. BLII[tl�t"a,TGPP�214iI'I�%F`IE�ES*r ��{� Business name:Polygon WLH LLC '. % #1hrersrbtuiel Structural plan review fee(or deposit): Contact name:Amanda Gavin FLS plan review fee(if applicable): Address:703 Broadway St.Ste 510 City/State/ZIP:Vancouver WA 98660 Total fees due upon application: Phone:(360)695-7700 Fax::(360)693-4442 Amount received: I'H06V?ifAIAR11F I XS3< FEES E-mail:permitsubmittals@polygonhomes.com = q i� r ,- y r� ._ r Commercial and residential prescriptive installation of W: .0 't l"4 4e, �.• Alk;,'-- -!'0.0' 1roof-top mounted PhotoVoltaic Solar Panel System. Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist. City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review and administrative fees): $180.00 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 Authorized signatur•'I �_/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda Gavin Date: 10 j r I b *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) • Mechanical Permit Application FOR OFFICE USE ONLY E,Cily a Tigard 97223 Penni;No..: . • .13125 SW Hell Blvd.,Tigard,OR 74 E parriar. Plan RI-kV 1 C W ; I '. Moor: 5017182439 Fax: 503.598-1960 f.hkr f". -rnitMs-r alA_Cis.. "5,-sti! Th,-r. iiirr. Inspection Lint: 513.639.4175 TiGARD Dair RrudylBy: isleliti1r ftt 4-sfAii-uunOr„guv NatifiatIMelhod: .3'w' ': 0 Six Pu,v 2.fur- . SUffplanental Information • „.:...... : .. ... , . - . . ...,, -:-..• --- . ._ , , ...:i,...:,-::Ej„::::.:::.i:.::::',!:- •'..!:.i..ji: of.::4,0k..2,::„:.-..:„ :,...i,:!:.;,::ii:.•.:;.,::::.!::',;,,,;i::,',;:ejitliT.,!,7:7,'.:1, 7":'.*,7=,;'...;-7 gc.m.rixEfrwir,9;.." 1!". 0.1Eptil., -,,;: t7,st-.at.. c.1,41.07:-.7.-'..,:. . _ ... . . . . .. _ ' lvieehanit permit fees.*are based on the value of the work 1.New coustrudion 0 Additunialteratianfrepineerneut Perfbancd.indientntlin value(rounde4 to the itarest do tier 1 of M.I' • 0 Dentolitinn 0 Other i mechanical materials.equ'unnerd,1thor.overhead,.aud profit ' Value: ..,':51.r...'.':•'''-':77':--:::;''''-''.:- 7: -;- ''-',:';i.,-6i'it•t;dit'Ve:IJii:aSit.:filii6tioN41- "---:74! ".':1-,-Zj''',.,,' :--'-'';':•,:"';'-:';-:''"-' S ” -----•-•:,-- --,--•-,••-----,•,-- -,----•-—-- -L.-- . - ,•- -:"... -- ' '.---''''-•'-'' ..'''-'"'"'''''''''''''''''''' . — : -•:- ' ' ''-:- ' '''..; -- - ... '.::' '';'WO)01.104ttW:PTATIO71:PWYES :::'''.. Cl l''and 2.4*raity dwellint 0 Courimurciallinthistrial E1 Aceery building rurspeclul thfurnSaittlif use checklist • ' r Multi-family 0 Mister builder 0 Other Descriptiori I Qty. I .Ez_ I Total. '-'-',;•:'4:•:!1::;;!*,:.-iiiii::glikr;iii0.6111/41,itieti:1141):teiek.iiii.? :',::'S':::i•ji-."';-!1:11 :-:: :T'f-'71 11"tiutk'lingF Mr conditioning . i I 46.-j- ..lob size addrmt 14 Li 1 191, C Y\) , 112 f 1'41 AV/.4 A A A A I Furnace l00,000 BTU fdae6gventi 1 4675 CityiState./11P Tt...ard,OR 92224 Formice 100.000+13Th(ducParlto I Heat pump . 61.06 I SuiteluidgAts_na.: ixtet work PPC4Et1 niYUC- r i 11A i VosVAL- , 2332 I .-. Cre&s streetidirections ho job site: I ap Q i livdrunic hot water wstem 1 . 2332 I 1 - I akytimResitti)al boiler(radiator or hk)-i- - 1 23.3" 1 1 Unit heater&(fuel-type,not electric), : in-wall_in-duct.suspended,etc. 4.6 75 i I, Flueveut for env of a/sm. I . 