Permit V .ffi �I
Plumbing Permit Application` �. .
Building FixturesAUG 2 0 2020 FOR OFFICE USE ONLY
III .
City 5 W Hall
Received rjA-/� �ti Permit N�5'27 ii ,54 (Sc?
r-o n--- �- c 3r 'r L"j Received
210 4V rim
il
a 13125 SW Hall Blvd.,Tigafh,"O`jC QJ,RP9 i ;t,,"ah'tf c i Plan Review
Phone: 503.718.2439 Fax 503 8M6EyI\fll�jj���� 8/1�7p A 64 Other Permit No.:
f ` Date/By:
TIGARD Inspection Line: 503.639.4175 Date Read IB ® See Page 2 rot
Y Y'i !!/Z/2G7 .N L' SEr Supplemental Internet www.ngard-or.gov' Notiticd/Method- � Su lemenlal Information
TYPE OF WORK 4 ,rt.-. 1111,4.•- FEE* SCHEDULE J.
New construction ❑ Demolition For special information use checklist.
Description 1 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
-
VI and 2-family dwelling 0 Commercial/induslri d SFR(2)bath 437.78
----- -- --- SFR(3)bath 500.32
❑Accessory building 0 Multi-family
.-_-____-___._---- _ ----- - -------- Each additional bath/kitchen 25.02
❑Master builder 0 Other. lire sprinkler LW5 1126 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: ' _
Job site address ALA.2S(d C`� 6DI. D et 1 7.6._ Catch basin or area drain 18.76
Dr���,,...,„„a
,„ d ^v. c12-14 0 Footing
drain
line,one trench drain 18.76
2
City/State/ZIP: ���t Y!./) -
Foohngdrain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: `& I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: �-�L7 Manholes 18.76
Rain drain connector 18.76
_ k_ �^6' 5- f k-A_7(4' ,( ,�-�O Sanitary sewer(no linear ft.: ) Page 2
} L ` ,-�J C� Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision. _ --. [ Lot no.: Fixture or item:
Tax map/parcel no. Backflow preventer 31.27
i---- - -"---- - -- _ -- - Backwater valve - 12.51
DESCRIPTION OF WORK -" - ---
- _. Clothes washer 25.02
_t' n Dishwasher 25.02
_ AQ. 1 �1\(j. 4 Fn Drinking fountain 25.02 -
Ejcctors/sump " 25.02
❑ PROPERTY OWNER 0 TENANT _Expansion tank 12.51 _--_
- c Fixture/sewer cap 25.02
Name.
� �i`� JO Floor di ain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT__; 0 CONTACT PERSON Interceptor/grease trap 25 02
Business name: Medical gas(value:$ ) Page 2
------------- - -- - ----- Primer 12.51
Contact name:
-___ __ _ Root drain(commercial) 12 51
Address: _ Sink/basin/lavatory 25.02
City/StaleiZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan I 12.51
---- _---- - -- Urinal 25.02
E-mail: ---" ---- -_..
- -- - - - I Water closet 25.02
CONTRACTOR
-- _r(,�,� -� _.- � - Water heater 37.52
Business name: . •r T�]J�.1, -_���.SXV_ _kC='S.L_ Water piping/DWV 56.29
AddressilO'AS kpl1�{i C��kurrkbt �_ Other: 25.02
City/State/ZIP: ���,A�l 7.^ale /�i -�0 Subtotal
Phone:( (0c q- U 9 .1 Fax.( 16 b,,`-1 ei yl 1 Minimum permit fee: $72.50
- 1 �7/� Plan review (25%of permit fee)
CCB Lic.: ,1--2.254._ Plumbing Lic.no.: z _ g2,141I� ---- ------ a ---"--
► __----- State surcharge(12/a of permit fee)
Authorized signature: I TOTAL PERMIT FEE
Date: ^^ �y-� This permit application expires if permit is not obtained within 180 da)'s
Prirll nettle Z-..1 p. after it has been accepted as complete.
----- �.l reac +�c. r 1-
'Fec methodology set by Tri-County Building Industry Serviec Board.
I ABmldmaMermiiorLML-PermaApp.doe I0/0I/09 44(1-45151(IOIp2'COM Wen)
CITY OF TIGARD MASTER PERMIT
: I ' COMMUNITY DEVELOPMENT Permit#: MST2020-00130
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2020
Parcel: 2S107AA10800
Jurisdiction: Tigard
Site address: 14256 SW GOLD COAST TER
Subdivision: ROSHAK RIDGE Lot: 108
Project: Polygon at Roshak Ridge, Lot 108
Project Description: New SFA
BUILDING
Floor Areas Reauired Setbacks Reauired
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: 0562 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
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 3 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woadstoves: 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 WI 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&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 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 Cntrl 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 952-001-0090. 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: e '(04 ---J Permittee Signature: B'I- "—if C h
)
Call 503.639A175 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.
o T- /o?
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
_ City of Tigard FEB 0 3 2020 ReeeiBy ' e I� Permit
Iii ' 13125 SW Hall Blvd.,Tigard,OR 97223 Date B . /-q/�f�v �(/J �����1(J77�,,(f -- a/Jo
PlanReview l��Z� i� Q�S/o22 -'J0079
Phone: 503.718.2439 Fax: 503.598.19®ITY OF TIGARD DzWBy 1 Other
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReadfB 5s yf� 9 rods: Ef SeePage2for
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
,`?A-/G- TD,,CT?3—
I TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑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 CONSTRIICTION work indicated on this application. 7�
El I-and 2-family dwelling 0 Commercial/industrial Valuation: $ "a I a3 v
ElAccessory building 0 Multi-family Number of bedrooms: 'L
❑Master builder ❑Other Number of bathrooms: >it
3 —
Total number of floors: l "�
JOB SITE INFORMATION AND LOCATION._ � U 1 '
Job site address: I ilk 2,6(, (3 t( "-r "reef_ New dwelling area: I Mt) square feet 5172
City/State/ZIP:Tigard,OR 97224 Garage/carport area: Liqn square feet
Suite/bldg./apt.no.: Project name:Roshak Ridge Covered porch area: square feet 5
Cross street/directions to job site: Deck area: -2. square feet
�t`CTR arr - 7`_ square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Roshak Ridge Lot no.: tdiS 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.: (=.(P 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 0 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:Tonj a Morris —
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: :( )
E-mail:permitsubmmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon WLH,LLC Submit two(2)sets of roof plan with connection details
Address:703 Broadway St.,Ste 510 and fire department access,along with the 2010 Oregon
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.:204238 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Tonja Morris Date:04/17/2019 *Fee methodology set by Tri-County Building Industry
Service Board.
I:13uil1ing\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
114
Da Permit Np!r1"j��i1ll_,,.Doi 3 p
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 FEB O 3 2020 Date/By: Other Permit:
i:i?A I L I i Inspection Line: 503.639.4175 Date Ready/By. June, El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method. Supplemental Information
DUILDING DIVISION
COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other. mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS SEES*.`.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: (1-%Z (2 Gap SY -r AirFurnace conditioning0, 46.75
v�+n �.I2•• l OQ000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Roshak Ridge Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision:Roshak Ridge Lot no.: (p$ 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
® PROPERTY OWNER ❑ 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 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,LLCFuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace etc.
Address:703 Broadway St,Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permi[submittals®polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating FeCooling 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
/CA. This permit application expires if a permit is not obtained within 180
V wa hum-am,r n ri days after it has been accepted as complete.
Authorized signature: v✓✓u.r I. * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
E:\B ildmg\Permas\MEC_Permi.pp_o40113.doe 4404617r(11/02/COM/WEB)
Electrical Permit ApplicatiBE
City of Tigard FEB 0 3 2020 Received Permit
0
, - 't 13125 SW Hall Blvd.,Tigard,OR 97223 Pan Review 0013
1 Phone: 503.718.2439 Fax. 503.598.1JJTY OF TIGARD Related Permit P:
Inspection lane: 503.639.4175 BUILDING DIVISION ReadyDate.Bp runs: SI See Page 2for
;TIGARD Internet: www.ti -or. ov
l;� g Notified/Method: Supplemental Information
- TiTh OF:WORK it • `RI-e .REVIEW. : -
®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.
0 Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
. ._ CA)IGORY_OF-CONSTRUCTION >:;:,•- ':•r - exceeds 10,000 amps at 150 volts or ❑Floating buildings.
ER1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builderamps for all other installations buildings.
