Permit Plumbing Permit Applicatic� ,'DIED
Building Fixtures DIED
F ORR OEEICL USE ONLv q
City of Tigard DEC 15 2CE0 •
oeieya 12I2 Z 1 z W Pemut No.:t T2a \-c 03
1 i 01 13125 SW Hall Blvd.,Tigard,OR 9722
r, Plan Rev ow II Phone: 503.718.2439 Fax: so3s9s. dY OF TIGARD I/i3/vo •
• a, Other Permit No.:
Date By:
nr.n Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyBy: q/ ( 7 it H SeePage2for
Internet. www.tigard-or.gov Notified/Method;1Z4, 2,, 42o 'nC. Supplemental information
TYPE OF WORK FEE" SCHEDULE
New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. f 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 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family •
Each additional ba hen 25.02
0 Master builder El _ Fire sprinkler( q.ft.)\XIII Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,�3} �'� r/l',,` Catch basin or area drain 18.76
�_ - �� �� I ' " '� Drywell,leach line,or trench drain 18.76
City/State/ZIP: ' \ -1 QQqQ����7777 , �
p` I � Footing drain(no.lineartie_) Page 2
Suite/bldg./apt.no.: '-T L Project name: i.cQ Manufactured home utilities 50.03 .
Cross street/directions to-lob 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: LSh / E�S- f(j Q 1 Lot no.: Fixture or item:
Tax map/parcel no.: 'y^'[5` Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
f Q_�_� -�� � 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 ❑ 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/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
F-mail Urinal 25.02
- - --- Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ,L 1 d)c; - �,I(�L; d ',f 17 �.���JJ �] Water piping/DWV 56.29
Address: 1 } LO �f O Y-{- ( (Y1L J Q�1 Qi {(ln� Other: 25.02
City/State/ZIP: e ' a jAl- 0 (-if3 Subtotal
Phone:(0-)' (+L} ryzzi Fax:(6I) ,).---? a7,0 1 Minimum permit fee: $72.50
CCB Lie.: 1 i 2 220 Plumbing Lic.no.: z6. S Z44 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: i
i TOTAL PERMIT FEE
Print name: P'`4S„� me Date: r2 v, toThis permit application expires if a permit is not obtained within 180 days
1 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building1Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
RI CITY OF TIGARD MASTER PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MST2019-00103
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2020
TIGARD Parcel: 2S107AA08000
Jurisdiction: Tigard
Site address: 14395 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 80
Project: Polygon at Roshak Ridge, Lot 80
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 562 sf Basement: 85 sf Left: 0 Parking Spaces: 0
Height: 29 Bathrooms: 3 Second: 562 sf Garage: 456 St Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 1209 sf Value: $165,002.85 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0 Other Fixture Units: .
MECHANICAL
Fuel 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
Fum>=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!500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr. 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1209
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Report Required
Prior To Pour
3 NFPA 13D Sprinklers
PHONE: 360-695-7700 PHONE: 360-695-7700 Required
FAX:
Total Fees: $24,533.51
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. 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 .. 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. • ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
id
/
Issued By: _. . y`:, Permittee Signature: 4) hi/W
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
his 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.
1L�1n(3) # 1* v....,(1\--
QD Building Permit Application
. Residential RECEIVED FOR OFFICE 1SE ONLI
City of Tigard Deceived �1G S Permit No; t�,"t' �JV1V
13125 SW Hall Blvd.,Tigard,OR 97223 MAR 21 2019 Plan Review MFIM
• : Phone: 503.718.2439 Fax: 503.598.1960 DateB : e i� 1 ...
TIGARD Inspection Line: 503.639.4175 (JlT}+ Ivl- l MAC o See Page 2 for
Internet: www.tigard-or_gov 1+t Ilt l�:�li`-: fllailgtir ll FRIEBB„may NM Supplemental Information
TYPE OF WORK 1II4QUIRED DATA: l-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
El Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,��q/d the pro CIO
fit for the
CATEGORY OF CONSTRUCTION work indicated on this application. 'Ik[77 o�.
Valuation: $
n� ® 1-and 2-family dwelling ❑Commercial/Industrial
WNumber of bedrooms: 9'
❑Accessory building ❑Multi-family
Number of bathrooms:
❑Master builder 0 Other: I
JOB SITE INFORMATION AND LOCATION Total number of floors: 4
Job site address: I I 95 560 ttoG e.) New dwelling area: tz _ quarefeet SIoZ
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 1 ✓``4'�}Pvsquare feet 5(2,
Suite/bldgJapt.no.: 11_.‘. Project name:Polygon at Roshak Ridge Covered porch area: square feet $c"
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.:2j b Permit fees*are based on the value oldie work performed.
Indicate the value(rounded to the nearest dollar)of all
I 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
ElPROPERTY OWNER 1 0 TENANT 41,y Number of stories:
Name:Polygon WLH LLC Type of construction:
Address:703 Broadway Street Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule) _
Business name:Polygon WLH LLC
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)693-4442
PHOTOVOI,TAICS01.4R PANEL SYSTEM FEES*
E-mail:perm itsubmittals@polvgonhomes.arm
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
Ci /State/ZIP:VancouverWA 98660 Permit Fee(includes plan review $180.00
ty and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247 Total fee due upon application: $201.60
Authorized signature. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Aran Gavin Date: IsC/�� *Fee methodology set by Tn-County Building Industry
f Service Board.
1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
e.
Mechanical Permit Application ELVED FOR OFFICE USE ONLY
City of Tigard Received
���1
Date/By: Permit No.�cT^ w11a—W1V.
'! 13125 SW Hall Blvd.,Tigard,OR 97223 APR 2 y 2019
: Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Review-��/ Date/By: Other Permit:
I I ilA It 1. Inspection Line: 503.639.4175 CITY l OF TI '�RD Date Ready/By: Juris: RI See Page 2 for
Internet: www.tigard-or.gov BUILDIN ['),�fl�ION Notified/Method: Supplemental Information
TYPE OF WORK l! COMMERCIAL NEE,* SCHEDULE —USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
rg 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AN LOCATION Heating/cooling:
AND
6
1 q Air conditioning 46.75
Job site address: IL}3a5 51.1.) `"r�-1j Furnace 100,000 BTU(ducts/vents) 46.75 __
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Roshak Ridge Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
. Flue/vent for any of above 23.32
Subdivision:Roshak Ridge Lot no.: 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
Oth
ElPROPERTY OWNER ❑ TENANTS' 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
El APPLICANT 0 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 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 •Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace --
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
'V 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 180
0,- days after it has been accepted as complete.
Authorized signature: ""' �u'�'�'�' * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
I:113uildinglPemtits\MnC_PermitApp_040113.doc 440-4617T(11102/COMMEB)
s r
Electrical Permit Applicatiofl ' ,x z 7 4
t.# A FOR OFFICE USE ONLY
- Received (�
ipli City of Tigard ,�L 2 2 2019 Date/By: Permilq�S- _W�p�
rr 13125 SW Nall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Orr: ' ( f.�i Date/By: Related Pemit8:
T1GAlil7 Inspection Line: 503.639.4175 !<t("' ?. „fit 3"SR; Ready Date/By: Iwis: I M See Page 2 for
Internet: www.tigard-or.gov -- "-='tr)..it.) .` Notified/Metbod: Supplemental Information
TYPE OF WORK PLAN 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 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling ❑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 ❑Master builder 0 Other: ['Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: rip ej p ❑Addition of new motor load of system.
