Permit (179) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00062
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/16/2019
T t ' 9 Parcel: 2S107AA00200
Jurisdiction: Tigard
Site address: 14219 SW 168TH AVE
Subdivision: ROSHAK RIDGE Lot: 2
Project: Polygon at Roshak Ridge, Lot 2
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 1174 sf Basement: 140 sf Left: 3. Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 555 sf Garage: 437 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1869 sf Value: $242,271.65 Rear: 0
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
Drains: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100Catch 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: 3 201-400 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 1869
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: $33,693.58
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 th
rough 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: _. Permittee Signature: ‘74,7 ,97 ' ,'
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.
•
,
r 'Building Permit Application L___L- \--\--,Residential R� h � 3 D FOROFFICE USE ONLYCity of Tigard Received14 FEB 0 6 2019 DateBy: a� �l S Permit No.�(� T ?�C1 /Q\l�I'l 13125 SW Hall Blvd.,Tigard,OR 97223 '",1111 llJ.�1Phone: 503.718.2439 Fax: 503.598.1960Plan Review 3/
TIGARDInspection Line: 503.639.4175CITY OF TiGHt�D Date/By: Other Pe .I 1� �av�2 forDate edJMe y: /` / f�j 7uris I See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 49,"?
Supplemental Information
t�'� /C— GAGyCQ
TYPE OF'WORK REQU#IREDDATA:1-AND 2-FAMILY DWELLING
®New construction 0 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 0 Other:
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
LID0.7
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ d� l 1
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms: ?j
JOB SITE INFORMATION AND,LOCATION Total number of floors: 2 0(O
Job site address: `H 2-1°1 bik) I lo 1 n /� l e New dwelling area: I square ��
� 6 V feet
City/State/ZIP:T)0‘01,1(1
,Y1 or,oil' Garage/carport area: (42) square feet t',4
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area:>C square feet (4-0
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Polygon at Roshak Ridge I Lot no.: 2 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Ncuo SF Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER a 0;TENANT Number of stories:
Name:Polygon WLH LLC
Type of construction:
Address:703 Broadway Street Ste 510
Occupancy groups:
City/State/ZIP:Vancouver,WA 98660
Existing:
Phone:(360)695-7700 Fax:(360)693-4442
New:
El APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WLH LLC
(Please re�ertnfee sctieaule)
Contact name:Amanda Gavin Structural plan review fee(or deposit):
Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable):
Cit}/State/ZIP:Vancouver WA 98660 Total fees due upon application:
Phone:(360)695-7700 I Fax::(360)693-4442 Amount received:
E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
—
CONTRACTORCommercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:William Lyon Homes,Inc.
Address:703 Broadway St Ste 510 and fire department access,along with the 2010 Oregon
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 lie.:207247
Total fee due upon application: $201.60
Authorized sign This permit application expires if a permit is not obtained
4
within 180 days after it has been accepted as complete.
Print name:Amand avin I Date: f fI)'J] I *Fee methodology set by Tri-County Building Industry
r I Service Board.
I:\13ui1ding\Permits\BUP-RESPermitAnn.doc 02/24/2011 440-4613T(11/02/COM/WEB)
' Mechanical Permit ApplicatiR,ECEIVED FOR OFFICE USE ONLY
City of Tigard Received
III " 13125 SW Hall Blvd.,Tigard,OR 97223 APR
9 2019 y Permit No.:
Plan Review Other Permit:
DateBy:
Inspection Line: 503.6 9.417.2439 Fax: 03.598.196(�IT,OF TIGARD Date/Ready/By:
TIGARD ((�',, ^ n' y^� niJam: El See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Al-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
lif Multi-family . 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: `42.1 I sW t 6,07,-, . Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Roshak Ridge
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision:Roshak Ridge Lot no.: Other: 23.32
( Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Apex Air LLC Other:
MECHANICAL PERMIT FEES*
Address:18004 NE 72nd Ave Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)342-8109 Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lic.:203034 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Tim Hay Date:04/08/2019
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application RECEIVED
FOR OFFICE USE ONLY
City of Tigard APR 12 2019 Received
Date/By: Permit#:
I ,.'• 13125 SW Hall Blvd.,Tigard,OR 9722 _
Tv Plan Review
Phone: 503.718.2439 Fax: 503.598.1 I I O -TIGARD Date/By: Related Permit#:
DIVISION
—
I1tii+,N_L7 Inspection Line: 503.639.4175 BUILDING SION Ready Date/By: ]amu: I H See Page 2 for
Internet: www.tigard-or.gov /61f!. Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction ❑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 stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION„ exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family 0 Master builder amps for all other installations. buildings.
❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
AddJob#: Job site address: tl{V 9 5 t- I(9fin4 ❑100HFoo of new motor load of system.
100HP or more. ❑"A","E","1-2","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:Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more_ 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Otv. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: d Includes attached-garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) - 75.00 2
PROPERTY OWNERRenewable Energy 0 See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2
Address: 703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
'PERSON Branch circuits—new,alteration,or extension,per panel
® APPLICANT 0 CONTACT
A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name:Jolene Smith B.Fee for branch circuits without
Address:703 Broadway St,Ste.510 service or feeder fee,first 56.18 2
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 Each manufactured or modular
Email:permitsubmittals@polygonhomes.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Portland Electric Sign or outline lighting 67.84 2
Address: 1915E 5th St.,Ste D Signal circuit(s)or limited energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:paul@portlandelectric.biz t 'i g Industrial plant(1 hr min) 78.18/hr
� � Inspections for which no fee is
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.i„990.26"" specifically listed('A hr min) 90.00/hr
cut, ��L� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: l�l.C��x
Subtotal:
Print name: Alex Shalya Date: 04/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: A .i41rk, TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: MISHCHUK,SERC Y Date: 04/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
•
•
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
- City of Tigard Received Permit No.:
'I 13125 SW Hall Blvd.,Tigard,OR 97223APR 9 2019 Date/By:
Phone: 503.718.2439 Fax: 503.596I 0 Plan Review
G�` OF TIGARD
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 V ITV 1L7C1 Date Read/B
Internet: www.tigard-or.gov BUILDING
DIVISION Ready/By: Iurs: Supplemental See Page 2 Inr
�_Y���I.JIN� Notified/Method: Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
X1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accesso buildin SFR(3)bath 500.32
rY g %-Multi-family
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: '1%424 e' 1/4.) (ci$ , 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.: 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 1 Lot no.: 2, Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER- I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib
25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
0 APPLICANT 0 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) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc
Water piping/DWV 56.29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Steve Fowler Date:04/08/2019
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMA-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: 'MST lA- wc)
Site Address: 1 - 2.1q sV) I lQ Sill Pc\Pe�
Project Name: Vpl Roshak- P.Id Lot #: 1.-
(New d suu'vision name;Addition or Alteratibn=last name of owner)
Planning Review
Proposal: NevJ (6t11 1 oad ed')
gVerify site address/suite#exists and active in permit system.
., River Terrace Neighborhood: ❑ No 1$; Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
igThree(3)copies of site plan MExisting structures on site
rite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
'Drawn to scale(standard architect or engineer scale) floor elevations
INorth arrow y�1,Itility locations&easements(required for new and additions)
ISISite address,project or subdivision name and lot number 171aSidewalk/driveway approach
rApplicant information(name and phone number) NaLocation of wells/septic systems
Lot dimensions and building setback dimensions OAFxisting trees to be retained with drip line,and tree
Square footage of buildings to be demolished protection measures
1.,ot area,building coverage area,percentage of coverage and Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) RI.Street names
Property corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [ ye No
4 foot differential) If yes,is a storm water quality facility shown? LJY s No
1, Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Facilities Improvement(PFI)Permit:
Required: ', Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: 1?DR.2iDt5-c3oOO2
Zoning: R,-12
X Required Setbacks: Front 8 Rear 0 Side 3 Street Side NA-- Garage lef &
45 Landscape Requirement: 20
,N Lot Coverage Maximum: 8 Q
I, < uilding Height: Maximum Height N/Pc Actual Height 2.0
+ O Visual Clearance
Sensitive Lands: ❑ Yes (No Type
'g. Urban Forestry Plan
,Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: tymo p Date: 2 2( lq
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_010118.docx
Building Permit Submittal
Original Submittal Date: alvd ,ck
Site Plans: #
Building Plans: # e`,
Building Permit#: Er Enter building permit#above.
