Permit _ CITY OF TIGARD MASTER PERMIT
�! COMMUNITY DEVELOPMENT Permit#: MST2015-00185
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/24/2015
Parcel: 2 S 1080001500
Jurisdiction: TIGARD
Site address: 15075 SW DANUBE DR
Subdivision: 1998-005 PARTITION PLAT Lot: 2
Project: Polygon at Bull Mountain, Lot 8
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First. 1587 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second 1842 sf Garage: 682 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3429 sf Value: $418,122.06 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters. 1 Water Lines: 100 Drains: Catch Basins 0
Bckflw Prevntr: 0
Footing Drain' 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning. Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents. 0 Woodstoves: 0 Gas Outlets: 5
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: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp0
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 SF VB R-3 3429
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC Required Items and Reports(Conditions)
109 E 13TH ST,STE 200 109 E 13TH STREET 1 Ersn Cnlrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $34,003.09
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. AT Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 010 throng �OAR95 -001-0090.. You �obtainopy of the rules or direct questions to OUNC by calling 503.232.1987 0 . 00.332.2344.
Iss d By: Permittee Signature:
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.
t
Building Permit Application
Pl�2esdential • • •
Received
Ci of Tigard Permit No.
City g P.an l :
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C'
=
Phone: 503.718.2439 Fax: 503.5 de � DateB Other Permih. .�(,I� JLy—
Inspection Line: 503.639.4175 Date Ready/By: Juris: 11 See Page 2 for
Internet: www.tigard-0r.gov a jo5i Notified/Method:// /B /� Supplemental Information
pC1 �%ffI-iL
a 1'YPE'IOF,r ";t,,w. ` t"a uQi7iRED'DAT} AtD 2aF DRLI7NG s
:�j , ,-"fl a 3 3 ;'tai3�a' i
n�
$Y#k"�T t�.u, S ',�',stir I'M r .vre,S��t,rz� tu 4�n ,3:«,
®New construction ObkPermit 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
r ,s .,nr,a,,-.; ,- = ,W^ work indicated on this app
lication.
': 7.�m'
?ri r `m -<CA 1GEGO1tY';OF G01YST3tUCT70N st;=:, ::� 2`s',i € x < .
V^9?: z:,;.c ..a'a,a,:.. �,�.' ri�r>
Valuation $
® 1-and 2-family dwelling ❑Commercialfindustrial 117,i
Number of bedrooms: 4
❑Accessory building ❑Multi-family
❑Master builder El Other:
Number of bathrooms 2,5,
r Total number of floors: 2
to a JO�ITEINFORl1It1TiON r1ND I0CAT�O r. i ,
Job site address. ' So �� \_DG F)`,(� New dwelling ar 3 square fef ��
City/State/ZIP:Tigard,OR 97224 Garage/carp ea: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: ' square feet $4
Cross street/directions to job site: Deck area: 3� square feet
Other structure area: square feet
:7QW may.,<<
REQIIIEIED,DATA.rCOMMERC7AL"USE Cf1EGi�a-ST "
Sub tvision:Polygon at Bull Mountain Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
T map parcel no.: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
''z'�;'i8�d3"s"'t'�'?::�. :.ts�2�'i.;;�r ..x-':_-..:'- <.:.ti„,+ :vr;a..`�.,. •'-�.a,s;:'r=a w*". -,-`�:""�--^,';'.�. .�R'`^�""S'a-z<^
S� Valuation: $
Existing building area: square feet
New building area: square feet
t. Nsi. ? ��Y49 2
7 ®PROPERTY i3WNER. x' ® TEIVAI�IT Number of stories:
.v_".r ,.
Name:Polygon WLH,LLC Type of construction:
Address: 109 E 13"Street Occupancy groups:
City/State/ZIP:Vancouver,CA 98660 Existing:
Phone:(360)695.7700 Fax:(360)693.4442 New:�� ccl>�rr4cr,PEiisiiiv.F�,
1 BUI1:DiNG tPERhtTf_FEES- �.;-a-
1,
�a6Pleaseref sr,ta`e�sckedntc q .>F
Business name:Same
ctural plan review fee(or deposit):
Contact name: h'
FLS plan review fee(if applicable):
Address: dicz
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
'-tPHOvQIh
lAICt' ass3? .'c,rs
R� N `s sa? t
;SOLA =PEL,SFn .