J-\ SW `�0 \"�� j 100HP or more. ❑•'A,•."E,',••1.2.•,••1.3•,,
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 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: FEE SCHEDULE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: ir0 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add']500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
C1v OJACitL. U'eA tt rya tMMS'
� f?,ot`i-061 0-5 (with q.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ 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
® 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 without
sAddress: 703 BroadwaySt Suite 510 brancheace or feeder fee,first 56.18 2
circuit
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 Each manufactured or modular 67.84 2
Email: permitsubmittals@polygonhomes.com dwelling,service and/or feeder
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 0 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(I hr min) 90.00/hr
Email: solarpdx@me.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4874 S specifically listed('A hr min)
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: [J � 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
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JUII 6 ft Received /�J�
ll 223E " 2��9 Date/By: Permit No.fx.i&-t^ utct,_e10.
't 13125 SW Hall Blvd.,Tigard,OR 97223 '' ``,� 11a VV1I
t a' . Phone: 503.718.2439 Fax: 50 4 6O y,) Plan Review
�..���h� ���Up-e'i';EJ Date/By: OtherPermitNo.:
TIGARD Inspection Line: 503.639.4175_, I r� �+lq ri Date Ready/By:
Saris: El See Page for
Internet: www.tigard-or.gov �1 ?..J' l.,i'a Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE '
®New construction ❑Demolition For special information use checklist Description I Q . I Ea. f Total _
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 1-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 437.78
1 0 Accessory building ®Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: `lA ,ct,5 t LoCi"r -s +.4 Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Roshak Ridge I Lot no.: gD Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
" ��DEES,CRIPTION OF tW�ORK q Backwater valve 12.51
C '�1f�,ek or, --c 21 CbU17� Clothes washer 25.02
V Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑'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 ❑ 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 Urinal 25.02
a
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing Water piping/DWV 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 Lic.:184601 Plumbing Lic.no.:PB732 State surcharge(12%of permit fee)
Authorized signature: i TOTAL PERMIT FEE
Print name:Robert Dishmau Date: This permit application expires if a permit Is not obtained within 180 days
after it has been accepted as complete.
*Pee methodology set by Tri-County Building industry Service Board.
1:\Building\Perm its\PLMU-PermitApp.doe 10/01/09 440-46 16T(10/02/COM/WEB)
c-
City of Tigard
14 COMMUNITY DEVELOPMENT DEPARTMENT
f
rl R Building Permit Review — Residential
Building Permit #: -v 'Oket-��d�
Site Address: (`131S SL✓ l69t Aft.
Project Name: Poly ;y� al- I�lak Riif Lot #: gQ
(New elling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
P�roiposal: Ji S FA . �W.t7VSe.
Le Verify address/suite#active in Accela. E'In River Terra : ❑ No 'Yes,River Terrace Review Addendum
SitOlan Elements: sion Control
Re[ co ies of siteplan on 8-1 2"x 11"or 11 x 17"paper tained trees with dripline and tree protection measures
P / PP
rawn to scale(standard architect or engineer scale) ••sprint of new structure(including decks)and FFE
1 „North arrow a I .'ty locations&easements(required for new and additions)
Lids' a address,project or subdivision name and lot number W,Sidewalk/driveway approach
Li�5Splicant information(name and phone number) J cation of wells/septic systems
hirLot dimensions and building setback dimensions Sydet tree size,type and location
IDS uare footage of buildings to be demolished
eet names ssting structures on site Comer elevations(2'contours if more than 4'diffejmttial)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? RYes ❑No
pervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑lestDNo
le Clean Water Services-Service Provider LetterAot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No ' yr
Public Facilitie provement(PFI)Permit: ' 4 tilt
P
— Required: Yes,applicant was notified ❑ No Applied For: Yes 0 No,stop intake
L;d/ dUseCase#: pOPUIS-O00O2 E Zedoning. IZ
*equired Setbacks: Front:- 1- Rear: 0 Side: 0 Street Side: 3 Garage: . "J1
L 13..pilding Height: Max. Height: Actual He•ight: as
IVPLandscape Area: 2,0 A Lot Coverage Max: r] /o
1 .1 -Entrance ❑ Set back no more than 8'from street-faring wall ❑ Parallel to street or offset 45 degrees or less
Windows El Minimum 12%of area of all street-facing facades
Garage 0 Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
IliW ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on Did floor.
