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Permit (82) CITY OF TIGARD MASTER PERMIT N il F ' • COMMUNITY DEVELOPMENT h; Permit#: MST2018 00330 t� Date Issued: 02/06/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 `' 'i �� Parcel: 2S107AA08200 \� Jurisdiction: Tigard Site address: 14409 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 82 Project: Polygon at Roshak Ridge, Lot 82 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: 3 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 670 sf Garage: 532 sf Front: 8 Smoke Dwelling Units: 1 Third: 634 sf Right: 3 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: 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 Horne/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: $25,491.07 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 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: \ S -.Permittee Signature: \ �+ �^( \��([�- 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- I w'3 Plumbing Permit Application ( ' E P t' Building Fixtures Ci _ ..al v , s.� FOR OFFICE USE ONLY g � 1��, F t Cityof Tigard Received 131SW Hag Blvd. ,Tigard,OR 97223 ��Q Date/By: 1\� e ��\ Permit No.:M� j _ . 1 ■ Phone: 503.718.2439 Fax: 503.598.1960.. Date/By:Plan Review 9/ / A G/ Other Permit No.: .y, z.. � .,, -1 ��(� /'C tJ7 T t G A R D Inspection Line: 503.639.4175 -� �t' i p..., 4,,.¢ Date Ready/By: ,. Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: ci Supplemental Information TYPE OF WORK FEE* SCHEDULE . _ 7New construction 0 Demolition 3 s \ For s p ecial information use checklist i •ton Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: Ne*1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION \___.- SFR(1)bath 312.70 ❑ 1-and 2-famil y dwellin SFR(2)bath 437.78 g ❑Commercial/industrial 0 Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(13841sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: L.C.�" c�, 1 f T f/ Catch basin or area drain 18.76 ty ' D vu �G�y ,4 tom, Drywell,leach line,or trench drain 18.76 City/State/ZIP: 74 i z: � // 1� /� Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: i.5 I Project name: iea-3ht k t',e c9jp Manufactured home utilities 50.03 Cross street/directions to job site: ff// Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Subdivision: Lot no.: Water service(no.linear ft.:_) Page 2 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 C_tL/v 7')Y1li.-t-tr k a j4? y,',k` ,,, ..54,,S-*_(,-, Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Contact name: �� Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone: ( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CO TRACTOR Water closet 25.02 V L / �� Water heater 37.52 Business name: L Z � �, C Water piping/DWV 56.29 Address: yd)( 86 d Other: 25.02 City/State/ZIP:✓ (log FE` t-j /w1( ('7 (j/7 Subtotal Phone:(1�I) 2s O56 t1 V f Fax:( ) I Minimum permit fee: $72.50 (: Plan review (25%of permit fee) CCB Lic.:1 26�t.�fes. Plumbing Lic.no.: �5�� 9State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: ,-"E'" 451-6116Zzig Date:Seo 12- This permit application expires if a permit is not obtained within 180 days r after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(to 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-I'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 l� 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 Work Performed: Replace/ Please check all that apply. Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ 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" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 11114 CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2018-00330 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2019 Tri; r n 9 Parcel: 2S107AA08200 Jurisdiction: Tigard Site address: 14409 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 82 Project: Polygon at Roshak Ridge, Lot 82 Project Description: New SFA.-Model Home BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 80 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 670 sf Garage: 532 sf Front: 8 Smoke Dwelling Units: 1 Third: 634 sf Right: 3 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 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 1 hour Fire Rated Eaves VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $22,948.70 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. r Issued By: .4/ .2�� Permittee Signature: .`r` 6 /[-V-i› Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. � � Lc ) Vs Building Permit Application / q � � ,. � i-' Residential FOR OFFICE USE ONLY - Cl of Tigard and Received, _ - - `J g - Permit No. '� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R : � "�'' Plan Review a Phone: 503.718.2439 Fax: 503.598.1960 p =Date/By:Review, I I C) A* Other Perms A)13 LIi _ 3 ..\ TIGARD Inspection Line: 503.639.4175 .51� °�dA� 1�� tateReadyBy: Juris: fa SeePage2for Internet: www.tigard-or.gov i i1$ DLNG t^IVIS 0 fied/Method: Supplemental Information " iJ 1.ehA817�1.J R`t 1� TYPE,OF WORIcRiEQUII D DATA t AND?FAMILY DWELLING KNew 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: equipment,materials,labor,overhead,and the profit for the ` iii work indicated on this application. �; �� `CAT,EGOItY:"OF COSTRLT�T�lO�1 ,rte. .-..e . g1-and 2-family dwelling 111Commercial/industrial Valuation: $ l �, � 0 Accessory building 0 Multi-family Number of bedrooms: I W ❑Master builder 0 Other: Number of bathrooms: '� JOB SiT'E I1,F5RMA`l� t]rN A1NJ i.LOCATIOl�t y Total number of floors: 3 `� l -- .„....w "-_ .r - - ,:rte= .v�° �. . _ .. _� �z Job site address: I ', : A, V .4 '' I �, C)i� r New dwelling area: I ��4 square feet (0 J1{ City/State/ZIP: r� o� 'J / Garage/carport area: 3D) square feet kt7 Suite/bldg./apt.no.: Project name:12u I(t'J`"o'�// -g,� v,os k r Covered porch area: square feet 50 Cross street/directions to job site: ' Ptra I Deck area: square feet Other structure area: square feet � QUIRED)DATA:COMMERCIAL-LSF CRECKLIST Subdivision:FOI 14�V�L J Oak- v O(I/�r,� V-1 Lot no.: 0 2) Permit fees*are based on the value of the work performed. Tax map/parcel not U r Indicate the value(roundedto the nearest dollar)of all equipment,materials,labor,overhead,and theprofit for the AC 0 �� isCRON F WOR{ work indicated on this application. ; j Valuation: $ Existing building area: square feet New building area: square feet ---- X-,21' PiiQPERT'Y WNE1 ' f4 . 'ENANNNT / Number of stories: Name: VOINO1A. �`/ .. UJ Type of construction: Address: / /p O 3 * Sk D Occupancy groups: City/State/ZIP:\aVwIV rL °I (/'^ Existing: Phone:( l ) ( C ? � /DFax: ) llG1 tI LI....„..:_,,,,,4_,,, New: : . 'APPLTr L ONTA*PER '` ,l:f.