Permit Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Cl of Tigard RECEIVEDReceived / V
illh - 13125 SW HallllBlvd.,Tigard,OR 97223 r� Date/By: (Z/ 4. ,/, r rj Permit No.: ►�AST201g-" 00225
I Phone: 503.718.2439 Fax: 503.598.1960DEC 1 1 2019 Plan Review ,t
Date/By: I^/.1'- 2 0.2O 4G4 Other Permit No.:
TIGARD Inspection Line: 503.639.4175 �p Date Ready/By: ` / tuns ® See Page 2 for
Internet: www.tigard-or.gov r'ITV (1'F TIGA ��� �-0
ti 1 Notified/Method Supplemental Information
TYPE OF WORK ...,-, /pt. ! /t,e,t. , FEE* SCHEDULE
®New construction ❑Demolition For special information use c/recAlist.
Description Qty. Ea. Total
❑Addition/alteration/replacement ❑Other: 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 ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: /
Fire sprinkler(1214 sq.ft.) ✓ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14239 SW 169"'Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Roshak 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 Lot no.:64 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
1)ZS IPTION OF WORK Backwater valve 12.51
', Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
►� PROPERTY OWNER ❑ TENANT 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
11 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Polygon Northwest Medical gas(value:$ ) Page 2
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
E-mail:jennifer.lopezhpolygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
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 Lic.:184601 Plumbing Lic.no.:PB732
I State surcharge(12%of permit fee)
�
Authorized signature: f- ....,77/ ) TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Gavin Thornes Date:12.16.2019 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-15' 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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
h 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:
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 Plumbing Installations
Work 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 ' CI 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 ® 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.
4"
Car Wash Drain Isometric or Riser Diagram.
Garbage -Domestic-non-food
Disposal -Domestic-food related ❑ 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_alliancepluml ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp
(3).doc
4r
CITY OF TIGARD MASTER PERMIT
F .
2 COMMUNITY DEVELOPMENT Permit#: MST2019 00225
Date Issued: 09/10/2019
T F GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S107AA06400
Jurisdiction: Tigard
Site address: 14239 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 64
Project: Polygon at Roshak Ridge, Lot 64
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: 37 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 8 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
0
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: 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: 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 Y
Other: N Other Description: Ecompasing:
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 5113 703 BROADWAY S:xtt r,St.11 510 4 -Efer 47fs
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Report Required
Prior To Pour
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $24,534.23
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: \ w� iL\--.—
Permittee Signature: -C-* .C \C•
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. ,. \."
. • --?.‘,k U
Building Permit Application 1
' Residential ,h:'° ' , > I ` FOR OFFICE USE ONLY
City of TigardReceived
I - 1-47-1:2 " ,' "0 Date/By. ' C �\ Permit No f —^ 4
II • 13125 SW Hall Blvd.,Tigard,OR 9722 i D Plan Review ^��
Phone: 503.718.2439 Fax: 503.59$.19 0 DateBy: L Other Perms 7a-Xsy c` - E
Z iGARD Inspection Line: 503.639.4175 ..�l!Y ice} ;. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING )10SI( N Notified/Method: Supplemental Information
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 ❑Commercial/industrial Valuation: $ ( ''
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SI tL INFORMATION AND LOCATION1 V' Total number of floors:
, tug
Job site address: 1 Lt/1/� Vt �loo t " 7) New dwelling area: 'O'(L f square feet SC1,,,,
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet 9D2....,
Suite/bldg./apt.no.: V\ Project name:Polygon at Roshak Ridge Covered porch area: square feet CI 0
Cross street/directions to job site: Deck area: square feet l
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Polygon at Roshak Ridge Lot no.: t l 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.
