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Permit (24) CITY OF TIGARD ;-i,, . 1,,: MASTER PERMIT 9 ger ,t 41- COMMUNITY DEVELOPMENT Permit#: MST2019-00141 Date Issued: 06/13/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 107AA06000 Jurisdiction: Tigard Site address: 14221 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 60 Project: Polygon at Roshak Ridge, Lot 60 Project Description: New SFA. 9/27/2019: REPRINT permit to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Total: 1214 sf Value: $164,352.30 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 Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1214 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 NFPA 13D Sprinklers VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required 2 Geo Tech Report Required Prior To Pour PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175 FAX: Total Fees: $24,670.76 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: '' , — 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. P 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. 1141City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT I:. " Transmittal Letter TIGttRt) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: CITY OF iGA Rb-- Q cc—N, DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: CnA,vIN -1-1-10 MES SEP 2 3 2019 COMPANY: AIA-1/11/4-14GEQL)MIINb CITY OF TIGARD BUILDING DIVISION PHONE: (503) 517-10535 By. .:-.AT- RE: ,IRE: 0-122.1 SIM 11091.4 AVE MST 2019- 00141 (Site Address) (Permit Number) RoS 4M 1.oT (Do (`t"\ -1, (Project name or subdivision name and lot numliatd ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: X Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: PREVIOOS KA-NS we—RE Too Lie or -ro REM FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: n Yes n No Fee Description: Amount Due: $ J '3 . f $ $ $ Special Instructions: Reprint Permit(per PE): ,Yes ❑No ffil Done Applicant Notified:? Date: 7/.?-7/i q Initial T:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 p Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard AUG 2 9 2019 DaceivedDPermitNo.. MST2019-00141 - w 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598grY OF TIGARD Date/By: c!-,2G-/moi Other Permit No.: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: f�/7 7/;; r turfs. See Page 2 for Supplemental www.tigard-or.gov Notified/Method. i/ ✓/ Supplemental Information Ti,PL: OF WOI:R [-.1FEE'"',SCHEDULE ®New construction ❑ Demolition -/-e"/J fr For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) C R OI U ION SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 D Master builder 0 Other: Fire sprinkler(1214 sq.ft.) Page 2 I O1t11IATIO$ AIS LO ATIO1"d, y. ,, Site utilities: Catch basin or area drain 18.76 Job site address:14221 SW 169th Ave 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.: '0 Project name:Roshak at River Terrace 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:Townhomes at Roshak 1 Lot no.:60 Fixture or item: Backflow preventer 3127 Tax map/parcel no.: Backwater valve 12.51 E I WQR 25.02 Clothes washer MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 { ; #'" �E�Y �nR ( ' 0 TENiATENANT .. Expansion tank 12.51 Fixture/sewer cap 25.02 Name:Polygon Northwest 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 Interceptor/grease 25.02 I.ICANT El CONTACT PERSONtrap Medical gas(value:$ ) Page 2 Business name:Polygon Northwest Primer 12.51 Contact name:Jennifer Lopez Roof drain(commercial) 12.51 Address:703 Broadway St.Suite 510 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)695-7700 Fax: :(360)816-7817 Tub/shower/shower pan 12.51 Urinal 25.02 E-mail:.jennifer.lopeznpolygonhomes.com Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DWV 56.29 Address:146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.:184601 Plumbing Lic.no.:PB732 e �'-��/ State surcharge(12%of permit fee) P---77 Authorized signature: � 71-, --.1 TOTAL PERMIT FEE Date:8.27.2019 This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thornes after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(I0/02/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 Sewer-1st 100' 62.54 3,601 to 7,200 $233.20 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 Storm&Rain Drain-1st 100' Valuation: Permit Fee: 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 Inspection of existing plumbing or for