-: ;` =BUILDING PERMITFEES* Business name: ��I wik)V 11 �� '' fFf rfer io ee sched tle) r "-- Structural plan review fee(or deposit): Contact name: •� �i014)/l I 9�➢ FLS plan review fee(if applicable): Address: V�-ow OM� �S r A,^ '/�A r,n O W Total fees due upon application: Ciry/State/ZIP: ,/ (/t �I l/Y I/l (3(00).091S 1171 Fax::( p0)(0019)q Li q 2 Amount received: Phone: ��qq�� I +A I/� ��) E mail„r al V wt ib I� Q i V U/L Q i� � 1 A t'1EI+E)T 1C S I PAi�i1 XSTEIII ES*, .,,, Commercial and residential prescriptive installation of .i; COl`TTRA�OR teg , _ f l,,,,.,,K yeeroof-top mounted Photovoltaic Solar Panel System. Business name: 'A,t U lob f,^0'w i y1.i Q C 1, Submit two(2)sets of roof plan with connection details Address: O"2 1�,vi ' A rItn+p)C �,L rs_,-,e,'151,0 and fire department access,along with the 2010 Oregon v ✓ r/V V(/l(/1 �IJpL)d lVl (/ Solar Installation Specialty Code checklist. City/State/ZIP: V 1 6 Cu ULV ,r Oi (n(PO Permit Fee(includes plan review $180.00 Phone:( )(/J�1S 00 Fax:(2(„OC)�[✓ ((4 9 and administrative fees): 0-72)4L V! IVI✓ l I IU t State surcharge(12%of permit fee): $21.60 CCB lie.: Total fee due upon application: $201.60 Authorized signature. /, This permit application expires if a permit is not obtained • 11, within 180 days after it has been accepted as complete. Print nameAM1 ti l / -/1l/� Y V I I/1 Date: I o O j/i s *Fee methodology set by Tri-County Building Industry 1 v Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) 1 Illia ----------' .... :., . Mechanical Permit ApplicatitiV), -'',‘ toa OFFICE USE ONIN . - - • • C. of Tigard . Rccraved , Permit Nu.: .13125 SW Hall Blvd.,"lizard,OR 97223 DEC6 2 rl 1 8 114 oat Plan Remcw : . MO= 503.718.2439 F 503.598.1960 Dateiiir. Other PomitMe.....25vAuSs_ --1-i G A tz.D ' ..S lespection Lin= 533.639 A 175 ' ',: ':- - '' . '• - '-' ----- Dqic Rcadvilv• Iarsq Pi. te Page 2.far. . .. , , .ititcMpt www.t.isard-or_gov Nrti.fi6:14.4e.thod.: ; Supplemental frtfurtuntion t rli:;F:?;0::-77:-:;e:7]77-A:4:ifiriVi.;;iolik..7.77:Ji,:!::7;, . :;::'ZI:..-.3,7,4q..-7.::.7_77j..;.7-' it-",--.T. 0,11.**0i46;.,rt. :::: eltEOtt. ;F:t.*E:click-Els17,-.:,:, machani=t permit fees',are based on the value or the work #714 New construction 0 Addifionialterationtrepineernent performed.toclicute the nine(rounded to the nearest(lunar)o r all i 0 Demolition 0 Otti= . atechrtnical materials.-equipment.labor.overhead_and profit. 1 Vine:S CATE0., . OF COR1.C11ON..:. -..--_,,,... . fp . 4., wwnrtSYSIXW: .F,: rS .-,',- -.::.. 0 i-and 2-fdatily dwerfint 0 Commercial/Mb-stria:I 0 Aecemtry Intel 1 r,or special by:grief:aloe use cher-Ails-a : . r Multi-fmnily 0 hustef Wilder 0 Other, I Description 1 Qty. 1 -Ea. I Totri , ;,.:• -•*.j.-,Trk :::-.•=i;:•4I':7.7:.. ,;:iiSii:i. i.ti:.-i1:40eliii-iitii*:i;iii4i,::teidAi-ie.. :: -.:--j;::E5i:5:-,':::;t:il: :::::.:F:'1-: Air condtoning_ I 1 46.75 Job site aadresst __ luluipol sk) iwol-kin Avq) Flatus=/00.000 1:.M.;t,,hrerVvertol , I 46:75 ,• . _ . City,StatedZIP Tigariti OR 917,24 ...) Funis 10(10004 8Th(rIneoivents) 54_9/ ' 61_06 Sr nPem name o.: r- • ',po,t) ov\ 06- v...c \rekv__ Heat pump Duct work 23.32. i Cross street/directions to job site: V1Pn HYdronic hot Inter system 23.32 -Residential holler(radiator or 1 . 23,31 , Unit hinters(fiutl-type.Dia ei=trk), . r in-wall.in-duet strspwded,etc. 46 75 Flue..xertt for any of above. , 1 , 23,32 --i Other: ' 23. 1 St11)644i*Itr.';‘\)(..r Tecrace ec,s 1_61 Other fuel approme .: - Tax Ellapiparcei no.: Water.itsman- I 1 .. . :.ii .':.:;•-?.-,-.1.;! ::;.?.'„-c.•::.::1!-.. .:‘.! :'. -: :-,,1:.0clkirn. .... :0,74T:9.r....,.8.7editk-,;.--e:. -,..?,.;•:,,r:: ,....zi.,:•,-.,!:!:.,;-:,-,.;..::,•,-,..,4_.:;. .,.,:.:;:.,,..:-.,, Gas fuepiaceliikr.1 . I ] 33_39 I ._ Flue vett for Waler he iv or ' fireplace .; 23.32 • ----; - - . ..