Permit Plumbing Permit Apnf i El V E
Building Fixtures AUG 1 7 2020 FOR OFFICE USE ONLY
City of Tigard Received((�� / �/
``t g 1 Date/B d/vfp/w ' Permit Nrtl�AST 26/g..._0 23
IN ot 13125 SW Hall Blvd.,Tig0t(Y9O2 F T�rltR plan RcvielwQ ill / I v"'`+
• G Phone: 503.718.2439 °'faxi:;: ct�uuC`ttl!IA60 Q `' Date/By. B/s'l2O AC4 Other Permit No.:
Inspection Line: 503.6394I75- ;`?- p/w�Ora y G/ ---
TICiARD Date Ready/By: / /) }ins. See Page 2 for
Internet www.ngard-orgov Nolificd/Method. 7/ may( �� 114 Supplemental Information
TYPE OF WORK .- 6 41.` r" - FEE* SCHEDULE
[XNew construction ❑ Demolition For special information use checklist. _
-- - - - - Description _ Qty. Ea. --Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
CAIIE(iORY OF CONSTRUCTION . SFR(I)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: - ---
-_. l Fire sprinkler(i t q.ft.)13 Yy Page 2
JOB SITE INFORMATION1 '� AND
�LOCATION Site utilities:
.lob site address: -I-ZSS- S�INp '(0 I'4�I^- AYIe--- Catch basin or area drain 18.76 -
City/State/ZIP: 5i e?_�.l)J3( A c - ' - 140 Drywell,leach line,or trench drain 18.76
`- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: dl kC7� Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18,76
Rain drain connector 18.76
-t- `^% 12 yk( - _ Sanitary sewer(no.linear ti.:_) Page 2 -
1 1 'f� �(J Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: - _ TLot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve I2.51
----- . Clothes washer 25.02
``` ��^��n _ - Dishwasher 25.02
_E_kfi`- �� .Q Q 9�__�,�,\ - E G 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
❑.APPLICANT 0 CONTACT PERSON, Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Ei,-mail: Urinal 25.02
--- -- ------- - Water closet 25.02
CONTRACTOR _------
-- - 1�y'�! ' l 1_A r^^({ Water heater 37.52
Business namee� a)P 1�pP{pine (I�NJ f ( J(, f�.Wok 1 _p' Water piping(DWV 56.29
Address: l O't t.rl)� nii Is,`, .- 0 Ll_.4 rn ii t'k N1 M _e_Tt�'Y Other: 25.02
City/State/ZIP: `T 2o,4 dQAc C32 C`.1 __ _ Subtotal
Phone:(( ) ���. 1 4 \ l Fax:( 1,5Z 06q - Q9,9 - _ Minimum permit fee: $72.50
CCB Lic.: r �^77 ^ Plumbing Lic.no.: 'l T f) Plan review (25%of permit fee)
lIZL4-2/ t(q' �, �Y...__ State surcharge(12%of penult fee)
Authorized signature: , JII T l TOTAL PERMIT FEE
Print name: r� ` Date: p This permit application expires if a permit is not obtained within 180 days
ikA�yQ ._ � Q_ _-_- (7'1�1 lw r�-i after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board.
I'1HuildingAPermil0WLMl1-PermilApp.doc 10/01'09 440-4616T(I0/lL/Ct1M.WHB)
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00323
T I i,;A R T7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2020
Parcel: 2S 107AA06700
Jurisdiction: Tigard
Site address: 14255 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 67
Project: Polygon at Roshak Ridge, Lot 67
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 646 sf Basement: 103 sf Left: 0 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 633 sf Garage: 532 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 1382 sf Value: $195,164.D8 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Fooling Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=10OK: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener. N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1382
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: $25,199.93
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 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: Ofj '1 2 PL...7 y eN
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.