2332 - ... 1 ther '3.31 Subdivica: N ucr- Tecrace Ecx-s Lot,a.: .O - i Other fuel app0aume Tan map/parcel Po,: . Water heater 23.32 I .gLiiie.ribiii::' 0.-Aiifoiik=1:-. :7-::,;;•.,":•:,7:,..;i.5y,-i::•. ::::,"-, . .1.i.::::•, .."..t. Gra firepisoefilve3339 I rt 1 : • • Flue not for-water heater or gas , fireplace 2332 • - --- . - .. Lo lighter(gas) 2332 I .-- I - . -••- - • i Wood'pellet stove 1 33.39 I Wood fireplace-mu-sea , 23.32 . Clikturmlitterlfluevent . 23.32 I :•.:':':...''..--.....-;..6'-*Ltiiii,367.SFW:*t*!:'41 'FlitY.1',: -:::-',':••:,:-'•,in"-f-k2c. -Y., :'. i -' --:..:•:--E'' c'hcr.- , • 11,31 - . ---'--- — - -- " - • -' "- • . - -.- " • • 1 Environmental exhanstand ventilation: Nmne:• . ,. O\tAo(DIA . VVI/R 1,Lt, .. I Range hoodiother kitchen I 1 if 33_39 — ) Add=: -7' 1 Vi7u r_7V Mgt VUYAM,.ci- Skt C 1 Le:quint-nerd I Cloth dryer exhaust ' I A i 33..39 I City iState42_11_2a.S29tfiLOOIL oi (.(2 y) 1 5.intile-duct cs.haust(bathrooms, 1 1 ' --.1 i toiit compartromes.utility romns) I 3 1 1---, „T- 1 Pb°8e: 'ZLQ0(04S 11 00 ...] .Fax:( 0)( lft1tJ2, I Attleterawlspa=fans 1 I I 23.32 .. •-•.: .,':.,,.:.::::laiL•kr..k.titAt.,:i-,,'..!-:::,.:;,...:7-..,::;;E' •,...i.:•-,,:Q,::" ."..•.a e.Gsimet,•iikaso,S1 ..:-.--.,.:i.,:,.-. , Other i I 2337 I Fuel piniurr. [ Business name.Polygon Will,LLC , • 14,15 fur first four:S4113 fer each uddirsonul . CoUttats. EtUftsg-, rtmo,R .6.1.2iv 1 0., 0(6t, FurraL-e,ek. 1 Address 1 0 3 "R)y-004upo,_ St- t SA•e 5 tO, . G.s,bear maim I 1 , . Wallistispendetikrnit heater 1 i City/Statz/ZIP:Vaatentreer,WA 98660 Water heater I . . , . . . Phone:(360)695-7700 I 'Fax::(3601 693-4142 Fireplace . E-inatl:-- errY\ suYyty;,Wats a•-iRok. sor,Vvorne5.ex rn , Barbecue It I . 4,..“!.. , t.7;;;SC'TRA,..0,41R: E,151:...--:.- ,.:. ....,.7,..:; • 4- .. I CirKbes dryer(gas) i I 1 1 . Other: 1 I Business nu=Apex Air LLC - . `.7'.•'. .,r.:,'7.,•::--..7.± .'-,'..j14:E.SBAtEi..til-t01SIFF-XElt.Stq::::,... ..j..!:....,....,..;,:•,..!...-:::: 1 • Address:1&064 NE 72'd Ave 1 I Subtotal I _• CkyiStateiZIP"..Varrentiver,WA 93686 1 Minimum nem/it fee( 9o. 1 man review(25%of permit fee) I Phone 1360q 3424109 . I Fax,:(360)32'6-1769 1 1 tate surcharge(12%of permit Teel CCB lic.-,203034 I TOTAL PERMIT FEE Ast”signature; --- ,,..., -, I Date: J11,1 Li.1 I Fl 1 Mat tun= 1 tdoN, ,/ 4 . ..... . ., _ sihripen:tedit application ryx.rpti_confrizs if::earittnidiitaisg:dui usbir,12..is=„ieettes3 wi:i:LSO dzy5.after is has been acssepte4 as mil:Atte. l'ikkithar,TrtrriTAIMEC_Ptralizkmpt5# 13 goc 440.41,i:71'nil:*COMVER i Electrical Permit Application FOR OFFICE USE ONLY Cityof Tird Received Date/B : Permit#: , Y 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.7182439 Fax: 503,598.1960 Date/By: . Inspection Line: 503.639A175 ReadyDate/By: Juris: - TIGARDQ See Page 2 for .a Internet: www.tigard-or.gov Notifed/Method: Supplemental Information s '."# TYPE 6EO ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition Oilier: 0 Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. C`ATEGQ 1( OF .0:1W FRIICTT01!!- ., _ _ exceeds 10,000amps at 150 volts or .. _._ �?.