and including$10,000.00. which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to Inspections outside of normal business 90.00/hr and including$25,000.00. $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: Other Fixtures: 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*. Quantity by Fixture Type Fixture Type for Replace/ Plan Review for PIumbing Installations u ork Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath Tub/Shower Please check all that apply. Jacuzzi/Whirlpool DJ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain II Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3 Submit 2 sets of plans with any of the above. Car Wash Drain Garbage -Domestic-non-food Isometric or Riser Diagram Disposal -Domestic-food related LI Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the https://allianceplumbing-my.sharepoint.com/personal/gavin_alliancep1um15�1ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF PermitApp (3).doc CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2019-00141 T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S107AA06000 Jurisdiction: Tigard Site address: 14221 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 60 Project: Polygon at Roshak Ridge, Lot 60 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1214 sf Value: $164,352.30 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: 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 addl 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 1214 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 NFPA 13D Sprinklers VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required 2 Geo Tech Report Required Prior To Pour PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175 FAX: Total Fees: $24,534.23 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 0 R 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. r� Issued By: \. 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. r. Building Permit Application `�,,�tL�,�� \'Q k.--C—"\--' U.,0 Residential a4 f FOR OFFICE USE ONLY City of Tigard R E C Gi E D Received DateBy: Lk ►`� HCl .( jT Permit No. s-v-xAci 13t 13125 SW Hall Blvd.,Ti_aard,OR 97223 FEB ® R Phone: 503.718.2439 Far: 503598.1960 t !J 9 114 p DatePlanBRevyiew y Other Perini. TIGARD Inspection Line: 503.639.4175 Date Read/B a� (� J ;S: � 1ci�`Y` � Intemet: www.tigard-or.gov CITY 01- E?WARD Ready/By: Ea SeePage2for b BUILDING DIVISION Notified Met ;d��itiC/ Supplemental Information i P y 6-0,,/ TYPE OF WORK REQUIRED DATA: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. ® 1-and 2-family dwelling 0 Commercial/industrialValuation: $ l ^ i 5� ID Accessory building ❑Multi-family Number of bedrooms: /.,„ ` ❑Master builder 0 Other: Number of bathrooms: JOB SI r E INFORMATION AND LOCATION Total number of floors: ` u u& , Job site address: I (,1. b7 � ) 1 � J�{-C/ New dwelling area: �J1 L�- square feet t6'Z, City/State/ZIP:Tigard,OR 97224 V Garage/carport area: square feet S( Suite/bldg./apt.no.: (0 Project name:Polygon at Roshak Ridge Covered porch area: square feet 9.0 l 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.: (aD Permit fees*are based on the value of the work performed. Tax map/parcel no.: VV 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. New SFk Valuation: $ Existing building area: square feet I BI i New building area: square feet PROPERTY OWNER ' 0 TENANT Number of stories: Name:Polygon WLH LLC Type of construction: Address:703 Broadway Street Ste 510(ly Occupancy groups: City/State/ZIP:Vancouver,WA 98660 Existing: Phone:(360)695-7700 Fax:(360)693-4442 , New: L./ lE1 APPLICANT ❑ CONTACT PERSON BUILDING PERAHT FEES* Business name:Polygon WLH LLC (1'lecserejerm��eschedutel Contact name:Amanda Gavin Structural plan review fee(or deposit): Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable): C f City/State/ZIP:Vancouver WA 98660 Total fees due upon application: t Phone:(360)695-7700 Fax::(360)693-4442 Amount received: E-mail:permitsubmittalspolygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details 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 pemut fee): $21.60 CCB lic.:207247 % _ Total fee due upon application: $201.60 Authorized signature- Print ignature This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name.Ama vin Date: (.9/(a/(:1 ` f / *Fee methodology set by Tri-County Building Industry Q ( / Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • Mechanical