,cIL"--CA0(% -* to LOB
Building Permit Application `'
Residential CFI\I F FOR OFFICE USE ONLY
Received ,.�,�C 1
City of Tigard DateBy: ij'kCk ,j Perm'ii U �Lq-003,43
13125SWHa18.243.,Tigard,OR97223FEB 07 2019 PlanRevewp ` vtOVL 1 \U
' C Phone: 503.718.2439 Fax: 503.598.1960 DateBy: /11/( All' erPenm � ��
TIGARD Inspection Line: 503.639.4175 CITY OF j7"tr'.j-fl DateReadyBy: I runs: El See Page 2for
Internet: www.t gazd or.gov BUlEDp NC ulv ISI ON Notified Method: [��z Cj I9 S r Supplemental Information
!' SV
/N TYPE OF WORK REQUIRED DATA: 1-AND 2-FAMILY DWELLING
l),` ®New construction ❑Demolition Permit fees*are based on the value of the work performed.
�J Indicate the value(rounded to the nearest dollar)of all
1 . ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTIONwork indicated on this application.
® 1-and 2-family dwelling El Commercial/industrial Valuation: $ Va l +'/-1
` ❑Accessory building ❑Multi-family Number of bedrooms: ( Y
r ❑Master builder ❑Other: Number of bathrooms:
"Cl17J JOB SITE INFORMATION AM) LOCATION Total number of floors:3 '`1 'y
Job site address: \u` , 5 �}, i (� -n . New dwelling area: square feet (`- 3
City/State/ZIP:Tigard,OR 97224 p V ` Garage/carport area:5 2 square feet 6 yL
Suite/bldgJapL no.: `a Project name:Polygon at Roshak Ridge Covered porch area: square feet I 03
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.: 0 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
fax 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
® 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)6934442 New:
(23 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WZH LLC (P4 cerejerrofeesrhedute)
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
Amount received:
Phone:(360)695-7700 Fax::(360)6934442
E-mail: permitsubmittalsr;polygonhomes.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
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 signatur This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Amanda yin Date: ei *Fee methodology set by Tri-County Building.Industry
�fn f 1 Service Board.
1:1Building'Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received �t� (mot j�(�'
_ Date/By: Penn it No.:Wsk. `J v` _w ,— ,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review `,'
Phone: 503.718.2439 Fax: 503.598.1960 AUG 2 9 2019 Other Permit:
Inspection Line: 503.639.4175 Date By:
S i tiA IL D Date Ready/By: IDris: El See Page 2 for
Internet: www.tigard-or.gov
CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCi1FDULE'- USECBECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT)SYSTEMS FEES*
rgi 1-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist
Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: tcvZj ) `\t 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.uo.: 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 auy of above 23.32
Subdivision:Roshak Ridge Lot no.: l Other: 23.32
!'�
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
^ _, Flue vent for water heater or gas
VlL CIL CA5Nr ra.e.A312- -3(0 tY ST Z0',9.-00 Z5 fireplace 23.32
Log lighter(gas) 23.32
. Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen '
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust i 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) it 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
Ia APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Polygon WLH,LLC Fuel piping:
S14.15 for first four;54.03 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
E-mail:permitsubmittals@polygonhomes.com Range
Barbecue
'0 CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECI1ANICAL:PERhIIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(S90.00)
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 a a permit
Qq�� days aftercation itexpires has beenif acceptedis asnot complete.obtained within 180
W
Authorized signature: a- 'It•�\ m, • Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
RECEIVE
Electrical Permit Application FOR rs > t
City ofTigardeceived Permit g AUGAUG292019 Dann : Mlle. i1% �a—�
't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960CITY OF TIGARD DateB : Related Permit#:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Ions. EIS See Paget for
r. Internet: www.tigard-or.gov Notitled/Method: Supplemental Information
TYPE OF.WORK PLAN;REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wlitems 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.
El 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agriculmml
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE'INFORMATION-AND'LOCATION=;`.. . 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: N2.6 5 S VJ t loc111.1 100HP or more. ❑"A',"E","1-z^,"1-3
❑Six or more residential units. occupancy.
