Permit Plumbing Permit Application vD
Building Fixtures FOR OFFICE USE ONLY
City of Tigard AUG 2 0 2020 Rec ived /�
III • 13125 SW Hall Blvd.,Tigarc(t OR QT ,�}.
Date/By. �1__4411 42/ � Permit No�S �p�r� I
y. Plan Review
Phone: 503.718.2439 Fai:F 3 9�1Q.)Y.1 10 DatCBy: 4311?O AC6A other Permit Na
Inspection Line: 503.639 411755 W\;(7`, ' f 7 n Date Ready/By: p�7/ Jl a Jars� 1 ® See Page 2 for
TIGARD Internet: www ti and orgo� ` ° 1?1� iC'J 1�9 F �•l it
b' Notified/Method: Supplemental Infurnmliun
TYPE OF WORK pi_ ,z_ 77,47,7-'9FEE* SCHEDULE
11-New construction ❑ Demolition For special information toe clncklisf
Description I Qty. I P:a. 1 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 ❑Commercialhndustnal SFR(2)bath _ _437.78
- - - SFR(3)bath 500.32
0 Accessory building ❑Multi-family --- -
-- - --- ---- -- ---- Each additional bath/kitchen 25.02
❑ Master builder ❑Other: l •' Fire sprinkler(1.9.1411c7.ft.) II XU Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: __
Job site address. ----kel.ccAs
Catch basin or area drain 1 18.76
DryweCity/State/ZIP: 5V e Q AN-1.--,/� Fes. _ C�q_I'o) Footing
1,leach line,linearor trench drain 18.76
l./^' '+�� ` "--�`�J� V 1 Footing drain(no. ft.:_) Page 2
Suite/bldg./apt.no.: . -QC\ Project name: Q oShzs(- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector I- 18.76
r ,�..pp ULA .k, Sanitary sewer(no.linear ft.:_) I Page 2
-- r �(A n� - � "-""" �� Storm sewer(no.linear f.• ) Page t
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer --_- _ 31.27 --
DESCRIPTION OF WORK Backwater valve 12.51
------------- - - Clothes washer 25.02
Dishwasher 25.02
ze _ Y d lOc.s.Q f-'l.(0 p` 4A.L/ Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: n 0.` Fixture/sewer cap 25.02
k"'c',\� �� '�'� �� Floor drain/floor sink/hub I 25.02
v -
Address: -
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone'( ) Fax:( ) Ice maker 12.51
❑ APPI.ICAN't ❑ CONTACT PERSON Interceptodgreasetiap 25.02
-
- Business name: Medical gas(value:$ ) Page 2 -
Primer I 12.51
Contact name:
Itoot drain(commercial) 12.51
Address: _ Sink/basin/lavatory 25.02
1 City/State/ZIP' Solar units(potable water) 62.54
Phone.( ) Fax::( ) Tub/shower/shower pan _ 12.51
E-mail: Urinal _ 25.02
--- -- ----- Water closet 25.02
CONTRACTOR
Nor,
Water heater 37.52
Business name: •QjeQ c,,, �,,k) C1loA _Wck Water piping/DWV 56.29
Address: 1D-q5 ti) ‘1A-oQA.C_s ecktAcr,rioNl i 44„,4 Other. 25.02
City/State/ZIP. e-VVC)1 k4d 49_ ` (160 _ ___ -_ Subtotal_
Phone:(5t tCJJ� :.' \I' k Fax:(C�j'4� /b�' q 1 - _- Minimum permit fee: $72.50
CCB Lie.: 11 `7 27 Plumbing Lie.no.: �.���, VN review (25%of permit fee)
� 1 n State surcharge(12%of permit fee)
Authorized signature:v, p1` \ TOTAL PERMIT FEE
_ VVV�w�V WI, ��}j nThis permit application expires if a permit is not obtained within ISO days
Print name: ,( j Dat : /hl L�J�(.f
' � �Q after it has been accepted as complete.
*Fee methodology act by Tri-County Building Industry Service Board.