--- Log lighter(gas) 23.32 - j Wood'peflet stove i 33.39 1 • Wood firepineetinsert 23.32 ; Chimey.linerilluelvent • 21.32 :'!.::.:,-I-:•,:"..01::igitiki.444" j*.fittt:iii.C:--Fili:: :'.1-ii.,}:-it..7!::::-"-----'.:::':,tp'.iiN*,iii,&z:F: .-::::-, ,::f.-.- :-:. Other Name:- YOIV) 01A 16i(iti LUG . Range hoodlother kitchen i 1 VOaCt93GlA4 c,5. S11,.C 10 IOothedterexhonm .. 1 33.39 Ci):IStalc711 Vesit)14(DtA,VeA( LOOk W(Q(PO Sinele-duct exhaust(bathroo-ms.„ toilli cortmattrnemts utility roonts1 3 123.32 Phone: ' A i f1 I . fax;(360)(0011-t4Lt Attiduakvispa=fans I 23.32 .... ... . . . . ,... , ii*idt:: !:,.:7:]!:".::•..-:-1:::j:,: ;:,.,'.:.F.5F.01:1.•,:CCOTAC*:i.iiii:50..Sif .1,: ,.:•,.,•:!, Other , 23-.3'1 . . ' Fuel pipit Stith:am naute:.Poen WL11,LLC . • sl 4.15 for first fear:54-03 cur each addifiemat COOta..1 ame-, \pigylApc(?) eipivLik Furnace.etc. Acid1 .. r-‘tw 10 3 1-00./ALI.D0,_ k-'. Sk•e- 10,. t , Gas hnt pomp Wallisuspendedfunit healer 1 1 1 t City IS-ta/&.7...1T-'.Vttoconver.,WA 9866o . wah,rbr...at..- Phone:(360)695-7700 Fax::(360)6R3-1 in Fireplace r_Th 1 Range I E-rattsTRe.rrY A-Su.‘Cyty;, 1/2-ck.ts.-/Rok.k3or,\Atvyves.ell ni -I i Barbecue I 1 1- 1 ..7.'..e.'::•':.-7;i::, - -a.'1':-.:'0LZ:: ii6:T.:::AlE'.1;P::..::';: et$StititA-c'..IPtC7';Ii' : ::,:2•:E7--ill'IN-::-:.';'•:•- :'7::: I °WI's dryer(Ps) . .....,_ Other: 1 Business name:Apel Air LLC 't'1Aikqt.14,0iicAr:OtilS.1017.tE*.:.:'!V::::•.. ....:... : •.'....' Arld.ress:18004 NE 72"Ave 1 , Subtotal I • . . . _ 1 Minimum permit fee(S90:00) , City/StuteiZIP:Vancouver,WA WU i Pima=•(360)3424109 • I Fax:(360)3264769 I Plea.review(25%of permit fm) .Srate surcharge(12%of permit Tee) Ca3 tic:,243034 . i TOTAL PERMIT FEE Antborized siznature; . liew ..............-- *Del : 4 #1")1`.6.re:mr:adit aopip:07stieet.nb,7:61.ctranrcs if xtypemrmidiitnis ImIndtetstry.btals4aNizent4 withwin: day&after it has,losto ateepted e. compieeo. l...,- • s '-j 1 . Electrical Permit Application FOR OFFICE USE ONLY City of Tigardi Received Permit i: °� '= Date/B 13125 SW Hall Btvd.,Tigard,OR 97223 plat Review Phone: 503.7182439 Fax: 503.598.1960 Date/B : _ TIGARD Inspection Line: 503.639.4175 Ready Date/By: Jurie: El See Page 2 for •a Internet www.tigard-or.gov -:.-:• ' " Notified/Method: Supplemental Information (_y ,OR WORT{ -�._ _.r..��.��._ -<.T..,:_. . _; _ - _ _ - P.LANMVIM - T ®New construction D Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Other: where the available fault current 0 Marinas and boatyards. `_ S"t w,c TEG)I V-OF coA-s`ITt17eTroltz / t' .._ ._ . . exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial E]Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ ❑Master builderamps for all other installations. buildings. Multi-family ❑Other: 0 Fire pump. 0 Installation of 150 KVA or _ TOB SITE INFORMA`ITOI W 'LOCATIC)N ❑Emergency systemlarger separately derived Job#: Job site address: 191.1001 ((p v l... v� laAddi10011?tion or of more.new motor load of system. U ❑"A• "E",`1-2" "1.3", City/State/7.TP:Tigard,OR 97224 0 Six or more residential units. occupancy. 0 Health-care facilities 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 120 IJ V ❑❑Hazardous locations 0 Supply voltage for more than t �V Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: V fg-fsep D_ULE I/ VP/ . Description V I Qty. Each I To4�1 I ° !/^ New residential single-or multi-family dwelling unit Subdivision: VA ve,,- ,elan& '"N 11t Lot#: 9\ Includes attached garage. 