City/State/LE":Tigard,OR 97224 ❑Health-cam facilities. ❑'Recreational vehicle parks.
Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. ❑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 1 Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: u, Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 11 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
C-SVLleY'OI,Li7'GZ -No r \SI' 2.019. L (with above sq.it.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT. Services or feeders installationnalteration,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 I
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, 7.42 2
each branch circuit
Contact name:Nichole Thorpe - B.Fee for branch circuits withouts -
Address:703 Broadway St Suite 510 branchce it feederitfee,first 56.18 2
branch circuit
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(I hr min) 66.25/hr
Phone:(503)319-2192 Fax: ( ) Investigation(1 hr min) 90.00/hr
• Industrial plant(1 hr min) 78.18/hr
Email'solarpdx@me.com Inspections for which no fee is
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4874 rj
specifically listed(%hrmin) 90.00/hr
ELECTRICAL PERMIT FEES •
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
f State stucharge(12%of permit fee):
Authorized signature: Z/ c ^— TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood I Date: 03/08/2019 days after it has been accepted as complete.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard AUG 2 9 2019 Received
y 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Permit No.:h,.� \
;� ' _ Plan Review r\\� itt� -��
��11 Phone: 503.718.2439 Fax: 503.598�9$0(OF TIGARD Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Sus: 0 See Page 2 for
Internet. www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑Demolition For special information use checklist.
Description I Qty. Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION " SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78
CIAccessory building ®Multi-family SFR(3)bath 9 500.32
Each additional bath/kitchen 0 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11.12GJ5 5 W 11oct-n4 Rue,
Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no,linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Roshak Ridge I Lot no.: ton Fixture or item:
Tax map/parcel no.: Backflow preventer % 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
ll.S�d. ' t r 1 w, -C 2 r b L- Clothes washer 1 25.02
6- V Q��� `1 tJ Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ ;TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 Garbage disposal ` 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 1 25.02
Phone:(360)695-7700 Fax:( ) Ice maker >, 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tonja Morris Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 4 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 .3 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
a
Water closet 4 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Alliance Plumbing Water pipingiDWV 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
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date: .t 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\ermils1PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COMVWEB)
V
City of Tigard
IIIa COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c D Building Permit Review — Residential
Building Permit #: tx\S->; lq_( jb
Site Address: l4/2SS \" ,) lt/ 94 Avg
Project Name: Poh / ` -
Lot #: (
(New,B g=subdivision name;Addition or Alteration st name of owner)
Planning Review
Proposal: AJe&) Q7ilit-
re Verify address/suite#active in Accela. W.In River Terr.ce: 0 No Yes,River Terrace Review Addendum
Site Plan Elements: tlyi Erosion Control
t3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper 1, 111�; -tallied trees with drip line and tree protection measures
rawn to scale(standard architect or engineer scale) In F otprint of new structure(including decks)and FFE
I orth arrow ' ."ty locations&easements(required for new and additions)
1QSite address,project or subdivision name and lot number gi Sidewalk/driveway approach
0 +.licant information(name and phone number) el ...+cation of wells/septic systems
iG . dimensions and building setback dimensions iv.5.treet tree size,type and location
t4 uare footage of buildings to be demolished I ' eet names
i!' . 'sting structures on site VCorner elevations(2'contours if more than 4'diffe tial)
7a Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced 4dYes ❑I�i6
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water .uali facili shown? .0i11 es o
\II lean Water Services—Service Provider Lettot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified 1sQ No Received: ❑ Yes ❑ No
Public Facilts Improvement(PFI)Permit:
quued: Yes,applicant was notified ❑ No ,, ll rlpplie or: ® yes ❑ o,stop intake
4nd Use Case#: c-Q/� L9OQO"�' Zoning —
aequired Setbacks: Front: Rear: fr / Side: (./� Street Side: Garage: ,(3
V/Building Height: Max. Height: Actual H ht:
Landscape Area: �V % m Lot Coverage Max: %
Entrance t back no more than 8'from street-facing wall 0 Parallel to street or o degrees or less
Windows 0 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 anther covered porch extending beyond garage.