�;_�,. ��, . — c,._._,�._�. __, __ El Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi family ❑Master builder amps for all other installations. . buildings. Other: ❑Fire pump. 0 Installation of ISO KVA or ... ,,g SrTE JNItORM-110*ANI)>UOCAT 0.$_ _ 0 Emergency system- larger separately derived Li ❑Addition of new motor load of system. Job#: Job site address: l"141 t7 S(V i(01-1-1-,1Pi 10011P or more. ❑"A","B",u1-z, 1-3 City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy, 0 Health-care facilities 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: o m In l b ( / ❑Hazardous locations ❑Supply voltage for more than poi �"I , `�Y�( O J A' ❑Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: / ire 1. Description i Qty. I Each I Total I •' p New residential single-or multi-family dwelling unit. Subdivision:r Vey l�'V `r/)St Lot#: (n Includes attached garage. v 6 J B VJ 1,000 sq.fl_or less 1 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 1 33.92 1 Ifigtea. ,_. ,, .__..DESCRIPTION GE WORK` _ _--, Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) PI€O1 ERT Gfl Eli '... -Renewable Energy ❑ See Page 2 ```" n SZ ""`-- '' - ` --3- - fi- Services or feeders installation,alteration,and/or relocation Name:. r 9 O IN d 'tA1 t ] / 200 amps or less 100.70 2 Address:' �l�� J s 1/1 v 4 .❑_ A 201 amps to 400 amps 133.56 2 y Vi, ` `� (�i n�' 401 amps to 600 amps 200.34 2 City/State/LW: Maw/!1 1 A\�QjY��/ b 1X�o 601 amps to 1,000 amps 301.04 2 Phone:( 3ee O ('6 > 1100 1UU Fax:( 0)(0,012)q I(, q Over 1,000 amps or volts 1 552.26 2 Email: 1(V YY�/l//I/ ``fit 5 b 1/� C, I (( 17�'n Temporary services or feeders installation,alteration,and/or �I @pLD1 oYuQ) ' I VV\/� 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 � fr � f y CU1V'Til� (}N, Branch circuits—new,alteration,or extension,per panel _,�-.,.,_._..._....,�--.., _.. ....:� . :_; � . ._ _,__.-�. ._ A.Fee for branch circuits with Business name.' pot 1 . 1 l F �l� above service or feeder fee, , \` Vl 1/V l each branch circuit 7.42 2 Contact name: lYnl/yyl B.Fee for branch circuits without Address: 'lO7 B VOC�t�(� I Gt- ct S 1 service or feeder fee,first branch circuit 56.18 2 ""�� !/ City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax::(360)693-4442 Each manufactured or modular Email: •e VIM,t e)vAb OA �,1 0 POI / 0 VM OW,l D S dwelling,service and/or feeder 67.84 2 � t'vw Reconnect only 67.84 2 RISAW— _ �:...t*.�,. M ,__.... , ,_ 1.Mktriiiit*-1 Pump or irrigation circle 67.84 2 Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:6101 NE St Johns Rd ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable in any of the above ! Additional inspection(I hr min) 6625/hr Phone:(253)320-1657 Fax:( ) Investigation(I hr min) 90.00/hr Email:bdaniels®gweusa.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: C1158 Electrical Lie.: 208174 Suprv.Lie.: 44965 specifically listed 06hr min) 9000/hr -—. T.- tiAlettragf~MtEIfBZI`,L4`0.ES _I: N: § Suprv.Electrician signature,required: Alt y Ad I/ Subtotal: Print name: Joan P Albert Date: 1p - LI - ,e 0 Plan Review Required(25%of permit fee): 1� ��� _ State surcharge(12%of permit fee): Authorized signature: 7` __........