1,000 sq.R or less ( 168.54 4 Tax map/parcel# Ea add'1500 sq.ft.or portion , 33.92 1 l . tRI _a ..::DF`SCrON ESE WORD A Limited energy,residential S 0 (with above sq.ft) 7 .0 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 `- , lPROLER NO Is<,__ 4.1. F .v 1-TENe; F4. -- Services or feeders installation,alteration,and/or relocation Name 200 amps or less 10030 2 Address:` 0 201 amps to 400 amps 133.56 2 Irl / ¶/ V .AI 1/ �/ r��„ 401 amps to 600 amps 200_34 2 City/State/ZIP. a vuatve I n (" U 601 amps to 1,000 amps 301.04 2 Phone: �o O tefj 0 1'vFax:( } Over 1,000 amps or volts 552.26 2 � u � Ferni �}[(� I/�n Temporary services or feeders installation,alteration,and/or Email: It CvYLbYlV� (/hls�/ ' Y L' O1 +U �(VIVI relocation Owner itallation:This installation is being m de os l.r erty 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 Fn Branch circuits-new,alteration,or extension,per panel ?�_ �� p��C�'�.� „ -x.�xcf?IaT2iCT.PIIfSOI!�,_�._�. A.Fee for branch circutts with Business name 1201 pv w �/�l VIA lij f!, above service or feeder fee, P % V VeO1 1v each branch circuit 7.42 2 Contact name:l /�/A +A' �Q B.Fee for branch circuits without V t V V11 service or feeder fee,first Address:' r_ branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 t Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 • • • Fax::(360)693-4442 Each manufactured or modular Email /Q/�/l/I r /l� i(� dwelling,serviceoand/or feeder 67.84 2 mss:_ I �i`C1�A V--l' � �� •�I'J �� A �� A� � �V, Reconnect only 67.84 2 _ �..ati_.. Pump or irrigation circle 67.84 2 Business name:Garner Electric Washington,LLC • Signor outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:6101 NE St Johns Rd 0 See Page 2 2 panel,alteration,or extension. Each additional inspection over allowable in any of the above d City/State/ZIP:Vancouver WA 98661 Additional inspection(1 hr min) 6625/hr Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr Email:bdaniels®gweusa.com Industrial plant p hr min) • 78.18/hr k Inspections for which no fee is CCB Lic.: C1158 Electrical Lie.: 208174 J Suprv.Lic.: 4496S spectficaltY listed(%hr mm) 90.00/hr --. —. M ELE TRI " EV ES Suprv.Electrician signature,required: '-dAi; ` vit = Subtotal: Print name: Joan P Albert • Date: 121 if l Ig 0 Plan Review Required(25%of permit fee): l ~-,.. _ State surcharge(12%of permit fee): 1 --- --- — '� TOTAL PERMIT FEE: Authorized signature: (-.- V I This permit application expires if a permit is not obtained within 180 Print name: Bill Daniels Date: • days after it has been accepted as complete. 1 * Number of inspections allowed per permit l:lBuildingtPennitslf.0 PemitApp_EI.R ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB r . . . . ,. Plumbing Permit Application -- Building Fixtures city of Tigard Received Permit No.: DateBv: .413125 SW Hall Blvd.,Tigard,OR 97223 Plan eview- . R All . Phone: 503.718.2439 Fax: 503.598.3960 OthaPanut ... Dateiny: Inspectitin Line: 503.639.4175 TIGARD Dale Ready/By: huh: iii See Page 2 for Internet www.tigard-or.gov Noti6edtMerhod: Supplemental Information TYPE OF WORK FEE* SCHEDULE Far special information use checklist. El New construction 0 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) CATEGORY OF corismucTioisr - SFR(1)bath 312.70 SFR(2)bath 437.78 2 1-and 2-family dwelling II]Commercialimdu.strial El500.32 Accessory building El Multi-family SFR(3)bath 1 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: I ''f q 0°1 