I1&aiding\PermiiOi'i.Mt1-PernnlApp.doc 10/01/09 441)-4616Tt10:02/COM'WEB)
CITY OF TIGARD MASTER PERMIT
111 ® COMMUNITY DEVELOPMENT Permit#: MST2020-00131
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2020
Parcel: 2S 107AA10900
Jurisdiction: Tigard
Site address: 14244 SW GOLD COAST TER
Subdivision: ROSHAK RIDGE Lot: 109
Project: Polygon at Roshak Ridge, Lot 109
Project Description: New SFA
BUILDING
Floor Areas Reauired Setbacks Reaulred
Stories: 3 Bedrooms: 2 First: 56 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 34 Bathrooms: 3 Second: 562 sf Garage: 497 sf Front: 12 Smoke
Dwelling Units: 1 Third: 562 sf Right: 3
Detectors: Yes
Total: 1180 sf Value: $172,230.89 Rear: 5
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: 2 Backwater Value: 1
Drywall-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 3 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'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio 8 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 VS R-3 1180
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntd 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $25,336.92
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 952-00 - 090. 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: 47 Permittee Signature: OA/
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.
i
Building Permit Application Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Received -
■ rEB 0 3 Date/By / 21 .20 400 PermitNpf 7�vc20 _00/3/
13125 SW Hall Blvd.,Tigard,OR 97223 2020 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateiBy: y/7j� 7j622 AIt otherPermtl.Q,4770 —000,�0
TIGARD Inspection line: 503.639.4175 CITY OF TIGARD Date Ready/13y. 5"/ t� Juris: H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified Method: / Supplemental Information
67`'l''91L ArG —fr
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 ❑Other. equipment,materials,labor,overhead,and the profit for the
CATEGORY OF C ONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ i-]).' 0
❑Accessory building ❑Multi-family Number of bedrooms: 7,
❑Master builder 0 Other. Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 5
Job site address: 14Zl}A GNI) sofis-c 'Ewa_ New dwelling area: I lict) square feet 542,
City/State/ZIP:Tigard,OR 97224 Garage/carport area: l.tG1, square feet 5tQ2,
Suite/bldg./apt.no.: Project name:Roshak Ridge Covered porch area: square feet S4
Cross street/directions to job site: �DDeck area: square feet
"9 g bttdl'd'�e"a: —7,D„- square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Roshak Ridge Lot no.: UPI Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: '..CP equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon WLH,LLC Type of construction:
Address:703 Broadway St.,Ste 510 Occupancy groups:
City/State/ZIP:Vancouver WA 98660 Existing:
Phone:(360)695-7700 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Tonja Morris
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::( ) Amount received:
E-mail:permitsnbmmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon WLH,LLC 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)6934442 State surcharge(12%of permit fee): $21.60
CCB lie.:204238
Total fee due upon application: S201.60
Authorized signature: ` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
. Print name:Tonja Morris Date:04/17/2019 *Fee methodology set byTri-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received PermitN
Ili 'I 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:Plan Review 07 ��0%�'/
`E8 0 Date/Bview
Phone: 503.718.2439 Fax: 503.598.196 2020
Other Permit:
DateBy:
11 tr.d 1I I i Inspection Line: 503.639.4175 Date Ready/By: orris: El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
JILDING DIVISION
—
TYPE OF WORK COMMERr'fsr FEE* SCHEDULE` USE CHEMIST ,;
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value$
CATEGORY OF CONSTRUCTION. RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
(g 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating,/cooling:
' Air conditioning 46.75
Job site address: Gc oc,o ��g-, -reet2_ 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:Rosbak 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 I Lot no.: 10 1 Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
. Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
El PROPERTY TENANT PROPERTY OWNER 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 Gras 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
A' CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 190
A� days after it has been accepted as complete.
Authorized signature: Wa 'I(l Ju' 2' * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
1:iBuilding\Penoits1MF-C_PemitApp-040 113.doe 440-4617r(11/O2/COM/WEB)
•
Y G _r'3' 1'... s�4F..� r.,T e. w�l c L c..•Y. ,... .`
Electrical Permit Application ,.,, h 4f Fr k ,
Cit and Receved
t y o f Tigard FEB 0 3 202Q DateBy: Permit if:/ 7 41,20 - J3i
i:,s " 13125 SW Hall Blvd.,Tigard,OR 97223 p�Review
! i Phone: 503.718.2439 Fax: 503.598.196 RelatedPermitq:
ulTY OF TIGARD Date/By:
N"`<;-` Inspection Line: 503.639.4175 Ready Date/By: ram: Ei See Page 2 for
kT GAD Internet wwwhgard-or.gov BUILDING DIVISION
--:-._:::..iv". Notified/Met6rv7• Supplemental Information
•
•.. .
.. . TYPE OF-'WOW .•;:?. < � '• • �-�F-" :..- : Pj A'V;R ;'t'
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other
where the available fault current 0 Marinas and boatyards.
'''a 1. CATEGORY._OF.-CONSTRUCTION., ., ;::-: {.i::.,.:... . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial D Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family I Master builder ❑ Other: ❑Fire pump. ❑Installation of150KVAor
:{:.; . .JOB SITE::l NFQi-JWiOwAND'LOCATIOI;t; 0 Emergency system larger separately derived
0 Addition of new motor load of system.
Job##: Job site address: I t 'j.LK G01,0 NAST ttzJ— 100HP or more. ❑"A","B","1 2""1-3"
City/State/Z]P:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suitelbldg./apt#. _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 60D volts nominaL
Cross street/directions to job site: FEE SCHEDULE `'...-
Description I Qty. I Each 1 Total I ce
New residential
Subdivision:Polygon at Roshak Ridge Lot#: MCI Inc Includes attached garages multi-family dwelling unit.• 1,000 sq.ft or less 168.54 4
Tax map/parcel#: •
Ea add'l 500 sq.ft.or portion 33.92 1
• DESCRIPTION OF'WORK Limited eneru,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft)
�.PROPERTY;-OWNER«`..:.. . Renewable Energy El.See Page 2
❑ 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. 201 amps to 400 amps 125.08 2
Owner signature: • Date: 401 amps to 599 amps 168.54 2
..g APPLICANT . ❑ CONTACT PERSON . Branch circuits-new,alteration,or extension,per panel
A Fee for breach circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name:Nichole Thorpe a Fee for branch circuits without
Address:703 Broadway St Suite 510 service or feeder fee,test 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 xnsmi actured 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 belting 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) 6625/hr
Phone:(503)319-2192 Fax ( ) Investigation(1 hrmin) 90.00/12r
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18 hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871E specifically listed eh 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 ter/ State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMTT FEE:
/// This permit appilcaton expires if a permit is not obtained within 180
Print name: Kile,Rood Date: 03/08/2019 I days after it has been accepted as comp1r te.
Plumbing Permit Application
BuildingFixtures RECEIVED
FOR OFFICE USE ONLY
City of Tigard FEB 0 3 Received
R 2020 Date/By: PemiltNo �T�,j�0 0 3/
nl ■ 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1g0TY OF TIGARD Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Iris:- 0 See Paget for .
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I 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 SFR(2)bath 437.78 dwelling ❑Commercial/industrial _
❑Accessory building ®Multi-family SFR(3)bath 500.32
Each additional bath/ldtchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION Al']) LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: I4Z'-U4 pi.xp C5)prgr 'r am
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.: 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 Lot no.: (bOk Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORKBackwater valve 12.51
Clothes washer 25.02
V 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:Tonj a Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet
CONTRACTOR 25.02
Water heater 37.52
Business name:Alliance Plumbing Water pip ng DW V 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,L,_
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:RobertDishman - - - - 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.
I:1Buidding\Permas\PLMU-PermitApp.doe 10/01/09 440-46 16T(10/02/COM/WEB)
" City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: /'IS f e20 �p ^ e)®/2/
Site Address: 14244 SvJ Gold Cict Ti -mace
Project Name: RCA.S _R oa,e-,. ._ _ ` . , - Lot #: I 09
Planning Review
Proposal: lD W hOUCG (An l+
V Verify address/suite#active in Accela. W., In River Terrace: 0 No tS1 Yes, River Terrace Review Addendum
SitePlan Elements: erosion Control
VJ6 copies of site plan on 8-1/2"x 11"or 11 x 17"paperetained trees with drip line and tree protection measures
J t)rawn to scale(standard architect or engineer scale) Footprint of new structure(including decks) and FFE
Iorth arrow ,Utility locations&easements(required for new and additions)
j Site address,project or subdivision name and lot number Sidewalk/driveway approach
Applicant information (name and phone number) V ' .cation of wells/septic systems
Lot dimensions and building setback dimensions ! treet tree size,type and location
IV Square footage of buildings to be demolished �5treet names
IV sting structures on site ,Corner elevations(2'contours if more than 4'differential)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 12 io
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Y es DENo
N' Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified lir No Received: ❑ Yes ❑ No
,Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑ Yes a cant was notified ,iir No Received: 0 Yes ❑ No
SDC Examptie lied-fer.- 0 Yes g No Received: ❑ Yes 0 No
Public Facilities Improvement(PFI) Permit:
Required: 0 Yes,applicant was notified 'No Applied For: 0 Yes ❑ No,stop intake
CELLand Use Case#: PP Q'20 I'3-U 0%."v Z X Zoning: R.-12
tk Required Setbacks: Front: l Rear: S Side:q 0 Street Side: N I Pr Garage: I 8.S.-
-EX.-Building Height: Max. Height: IIJ/ PI` Actual Height. r 31-
Landscape Area: 20 % ( Lot Coverage Max: i (r)
Entrance 11 Set back o m re than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ■I Minim 12°/ of.rea of all street- a facades
Garage ■I i . aged or' b:` d widest strtl 0 Yes 0 No,one of the following is met:
Ilii Do r t- � o more than 5'from wall and ere i a c vered or exten ' beyond garage.