,M ,
E-mail:maggie.gordon@polygonhomes.com t,
.,. atm,-=;;_;. g ? '"� 4;` r.-=%- '; ` '1t. N Commercial and residential prescriptive installation of
CONTRA(IOR nq : y ' roof-to mounted Photovoltaic Solar Panel System.
# '�- ... P Y
Business name:µ /l Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) 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: Date: *Fee methodology set by Tri-County Building Industry
Service Board.
\ I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 44011613"1'(11/02/COM/WEB)
Electrical Permit Application FOR OFFICE (ISE ONLY mmmml I
City of Tigard I:eeeived Pel nfl No
vale/I1,•:
• 1312>SW Mall 131vti.'I'igard.OR 97223 Plan Revlc,v
Phone 503.718.2439 Pax: 503.598.1960 Inue/Ity. bei Petnmt
Inspection Linc: 503.639 41 75 Dale Ready/fly n , See Pate 2 for
Internet www.tigard-nLgov Not Supplemental Infurmaliun
TYPE,OF.WORK PLAN REVIEW
®New construction ❑ Addition/alteration/rcpl;lceincnt Please check all Thal apply(Submit 2 set,orplan>w/ilrm>checked
❑Sen•ice or teedel 400 amps of mote ❑nuilding o,et three mol'les
E) Demolition Other: wlicre the available Ilmlt cwrcm ❑matinas and bualyal&
.CA(TEG.ORY OF CONSTRUCTION. ccccds 10.001:un ;: 150vrlts of ❑Floating buildings
less to ground.of exceeds 14.000 ❑Comunctcial-use aclicuhulal
® 1-and 2-family dwcllitlg ❑Commercial/inclUstrlal E] Acccssory building atmps tin all ollief installations buildmes
❑ 11\'1UIll-Ialllll\' D Master builder Other: ❑Pile pump ❑htstallation of 75 KVA of
J,OB.SITE JNFORNI ATION.AND LOCATION ❑lilmelgency sy,lem tat_er sepf:uel\do ,t sv,aenf
. •T .- ❑Addition of new nunot land of ❑"A '9 '-1 '. ..1
.lob no.: lob site address: 15�SW Danube Dr 10011Pol mote. occupcfnev
❑Sn m mote le,idenlial inn, ❑Recreational,chicle pack,
C,Ily/`)title/Ill': Tigard,OR ❑health-tale facilllfns. Cl Supply,oll;aee fur mole than
❑I laialdous location, 600,u11s..... l
Suttle/bldg./apt. I70,: Pro.jecI Ilanle: ❑Service m teeder(Mll amp,or mote.
Cross SU'eeUFEE SCHEDULEdireclions to job title: Description (h'. Fee. total
New residential single-or multi-family dwelling unit. {
Includes attached garage.
Subdivision: I.ot no.: J. I.000sq fi of less Ios :t — i-!
l�az map/parcel no.:
I[a.add'l 500 sq.Il or portion �— 33 92 I I
Limited cncrg)'.residential �
IYESCRIPTION OF WORK`. (with aho\e ski.ti ) _75 00 -
Limited energy.InUhl-tanlil)'
New electrical service and Wiring residential(\vah above S", Il.) 00
Il.) L
Services or feeders installation,alteration,and/or relocation
300 anlps or less OU 70 2=
111
.Q=7PROP.C1'RTY OWNER`. 201 amps to 400 amps 133 56 ?I
' ��TENANT P- 1
Namc: 401 amps to 600;amps 200 34 _
601 amps to 1.000;unps 301 o'FF Address: Over 1.000 amps or volts S.2 36 �—
Cil\'/State/LIP: Temporary services or feedcrs installation,alteration,and/or
relocation
Phone:( ) �' ( ) --- 200 amps or less 5936 I
20 1 amps to 400 amps 135 UK ,
Owner installation: This installation is being made on properly that I awn which is mol
inlcnded lox sale. lease. rent,or exchange. according to ORS 44'7.449. 670. and 701. 401 amps to 591)amp, 1('s 54
Branch circuits—new,alteration,or extension, er panel
ON'Iler Slgllilltlrl':- Date: A Pee rix branch circuits ncw)
"APPLICANT'' ' ------ •❑ CONTACT'PERSON above service or tcccfer Ice.
7 43
each branch circuit _
Business name: B. Pcc for branch circuits%,jotomr — ---
service or Iccdcl tcc.lira
ConflictConflictname:C: brunch co-curt 56 18 2]
Address:
I?ach add'I branch circuit 1 7 42
Miscellaneous service nr'feeder not included)
City/Stale/LIP: Each manufactured or modular 67 8-!
dwelling,service and/or t'ecdci
Phone:( ) Ira\: :( ) Reconnect oral) 67 S4
Pump or Irrigation circle 67 84 3
Sign or uulline lightine 67 84
CONTRACTOR Signal cocuil(s)or hmitcd-mercy
R USincss name: Simply Electric )incl,alteration.of cstcn,ion Pa_-c '
Each additional inspection over allowable in an\ of the above
A(Idress: PO &)a 822408 Additional Inspection(I hr till)
Cily/Slate/LIP: Vancouver,WA.98682 Illwstigaoon(I hr min) 66 25/hl
Industrial plant(I hr min) 78 IS/hI
Phonc:(503)8.39-8202 Iran:(360)314-4945 Inspections fix which no Icc Is
specifically listed(%hr min) 90 00/hi
C'C13 1.ie.: 204615 Hcctrical I.ic.: 067 Suprv. I.ic.: 43945 -.'ELECTRICAL. PERMIT FEES
A Subtotal
Supri'. I::Icctrician signature, required: �fL-LCf fs l�, -�
Platt rcvic\% (25%of�permit Ice)
('Tint name: Victor Larrhitsl y Uatc: I 117/2015 Stale surcharge(12'%,a,f gemma fee) �—
Authorized signature: l'(�'f/U.I'F.Rr�11 h IrI.I �---I
this permit application v,pires if a pe-mil is not obtained„ithin IRI)
Print 1181111': I)illi.': days after it has been accepted a,complete.
' Number or ntq,eclions allowed pet p—ml
I',nwlJmeV'cnnu,lFl.C'-I'cnnn,\ppdor 07/0I/I0lau.na
Mechanical Permit Application
City of Tigard Recti ved Dalel8y:, Permit No.;,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rmlew
Pb6rie: 503.7181439 Fax: 503.598.1960 DatetBv, OtherPennit:
Irks*ti6n Line: 503.639.4175 i
I Dait 10 See Page 2 for
Ititenict: www.tigard-or.gov Supplemental Information
R
Mechanical permit fees*are based on the value the work
KNew construction C1 AMdon/alterationireplacement performed.Indicate the value(rounded to the nearest dollar).of all
❑Demolition r_1 Other: mechanical materials,equipment,'labor,overhead,and proft
Value:S
RIESikIN
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For sperJal infonnation,use ch eckrist
F1 Multi-family. ❑Master builder El Other: Description Total
Heatin ling:
Air conditioning 46.75
Job site address:15075 SW Danube Dr Furnace 100.000 BTU(ductsivents) 1 46.75
Ciiy/StaterLIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts,'vents) 54.91
Heat pump 61.06
Suite/bldl;Japt.no.: Project name. Duct work 2332
Cross street/directions to"job site: -Hydronic hot water system 2332
Residential boiler(radiator or
hydronic) 23.32
Unit healers(fuel-type,not electric),
in-wall.in-duct suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other. 23.32 1
Otber fuel appliances:
Tax map/parcel no.: Water heater 23.32
Gas*fireplacerinsert 33-39
�6 OW Flue vent for water heater or gas
fireplace 23.32
Log lililiter(ps) 23.32
Wood/pellet stove 33.39_
-Wood fireplace insert 23.32
Chimneyllincriflue/vent 23.32
Other: 23.32
Environmental exhaust and ventilation:
"No
"I - -if
Name:Polygon Northwest Ranpment 1 33.39
Range hood/other kitchen
ui
Address:109 E 131h St eq
Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 97661 Single-duct exhaust(bathrooms,
toilet compartments.utility rooms) 4 23.32
Phone:(360)816-7800 Fax:( Attic/crawlspace fans 23.32
M '�c other., 23.32
§_6 ,
Fuel piping:
Business name:Polygon Northwest
514.15 for first four,54.03 for eseb additional
Contact name: -Furnace.etc.
Address:109 E 131h St Gas beat pump
Wall/suspendedhinit heater
City/State]ZIP:Vancouver,WA98661 Water heater
Phone;(360)816-7800 Fax:: Fireplace
E-mail: Range
Barbecue
Clothes dryer(m)
d_
Business name:Andersen Heating,Inc Other
Address:16285 SW 850 Ave Ste 410 Subtotal
City/State/ZIP:Tigard,OR 97224 Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Ph.o.ne:(503)99 -6664 Fax (503)536-6615 State surcharge(12%of permit fee)
CCB lic.:169214 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained mittila ISO
days after it has been accepted as completes:
Authorized signature: Fee methodology set by Tri-Counry Building Industry service Board
[Print name:Art Andersen Date:11120/2015
1',1BW]dingVkcrminlNEC—PamhApp_040113,d- 440461 Tr-(l 11MCOMAWER)
EJIVEP
Pinmbin Permit Application NOV 1 2015
Building Fixtures
Received Permit No.:
City of Tigard .