It\) I 0 q f-V1 / v1V,U)Z, Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.: ) Page 2 Suitehldg./apt.no.: Project narr poi ullov\ / , Manufactured home utilities 50.03 Cross street/directions to job site: I ' /ken Manholes 18.76 0 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 p v Subdivi e,y-rt vymffALot no. E»ec, : Fixture or item Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK - ' Bacr"kwatevalve F-1, 12.51 "- Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/munp 25.02 12.51 '. .' PROPERTY OWNER U TENANT Fixture/sewer cap 25.02 Name:A YU t oVI Vvu. Floor drain/floor sink/hub 75.02 Address: ' II,aOir /4 A LA ill ' I Garbage disposal 26.02 CitY/St'ated21P: !OfVIA 0 Ofi Ve/Cr 1/Lilit f ni,(o0 Hose bib 25.02 Phone:( • / g 1100 Fax:(N(2)(4,01- efyitz,, Ice maker 12.51 APPLICANT-" '" , , CONTACT PERSON ' : interceptor/grease trap 75.02 Medical gas(value:$ ) Page 2 Business name: ?(./ 0JVI IN ..... Medical Primer 12.51 Contact nara \91e: I 4 ARoof drain(commercial) 12.51 Address: 07) V)Iro FOP ' i .e I Sink/basin/lavatory ... .„ 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)•695-7700 i Fax::(360)693-4442 Tub/shower/shower pan 12.51 Urinal 25.02 E-rnait 1 vfx\AatilAlovvik-t-otl,( epolwroylAilevRt( . Water closet 25.02 Wsterheater 37.52 Business name: ,44-._..6 k)tv407,1n..4....5.0,‘„5, „it__CONTRACTOR Water piping/DWV 5629 Address: p,11). ft)_evc, Cf , Other: 25.02 City/State/ZI : 5-r. e 41..4 ore, q I Subtotal Minimum permit fee: $72.50 Phone:($63'--$4d 14f/1/ Fax:(41:11 V..•''74/..-tr YID - Plan review (25%of permit fee) CCB Lie.: /841 31,3,..., Plumbing Lie.no.Pei ice3q State surcharge(12%of permit fee) Authorized signature: 40,.t..0.14., 17:0t.ob-d"'--.,.._____ TOTAL PERMIT FEE Print name: Sq-f....vt, p,u3ke,..._ Date 1 9.1 cii(i)...1 This permit application expires Ifs permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Bilard. MuilaingiPermitsTLNIU-PermitApp.doc 10101/09 440461.6T(10/02/C0MMEB) City of Tigard ~ COMMUNITY DEVELOPMENT DEPARTMENT }\n Building Permit review — Residential TIGA Building Permit #: '(x ,-— AQ\ _ Ola Site Address: /2/1-/O C/ f) / L4 &-e__ Project Name: Pd/ )/ 0a7L. f 4/041- C. Lot #: 632 (Ne fling=subdivision name;Addition or Alteration name of owner) Planning Review Proposal: /Veto \. - p 4iver erify site address/suite# exists and active in ermit stem. Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached SitPlan Elements: Vl hree(3)copies of site plan WI':,Ssting structures on site e plan must be on 8-1/2"x 11"or 11 x 17"paper II Footprint of new structure(including decks)with finished �wn to scale(standard architect or engineer scale) or elevations rth arrow ''ty locations&easements(required for new and additions) ddll to address,project or subdivision name and lot number hCJS dewalk/driveway approach (1. .plicant information(name and phone number) P 'L anon of wells/septic systems FAI . dimensions and building setback dimensions I''i 'sting trees to be retained with drip line,and tree ii .uare footage of buildings to be demolished otection measures 7 Lot area,building coverage area,percentage of coverage and treet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Street names Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replac ? gYes ❑ o 4 foot differential) If yes,is a storm water quality facility shown ❑Yes No v / can Water Services—Service Provider Lett (lot platted prior to 9/10/1995): 1 equired: IDYes,applicant was notified No Received: ❑ Yes ❑ No Public Fac • Improvement(PFI)Permit: P//2 o/( —0 Q®/93 equired: Yes,applicant was notified ❑ No Applied For: ilYes ❑ No,stop intake 'fijileand Use Case#: ib-be_.