New SEA, Valuation: $
Existing building area: square feet
New building area: square feet
1 ® PROPERTY OWNER ❑ TENANT Number of stories:
J 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:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer fee schedule)
Business name:Polygon WLH LLC
Structural plan review fee(or deposit):
Contact name:Amanda Gavin
FLS plan review fee(if applicable):
Address:703 Broadway St.Ste 510
Total:fees due upon aplication:_ x. v _. -
Amount received:
Phone:(360)695-7700 Fax: :(360)693-4442
E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
City/State/ZIP:Vancouver WA 98660 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: $201.60
Authorized sign4 .1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Aman s a l avin Date: al(.01 ti *Fee methodology set by Tri-County Building.Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
{
Mechanical Permit Applicatl : ll .FOR OFFICE USE ONLY
Received
NCity of Tigard Permit x
Date/
By:
13125 SW Hall Blvd.,Tigard,OR 97223 }t j I�; 1 Review
�' �
1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Y I*A it ri Inspection Line: 503.639.4175
CiTy i ( Date Ready/By: Jut,,
Internet: www.tigard-or.gov Supplemental See Page 2 for
o g 91 e e.,i e e l ,etc,.t,,E'¢ Notified/Method: Information
TYPE OF WORK COMMERCIAL,FEE*.SCJJJ•DULE.— USE CHECKLIST`
Mechanical permit fees*are based on the value of the work -
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION -
Value:$
RESIDENTIAL EQUIPMMENT/• SYSTEMS FEES*
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
I j Multi-family ❑Master builder
❑Other: Description I Qty. I Ea. i Total
JOB SITE INFORMATION AND LOCATION' Heating/cooling:
�Z3q \Coque Air conditioning ' 46.75
Job site address: Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bidg./apt.no.: , Project name:Roshak Ridge Heat pump 61.06
l
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.: G,(-t Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
N S�7^1Q —. O b 2,25 Flue vent for water heater or gas
1 !�/ —1 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 E TENANT Other. 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.39
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 ❑ 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
WaU/suspetsded/unitneater_ _ ___._ _. : ,_ -_
Water heater
Phone:(360)695-7700 Fax:;(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
ilk 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($90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( )
State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
fn� This permit application expires if a permit is not obtained within 180
V I(�� 1)�, days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
Electrical Permit Application` r7 '. '
FOR OFFICE USE ONLY=
City o_f T1garC1 Received
\= �� ��
a 13125 SW Hall Blvd.,Tigard,OR 97223 t ,-,y, '' Date/B : . r,
Plan Review
Phone: 503.718.2439 Fax: 503.5983 196Q. Date/B : Related Permit#:
TiGARD Inspection Line: 503.639.4175 Ready Date/By: .tori:: EI See Page 2 for
rn Internet: www.tigatd-or.gov NotifiediMethod: Supplemental Information
TYPE OF WORK .:PLAN REVIEW,.
E New construction ❑Addition/alteration/replacement Please check all that apply
(submit 2 sets of plans w/items checked):
0 Demolition Other:
0 Service or feeder 400 amps or more 0 Building over three stories,
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family 0 Master builder ❑Other; amps for all other installations. buildings.
Fire pump. 1
0 Installation ahon of 150 KVA or
JOB SITE.INFORMATION AND;LOCATION ' 0 Emergency system. larger separately derived
Job#:
0 Addition of new motor load of system.
Job site address:ttk23°► SW `(p�
T$h A VE' 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy,
0 Health-care facilities. ❑iRecreational vehicle parks.
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 I Qty, I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#:4.14 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
Nk .(5V\. �S�-1,0 t el — bb'2-SS (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy
® PROPERTY OWNER ❑ .'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
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
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
® APPLICANT 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,
each branch circuit 7 42 2
Contact name:NichoIe 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)695-7700Miscellaneous(service or feeder not included)
Fax: :(360)693-4442 Each manufactured or modular
Email permitsubmittais@polygonhomes.com
dwelling,service and/or feeder 67.84 2
. _ . . ..:. r'k � o
Rec nnect only 67 84
-_ - • -. .�� - - _ .._ -.�.. z:.--'4'' . lotimp-prlrrTtWac¢c eb7.�4- 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Address:3415 NE 44th Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
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(I hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 199188 Electrical Lie.: c923 Suprv.Lie.: 48711S,- 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):
State surcharge(12%of permit fee):
Authorized signature: i�-r��— TOTAL PERMIT FEE:
Date: 03/08/2019 This permit application expires If a permit is not obtained within 180
Print name: Kile Rood days after it has been accepted as complete.