Workflow Routing: Et/Planning ❑ Engineering IN/Permit Coordinator Et/Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Et/Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: . .1. (kOt
Engineering Review 71)
Slope at building pad: 5-D
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
,a Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes i No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: LI et 1 16X- y t N E zrLr tic; t R-th)PJl t- [c �'0 /S-5./
'Approved by Engineering: //--4, Date: Z2-64i i
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Co ditions "Mer-prior to issuance of building permit
Ap roved,NOT Released: Date:Z/ 2 1 9
Notes:
Revisions (aft,r Building Submittal only)
Revisio otice 1: Date Sent to Applicant:
Revi 'on Notice 2: Date Sent to Applicant:
R-•'sion Notice 3: Date Sent to Applicant:
1r',DC Fees Entered: Wash Co Trans Dev Tax: Eyes ❑ N/A
Tigard Trans SDC: "Yes ❑ N/A
Parks SDC: IVYes ❑LA
LIDA ID Yes V N/A
OK to Issue Permit J
Approved by Permit Coordinator: Dat
I:\Building\Forms\BldgPermitRvw_RES_010118.docx
•
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R D River Terrace Building Permit Review Addendum
Building Permit #: av\ok_ QCj
Site Address: 142.1 S\A 11195th J
Project Name: POi pyo ( R t4 R� Lot #: 2
(New dweWng=subdivision name;Addition or Al ration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1):
Is the project subject to the plan district design standards?i.Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 ft. deepBalcony w/access 2 Window Projection Vertical Wall Offset a
ft. deep min. 2ft.,5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
❑ ❑ ❑ ❑
2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: 2S0/o
3. Entrances:At least one entrance must meet both of the following standards:
facing wall Parallel to street,angle no more than 45° from street,
, 'Max. 8 ft. setback from longest street-
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes,all the following apply: .Et"25 sq.ft. min.
One street facing entry 8.12 ft.max.roof above floor of porch
iEtr5 ft. depth min. , 30%min.porch roof coverage
4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
Covered porch min. 5 ft.wide x 5 ft. deep ISeRecessed entry area min. 5 ft.wide x 2 ft. deep
Wall offset min. 16 inches ❑ Dormer min. 4 ft.wide
❑ Roof eave min. 12 inch projection 'Roof offset min. of 2 ft.
❑ Roof shingles either tile or wood g Gable,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ❑ Horizontal lap siding min. 3-7 inches wide
❑ Accent siding min. 40%of street façade ❑ Window trim min. 2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street façade
5. Garages and Carports: May face the front or side lot line on a corner lot.0o r _alley) 1(,Jl1C(/�-
'oG.- „
Setbacks:
No closer to front or side lot line, than longest street-facing wall. ❑ Yes ❑ No. If No (Check one):
❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one) tai 1,1N- a1 / i 1,0 UM
❑ 12-foot-wide garage door ❑ 40%max. of street façade
❑ 50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: ____*o_ Date: 2 2(p q
I:\Building\Fornis\BldgPermjlayw_RES_RT_121417.docx
Electrical Permit A licatio k FOR OFFICE use ONLY
PP i. i �
Received
Date/By:
City of Tigard Recei -4-1 ciA kct (c-c- Permit II:tc\VI—">ivtG-
III v 13125 SW Hall Blvd.,Tigard,OR 97223 0l 11 i I I{-i 1 Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.196 Date/By: Related Permit#:
Inspection Line: 503.639.4175 !-:8 1 0. -I Ready Date/By: Juris: Ed See Page 2 for
TIGARD as a 3 ,y ,
c Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF%OI Va3, s , P
LAPI REVIEW .s, 4I ..,2 .
®New construction 0 Addition/alteration/replacement .-< Please cheek all that apply(submit 2,sets of plans w/items checked):
'• 0,..? 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: '1 e'6\N where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION "Ns, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory s uilding less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Y ,
Job#: Job site address: 1A "Q► Std ll p I P/l 100HP or more. ❑"A","E","l-2", '1-3
4
❑Six or more residential units. occupancy.
OR 722
City/State/ZIP:Tigard, 9
tY g � ❑'Recrearional vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE,SCHEDULE,'
Description - L Qty. I Each I Total i
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge ( Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION O .WORKLimited energy,residential
Z 20"—000(02 (with above sq.ft.) 75.00 2
Q Y� 6 i E? Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:William Lyon Homes,Inc. 200 amps or less 100.70 2
Address:703 Broadway St Suite 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 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
® APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
7.42 2
each branch circuit
Contact name:Nichole Thorpe B.Fee for branch circuits without
sAddress:703 BroadwaySt Suite 510 brancheaice or feeder fee,first 56.18 2
circuit
City/State/ZIP:Vancouver,WA 98660 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
dwEmail: permitsubmittais@polygonhomes.com Reconnectne, onlservice and/or feeder
only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Address:3415 NE 44th Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Portland,OR 97213 Each additional Inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871/$ specifically listed(l hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
- State surcharge(12%of permit fee):
Authorized signature: rte,. TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 440.4615T(11/05/COM/WEB