13125 SW Hall Blvd.,Tigard,OR 9'T2.23Plan Review pour Permit No.:
n Phone: 503.7182439 Fax: 503.50MDING DIVISI O1 a t dsr• m See Page 2 for
inspection Line: 503.639.4175 e RwadyB3r. Suppiemental Information
Internet wwwAigard-or.gov NotifiedlMetlwd
Fors edaI!g orrnoriodusechecklist
New«�nstrttction ❑Demolition Description Ea Total
[I Addition/elteration/replacement Other: New 1-yfamity dwellings(includes 100 R for each utility connection)
SFR(1)bath 312J0
_ Y SFR(2)bath 437.78
1-and 2-family dwelling Cl Comrnereiaifindustrial SFR(3)bath 50032 rj�bt�j
Accessory building ❑Multi-family Each additional badYkitchen 25.02
Other- Fire sprinkler C__sq.R) Page 2
Master builder Site utilities:
r• y - Catch basin or arca drain 18.76
Job site address: 5� / `� ��U Drywell,leach line,or trench drain 18.76
City/StatriziP: �\ "t T�"`� Footing drain(no,linear R:^_J Page Z
4f7� �j Manufaetumd home utili18
ties .
03
SuitdbldgJapt no.-o.: •project name: L3�
Manholes 18.7676
.
Cross sb=Vdirections to job site: Rain drain connector 18.76
Sanitary sewer(no.linear ft:�� Page 2
Storm sewer(no.linear ft:/I Page 2
Water service(no.linear R:/� Pagc 2
Subdivision Loi no.: Fixture or Item: 31.27 ,2
Backflow preventer
Tax map/paroel no.: Backwater valve 12.51 `'l•�j�.
Clothes washer 25.02MOWS ,a ,0
Dishwasher 25.022
Drinking fountain 25.02
Ejectors/sum25.02
p
Expansion tank 12.51
Fixturdsev=cap 25.02
Name: Q p 1�� Floor drain/floor smkth 25.02
Address: J ` �--r w `J Garbage disposal 25.02
Hose bib 25.02
City/Staterzip: 12-512
lee makes
Phone: Q Fax:( ) lntcrccptnr/grease trap 25.02
a Medical gas(value:S ) Page 2
Business name: Prima 12.51
Contact name Roofdrain(commercial) 12-51
Address: .D Sinkthasm/lavatory "7 25.02
6l Solar units(Potable water) 62.54
city/S181erL�P: 3
Fax::( ) Tub/shower/shower pan 12.51
.
Phone:O 3 d Urinal 25.02
E maiWater closet 25.02
Water heater 37.52
Business name:
V LL
Waterpiping/DWV 56.29
Other. 25.02
Address: Subtotal
CitylState/ZIP: /�r� Minimum permit fee: $72.50
Phone- Y.; s d3 Fax.( ) Plan review (25%of permit&0
CCB Lie.. Plumbing Lie. -2- State surcharge(120K of permit fee)
TOTAL PERMIT FEE
Authorimed signature
This permit application expires if a permit is Dot Obtained within]80 days
• Date: after it has been accepted as compretn
Print name [• - -Fee methodology set by Tri-Cowdry Buildio8 lnduslry Service Board.
r:vEwatat�+rermiuutrtur�,vutpp.aoc ioroi� aao•aalsr(iarieorvwM)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
a
Building Permit Review — Residential
Building Permit #:
Site Address: O5 D J 5 S Int b
Project Name: o on cz+ 4 Bull IqMX Lot #: $
(New dwelling= subdivision name;Addition or Alteration= last name of o
Planning Review
Proposal: e S F - M a d eA 0,(Y)e .
eVerlfy site address/suite# exists and active in permit system.
River Terrace Neighborhood: ,WYes ❑ No
Site Plan Elements:
A'fhree (3)copies of site plan )0�_-xisting structures on site
5eite plan must be on 8-1/2"x 11"or 11 x 17"paper XFootprvnt of new structure(including decks)with finished
RDrawn to scale(standard architect or engineer scale) floor elevations
NNOrth arrow M'Utility locations(required for new,may apply for additions)
Site address,project or subdivision name and lot number Location of wells/septic systems
RApplicant information (name and phone number) Wrosion control (including drainage-way protection, silt fence
RL,ot dimensions and building setback dimensions design,location of catch basin,etc.)
' Lot area,building coverage area,percentage of coverage and ®'Street names
,�.,_, impervious area (applicable if R-7,R-12,R-25&R-40) ('Street tree size,type and location
IXIP//roperty corner elevations (2 foot contour lines if more than Ekl�xisting trees to be retained with drip line,and tree
4 foot differentialprotection measures
Clean Water Services —Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ,i-No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI)Permit:
Required: k Yes,applicant was notified ❑ No _-Applied For: '"Yes ❑ No,stop intake
Land Use Case #: �"j(,l8 a.0 15 -OCA U O
Zoning: R - 4 .5
(� Setbacks: Front o Q Rear IG Side 5' Street Side — Garage oZ O
ICJ Landscape Requirement: t 1 fA % ao dp3b E
_J
,LI Lot Coverage Maximum: hij A %
❑ Building Height: Maximum Height 30 Actual Height
Ar Visual Clearance
'Easements
Sensitive Lands: ❑ Yes
K No Type
Urban Forestry Plan
❑ onditions "Met"prior to issuance of building permit I
Notes: C!u (e- 0 COnc� ifiu✓v h _O be Mei _
r Ana Approved By Planning, Date:
Revisions (after Building Submittal only) Reviewer D to
Revision 1: � Approved ElNot Approved m Le�)r b ( � IJ
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw_RES_070915.docx.
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: ErInter building permit#above.
Workflow Routing: ��Planning PITngineering ermit Coordinator Building
Workflow Sign-off: A2'Sign-off for Planning(include notes from planning review)
Route Application Documents: ;(Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
O'Building: original permit application,site plans, building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: �7/1j
v
En-ineering Review Z
�J S_lope at building pad:
0 Conditions "Met"prior to issuance of building pern-it
❑ Easements (encroachments) per engineering conditions of approval and plat
f 2'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes e No
Assess Water Quantity Fee in-lieu: ❑ Yes ,r No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes: P<PpAYOa &.�T PJ0 T � r� �fia-1�it�-�h Lid+.-6tYta-
Approved by Engineer' g: Date: /0 IJ
Revisions (after Bu' ing Submittal only) Rev tewe Date
Revision 1: EVApproved ❑ Not Approved ✓ _
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
Approved,NOT Released: Date: )v I
Notes: v GSM 4L�/ oe� � ^
1 IV
V IV
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:
SDC Fecs Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: 03:pYes ❑ N/A
OK to Issue Permit
/Approved by Permit Coordinator: Date:
1:\BuildingTonns\BldgPennit Rvw RES_070915.docx
44 S7' ).as--- of1S—
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT .
so
11111
_ Transmittal Letter
TIGARL) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: I A-A-521-4 f/ 'l DATFRECOMED
DEPT: BUILDING DIVISION
NOV 17 2015
/i t - CITY OF TIGARD
/
FROM: 'Q. - BUILDING DIVISION
COMPANY: /q,/yjo -7 -/ 42
PHONE: .322_._3 3/. low/ C3k=0( 2_
RE: /Sl> 75 �4.) ham ctioC
—(-Sie Address) (Permit Number)
( ctrsub on name anHd/o/t numberj1.
ATTACHED ARE THE FOLLOWING ITEMS:
I Copies: 1 Description: _ Copies: Description: 1
Additional set(s) of plans. 0 Revisions:
.2.11) _ Cross section(s) and details. 2 Wall bracing and/or lateral analysis.
dZ_ Floor/roof framing. 0 Basement and retaining walls.
a Beam calculations. 2 Engineer's calculations.