* Number of inspections allowed per permit.
Plumbing Permit Application
Building Fixtures J .,1
FOR OFFICE USE ONLY
City of Tigard Received
114 . �� yy 7 Date/By: k\ -l A CI S Permit No S N- its`
13125 SW Hall Blvd.,Tigard,OR 91W 1 i 201!-J \ v`
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 °e` "
Internet: WWW.tI and-or. ov ( t i ° r + Date Ready/By: Juris: Ed See Page 2 for
g g C (LD' \ r'V ii'r ''�' Notified/Method: Supplemental Information
TYPE OF WORK ', S„�"
. .... .. . .� .,� �s. , �,FE *� „SCHEDYILE-; :4,,,::4,2'.','''' '
®New construction 0 Demolition For special information use checklist
Description I Qty. 1 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
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND' LOCATION Site utilities:
Q Catch basin or area drain
Job site address: r��T1 �� ��Gls.� (�, �� 18.76
City/State/ZIP:Tigard,OR 97224
t V�� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: ,\ I 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,: (e`-f Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF i WORK` Backwater valve 12.51
C � \ G? 2-01 al_00�ZS Clothes washer 25.02
`jJC "kJ ` Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® 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(notable water] 2.541„- _
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing Waterpitpingl 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)
4/A: State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Robert Dishman Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46161(10/02/COM/WEB)
.
City of Tigard
INr COMMUNITY DEVELOPMENT DEPARTMENT
II ;
T 1 c u n Building Permit Review — Residential
Building Permit #: kx\S T - \C\-(.., --=-)
Site Address: /2-71-2 --5: C) S2 j /Ca -1-A /9y 2
Project Name: PO?A, ,Y1 - e,(L iLot #: `e
(Newo' ' g=subdivision name;Addition or Alteration ast name of owner)
Planning Review
Pr posal: (L)
V Verify address/suite# active in Accela. In River Terra. e: ❑ No /Yes,River Terrace Review Addendum
Sit Plan Elements: iv. rosion Control
Pcopies of site plan on 8-1/2"x 11"or 11 x 17"paper BI '1.tained trees with drip line and tree protection measures
rawn to scale(standard architect or engineer scale) :otprint of new structure(including decks)and FFE
rth arrow M I -ty locations&easements (required for new and additions)
IL'S e address,project or subdivision name and lot number RI Sidewalk/driveway approach
V .plicant information(name and phone number) 111 ��cation of wells/septic systems
YALot dimensions and building setback dimensions ►S eet tree size,type and location
{0 are footage of buildings to be demolished beet names
V 3114.ting structures on site V Comer elevations(2'contours if more than 4'differ tial)
■ .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ❑0N
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shownWYes 2o
06ean Water Services—Service Provider Lette of platted prior to 9/10/1995):
quired: ❑ Yes,applicant was notified No Received: CI Yes ❑ No
fvike-
Public Faciliti mprovement(PFI) Permit:
Required: Yes,applicant was notified ❑ No Applied For: Z1 Yes ❑ o,st p intake
6..and Use Case#: �1� °�0/�- o60( - ❑ Zoning: f•--A? ,(-� —
IV t equired Setbacks: Front: 0 Rear: Side: 0 Street Side: 7v7 — Garage: _
uilding Height: Max.Height: Actual He- ht: - ,
I% Landscape Area: 2� % ®'Lot Coverage Max: 0/0
Entrance ii -- .ack no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ❑ Minimum -' : . area of all street-facing facades
Garage ❑ Garage door is behind . .eet-facing wall \3 ❑ Yes ❑ No,one o •- •I owing is met:
❑ Door extends no more than 5' r. Aland there is a covered so • - ending beyond garage.