()' _ S^ 0'0('0 ring: X—i (i)D)Required Setbacks: Front ear �+� Side / Street Side p ara e ndscape Requirement: �Q cyo 4J •t Coverage Maximum: A,uB,ilding Height: Maximum Height Nl Actual Height 60 RI isual Clearance !1 • ensitive Lands: 0 Yes �No Type J Urban Forestry Plan ❑ Conditions "Met" or to 'ssuance of building pe 't Notes: II e A i.: I. / • / 44 , Jr- i ...lid J u/ i ❑ Approved By Planning: /jam/ Date: 1.2-/L2//A Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved I:\Building\Forms\BldgPennitRvw REs 061417.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: 2'Enter building�er permit#above. Workflow Routing: 13' Planning L7 Engineering 2'Permit Coordinator E7' Building Workflow Sign-off: R" 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. L'Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: f� Date: 1(s) `( Engineering Review 9 JX'Slope at building pad: 5-U <° ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat da-Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes i No Assess Water Quantity Fee in-lieu: 0 Yes %I No LIDA Facility on lot: 0 Yes a No J21 Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 6l. I Date: (2— 13/1 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 „_prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: O -ND ISSLA, .Co &viir o rL- ISS U-P S 11'l c o 81 Revisions (after Building Submittal only) VICAQ0LeS Ylrl -t hOm'Q'S. 2eAr M t Ido 1N let tit- 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: Yes 0 N/A Tigard Trans SDC: Yes 0 N/A Parks SDC: Yes 0 N/A LIDA 0 Yes Er N/A ty.-OK to Issue Permit Q � Approved by Permit Coordinator: o`".0'p",, Date: t 2411 I�� I:\Building\Forms\BldgPermitRvw_RES_010118.docx City of Tigard 11111 ■ COMMUNITY DEVELOPMENT DEPARTMENT I T 1 c A R D River Terrace Building Permit Review Addendum Building Permit #: m -C'� ��— .)-b� j Site Address: /4/ fel9 2k) / ?,44 /9v.0 Project Name: i o %i /�or _ ;' ,� Lot #: c� (New dwe 'e bdivision name;Addition or Alteration=last nam•4gl.wner Planning Review of River Terrace Plan Distrie'fDesign Standards (18.640.0701): Is the project subject to the plan district design standards?V. 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. Balcony w/ access 2 Window Projection Vertical Wall Offset a Porch min. 5 deep ft. deep min. 2ft., 5 ft.wide min. 2 ft.,6ft.wide Gabled dormer ❑ ❑ ❑ ❑ 2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors. Percentage Shown: .'. 02 °e 0 3. trances:At least one entrance must meet both of the foils• • g standards: 'VA Parallel to street,angle no more than 45° from street, Max. 8 ft. setback from long street- facing wall or open onto porch Entr nce opens to a porch: Yes IiiNo If es, . the following apply: 15 sq.ft.min. ne street facing entry ft.max.roof above floor of porch 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: �! overed porch min. 5 ft.wide x 5 ft. deep ❑ 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 0 f 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. ❑ 19orizontal lap siding min. 3-7 inches wide , ❑ Accent siding min.40%of street facadeendow trim min. 2'/2"wide by 5/8"deep ❑ Window recess min.3 inches for all street facing 0 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 façade es and Carports:May face the front or side jiq line on a corner lot. Setbacks: NN 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-. int .orch and gara. e: not extend beyond the front porch. ❑ May extend up to 5 ft.where the garage is part of a . -• .It 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- :..!