--.----'---:1--- � TOTAL PERMIT FEE: I-"t) � �,� This permit application expires ifa permit is not obtained within 180 Print name: Bill Daniels Date: f. -- t days after it has been accepted as complete. ]I * Number of inspections allowed per permit I:1BuildinggPermitslEt,C PermitApp_ELR ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/wEB , Plumbing Permit Application - - , Building Fixtures Cityof Tigard Received Penni(No.: v 13125 SW Hall Blvd.,Tigard,OR 97223 Da =y: . Plan Review � "11 Phone: 503.7182439 Fax: 503.598.1960 OtherPermitNo. r (S �` Inspection.Line: 503.639.4175 Da I3y: �aU� Ti G A RD pDate Ready/By: lens: 0 See Page 2 for Internet: www.#pard-or.gov Notified/Method: Supplemental Information < TYPE OF WORK FEE*":SCHEDULE ' For special information use checklist 1� New construction (`Q�{Demolition Description ( QtY• a Tota( 0 Addition/alteration/replacement LJ Other: New I-2-family dwellings(includes 100 ft for each utility connection)iTECs£}RX OF COItiISTi�i3CTIt1N SFR(I)bath 31.2.70 ' SFR(2)bath 437.78 1-and 2-family dwelling 0 Commercial/industrial SFR(3)bath I 500.32 0 Accessory building 0 Multi=family Each additional bath/kitchen 25.02 Master builder 0 Other: Fire sprinkler( sq,ft.) Page 2 -;. -.. JOB SITE INFORMATION AND LOCATION t ,....,.. :; Site utilities: Job site address: 1-1"11"I s K) I ill pt Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: ç)() l(t' WSh Il L ii(f Manufactured borne utilities 50.03 Cross street/directions to job site: Q.n(i I Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no,linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no,linear f.: ) Page 2 Subdivision. ..t ve V "rt l rt.ld l/` tut St Lot no.: g Fixture or item: Tax map/parcel no.: Y V Backflow preventer 31.27 I)ESC RIPT1NOF:WORK,: Backwater va1�e % 12.51 _- Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 p .': Expansion tank 12.57. Name: 1201_1 V L 4 LL Fixture/seweror drain/floor cap 25.02 Floor sink/hub 25.02 Address:10 3 aye,Gtot,tk3604 St s-re S 1 u Garbage disposal 25.02 City/State/ZIP: Vet vi c O wV gyp. p'"(J&,) Hose bib 25.02 Phone:(t'3(if0 670 5-2-700 Fax:( ,itvt (4 Li trz, Ice maker 12.51 APPUCAN3',; Gt3NLAC F PERSON. M . .. _ _- -lnterce�tor/grease trap 75.02 Business name: Q �I n '^ i�� �� Medical gas(value:5 ) Page 2 �n V" t v '�/ Primer 12.51 Contact naive: 'I l Lo � W 2 ( Roof drain(cot�„ueroisI) 12.51 Address: 1( -- 16VIS(GA'(t fin( c-k. )1 D Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 "" Solar units(potable water) 6234 Phone:(360):695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 I Urinal 25,02 Email -,e l/► 1 ft to l 1. At A4A. I A._, ;sierelaset 25.02 CONTRACTOR Water:fieater 3752 Business name: 64.....i Lwttb N'Yi„.,CA Wateri in 'WV 5629 PP Address: ,,Q, 6-ciiv 't� Other: 25.02 City/State/': 5std.- t`. e(Lill art- c 1'31 Subtotal Phone: 3 ..-st .- 1'I [ Fax:(f.1 )""'7e7,"'7 f"C Minna' lure permit fee: $72 e) r}.� } Plan review (25%of permit fee) CCB Lie.: 1811 J f Plumbing Lie.no.Pb i q State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE n This permit application expires if a permit is not obtained within 180 days Print name: "/�!