D Other(explain): /
REMARKS:�� // .yJ,Q c �., It A, /99 p/ G�� a// i n�fC�;% �hw•��s �fi
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FOA OFFICE USE ONLY
Routed to Permit Technician: Date: J]f J % 1 13" Initials: tit
Fees Due: Yes ❑ No Fee Description: 0110_1..k p1 a•,_r.-v:.w Amount Due:
$ CIO oo
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
ri a," r
FA CStrigill re..rnlit,APPlicati4i ECE v r:,
I • i Ott 01 Pit f.t SL cpstA
City cif Tard
13/25 SW Hell igDiva,Tigard,OR 97223 SEP 2 0 2016 mfe.13,-;/" 7- :S'1,4 '' d 91'7--C 7:- 0'i-5'7..a 6?1(f-5
Plan Review ,-
Phone: 5l33,71S.2439 Fax: ibmtiL)
5015986isfy ,
InspeetiOn Line: 501639.4175
intMell wtamtigard-Orgov 'Jr I , •
Ready rtare.03Y:
BUILDING noviqInr' NotifiedBilgtho& Rilutzd Ambit#-•
la Set Page 2 for
EMI Supplemental Information
',..Y. _IFY,Pg'-''.43r.,:_,Wompf2•--;:.',!_;7,•• :-',z„..:,..,r,:. ,i..,',.;-..A-..: ::--:..,;,•• -..-:!-;";,-.,-:-::.,:./.:-V-!-TT*Evi*.faVasiCiA7:: -f 1:'i:..:f:ti,,
Fli New construction 0 Additionfalterationtreplacement Pleasecheek all that appiy{soh*2 sets of plus winetris cheake0
0 Service or feeder 400 amps or more 0 Building over three stories,
•0 Demolition 0 Other: . , , where the available:fault eurrent Q marinas end boatmds,
1'EGOilt.0E.CONSTRBC-140$1 ., -1::1. L :-: i'-7"-j caeca&10,000 amps at 150 volts or 0 Mating buildings,
Ct I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building leas to ground,or exceeds 14,000 0 Commercial-use apieultand
amps for all other installations buildings.
0 multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
-.-.''..11.W.Sitt keitOiStiltiON-.101131404iblit- „
....;- ',-.''•.1..; ,; 0 EmnencY sYstem-
, . . larger seprately derived
0 Addition of new motor load of system.
Job : ; Job site.addressicnc5W Da.41A176 Onte, 1001fP or more:
. ' 0 Six or more residential units, occupancy.
City/StateZIP:Tigard,OR 97224
0 Recreational vehicle parks.
El Health-care facilities.
°Hazardous locations
Suileibi Project natne:poivr04 6 i)--- pv, a f,A,,,,,„,ID,r, ' . : 0 Supply voltage for more than
," ' 4''.4- 4 0 Service or feeder 600 atnps or more, Oa wits 994994
Cross strectidimctions to job site: :••,..'f ''..-,': ',.•-,_:-'7:•-•..:'7:.FEE:Se00.4ti.,- ;7,-„,:-,
Description I Qty. I Each I Total .
New residential single-or rn 41d-family dwelling unit.
• ,„ „
Subdivision:11.U- 610 1 er-bw; A:Los.isi-t' ,A, Lot 4: .
IP includes attached garage.
Tax map/parcel ;
1,000 sq,IL or less f 168.54 4
#•
',!:.:...•-7,34? . '.•,..-,.,1- ..#,:r•A;; ...friMtipT1014•(0P,.WQR.1 -,::',7..'':;:--':•:' „. -;'':-'-•,',':-..''q , El.arld'i SOO sq:fror portion ST 33921
Nivadurthane • Limited enemy,residentia/
(with above sq.ft-) 75.00 2
Limited energy,multi-family
- •
75.00 2
.iikb:..;Mt7.7t:'sbit.1401,j.:".‘,7:,7771:-:::..T. ,.7.7,- s.t:?..701::ritteir.151,4: -,,,7-:-.. .. residential(with above sq.ft.)
Name;AD.VL Land Holdings,LLC Renewable Energy El See Page 2
Services or feeders installation,alteration,and/or relocation
Address:7600 E Doubletree Ranch Road
200 amps or less 100.70 2
City/Srate/ZIP:Scottsdale,AZ 85258
201 amps to 400 amps 133.56 2
Phone:(602)694-4031 ' I Fax:( )
401 amps to 600 amps 200.34 22
Entail:
Owner installation:This installation is being made on property that I own which is not 601 amps to 1,000 amps 301.04
intended for sate,lease,rent,or exchange,according.to ORS 447,449,670,and 701.
