Permit ED
Plumbing Permit Appli a n���
Building Fixtures AUG 17 2020
City of Tigard CITY OF TIGARD Received �� �� y6 �S7-�14 �3
DatJBy: Permit
n 131255W Hall Blvd iSf T7 (�It/IC�'I�r�
Phone: 503.718.243 FakR.- .59 ( !V Plan Review., ,L
Date/By: ' �3Q AVGr! Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: - ilk See Page 2 for
TIGARD Internet: www ti*ard-or.*ov
6 b N'otiticd'Melhod'. 4.-/GO "6�0 � Supplemental Informnlion
TYPE OF WORK ,4 J 7 x7r4- FEE* SCHEDULE
--------
New construction ❑ Demolition _ For special inJormatian use checklist
- -- - ---- Description Qty. I Ea. -I Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
- _- --- SFR(3)bath 500.32
0 Accessory building Cr Multi-family -- - --------
-. -.- -- ------ Each additional bath/kitc n 25.02
❑Master builder El Other: Fire sprinkler( q.ft.))-1,0 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _ _
Job site address: 14 ���� 31/3 1 �61-Ih Ay� Catch basin or area drain 18.76
City/State/ZIP: 18.S�Pj&) X 9� 14 0 Drywell,leach line,or trench drain
Footing drain(no.linear ft.: ) Page age 2 2
Suite/bldg./apt.no.: 1 Project name: J E Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
'Eut`i.ct.,.6 1 L h' ----- Sanitary sewer(no.linear ft: ) Page 2
-- Storm sewer(no.linear ft.:_) Page 2
_. --- Water service(no.linear fl.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow presenter -__ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
--- - Clothes washer 25.02
Dishwasher 25.02
U..) ' .9i n�� �t{ Drinking fountain 25.02 -
Ejectors/sump 25.02
❑ PROPERTY'OWNER - ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
-- ----- ------ Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: _ Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
[41 APP.UIcA$Tr : ,❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ I Page 2
- - ------- --_--- Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) j Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal _ 25.02
-- - - ---- Water closet 25.02
CONTRACTOR __ Water heater 37.52
Business name: , ypCQF.� o1� - �.{--I(JPS � �' Water piping/DWV 56.29
v` ` S - p p
Address 'Q`�S 1� 1TvQ(( C_d“/mbIA V10QQ_Al1 Other: 25.02 ____
City/State/ZIP: •'iaR-EC�61e `"I'10h0 _-_^ Subtotal
Phone:( (06::)� _ 1.1r-24 Fax:( 0 644,". 9i,c,I Minimum permit fee: $72.50 _-
Plan review (25%of permit fee)
I CCB Lie.: L I '277-O _ Plumbing Lic.no.: Z�- g20. KJ -- - State surcharge(12%of permit fee)
Authorized signatur / TOTAL PERMIT FEE
LPrint name: r 1 This permit application expires ita permit is not obtained within 180 days
-(�(3 Dater after it has been accepted as complete.
1 s� `Fee methodology set by Tri-County Building Industry Service Board.
I:\nnilding\permits\PLMU-PermitApp.doc 10/01/49 440-4616T(111'02'COWW1213)
CITY OF TIGARD MASTER PERMIT
111. 3` COMMUNITY DEVELOPMENT Permit#: MST2019-00325
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2020
Parcel: 2S 107AA06900
Jurisdiction: Tigard
Site address: 14279 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 69
Project: Polygon at Roshak Ridge, Lot 69
Project Description: New SFA.
BUILDING
Floor Areas jteauired Setbacks Required
Stories: 3 Bedrooms: 2 First: 562 sf Basement: 85 sf Left: 0 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke
DwellingUnits: 1 Detectors: Yes
Third: 0 sf Right: 0
Total: 1209 sf Value: 3169,008.04 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 SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 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 1209
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 NFPA 13D Sprinklers
Required
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $24,569.89
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 thrQughAR-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.
PI mil'..r .
Issued By: - `_---_ __ ?,,•
.ter� t,� i._' r: rrr,,' .; t
Permittee Signature: ti-
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.