�i�� Dale:"- ate \'? I�' Y 1 after it has been accepted as complete. j vV *Foe methodology set by Tri-County Building Industry Series Beard. L'auldingll'amitsIV11.41:34'amitApp.tioc 1WO1/09 44o-40i6T(iO/o2/cOW WEa) • City of Tigard ~ COMMUNITY DEVELOPMENT DEPARTMENT 14 GBuilding Permit Review — Residential TIBuilding Permit #: MST,bAU Site Address: /2/2717- ' )0 /'Wh ,/v- Project Name: v4/ ri ea-72- e-Od � <42Lot #: g (Ne g=subdivision name;Addition or Alteration a t name of owner) Planning Review Proposal: New -' 1- IN e EL. 1--i eyil, i NJ erify site address/suite# exists and active in ermit stem. 7p 0 River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached SittIPlan Elements: V}/Three(3)copies of site plan i ., :sting structures on site gleite plan must be on 8-1/2"x 11"or 11 x 17"paper "A Footprint of new structure(including decks)with finished Or wn to scale(standard architect or engineer scale)Opro or elevations ) rth arrow 'ty locations&easements(required for new and additions) Ito address,project or subdivision name and lot number hdS dewalk/driveway approach h. .plicant information(name and phone number) it L ation of wells/septic systems FA . dimensions and building setback dimensions AKsting trees to be retained with drip line,and tree g. '.uare footage of buildings to be demolished otection measures i•Lot area,building coverage area,percentage of coverage andL�id treet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) 1lJStreet names Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replac ? Lid Yes ❑ o 4 foot differential) If yes,is a storm water quality facility shown: ❑Yes No 0 �can Water Services—Service Provider Lett (lot platted prior to 9/10/1995): equired: LI Yes,applicant was notified 02 No Received: ❑ Yes ❑ No Public FaciliImprovement(PFI)Permit: P)/�0/(—D0/03 equired: Yes,applicant was notified ❑ No Applied For: ilYes ❑ No,stop intake md Use Case#: AbeQ( c^_-6"3OD�/ ae ji N 00� ing: X/Q- (P b) Required Setbacks: Front Rear ^^,) Side Street Side . Garage V � tJ g irziandscape Requirement: 20 0/0 t Coverage Maximum: -- ---6---- YJ :uilding Height Maximum Height p1. Actual Height ,g0 74 Visual Clearance !l t..ensitive Lands: ❑ Yes iNo Type J Urban Forestry Plan ❑ Conditions "Met"pjior to 'ssuance of building pe. :t Notes: �/ i or j i_ /. / A /v i i ,ter/i 1 C- At_e/ ❑ Approved By Planning: — NT Date: i....2_/Le_//A Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 061417.docx • Building Permit Submittal Original Submittal Date: t Site Plans: # 3 Building Plans: # 9 Building Permit#: Enter building permit#above. Workflow Routing: [ 'Planning Er Engineering [ Permit Coordinator ©'Building Workflow Sign-off: 2'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. R"Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: I 1 IC (l� s::. .�s:;rr..�rzXad.,G:'o "u.<s-swy.'6!..FL{'iWaTi?.c.:m.:st.✓�a.ase:: iwA`P• .. ZS.'.a "F.k' RFT's.43,r'v3 .t..,:wr, 'Y4: ._ X,i t'.+ Engineering Review jkslope at building pad: ❑ 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: 0 Yes "E' No Assess Water Quantity Fee in-lieu: 0 Yes Cr No LIDA Facility on lot: 0 Yes ,,a No Final Plat Recorded: 0 NOT Approved by Engineering: Date: Notes: Approved by Engineering: kn-t � Z Date: /Z. l,2---/11 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review CO onditions"Met"prior to issuance of building permit 0 Approved,NOT Released: Date: Notes: bk- 10 t q/1-6 iV AtV( WV%Of) W L U Yl YY► * Ctnctl-ft h4 b ri iYi s Ip1A f h,G�ir Revisions (after Building Submittal only) Y 910al Q hnernes 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: 50.. Yes 0 N/A Tigard Trans SDC: or Yes 0 N/A Parks SDC: Vt Yes 0 N/A LIDA 0 Yes , VA J OK to Issue Permit I Approved by Permit Coordinator: Date: 12-1 (� ( i I:\Building\Forms\BldgPermitRvw_RES 010118.docx City of Tigard " COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 G A R D River Terrace Building Permit Review Addendum Building Permit #: coc`c{a, a,-( Site Address: /1)119-C) 2t/t) / 9,4 /9v Project Name: !0 ,tet Q /f is , _ ,�' Lot #: (New dwe bdivision name;Addition or Alteration=last nam-�.4.wner Planning Review of River Terrace Plan Dist4d Design Standards (18.640.070.1.): Is the project subject to the plan district design standards?V Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing façade that has 30-60 ft. of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch min5 . dee Balcony w/ access 2 Window Projection Vertical Wall Offset a p . ft. deep min. 2ft., 5 ft.wide min. 2 ft., Eft.wide Gabled dormer CICICI ❑ 2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: /S^ 02 0 0 3. trances:At least one entrance must meet both of the foll.. ' g standards: Max. 8 ft. setback from long street- facing wall IVA Parallel to street,angle no more than 45° from street, or open onto porch Entr nce opens to a porch: Yes ElNo If es, .ll the following apply: 5 sq.ft. min. i ne street facing entryalft. max.roof above floor of porch 11, 5 ft. depth min. 30%min.porch roof coverage 4. P t iled Design:All buildings shall include a min. of five of the following elements on all street-facing facades: it overed porch min. 5 ft.wide x 5 ft. deep Cl Recessed entry area min. 5 ft.wide x 2 ft. deep all offset min. 16 inches ❑ Dormer min.4 ft.wide Roof eave min. 12 inch projection ❑ Hof offset min. of 2 ft. ❑ Roof shingles either tile or wood VGable,hip or gambrel roof design ❑ Roof pitch oriented south min. 500 sq. ft. ❑ Hyrizontal lap siding min. 3-7 inches wide ❑ Accent siding min. 40%of street facadeindow trim min. 2 I/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 . . : . •es and Carports:May face the front or side 4t line on a corner lot. Setbacks: No closer to front or side o- - an longest street-facing wall. ❑ Yes ❑ No. ''. Check one): ❑ May extend up to 5 ft.if there is a cover-. .nt .orch and gara t- e.:-s not extend beyond the front porch. ❑ May extend up to 5 ft.where the garage is part of a . :- -• 1..r building and there is a window at the second story above the garage that faces the street with . • . area of 12 sq.ft. Width: (Check one) ❑ 12-foot- :,- :.rage door El 40%max. of street facade • i'o max. of street facade with 7 detailed design elements Notes: Approved By Planning: r 11g Date: i / ii I:\Building\Forms\BldgPermitRvw_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. 