❑ . r t:� .s o more than wall and r age on 2n floor.
� a
II Garage .oo wig this 0 12'or I ss tall
or I ss o a a e 60%or less and includes 7 of following:
❑ Cove d porch ❑ Recessed entrance 0 Wall offset ❑ 1'Roof eave 0 Roof offset
❑ Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer
O Accent siding Window trim 0 Window recess 0 Window projection 0 Balcony
K -Visual Clearance Urban Forestry Plan
lit Sensitive Lands: 0 Yes X No Type:
,Conditions met prior to issuance of building permit
Notes: //��
Approved By Planning: ] n�j (i'---•,- Date: L. I (TORevisions (after Building Submittal only) BUJ Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw_RES_122419.docx
Building Pen nit Submittal
Original Submittal Date:
Site Plans: # 3
Building Plans: #
Building Permit#: ET-Enter building permit#above.
Workflow Routing: Planning M.-Engineering Gkre-rmit Coordinator EI—Suilding
Workflow Sign-off: Er Sign-off for Planning(include notes from planning review)
Route Application Documents: O'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: y�- le
Engineering Review
Ild" Slope at building pad: LS �/
2/Conditions "Met"prior to issuance of building permit /(//,
2/yasements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes M/No
Assess Water Quantity Fee in-lieu: 0 Yes krNo
I ,/
LIDA Facility on lot: 0 Yes No
[ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
/Approved by Engineering: Date: AaVZ,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Permit Coordinator Review
gConditions "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:
SDC Exemption: ❑ Received A Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: ,a Yes ❑ N/A
Tigard Trans SDC: 2t� Yes ❑ N/A
Parks SDC: isy Yes ❑ N/A
LIDA ❑ Yes X N/A
f ' OK to Issue Permit ('
Approved by Permit Coordinator: A/4 �i 4. Date: 61
I:1Building Tams\BldgPermitRvw_RES_122419.docx
City of Tigard
IICOMMUNITY DEVELOPMENT DEPARTMENT
C
T, A R o River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 142zit4 SW Gold Co c+ Ter
Project Name: 120Slq,k Rol Lot #: 109
(New dwelling=subdivision nala Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards?,KYes ❑ 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 Gabled dormer
ft deep min. 2ft., 5 ft wide min. 2 ft,6ft.wide
2. Eyes on the street: a minimum of 12% of each street facing facade must include windows or entrance doors.
Percentage Shown: i -. 1 t�Flo R. 13`'/O
3. Entrances:At least one entrance must meet both of the following standards:
DR-
Max. 8 ft. setback from longest street- facing wall Parallel to street angle no more than 45" from street,
or open onto porch
Entrance opens to a porch: ' es ❑ No
If yes,all the following apply: 25 sq.ft. min.
. -One street facing entry 12 ft. max. roof above floor of porch
Ift. depth min. 0%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_ ❑ Recessed entry area min. 5 ft wide x 2 ft. deep
❑ Wall offset min. 16 inches ❑ Dormer min. 4 ft.wide
Roof eave min. 12 inch projection -F- ( R 0 Roof offset min. of 2 ft.
❑ Roof shingles either tile or wood Gable,hip or gambrel roof design F- ( tL
❑ Roof pitch oriented south min. 500 sq. ft. (Horizontal lap siding min. 3-7 inches wide R.
.. Accent siding min.40%of street facade' Window trim min. 21'wide by 5/8"deep F
❑ 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 ❑ Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
No closer to front or side lot line, than longest street-facing wall.KYes ❑ No. If No (Check one):
❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ May extend up to 5 ft. where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
E112-foot-wide garage door ❑ 40%max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: kfr V" _ Date: -4 I ot -20
1.1Building\Forms1B1dgPermil Rvw_RES_RT_121417.docx