❑ Door extends no more than 5'from wall an. i - - sq ft.window above garage on 2"d floor.
❑ Garage door width is ❑ 12'or less ■ :`o or less of faca s e ■ 60%or less and includes 7 of following:
❑ Covered porch ■ sed entrance Q_Wall offset D- 1' ;.... 1 1:1._-Roo Off et
❑ Fire s. • ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roo ■ Dormer
ro Accent siding ■ Window trim ❑ Window recess ❑ Window projection ❑ :a .-
11lr isual Clearance 7 Urban Forestry/Plan
IN-nsitive Lands: ❑ Yes 1V No Type:
7 Conditions met prior to issuance of building permit
Not :
Approved By Planning: s- Date: (—__i
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
Building Permit Submittal
Original Submittal Date: I-1-1
Site Plans: # 'J
Building Plans: #
Building Permit#: gn�ter building peynit#above.
Workflow Routing: g Planning Engineering R Permit Coordinator Building
Workflow Sign-off: Elf Sign-off for Planning(include notes from planning review)
Route Application Documents: Et Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: 1 \CA
Engineering Review
Slope at building pad:
ea-Conditions "Met"prior to issuance of building permit
0 Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes Zr No
Assess Water Quantity Fee in-lieu: ❑ Yes .a No
LIDA Facility on lot: El Yes 3 No
Final Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
/2"-Approved by Engineering: du- Date: 5139/11.
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: El 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: 27
�DC Fees Entered: Wash Co Trans Dev Tax: ,,R"//Yes ❑ N/A
Tigard Trans SDC: [3 es ❑ N/A
Parks SDC: L9 Yes ❑ /A
LIDA ❑ Yes N/A
OK to Issue Permit
Approvedditi/ (3
by Permit Coordinator: Date: /)
I:\Building\Forms\BldgPermitRvw_RES_022819.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
" C
TIGARD River Terrace Building Permit Review Addendum
Building Permit #: \\C\ I" \Q_C S
Site Address: �`-, C.> 9 ) gi344/i344i v-e_
Project Name: /in : r I e :14, ‘1—sti ‘ Lot #:
ew'( IR g=subdivision name;Addition or Alteration= 4name of owner)
Planning Review of River Terrace Plan Disyct 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 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 ft. deep ft. deep min. 2ft., 5 ft.wide min. 2 ft.,Eft.wide Gabled dorm
❑ ❑ ❑ ❑
2. Eyes on the street: a minimum gf 12%of Z
ch street facing facade must include windows or entrance doors.
Percentage Shown: t 4
3. trances:At least one entrance must meet both of the folio g standards:
Max. 8 ft. setback from longest street acing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: ❑ Yes No
If yes,all the following apply: 0 25 sq.ft.min.
❑ One street facing entry ❑ 12 ft.max.roof above floor of porch
❑ 5 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 ❑ Ijefessed entry area min. 5 ft.wide x 2 ft. deep
❑ y4 ll offset min. 16 inches ® Dormer min.4 ft.wide
QRoof eave min. 12 inch projection ❑ oof offset min. of 2 ft.
❑ Roof shingles either tile or woodTri Gable,hip or gambrel roof design
❑fcoof pitch oriented south min. 500 sq. ft. ❑ Ijorizontal lap siding min. 3-7 inches wide
El Accent siding min.40%of street facade VWindow trim min. 21/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade
5.Garages and Carports:May face the froni or side to on a corner lot.
No closer to ro : '.e lot line, than longest street-facing wall. ❑ Yes ❑ ► e. No (Check one):
❑ May extend up to 5 ft. if there ' ; • ered front porch and r - •oes not extend beyond the front porch.
❑ May extend up to 5 ft.where the garage is par •►- -..•o-story building and there is a window at the second story
above the garage that faces the street wi . . . area of 12 sq. .
Width: (Check one)
❑ 12-foot- it- :,rage door ❑ 40%max. of street facade
• i•o max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: ,i Date: M
I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx