Permit (4) CITY OF TIGARDII MASTER PERMIT
2' ' COMMUNITY DEVELOPMENT Permit#: MST2017-00325
Tigard OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 02/27/2020
T[[ \Rf7 9
Parcel: 2S106AD08700
Jurisdiction: Tigard
Site address: 16994 SW LEMONGRASS LN
Subdivision: RIVER TERRACE EAST Lot: 194
Project: River Terrace East, Lot 194
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 2 Bedrooms: 3 First: 805 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 939 sf Garage: 423 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1744 sf Value: $215,340.09 Rear: 5
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: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
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: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1744
Owner: Contractor:
WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
109 E 13TH ST 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Required Prior To
Pour
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $30,961.54
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.Y 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: �� �� ' " 4 Permittee Signature: 0N' ,'1 T%, L-,/L'477d/l//)
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.
Mechanical Permit Applica',�)1 . CE V ED FOR OFFic F 1SE ONLY
Cityof Tigard ate'K' y7 1
3 ta+ 22 /� trtaRr. Permit N sj-�„irrj_!/42.7Or�
131_5 SW Hall Blvd.,Tigard.OR 97_.,; I.1 OV t7 2018 STr�
a Phone: 503.7182439 Fax: 503.598.196 Ptan12y- Other Permit
Uatelly:
TIGARD Inspection Line: 503.639.4175 CITY
^t ��+q n' Y Y ®sec Page 3 for
Internet: tvvvAv,daard-or.gov �^�1CI IY N ..I IG!ARtD-� Ma ethod: t s S
I Ui!.. IN DIVISION
supplemental Mfarmafiop
,ai :,. . .;. .,ok `* "x tr4lhiER� `SCH -EpUt,E t r1,oB lt'4vr
" Mechanical permit fees*are haled 0n the slue of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value tmunded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead.and profit.
Value:S�
.. _ ..,, � .r1YE.��lli• Fl�1,F � �FEt:S'
❑ 1-and 2-famih dwelling ❑Commercial/indttsgrtal 0 Accessory building For special information use checklist
®Multi-family 0 Master builder ❑Other: Description Q1y. Ea. Total
49 ,-`S1IF{3 T1 * IQAI s il eDoling:
- Reatinp Air conditioning I 46.75
Job site address: 1,10 Furnace 100.000 BTIJ Woos-eats)t r V---r4LV YL 4f.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000t BTU idactshenis) 34.91
Ilcat pump 61.06
Suilethldg.lapt.no.: Project name: 121 w-it.YV`C14f 1(-- Duct walk 23.32
Cross street/directions to job site: v■ V t^"" t Ifydronic hot water systcm 23.32
Residential boiler(radiator or
hydronk) 23.32
Unit heaters(fuel-type,not electric),
in-wall.in-duct,suspended,etc. 46.75
�/ Terrace) r/�( {- Flue/vent for any ill'above 1 23.32
Subdivision: g1 vev i'l,rra.() 'CJ(/1,0I Cie-} Other: 23.32
i..oi no.: 1
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
i ,I,W1.. -. ... -_'.x -' _4 44ti-t xi. ,; r;' Gas fireplace/insert , 33.39
Floc veal for water heater or gas
fireplace 23.32
Log lighter(aas) 23.32
Wood/pellet stove 33.39
Wood fireplacelinsert 23.32
Chimne3Ainer/fluervent 23.32
'Al ` ,,.. '... Q '1'F -., - 4 Other. 23.32
_ - m "_ Environmeatal exhaust and vcantalian:
Name:Polygon Will,LLC Range hood/other kitchen
- equipment I 33.39
Address: 109 East 13rs Street
Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms, y
toilet compartments,utility moms) <1 7 23.32
Phone:(360)695-7700 Fax:(
Attic/craulspa:e fans 23.32
e r _ ,_.-.
z._.`_,. .° ,,;�.?� � 1TS'Zr� . i.. 4 CON"1'AG`i'f' � -��.f F-> Cxher 23.32
Business name: Polygon Wilt,LLC Fuel nipiag:
514,15 for first faun 54.03 for each additional
Contact name:Angela Grajcwski Furnace.etc.
Address: 109 East 13th Street Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace I
Range i
E-mail:Angela.Grajewskigipotygonhomes,c0ta Barbecue
' " .'" �-. ' 4 r #i t Clothes dryer(aas)
Business name:Ape:Air LLC Other:
Address: 1800.1 NE 72"Ave Subtotal
City/StateIZIP:Vancouver,WA 98686 Minimum permit fee(S90.00)
Phone:(3fi0)342-8109 Plan review(25%of pemvit fee)
Fax:(360)326-1769 State surcharge(12%of permit fee)
CCi3 lic.:203034 TOTAL PERNOT FEE
'I ho permil application expires ita permit is not obtained within tan
days after it has been accepted as campkte.
Authorized signature: ' i ee methodology set by id-County Building Industry Semen Hoard
Print name .( Date: 4.pi.ft...
I OnuirdIn Tovits`_MEC FinatAtp!._04.9111 due 4404617rt r 1./11VCOMAvnnl
Electrical Permit Application ���E� Received
FOR OFFICE USE OM`E
ofTigardEC
City Date/B : Permit ti/Mf raO/7-.003
13125 SW Hall Blvd.,Tigard,OR 97223 ,
' 7 6'—
Phone: 503.718.2439 Fax: 503.598.196 " 2 ZO2� Plan Review Darers Related Permit ii:
Inspection Line: 503.639.4175 RD ReadyDate/By: 1uris:
1I(,ARD Internet: www.ti rd-or. ov CITY OF TIGA ® SeePage2for
ga g Notified/Method: Supplemental information
tI ILDING DI`JISION
TYPE OF W K PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder
0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
��A\rftt ❑Addition of new motor load of system.