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 71 II Transmittal Letter T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: \°01(ii\cOV\ 1'1 r M sbrnvl DATE RECEIVED: DEPT: BUILDING DIVISION0 ' ,� N 0 JAN 32019 '(. '' FROM: �UJ '�O CR `� COMPANY: r/I (/� CL (i CAV I V\ BLIP�Cli":3 ;., U PHONE: LoI) (Q V\S -1 DD By: ,. RE: La Site 1.k-A O SU.) IlQui O� ` AUi ,uuL , MST MI?) - 037DV ess) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: rt I C 1 AirL IA Y(41 7 V Cross section(s) and details. Wall bracing and/or lateral analysis./ r Lk Floor/roof framing. Basement and retaining walls. (A2)lit, Beam calculations. I Engineer's calculations. i),(9)ul.g 7< Other(explain): tRASS ar2l W 1\4 rsvi DV 1 "F5 REMARKS: FOR E USE ONLY Routed to Permit Tec ic'. : ate: l i Initials: Fees Due: ❑ Yes / Fee Descript on: Amount Due- ./(?1j\..• 6 $ Special Instructions: Reprint Permit(per PE): ❑ Yes No n Done Applicant Notified: ate: (/�)/1 Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 Plumbing Permit Application Building FixturesEi P d E .{ FOR OFFICE USE ONLY City of Tigard Received Permit No. t c Date/By: i t5 i iG S.-t 1�c,T-v k CX.;''3k3t II . 13125 SW Hall Blvd.,Tigard,OR 972221 1. I. b 2 019 Plan Review Phone: 503.718.2439 Fax: 503.598 1960Other Permit No.: Inspection Line: 503 639 4175 fry, c�l , 4 Date/By: TIGARD (,�6 a < 1�(-3:..\� Date Ready/By: Joos Fd See Page 2 for Internet: www.tigard-or.gov t s (� �i t m, i r,' Notified/Method: Supplemental Information k1 TYPE OF WORK ( r fw e dws ��^ a __., a- . ....�. ._ .v. .. .�__ _..,.., � ,_.4..� ..,,.. .� ..W _.-FEE*gSC`AE��[J)i,�� , , 0 New construction ❑DemolitionV . For s,ecial in ormation use checklist. vwe C ": aescri.tion NMI Ea. Total ❑Addition/alteration/replacement 0 Other: \C li ew 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 buildingSFR(3)bath 500.32 ❑Accessory ❑Multi-family Each additional bath/ldtchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: (y l,Oc l(d. \_R„4. kv Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge I Lot no.: $(0 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 lel •-b3W Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.,Ste 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 E APPLICANT ❑ CONTACT PERSON. Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Contact name:Tonja Morris Primer 12.51 Roof drain(commercial) 12.51 Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) t 62.54 Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 a CONTRACTOR` Water closet 25.02 i Water heater 37.52 Business name:BDL Plumbing LLC Water pipng/DWV 56.29 Address:PO Box 85 Other: 25.02 City/State/ZIP:Corbett,OR 97019 Subtotal Phone:(503)351-3903 Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 180345 Plumbing Lic.no.:PB1582 State surcharge(12%of permit fee) Authorized signature: i7 TOTAL PERMIT FEE Print name:Brandon Lanter Date: This permit application expires if a permit is not obtained within 180 days after it bas been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)