Over 1,000 amps or volts 552,26 2
Owner signature: --,•• - . .. :• •• . . Date:- -
se
. Temporary services or feeders installation,alteration,and/or
:::-.4P(4::'::::•'.-:..-: ::'°ZejiA014:10.01t:,-:: '-::.'11'-:i.:[:;'-',.:::..."ATOKI*11 '.:...--'---- - reineation-
Business name:William Lyon Homes,Inc. . • • •200 amps or less 59.36 1
Contact name:Angela Grajewski , •
• 201 amps to 400 amps - 125.0g 1
Address:109 East 13th Street • •
• • 401 amps to 599 amps 168.54 2
City/State/ZIP:Vancouver,WA 98660 •
- - Branch circuits-new,alteration,or extension, cc panel
Phone:(360)695-7700 I Fax::(360).693-4442 A.'Fee for branch circuits with
above service or feeder fee, 742
Email:Angela.Grajewski@polygonhornes.com • each branch circuit •
2
,. .:,,.. ,,...,..... ..,. : •R.b$eFeervicfcoh:o.hrtzloch
eecrirrez,itsfirswtithut
o
. ..,, .‘A8
Business name:alameda electric rt 1 '
'
•
Each addlbratich circuit. ; 742
2
2
Address:3415 at 44th •
Miscellaneous(service or feeder nntinclitded)
004state/zip;maim cbryi 1a,,,, ,,(..4 /2... /4, 7.2-/3 ‘• E4e.t,amaufactured or modular -6.7..,g4' ,.•. . ,,
dwelling,service and/ør feeder :
Phone:(503)3192192 I Fax:( ) •' •
,... • ..-.•,..
•
Reconnect only • 67.84 • . -i• '
Email:solatpdx@me.corn
:. .
Pump or irrigation circle • b7,84 ' - ::
: ....
CCB Lie.: 199188- rElectrical Lie •
,: c923 Suprv.Lie.: -9,(71,5 . ; • •”
• : Signor outline lighting . •• • • 67,84
Suprv,Electrician signature,required: -
Signal circuits)or limited-enerp .. •'... --.. .
•
Print name: /Li,/,c /2 ..„( Date: (--/z1//,/ ' -panel,alteration,or extension. 0 Ste Page • ,.. '•: ,
Each additional inspection over allowable in any of-the AboVer. --'
Additional inspection(1 hr min) ' 1
Authorized signature: - ••:,...., ,. ..
).,,,,.....: ,,aisua ,,,-"" - • - • • , .
,, ,0hr - -
Print name; / e.„-, --e----- /4. . „.,.:.,:.
Datkis--. 43Investigation(1 hr nun)
"-' " - '- • ' '
ifef.iiktivtaraitMC_PtstaitApp ELR_Egedoc Rev on ma's 440-461.5T01/05,(COMME13 . ,
' '• .
, . .:' ., ,• :::- , : • - c . ' " " : , •. ':
. -
Aleetallies' Permit Appl riwi' ft
,EVEr f()R ofTi( E[ SE()\[ i
City of Tigard ilm'':toevedr /0/e ///(.,
.-- 13125 SW Hall Blvd.,
gard
TOR 9
i , 7.AIFp
lit 2 0 2016
Plan iteview
Phone: 503_71$2439 Pax: 503598.19-F0 nBy, Other 1-"'aufil..
T r GA it D ,InVecti"l'ine: 5°3439`4175 ciTy OF t ibt-ttiu Date Reach,ny f..it, .0 segpatezfor
. - Internet: Www-110ard-9tZ9v nr,ft(''r. " Wohliellytethod: Suppletrouitat toformatifut
BUILDINC; _ ______,
TYPE OF WORK FI)MMERCIA1 FEE SCTTEDVEE- VSECIIECKEIST
Niechatuad permit fees*are based on the value of the work
.
...,., New construchon 0 Addition/alteration/replacement portiwined,Indicate the%whit-(inauded to the nearest&Hertel:oil
0 Denial Wort 0 Other n.e.eitanical materials,e (inerf labor,overhead:and milt,
tiattre:S
CATEGORY OF cossraticrioN '
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 I-and I-family&veiling 0 Commemiallindustrini 0 Accessory bolidiau For spedol inforrnalion use cherAlirt
, . ,.Multi-Larnilv 0„Master bonri der t„,„1 Other: Desettnitan DIY.
JOB SITE INFORMATION AND LOCATION litatilln°;,/ *015 01*. r —1
Jobat:, / ss 0 saddrms- 7 w an
-1 -' ' 1A,19e pr. 4:4""4.11140(7,Ii100"
CityiState/ZIP:Tgrd*OR 97224 Purae4i.100,000+BTU tdoersrvemsi 54,91 ,
„„ , „,„ , .... . litu puma 61.06 ISuire/Jthitpt.Ntitemun.e..rapt.DO,: Project name:Polygon at Dull mountain
aim-work 23,32
Crass streeildirectiors•la job site: II,* Irk hat water vat= 2332
Residential/loiter(radiator or
hYdronic) 2132
Lloir heaters(inel-vae„WI electric),
in-wall,in-cluitt„ tispendett,ate. 46,15
Ruchcill for row of obore % 2132
Other- 2132
Subdivision;Polnort at Bull Mountain i.ot on 4 •
• '- •
giber fuel appllaucest
Fta;rotipiparcei no:, Water heater '23.32
,
, ,• - DESCRIPTION OF W'ORK. Ga fir9Placvansell 33,39 I
C air than9 0 F,,11.10 I:vat for water flowti-or gas
it . ,L.-- 2332
t....