- Building Permit Application LOT uR
Residential _ gg�.-ge�yr FOR OFFICE USE ONLY
ri A 3...e.I V F u Received
Cityof Tigard • �p1 (i 5
g Date/By: S 1Q S � Permit NA q�
13125 SW Hall Blvd.,Tigard,OR 97223 t- 7 Plan Rev ew d / ,��("�i
Phone: 503.718.2439 Fax: 503598.196E g 0 2019 DateBy: 8/(9 I A1k OtherPermft _C�
TIGARD Inspection Line: 503.639.417' � _ ali/ Date ReadyBy: / funs. El See Page 2
for
.w
��((}} Internet. www.tigard-or gov 1, ' ' t�' �� Notified/Method: �/ 9 1g i'/ Supplemental Information
`V- „t
4 TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILYDWELLLNG
Permit fees*are based on the value of the work performed.
El New construction 0 Demolition
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑ 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: $ ,liq I Gob
El Accessory building El Multi-familyNumber of bedrooms: 1
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:3 t(2 39
Job site address: \L / 'Jf j/� ) 1 0 V�A� New dwelling area: 1 [ square`` feet 2
City/State/ZIP:Tigard,OR 97224 v V ll Garage/carport area: I4V t square feet 5'L
Suite/bldg./apt.no.: iA Project name:Polygon at Roshak Ridge Covered porch area: /J square feet fas
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 Lot no.: 6,9 Permit fees*are based on the value of the work performed.
w Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 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
El PROPERTY OWNER 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:
® APPLICANT D CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon MT,H LLC (Please refer rojee schedule)
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 application:
City/State/ZIP:Vancouver WA 98660
Phone:(360)695-7700 Fax::(360)693-4442 Amount received:
E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Aman Gavin Date: J ICJ} *Fee methodology set by Tri-County Building Industry
!t L �� Service Board.
.:\Building Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Mechanical Permit Applica}t'auyn FOR OFFICE USE ONLY
Cityof Tigard 1 IICEIVED Received
��1�_� %
- ,t 25 g Dan Re Permit No.
13125 SW Hall Blvd.,Tigard,OR 97223�it [�
Phone: 503.718.2439 Fax: 503.598.19617-tapilUG hii s7 ZO19 Plan Review
Date/By: Other Permit:
.11 t:A K i i Inspection Line: 503.639.4175 Date Ready/By: lane: 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARDg
BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
N New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY 01? CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling D Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑Master builder 0 Other: Description P Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION - - Heating/cooling:
Air conditioning , 46.75
lob site address: .'k'L"t♦9 5W Llo`1.^N 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.: ISI4:‘ 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
[Ni o sy\ -No mST-2.Ot t- it)02,6 fireplace 23.32
Log lighter(gas) 23.32
. Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
2 PROPERTY OWNER s ❑ 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
1 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms, 2
toilet compartments,utility rooms) J 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:
S14.15 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
'(1kN 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 lic.:209001 TOTAL PERMIT A FEE
. a-
w This permit application expires if a permit is not obtained wlthiu 180
✓WQi i) 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'\n,,m.—NP..m0dOKt o....,.s.... /uMn 4..- ... ...�........__.._.__.
Electrical Permit Application RECEIVE ' F., EvQ `' 7 ,v
City of Tigard Received
AUG 2 9 2019 Date/By: Permit tl:hr`Ct�\a_�, -s
III 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��\72�
Phone: 503.718.2439 Fax: 503.598.1960 Related Permit 4:
CITY OF TIGARD Ready :
TIGARD Inspection Line: 503.639.4175 Ready Date/By: 1uris: El See Page 2 for
c Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
•
TYPE OF WORK -`,..'.... PLAN,REVIEW ,
®New construction 0 lAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
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
amps for all other installations. buildings.
❑Multi-family E Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
_ JOB SITE;INFORMATION 1ND LOCATION ',. 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 1 42.19 S W \(pC-{ ,4 NZ 100HP or more. ❑"A B",`1-2 , t-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 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 - I 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 I 33.92 1
DESCRIPTION OF'WORK Limited ener
MtOYVICYMAITe 4o msz gy,ve q.residential 75.D0 2
V�J Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
® PROPERTY,OWNER I. 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. 20] 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, 742 2
each branch circuit
Contact name:Nichole Thorpe - B.Fee for branch circuits without
service or feeder fee,first
Address: 703 Broadway St Suite 510 branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:permitsubmittals@polygonhomes.com Reconnect 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 ❑ 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 indusrialplant(Ihrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 487115 specifically listed(%hrmin) _
• ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):_
This perm
Stateapplica surcharge(12%of permiTt feeFE):
Authorized signature: r
Tit tion ezpirea OTAL PE if a permttRMI is not... _t-3,
obtained within 180
Print name: Kile Rood Date: 03/08/2019 I days after it has been accepted as complete.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
g G 2 9 2019 Permit No.�S-<1i�\q.�D
II v 13125 SW Hall Blvd.,Tigard,OR 97 Dale/By: �JV
i _ Plan Review
Phone: 503.718.2439 Fax: 503.5 Other Permit No.:
( OOF TIGARD Date/By:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: kris: H See Paget for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. I Ea. I Total
0 Addition/alteration/replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
' ' CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ®Multi-family SFR(3)bath ` 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION` ' AND LOCATION Site utilities:
Job site address: IL LZ C SW k VJ_`-l‘{ 1J ' 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.lapt.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
F
Subdivision:Roshak Ridge Lot no.: tY l Fixture or Item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
�y p� 3, Clothes washer 1 25.02
"" VEA �Y� t► t c �k -1' to3Z,S Dishwasher 1 25.02
V
Drinking fountain 25.02
Ejectors/sump _ 25.02
® PROPERTY OWNER El 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 1 12.51
® APPLICANT ❑ 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 3 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 Z 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
a
Water closet 3 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Alliance Plumbing Waterpipiag/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 I Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lie.:184601 441i1C Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date:1121 d I$ 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:\Building\Permits1PLMIJ-PermltApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
L
City of Tigard
III ■ ul COMMUNITY DEVELOPMENT DEPARTMENT
A►z n Building Permit Review — Residential
Building Permit #: 1\1\STa'o161- a5
Site Address: L/2 3-q ,a) // 94A etYV -
Project Name: h .-4-1-Pa/ e, Lot #: 6 of
(New g=subdivision name;Addition or Alteration �t name of owner)
Planning Review
Proposal: Akk) ri - /
Er Verify address/suite#active in Accela. In River T . 1 ce: 0 No Yes,River Terrace Review Addendum
Site Plan Elements: J4 Erosion Control
4d3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper IU�: tained trees with drip line and tree protection measures
yawn to scale(standard architect or engineer scale) t,F otprint of new structure(including decks)and FFE
orth arrow � 'ty locations&easements(required for new and additions)
VaySite address,project or subdivision name and lot number in Sidewalk/driveway approach
156 ,plicant information(name and phone number) 01 ,h cation of wells/septic systems
iG Lo dimensions and building setback dimensions ivi 5kreet tree size,type and location
14.l uare footage of buildings to be demolished LMS et names
I!'% "sting structures on site VCorner elevations(2'contours if more than 4'diffe tial)
V Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced> 6QYes ❑I'
impervious area(applicable if R-7,R-12,R-25&R-40) If es,is a storm water .uali facili • shown? .0i es o
��I' lean Water Services—Service Provider Lettot platted prior to 9/10/1995):
quired: ❑ Yes,applicant was notified 11Q No Received: 0 Yes 0 No
NJ Public Facilt s Improvement(PH)Permit: ('
quired: Yes,applicant was notifiedti ❑ No , / Applie For: Yes ❑ o,stop intake
4and Use Case#: �Gfi O/S= t��� 7" IG Coning:
equired Setbacks: Front: 42 Rear: tN / Side: t� Street Side: Garage: 3
ilding Height: Max. Height: k Actual H ht: `�
Landscape Area: '� % Lot Coverage Max: e
Entrance back no more than 8'from street-facing wall ❑ Parallel to street or o 5 degrees or less
Windows El Minim %of area of all street-facing facades
Garage ❑ Garage door is be ' widest street-facing wall ❑ ❑ No,one of the following is met:
❑ Door extends no mor 5'from wall anti th111 er���1 ' covered porch extending beyond garage.
❑ Door extends no more than 5' ere is a 12 sq ft.window above garage on 2°d floor.
❑ Garage door width is ❑ 12'or le 5 ess of facade 0 60%or less and includes 7 of following:
❑ Covered porch ❑ cessed entrance ❑ a et ❑ 1'Roof eave 0 Roof offset
❑ Fire shin Lap Siding ❑ Roof pitch ❑ a ' ,or gambrel roof ❑ Dormer
❑ t siding Window trim ❑ Window recess ❑ rojection D Balcony
4� ual Clearance Urban Forestry n
It ensitive Lands: ❑ Yes No Type:
Co ditions met prior to issuance of building permit
No
Approved By Planning: Date: 3
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: a,1"}1 101
Site Plans: # ,
Building Plans: #
Building Permit#: LY Enter building permit#above. /
Workflow Routing. ("Planning a/Engineering [Permit Coordinator [ 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.
❑//uilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: \slk.�,`.,� Date: cg 40%
En eering Review
Slope at building pad: , J
0 Conditions "Met"prior to issuance of building permit 4///t'
2'Easements (encroachments)per engineering conditions of approval and plat
la—Water Quality/Quantity Facility: ,..,,�� `
Assess Water Quality Fee in-lieu: 0 Yes lfd_No
Assess Water Quantity Fee in-lieu: 0 Yes Ii-No
LIDA Facility on lot: ❑ Yes 11l-1Vo
C7 Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:
[ Approved by Engineering: Date: c:9/%.2/1"
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions"Met"prior to issuance of building permit
0 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:
�J/SDC Fees Entered: Wash Co Trans Dev Tax: l�Yes ❑ N/A
1/ Tigard Trans SDC: IA./Yes ❑ N/A
Parks SDC: 17/Yes 0 N�/A
LIDA 0 Yes N/A
OK to Issue Permit l q
Approved by Permit Coordinator: 44:late: �! ��G
l:\Building\Forms\BldgPermitRvw_RES_022819.docx
• n
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
C
T A n River Terrace Building Permit Review Addendum
Building Permit #: Ck1ST r C W2
Site Address: 71-2 l )) /6 q /7114e
Project Name: 0/ I Lot #: 67_1?
(New e g=subdivision name;Addition or Alte 'o =last name of owner)
Planning Review of River Terrace Plan Dist ct Design Standards (18.640.070.L):
Is the project subject to the plan district design standards?adi 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., 6 wide Gabled do
❑ ❑ 0
_aiDE Nrr
2.Eyes on the street: a minimum of 12%o each street facing facade must include windows or entrance od ors.
Percentage Shown:
3. Fj(ttrances:At least one entrance must meet both of the folio standards:
an 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: 0 Yes No
If yes,all the following apply: 0 25 sq.ft. min.
0 One street facing entry 0 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:
❑fZovered porch min. 5 ft.wide x 5 ft. deep 0;Recessed entry area min. 5 ft.wide x 2 ft. deep
leyWall offset nvn. 16 inches [ Dormer min. 4 ft.wide/
Roof eave min. 12 inch projectionf,)A, 0 y,t6of offset min. of 2 ft.
❑ Roof shingles either tile or wood YE'Gable,hip or gambrel roof designf1
❑,$bof pitch oriented south min. 500 sq. ft. ❑ (,Iorizontal lap siding min. 3-7 inches wide
Ogi Accent siding min.40% of street facade Window trim min. 2 t/z"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 0 Attached garage is 35%or less of street façade
5. and Carports:May face the front or side lot line �coyter lot.
Setbacks:
9U 1(
No closer to front or side lot , longest street-facing wall. 0 Yes 0 No. heck one):
❑ May extend up to 5 ft.if there is a covere t orch and gar not extend beyond the front porch.
0 May extend up to 5 ft. where the garage is part of a building and there is a window at the second story
above the garage that faces the street with " . area of 12 sq.ft.
Width: (Check one)
❑ 12-foot- ' ge door 0 40%max. of street facade
o max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: �� Date: —7--
1:\Building\Forme\BldgPermitRvw_RES RT_1214 17.docx