Permit Applica g FOR OFFICE USE ONLY City of Tigard "�"' Date/By: PermitNo.: C ^ 'I 13125 SW Hall Blvd.,Tigard,OR 97223 y S /�� ' - Plan Review Phone: 503.718.2439 Fax: 503.598.19601111 R2 2019 Date/By: Other Permit: F i,`�.i Inspection Line: 503.639.4175 -, Date Ready/By: Juris: I H See Page 2 for 'i Internet: www.tigard-or.gov �J m fi,.)5 i � cite` Notified/Method: Supplemental Information U'�(9IL \iC- f.)1y1t ,li l • - TYPE OF:WORK COMMERCIAL FEE* SCHEDI1LE USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 9 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION,' RESIDENTIAL EQUIPMENT/SYSTEMS FEES* cg 1-and 2-family dwelling ❑Commercial/industrial 9 Accessory building For special information use checklist. 1 Multi-family 9 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: site " t 4 2,t svA) t LP t � AirFurnace conditioning0 ,046.75 Job address: ��.{ 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.: (DO 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 frreplace/insert 23.32 Chimney/liner/flue/vent 23.32 ® PROPERTY OWNEROther: 23.32 TENANT'' 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/suspendedhmit 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:Pro Heating&Cooling Other: MECHANICAL PERMIT FEES* Address: NW Alociek Dr,Ste.1104 Subtotal City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee) CCB lie.:209001 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 1.1. Ci. days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 1:\Building\Permits\ME.C_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) ►t ' Electrical Permit Applicatia , FOR OFFICE USE ONLY City Received _ A Tigard ;y (' Date/By: Permit#: 164.S I y I — 0 1 ty I 9N `A 13125 SWW Hall Blvd.,Tigard,OR 97223 �� P 2 0 J Plan Review . . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#: Inspection Line: 503.639.4175 C '1 n) )'1 tii;.9i.:1t Ready Date/By: lures: 1 H See Page 2 for .I:iLi 9-t1 Internet: www.tigard-or.gov -yil,4rw c¢\ifc`I�r,z.,,j Notified/Method: Supplemental Information TYFIR.+I,F'.'WORK. PLAN REVIEW , ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ['Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE:INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 114 7,-2,1 s W l(�°l-� 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. ['Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than I ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qtv. I Each I Total ....I:..* New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: (pd Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) RenewE ❑ 2 PROPERTY OWNER TENANT Servicesable or feedersnergy installation,alteration,SeePage 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 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 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 ii APPLICANT [0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel ' A.Fee for branch circuits with Business name:Polygon WLH,LLC above service or feeder fee, 7.42 2 each branch circuit Contact name:Jolene Smith B.Fee for branch circuits without serAddress:703 BroadwaySt,Ste.510 branchce i feederstfee,first 56.18 2 branch circuit City/State/ZIP:Vancouver,WA 98660 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 67.84 2 Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder Reconnect only 67.84 2 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 ❑ 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) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:paul@portlandelectric.biz Industrial plant(1 hr min) 78.18/hr s Inspections for which no fee is 90.00/hr CCB Lic.: 194066 Electrical Lie.: C760 Suprv.Lic.; 0specifically listed('V2 hr min) n n- ELEC MICAL PERMIT FEES Suprv.Electrician signature,required: clic, A� n pSubtotal: Print name: Alex Shalya Date: 04//08/2019 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: 711.41 ,(., 4, TOTAL PERMIT FEE: Tnts permit application expires tf a permit Is not ohcarned wiTnln Igo Print name: MISHCHUK,SERC Y Date: 04/08/2019 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(I 1/05/COM/WEB c Plumbing PermitApplicat' IT-Building Fixtures ` ?n . FOR OFFICE USE ONLY r B City of Tigard ^�P R 2 Receivedrti Date/By: Permit No.:/t.j .ST-74.)/C)-;a/9/ IN - '1 13125 SW Hall Blvd.,Tigard,OR 97 ;" ..) Plan Review r `` / Phone: 503.718.2439 Fax: 503.548e 6 nay., i-.lg(i +t l"'� $ Date/By: Other Permit No.: Inspection Line: 503.639.4175 l I d' < s ),1.•," 1 b Date Read/B Jur s: See Page 2 for TIGARD Internet: www.ti and-or. ov Ready/By: g $ $ Notified/Method; Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist Description I Qty. Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-familydwellings(includes 100 ft.for each utility P connection) g CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(-sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: L 4 ti:7A. Ski.) k(pcl-,f-k4 " 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.: 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 Lot no.: COO 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 0 PROPERTY OWNER 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 ® 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 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 Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print nameSteve Fowler Tate (14/OR/2019 This permit application expires if a permit is not obtained within 180 days Aft it has been accepted as cvmpletc. *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) r City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT I r l �,,�o Building Permit Review — Residential Building Permit #: 'MST-3'C,1C1_ CO tL 1 Site Address: HHUI S`J 1616 Avt Project Name: P l yq n Lk R �� lej e Lot #: CO (New welling=subdivision nam ,Addition or Alteration=last name of owner) Planning Review Proposal:� N et./ ci'L. S �/ L1 Verify address/suite#active in Accela. LI,1'In River Terrace: ❑ No l2 Yes,River Terrace Review Addendum Site lan Elements: � r sion Control pies of site plan on 8-1/2"x 11"or 11 x 17"paper [ etained trees with drip line and tree protection measures wn to scale(standard architect or engineer scale) Of:e tprint of new structure(including decks)and FFE rth ow I tility locations&easements(required for new and additions) Sye ' address,project or subdivision name and lot numbern Sidewalk/driveway approach Q/ plicant information(name and phone number) 1r, .cation of wells/septic systems dimensions and building setback dimensions V SS eet tree size,type and location S e footage of buildings to be demolishedrnil; S eet names rting structures on site Corner elevations(2'contours if more than 4'differential) o [t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [ 'Yes ❑No Timpervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑`J4JNo ig Clean Water Services—Service Provider Letter of platted prior to 9/10/1995): Yes,applicant was notified UG No Received: rt �'� Required: ❑ Y ,,�� ❑ Yes ❑ No Lid'Public Faci iti7Improvement(PFI)Permit: IA J�€ equired: Q"Yes,applicant was notified ❑ No Applied For: 21 Yes CINo,stop intake nd Use Case#: P00,4iS-00062_ IlX Ztu _ong: � I2 f�� Lequired Setbacks: Front: iili Rear: 0 Side: 0 Street Side: Garage: 3 Building Height: Max.Height: P. Actual Height: ZLI& 2/Landscape Area: 2.0 % Lot Coverage Max: 810 cyo kiAJ Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows ❑ Minimum 12%of area of all street-facing facades ( Garage ❑ Garage door is behind widest street-facing wall ❑ Yes 0 No,one of the following is met: ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage. ItralQ ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset 0 Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer `--2( ❑ Accent siding C� Window trim ❑ Window recess ❑ Window projection ❑ Balcony ual Clearance UI Urban Forestry Plan G Sensitive Lands: 0 Yes [Li/No Type: ■)Conditions S met prior o issuancei of b gpermit i pt's: l J40—i-iN1 . Fell f ser ti ur!lr 1j, w'ev1- iafv'CC LIApproved By Planning: � �-offCIA" ' _ Date: `( i-I y Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 022819.docx r Building Permit Submittal Original Submittal Date: c.\-�VCj Site Plans: # Building Plans: Building Permit#: Enter building permit#above. Workflow Routing: Planning Er Engineering R'Permit Coordinator a Building Workflow Sign-off: [2' Sign-off for Planning(include notes from planning review) Route Application Documents: [3'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: `,k_,,.`. Date: L '\ kOt Engineering Review ,B' lope at building pad: 51) 76) it Conditions "Met"prior to issuance of building permit .2' Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 21/No Assess Water Quantity Fee in-lieu: 0 Yes 0 No LIDA Facility on lot: ❑ Yes 9. No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: i-, Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: XSDC Fees Entered: Wash Co Trans Dev Tax: &'Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Rt. Yes ❑ N/A LIDA ❑ Yes _g`N/A OK to Issue Permit Approved by Permit Coordinator: CP/VIA- Date: Li 1 ZZ I I,41 I:\Building\Forms\BldgPermitRvw_RES 022819.docx s 11111 City of Tigard I a COMMUNITY DEVELOPMENT DEPARTMENT 1 I c A R n River Terrace Building Permit Review Addendum Building Permit #: mS—`- k tilt Site Address: '11711 sc W With" 9 Project Name: Pelx4ik ki- Riikikk 1Z4je Lot #: 60 (New`d(velling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan Dist 'ct Design Standards (18.640.070.1): Is the project subject to the plan district design standards? [ Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing 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 min. 5 t. deep Balcony w/access 2 Window Projection Vertical Wall Offset a ft. deep min.2ft., 5 ft.wide min. 2 ft.,6ft.wide Gabled dormer ❑ 0 0 1/ 2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: 2-S.0/. . 1 >,9/ 3.E Entrances:At least one entrance must meet both of the folio g standards: I J Max. 8 ft. setback from longest street- facing wall 2 Parallel to street,angle no more than 45° from street, or open onto porch Entrance opens to a porch: iYes 0 No / I11378,all the following apply: sq.ft. min. e street facing entry [ '1}ft.max.roof above floor ofp orch 5 ft. depth 0%min.porch roof coverage 4. D tailed Design:All buildings shall include a min. of five of e following elements on all street-facing façades: Q'tovered porch min:5 ft.wide x 5 ft. deep 5. [ Recessed entry in. 5 ft. ❑ Wall offset min. 16 inches [ ' area mwide x 2 ft. de epF ��,, �� CDDormer min. 4 ft.wide L.iYKoof eave min. 12 inch projection f2 Roof offset min. of 2 ft.S ❑ Roof shingles either tile or wood j Ci:Voble,hip or gambrel roof design P i$ ❑ Roof pitch oriented south mi ,,��// n. 500 sq. ft. orizontal lap siding min. 3-7 inches wide5 I 'Accent siding min.40%of street facade F 0 Window 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 0 Attached garage is 35%or less of street facade 5. Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: �� No closer to front or side lot line,than longest street-facing wall. ❑ Yes ltd No. If No (Check one): ❑ I Jay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. a ay 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:dt (Check one) IJP 1Z-foot-wide garage door ❑ 40%max. of street facade ❑ 50%max. of street façade with 7 detailed design elements Notes: e• ... W.. ate: —( -t q I:BuildingTonns131dgPermitRvw_RES_RT_121417.docx Electrical Permit Applicationr 2,-- ; • � FOROFFICE USE ONLY City of Tigard Reoerved y Illii 's 13125 SW Hall Blvd.,Tigard,OR 97223 -` °% Flate/By. \�3l�q S� Permit#:r{1S1"„ G(` _ �1 1.' Phone: 503.718.2439 Fax: 503.598.1.960 Date/By:Review `T DBy: Related Permit#: Inspection Line: 503.639.4175 Readyy I H See Page 2 for TIGARDDate/B : Jur s: G Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW;;; E New construction ❑Addition/alteration/replacement s�5to ' s 9Please check all that apply(submit 2 sets of plans w/items checked); ernIk a * 'y . ❑Service or feeder 400 amps or more ❑Building 0 Demolition - 0 Other: over three stories. \ m where the available fault current CATEGORY OF CONSTRUCTION ` 0 Mortis and boatyards. exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessor}E — less to ground,or exceeds 14,000 0 Commercial-use agricultural 0 Multi-familamps for all other installations, buildings. y 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB .Stilt INFORMATION AND;'_LOCATION C]Emergency system. larger separately derived 422.1 SW 1 ❑Addition of new motor load of system. - lock Job#: Job site address: k100HP or more. ❑ `A,'E,'1_2 "1.3„ City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.'#: ,,.I Project name:Polygon At Roshak Ridge ❑Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: .. FEE SCHEDULE Description j Qty. I Each i Total j New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge I Lot#: (p0 Includes attached garage. Tax map/parcel#: 1,000 sq.ft,or less 168.54 DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 ��-tt'\\� ,gyp �1 �p �c,, �7 et+ Limited energy,residential `-^" - 'V e.AA& �' C5 r 1 p'r T l O `--o a 1 Li) with nergy,�.ft. 75.00 Limited energy,multi-family 75.00 2residen residential(with above sq.R.) Renewable Energy 12:1r PROPER'L'Y OWNER ' 0,:TENANT ❑ See Page 2 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 City/State/ZIP:Vancouver,WA 98660 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:(360)695-7700 I Fax:(360)693-4442 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 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 ►:� ,PERSON Branch circuits-new,alteration,or extension,per panel APPLICANT I 0 CONTACT A.Fee for branch circuits with Business name:William Lyon Homes,Inc. above service or feeder fee, each branch circuit 7.42 2 Contact name:Nichole Thorpe B.Fee for branch circuits without Address:703 Broadway St Suite 510 service or feeder fee,first branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Phone:(360)695-7700 I Fax: : (360)693-4442 Miscellaneous(service or feeder not included) Each manufactured or modular Email:permitsubmittals 01 dwelling,service and/or feeder 67.84 2 @p ygonhomes.Com :.CONTRACTOR . Reconnect only 67.84 2 Business name:Alameda Electric Sign or outline lighting 67.84 2 SiAddress:3415 NE 44th panel,lalt alterations,orcircuit()orlexixttension gy ❑ See Page 2 2 City/State/ZIP:Portland,OR 97213 Each additional inspection over allowable in any of the above I Additional inspection(1 hr min) 66.25/hr Phone:(503)319-2192 Fax:( ) Investigation(1 hr rain) 90.00/hr Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 199188 I Electrical Lic.: c923 l Suprv.Lic.: 4871 'S,. specifically listed('''/hr min) 90.00/hr Suprv.Electrician signature,required: ELECTRICAL PERMIT,FEES Subtotal: Print name: Kile Rood J Date: 03/08/2019 0 Plan Review Required(25%of permit fee); - — r State surcharge(12%of permit fee): Authorized signature: _ TOTAL PERMIT FEE: Print name: Kile Rood Date: 03/08/2019 This permit application expires if a permit is complete. within 180 days after it has been accepted as complete, * Number of inspections allowed per permit. l;\Building\Permits\ELC PermitAao ELR ERE doe R 05/171701; Plumbing Permit Application Building FixturesA Er , .1 ,' . _.,_ y rt FOR OFFICE USE ONLY 11 City of Tigard Received 's 13125 SW Hall Blvd.,Tigard,OR 97223 i( 1 i. Date/By: I(�l I ck SV Permit No:�c 1\ C 11 Plan Review , ' Phone: 503.718.2439 Fax: 503.598 1060 Other Permit No.: TIGARD Inspection Line: 503.639.4175 -s-.t.,, -, Date/By: Internet www.tigard-or.gov ( Date Ready/By: Jas I See Page 2 for ....Iii> Notified/Method: Supplemental Information TYPE OF �air .G .{rv. .. 'i {. FEE*, sCHEDI)LE A y5* :.;'.. N A.r"r• ®New construction � � ❑Demolition R v*� ;-- ' For special information use checklist. r •1,:4}4,----•''',..„-4\ Description - ❑Adition/alteration/replacement ❑Other: I Qty. I Ea. I Total \\.'-'` New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY'OF CONSTRUCTION , ! SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ®Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB;SITE INFORMATION AND LOCATION' Site utilities: Job site address: 1'-122,0 I( Ci-TH g Catch basin or area drain I I 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Suite/bldg./apt,no.: w I Project name:Roshak Ridge Footing drain(no.linear ft.:__) Page 2 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 Subdivision:Roshak Ridge I Lot no.: '_n Water service(no.linear ft.: ) 1 Page 2 Fixture or 1tem: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF,•WORK Backwater valve 12.51 ( V-a t ,�\ i 2 \ 1G? �1 - OO( '` Clothes her washer 25.02 �C./v�.V��. ,i �J ` 6 'i 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 City/State/ZIP:Vancouver,WA 98660 Garbage disposal 25.02 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 et 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 Address:703 Broadway St.,Ste 510 Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 �13iunits-(potahipAygteT} f 62.54 _ Phone:(3a6)695-7700 Fax: :(360)693-4442 Tub/shower/shower pan if 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Business name:Alliance Plumbing Water heater 37.52 Water piping/DWV 56.29 Address:146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 CCB Lic.:184601 / Plumbing Lic.no.:PB732 Plan review (25%of permit fee) Authorized signature: State surcharge(12%of permit fee) i 4'' TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Robert DIshman Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-pennitApp.doc 10/01/09 440-46I6T(I0/02/COMJWEB)