❑ Door extends no more than 5' ere is a 12 sq ft.window above garage on 2na floor.
❑ Garage door width is 0 12'or le 5 ess of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch essed entrance ❑ W et 0 1'Roof eave ❑ Roof offset
❑ Fire s ' 1 Lap Siding 0 Roof pitch ❑ a ' ,or gambrel roof ❑ Dormer
❑ nt siding Window trim ❑ Window recess 0 rojection ❑ Balcony
4� ual Clearance Urban Forestry an
�� ensitive Lands: 0 Yes No Type:
Co ditions met prior to issuance of building permit
No •
Approved By Planning: Date: 3
43_
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw_RES_022819.docx
V
Building Permit Submittal
Original Submittal Date: a 1--4 119
Site Plans: # ?-1
Building Plans:
Building Permit#: S Enter building permit#above.
Workflow Routing: [34Planning 131''Engineering ES/Permit Coordinator Er 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.
Er/Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: �-4.„, Date: \CA
Engineering Review
a
Slope at building pad: 4 6
O Conditions "Met"prior to issuance of building permitie7
fly'Easements (encroachments)per engineering conditions of approval and plat
ri Water Quality/Quantity Facility: y
Assess Water Quality Fee in-lieu: 0 Yes f�/a� No
Assess Water Quantity Fee in-lieu: 0 Yes Ll No
LIDA Facility on lot: ❑ Yes tfNo
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved 0 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:
Re sion Notice 3: Date Sent to Applicant:
VSDC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC: � ❑ N/A
Parks SDC: [ Yes 0 WA
Issue Permit
0 Yes IP N/A
OK to �j�� /3 g
Approved by Permit Coordinator: �1ft!1 Date:� � l
1:\Building\Fonns1BldgPennitRvw_RES_022819.docx
City of Tigard
p
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
rasa ' — — _ - _ _.
Building Permit #: k\c\SZauCi_ (X.),D.3
Site Address: 9.2 S----- 0 /6 ,
Project Name: j�p1 ,, ,_4 / .1- _% ..' Lot #: 6-9-
(New er ing=subdivision name;Addition or Alter,. =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?0 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. deep Balcony w/ access 2 Window Projection Vertical Wall Offset a Gabled dotrne
ft. deep min. 2ft.,5 ft wide min. 2 ft., 6fy.wide
❑ D ❑
2.Eyes on the street: a minimum\of 12%o each street facing facade must include windows or entrance aoorrs.
>
Percentage Shown: ° d
3. trances:At least one entrance must meet both of the folio g standards:
wi Max. 8 ft. setback from longest street- acingwall 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.
D One street facing entry 0 12 ft.max.roof above floor of porch
❑ 5 ft. depth min. 0 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:
❑govered porch min. 5 ft.wide x 5 ft. deep 0 lj,fcessed entry area min. 5 ft.wide x 2 ft. deep
IgyVall offset min. 16 inches L DDormer min.4 ft. widef
a Roof eave min. 12 inch projection 0 ykof offset min. of 2 ft.
❑ Roof shingles either tile or wood I2 Gable,hip or gambrel roof design
❑ oof pitch oriented south min. 500 sq. ft. ❑horizontal lap siding min. 3-7 inches wide
Accent siding min.40%of street facade'`/ 'VCEd Window trim min. 2 1/2"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. and Carports: May face the front or side lot line a co er lot.
Setbacks:
No closer to front or side lot , n longest street-facing wall. 0 Yes 0 No. heck one):
O May extend up to 5 ft.if there is a covere t orch and gara not extend beyond the front porch.
O 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- ' rage door 0 40%max. of street facade
o max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: ;1 Date:
l:\ a Idmg\Porms\BldgF nitRvw_RES RT_121417.docx