Job#: Job site address: 't-I 5wLeryloMiAsS l00HP or more. ❑"A","E "1-2","Id",
City/State/ZIP:Tigard,OR 97224 ElSix or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:East River Terrace 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 Oty, I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision:East River Terrace Lot#: I1n LI Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.ar less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Change contractor on MST (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER I El TENANT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2
Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to I,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 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
l." APPLICANT I 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:Tonja Morris B.Fee for branch circuits without
Address:703 Broadway St,Ste.510 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
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
Signal circuit(s)or limited-energy
Address:3415 NE 44,t,Ave. panel,alteration,or extension. ❑ 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(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 199188 Electrical Lic.: c923 I Sunni.Lie.: 48715 specifically listed(F.hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: -.� Subtotal:
Print name: Kirk Rood I Date: 05/09/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: k,JC. /2-ene-,( TOTAL PERMIT FEE:
This permit application expires If a permit is not obtained within 180
Print name: Kirk Rood I Date: 05/09/2019 I days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:1Buitdiag'Permits1ELC PermiApp_ELR ERE.doc Rev 06/172015 440-4615T(II/05/COM/WEB
6
, y Plumbing Permit Applicatioi C E 1 ,
Building Fixtures N O V G 2018
City of Tigard ( Received
q 13125 SW Hall Blvd.,Tigard,OR 9 2 TY OF if �R r, Date/BY: Perma No.: /1 f7 f - /1 5
1 1 I la,.i7t-S tJ
�11 ,D N'� O,r ite/BY:Review
• R' Phone: 503:718.243I Fax: 503.5 ti th tl/ Sif•'�(1�Date/BY: other Permit No.:
1.(G A R D Inspection Line: 503.639.4175 Date Ready/By: hair: H Sec Page 2 for
Internet: www.tigard-or.gov Notified/Method: Suplementai Information
S' -- s.,.t -i ^,=-a.�s x...-.-t s x 1 . 3 ,t r...L ,- g<-• --- x, lf'. r
' �*:•, ... �"sue OFt; `"w"f+� ,ry' Ry'm.�-�n a; -L, "h ,,,:--1,-'�. ` �`^:•E*LS�:II' S✓• ' ' -,.€
❑Demolition For special information use checklist.
El New construction Description I Qty. I Ea I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
€ -." .,. -� c, _N,J SFR(1)bath 312.T0
SFR(2)bath 437.78
® 1-and 2-family dwelling ❑Commercial/industrial
SFR(3)bath ( 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.it) Page 2
h �x w.
xr - "-n, it „„ _,,,„„ 1t,F d ,s z t �„ , . Site utilities:
Job site address: i W CI V`� SI W Il/ O1A f t/YA via Q , Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 1`J`�V W I/t lJV Drywall,leach line,or trench drain 18.76
Footing drain(no.linear it.:. ) Page 2
Suite/bldg./apt.no.: Project name:r1 ve,f-i?.(V'( bp,ygS� Manufactured home utilities 50.03
Cross street/directions to job site: v' t Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
n`f Xp1f+r � p� Water service(no,linear ft.:_) Page 2
Subdivision: y U�r " 1•V Y 1 t/t-l� sk Lot no.: l ol-- Fixture or Item:
Tax map/parcel no Backflow preventer 31.27
2• - q a �. Backwater valve 1 12.51
Clothes washer 25.02
, Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
z lli t '"`''-r ` "-x a -z J Expansion tank 12.51
Nance:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/bub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) ice maker 12.51
_- r- T" ''` Interceptor/grease 25.02
t �rn'� f".�� r -.Ti: trap
s,t»
Business name:William Lyon Homes,Inc Medical gas(value:$ } Page 2
Primer 12.51
Contact name:Angela GrajewskI Roof drain(commercial) 12.51
Address:109 East 13th Street 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:Angela.Grajewsid@polygonhomes.cnm Urinal 25.02
"F'*a z� i{%�'-�`-"n �.nn-;� 0 ;- , ,�„ ,• •. Water closet 25.02
.-1_, .t'.. -s act ..- .:s.; s� ' s
Water healer 37.52
Business name: G,¢� \ L&IWJD\ �,t---,5 ,,� Water piping/DWV 56.29
Address: p.o. 6 )(4 GiA Other: 25.02
City/State/ZIP: ST, ' .t#4 &rt. Ci1(31 Subtotal
,88/_} 11411 (ell .7a.i.��.� Minimum permit fee: $72.50
Phone: D +�J«� 'fr Fax: .r
�}.� Plan review (25%of permit fee)
CCB Lie.: , r7 ! Plumbing Lic,no,Pb State surcharge(12°/s of permit fee)
Authorized signature: , y�, TOTAL PERMIT FEE
Print(tame:'Vft. wf
I"L D` Dater-3 -1 /V This permit application expires If a permit is not obtained within 180 days
b t;7 after h has been accepted as complete.
aFcc methodology set by TriComdy Building Industry Service Board.
1:'S3wldinpPamits1PLMU•PcrmitApp.doc 10/01/09 440-0616T(10/02/CO. WEB)