❑Other. 0Fire pump. 0 Installation of 150 KVA or
n JOB Silk.-.:7INF:ORMATIONAND LOCATIOld;-i •• ❑Emergencyeystem. larger separately derived
�� it _ CS 0 Addition of new motor load of system.
Job#: Job site address: (� (�p I OOHP or more. ❑"A","E","1-z","1-s^,
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑'Recreational vehicle parks.
Suite/bldg./apt#: _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominaL
Cross street/directions to job site: FF.F Sl 1 DULE
Description I Qty. 1 Each .1Total j *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot##: tel, Includes attached garage.
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 energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft) 75.00 2
• • • Renewable Energy ❑,See Page 2
®.PROPERit..OWNER . ❑ TEIVAN'r 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 55226 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
-..® APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Nichole Thorpe B.Fee for branch circuits without
Address:703 Broadway St Suite 510 brnch circuie t feetfee,first
braa nch56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add']branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax:: (360)693-4442 Eachmamrfactured 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) 6625/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(Ihrmin) 78.18/hr
Inspections for which no fee is
CCB Lie.: 199188 Electrical Lie.: c923 Suprv.Lic.: 48715 specifically listed(14 hr min) 90.00lhr
` ELECTRICAL PERMIT FEES •
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood - Date: 03/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit
e Plumbing Permit Application ECEIVED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard FEB 0 3 ZOZO Received Permit No`1S"��c?Q
• 13125 SW Hall Blvd,Tigard,OR 97 Date/By: )�?Q
Ire OF TIGARD Plan Review
Phone: 503.718.2439 Fax: 503.59 DING DIVISION Date/By: Other Permit No.:
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: kris: H 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 Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF.CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
IDAccessory building ®Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ' VC" C'(CU') Cjp .y( ?'ui L 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 Lot no.: 1,05 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF-WORK Backwater valve 12.51
Clothes washer 25.02
I,--.) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC FixtureJsewercap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/Z1P:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( .) Ice maker 12.51
• El APPLICANT- 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal25.02
. ._ - CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing Water r in WV
PP P� 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 diiii:/ -
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 - Datec 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:1Buildu,glPumits\PLMJ-PermitApp.doc 10/01/09 440-4616T(10/02ICOM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A K n Building Permit Review — Residential
Building Permit #: /`75 j .V p — 10 J d
Site Address: I4 (p SW Gold Cootcfi Tex-race
Project Name: 12,05Vy P—ka W `y - Lot #: t OS
Planning Review -
Proposal: ROW VIoUa-c, V 14[I—
V Verify address/suite#active in Accela. Cgi, In River Terrace: ❑ No ryi Yes,River Terrace Review Addendum
Site Plan Elements: ,'Erosion Control
Z6 copies of site plan on 8-1/2"x 11"or 11 x 17"paperetained trees with drip line and tree protection measures
Rtrawn to scale(standard architect or engineer scale) Ar,00tprint of new structure(including decks)and FFE
Torth arrow Utility locations&easements(required for new and additions)
msite address,project or subdivision name and lot number Midewalk/driveway approach
Applicant information(name and phone number) IV4Location of wells/septic systems
-iXLot dimensions and building setback dimensions Itreet tree size,type and location
N quare footage of buildings to be demolished names
(VExisting structures on site .Comer 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? E 1:. o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Y es Di,No
Ill" Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified X'No Received: 0 Yes 0 No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes ap "cant wq:s notified X'No Received: 0 Yes 0 No
SDC T r ' c ❑ Yes t No Received: 0 Yes 0 No
Public Facilities Improvement (PFI) Permit
Required: ❑ Yes,applicant was notified "No Applied For 0 Yes 0 No,stop intake
%..Land Use Case#: pa1226.1G--0%vuZ' 12:( Zoning: p.-12_
0—Required Setbacks: Front: Q) Rear: Side: 0' Street Side: Kit Pc- Garage: IS.S
'Building Height: Max.Height: N I Pr- Actual Height: i=31-
Landscape Area: 2.0 % l Lot Coverage Max: F5(7
Entrance II Set back o m re than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less
Windows !1 Minim 12°/ of. ea of all street- a facades
Garage II t . aged or i b:, d widest str f l 0 Yes 0 No,one of the following is met:
5 Do r to . o more than 5'from wall and ere i a c vered rc exten beyond garage.
❑ 0 r .s .o more than ' tall and r 4V�ge on 2.d floor.
I1 Garage .oo wi. is 0 ]2'or 1 ss LI 50%or 1 ss o a a e 60%or less and includes 7 of following:
❑ Cove d porch 0 Recessed entrance 0 Wall offset 0 1'Roof eave 0 Roof offset
O Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer
❑ Accent siding �/❑ Window trim 0 Window recess 0 Window projection 0 Balcony
MA-Visual Clearance R5, Urban Forestry Plan
Sensitive Lands: 0 Yes $ No Type:
A Conditions met prior to issuance of building permit
Notes: 4
-PSCApproved By Planning: — Date: '. 2.0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
IA Building
Building Permit Submittal
Original Submittal Date: .2/3/o-
Site Plans: # j
Building Plans: # 2
Building Permit#: [ -Enter building permit#above.
Workflow Routing: Planning -B Engineering 'ermit Coordinator e-Building
Workflow Sign-off: [� Sign-off for Planning(include notes from planning review)
Route Application Documents: Er Engineering: (1) copy of permit application, (1)site plan, (1)building plan and
9i0tal 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: /� /�,C jeta� Date:
En Bering Review ) v
Slope at building pad:
I�J//onditions "Met"prior to issuance of building permit 1/1j f
l ,asements (encroachments)per engineering conditions of approval and plat
lair Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes lt(No
Assess Water Quantity Fee in-lieu: 0 Yes
LIDA Facility on lot: ❑ Yes VG No
[ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
f Approved by Engineering: Date: 4'/2 ;/Zb
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
g 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:
Ig\-SDC Exemption: ❑ Received Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: g Yes 0 N/A
Tigard Trans SDC: 0 Yes ❑ N/A
Parks SDC: 0.-Yes ❑ N/A
LIDA ❑ Yes 'IA. N/A
OK to Issue Permit
Approved by Permit Coordinator: trINAO 1 "- Date: 4I2S/'o
I:16uilding\Forms\BldgPennitRvw_RES_122419.docx
City of Tigard
71 COMMUNITY DEVELOPMENT DEPARTMENT
■
T, n K D River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: l4 -5ZP SW Gold ci c+ Ter.
Project Name: RDS►Ist. Ra Lot #: I,06
(New dwelling=subdivision n Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.I.):
Is the project subject to the plan district design standards?4 Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch min. 5 ft. deep ft. deep min. 2ft.,5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
/ P }2_ ❑ 0 ❑
2. Eyes on the street: a minimum of 12°/o of each street facing faccade must include windows or entrance doors.
Percentage Shown: f'_ 1.010 42_'. 30/o
3. Entrances:At least one entrance must meet both of the following standards:
Parallel to street,angle no more than 45° from street,
Max. 8 ft. setback from longest street- facing wall or open onto porch
Entrance opens to a porch: A"Yes 0 No
If yes,all the following apply: 25 sq.ft min.
IY..-One street facing entry 12 ft.max.roof above floor of porch
Etitl ft. depth min. 30%min.porch roof coverage
4.Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
Covered porch min. 5 ft.wide x 5 ft. deep f 0 Recessed entry area min. 5 ft.wide x 2 ft. deep
❑ Wall offset min. 16 inches 0 Dormer min.4 ft.wide
laRoof eave min. 12 inch projection p ( 0 Roof offset min. of 2 ft.
❑ Roof shingles either tile or wood lZGable,hip or gambrel roof design -f( IQ-
❑ Roof pitch oriented south min. 500 sq. ft. XHorizontal lap siding min. 3-7 inches wide
%Accent siding min.40%of street facade F laWindow trim min. 2 1"wide by 5/8"deep R.I 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 R. 0 Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a comer lot
Setbacks:
No closer to front or side lot line,than longest street-facing wall. es 0 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.
O 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.
].the (Check one)
IP ir 2-foot-wide garage door 0 40%max. of street facade
l�` �, 4%max. of street facade with 7 detailed design elements
otes:
Approved By Planning: 02,-A— Date: .4-lot,l-2.0
1:1Buildwg\Forms 1BidgPermrtRvw_RBS_RT_12I417.docx