1,4Th . ❑ Garage door width is 0 12'or less ❑ 50%or less of facade 0 60%or less and includes 7 of following
❑ Covered porch 0 Recessed entrance ❑ Wall offset 0 1'Roof eave 0 Roof offset
❑ Fire shingles 0 Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof 0 Dormer
❑ Accent siding / Window trim ❑ Window recess 0 Window projection 0 Balcony
itgr
'sual Clearance JP Urban Forestry P an
VSensitive Lands: • Yes No Type:
• Conditions et pfior to issuance o buil ' permit
t ,"o • �nii M bt M,r 1)rive- Iv bvt ky fkrn.,1- (l✓antt.
[ Approved By Planning: Lf4AfrDate: 3-L -lq
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_022819.docz
-,
Building Permit Submittal
Original Submittal Date: 31ai 1Q
Site Plans: #
Building Plans: #
Building Permit#: EA Enter building permit#above. —/
Workflow Routing: Et Planning 2/Engineering L4'Permit Coordinator Er 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
original plan review routing form.
C"Building original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,`�,k.--- Date: 3a�.I
Engineering Review �j
,Slope at building pad: � 0
2.--Conditions "Met"prior to issuance of building permit
,.❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes ,B'No
Assess Water Quantity Fee in-lieu: 0 Yes 4J2'No
LIDA Facility on lot: 0 Yes .0'No
Final Plat Recorded:
( ❑ NOT Approved by Engineering: Date:
Notes:
.,JZ—Approved by Engineering 4 Date: 4' /E� ( ?
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ 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:
Revision Notice 3: Date Sent to Applicant:
C Fees Entered: Wash Co Trans Dev Tax: I, Yes 0 N/A
Tigard Trans SDC: [ '`Yes ❑ N/A
Parks SDC: L6? Yes �❑ N/A
LIDA 0 Yes IQ /A
to Issue Permit J C
Approved by Permit Coordinator: / Date: / ! 1
I:\Buiding\Forms\BldgPemritRvw_RES_0228I9.docx
4- .
1111 City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 c n�� River Terrace Building Permit Review Addendum
Building Permit #: MS-c2OCk-CEO\Q
Site Address: 1131S S1,J 16gth Avt.
Project Name: Poty 6tn at- a k� e Lot #: Po
(New .#ellmg=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Disyict Design Standards (18.640.070.L):
Is the project subject to the plan district design standards? Ld 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.,Eft wide Gabled dorm
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 2.3'/)' L0.6
3. Entrances:At least one entrance must meet both of the foliog standards:
Ip Max. 8 ft. setback from longest street- facing wall = 1 arallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: E Yes 0 No ///
If y.•,all the following apply: sq.ft.min.
t! 0,ne street facing entry ft.max.roof above floor of porch
e 5 ft. depth min. f'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:
0 Covered` porch min. 5 ft.wide x 5 ft. deep ❑ R cessed entry area min. 5 ft.wide x 2 ft. deep
LG'Wall offset min. 16 inches F f j E er min.4 ft.wide S
�oof eave min. 12 inch projection'l'S L�y'R/orf offset min. of 2 ft S
❑ Roof shingles either tile or wood L[IJ'G�a le,hip or gambrel roof design F
❑ of pitch oriented south min. 500 sq. ft L��'forizontal lap siding min. 3-7 inches wide S
L+d"Accent siding min. 40%of street facade p• ,'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 2 Attached garage is 35% or less of street facade 2
5. Garages and Carports:May face the front or side lot line on a corner lot.
IV' Setbacks:
o closer to front or side lot line, than longest street-facing wall. 0 Yes 0 No. If No (Check one):
O,.le, 0 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
5uf9t ove the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
2-foot-wide garage door 0 40%max. of street facade
❑ 50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: jd/r I Date: 3-lick(
IABuildnrg\Forms\BldgPe"nilR RES_RT_121417.docx