- •. age door ❑ 40%max. of street facade P. i'o max. of street facade with 7 detailed design elements Notes: ----. 1: Approved By Planning: — Date: A2-/Le//0 I:\Building\Forms\B1dgPermitRvw_RES_RT_121417do cx 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 2 Transmittal Letter T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: hI tb 0 V 1 Y [ IOjy DATE RECEIVED: , � � " DEPT: BUILDING DIVISION �°�,� �"/F n �rnrj'rito� c�r�v1i� JAN 3 �� FROM: � t., ',:; , , :�; COMPANY: 01A,� , -0-06t Q) s�►+ �aI"�z L., r "4 :,,,,s PHONE: (2-7v),40y(.0 " IS -11d0 By RE: LOVA e Al % S w 1 l�ot+V► /�v��n. ik i o3 (Site Address) (Permit Number ol oor su di-0.vinam' a an lot number)Y- V-Plie,UF-IverRA/YOut 0WW1 9 ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. >< Revisions: A IC6 l C rU I S Y `.t, Cross section(s) and details. Wall bracing and/or lateral analysis/p t} Floor/roof framing. Basement and retaining walls. 07. u-kg- Beam calculations. *� " {Engineer's calculations. Ot VI X Other(explain): S5 c ret W (vtS 1 ► " \din ti f— REMARKS: () I f S FOOFFICE USE ONLY Routed to Permi ec Ician: Date: \ (6 t� Initials: Fees Due: ❑No Fee Descr ti : Amount )1' ue: p 1/ eL ,./1 rzA.i .e.w $ - z/$ $ Special Instructions: Reprint Permit(per PE): ❑ Yes ❑Done Applicant Notified: 7- --Date: `/9 (3YikInitials: 4& I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 Plumbing Permit Application F j FOR OFFICE USE ONLY Building Fixtures ,. fi City of Tigard Received AS g 1 Date/By: c\h3�(C jt'� PermitNo.:Nrst i" d "-��J`" ��V . q 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 1J 20111 J Plan Review Phone: 503.718.2439 Fax: 503.598.1960Other Permit No.: TIGARD Inspection Line: 503.639.4175 CITY :,i Date/Ry: t a G}� Date Ready/By: kris; See Page 2 for Internet: www.tigard-or.gov t itl0 , e g-.,t.,nt Notified/Method Supplemental Information TYPE„OF•WORT( ,.FEE*;SCiir.DULE " ®New construction 0 Demolition For special information use checklist. Description Qty. I Ea. Total ❑Addition/alteration/replacement ❑Other: : i. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION % \1LASFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/i.. - . SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory El Multi-family Each additional bath/Idtchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 'ylt.0:1, i(,it"TH a.‘ Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 1 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.: Z Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ^`•^ V .• §` . 2 S-,.Ca0`7f+60530 Clothes hwerher 25.02 �=-��GX.aI w�.v�.�e� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 E PROPERTY OWNER I 0 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 rt APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Tonja Morris 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) 62.54 Phone:(360)695-7700 I Fax: :(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:BDL Plumbing LLC Water piping/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 Lie.: 180345 Plumbing Lie.no.:PB1582 State surcharge(12%of permit fee) Authorized signature: ,r- TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Brandon Lanter Date: 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)