Log balder(aut 2132
1 pc, _ Wood/pellet stove 1139
1 0 # Wood Oreplatailinacrt
2132
, ,
-
Chinarte•iiiinerilitrefuent
23 3,
/
-
2PROPE-RTY OWNER ' 0•TENA!'ll` Other t: 2132
rovirratmetuat exhaust and ventilation: - I
Name:Polygon WER,LLC 1 , Ranee hoodfother kitchill 1
- fli-rtWnt I 11,:uo !
Address:100 East 13 Street '-
Oodles thyer exhaust 31,0
City/StatealP:Viintouver,WA 98660 Singbdua 'xliallil ibattlioalus*
lotto en ,** ail toms 2332 I
Phone::(360)695-7100 Fax:( ) At/kit:ran Ispace 14/15 _ 1111111 2332 •
APPticAir 0 CONTACT PERSON' Other
1 23-32
Business name:Potygon WLR,LIC n'ttl PiPill'll
$14,15 thr tito Thu=S4.83-for eaett 2 dal:0400
Contact name:Angela Grajetmki Furrow,ete, I I
Addrsz 109 East 13th Street ' Das heat Po" I
111
- WellAIW,endettliinit heater I
City/StatetZIP:Vatteunver,WA 98660
Weer timer
.„
Phone:060)698-7700 1 Far:.(360)03-4442 FircP14co
1111
E-matt AngtILGrajewskiliTadygonhomes401/1
Barbettto illin
CONTRACTOR • Clothes d ,er(-=1-
1.3tLviness nalue:Apex Air LLC Clthet-
, - MEEXANICAL PERMIT FEES*
Address::18004 NE 72'4 Ave
Sabana/ I
. .
City/State/ZIP:Vancouver,WA 98686 Minimum permit let MOM)
- Flan teview(25%of permit fee) I
Phone:(360)3424109 Fax:136013264769 , . 1
Siatesnuthatge(12%of pernalt lbie) 1
....
CCB Itc7
,z 203034 TOTAL PERMIT FEE 1
Authorized signature; :14;te:erhiTkiotoYsliFserfttr11:47Tri-c:44:atho:srlylriltit:":":77431'1"17S-1::::101111"
Date: j
____
I Wu:k.411,5Pm.-11.,-,Mrt_P=grApp„.940i 0,64,1* 4,t44.(,i7T i_,!•;,2-comAvEw
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 25, 2018 at 4:07:35 PM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Provide approved thread sealant on cleanout caps.
Kitchen sink leaking at p trap.
Upper level main bath tub leaking at wall.
Right side master Lay hot and cold reversed.
Provide approved Backflow test report and inspection for lawn irrigation Backflow devise.
Not ready for Inspection, Work not complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 25, 2018 at 4:12:01 PM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide tamper resistant access port caps on ac. M1411 .8
Upper level main bath fan not on timer or de humidistat. M1507.5
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 25, 2018 at 4:14:51 PM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Kitchen counter outlet right side of refrigerator not gfci protected. 210.8(A)
Upper level main bath fan not on timer or de humidistat. M1507.5
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 31 , 2018 at 11 :21 :41 AM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 31 , 2018 at 11 :30:38 AM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Corrections from previous inspection complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 31 , 2018 at 11 :41 :06 AM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Remove debris from crawl space and fix lap on vapor barrier at footings.
Provide approved site plan and street tree certification.
All else appears ok.
Backflow devise test report, febco model 810, serial # HD34756
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 31 , 2018 at 11 :32:28 AM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Corrections from previous inspection complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15075 SW DANUBE DR, TIGARD, OR, 97224 July 31 , 2018 at 4:26:26 PM
Record Type: Record ID:
Residential - Master Permit MST2015-00185
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Corrections from previous inspection complete.
Street trees on site for installation.
Final erosion control approved.
Street tree certification received.
Moisture content form received.
Moisture barrier form received.
High efficiency lighting form received.
Blower door test report checked.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor