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Permit
CITY OF TIGARD ' „ 1 l'', �A '�s MASTER PERMIT 111 n COMMUNITY DEVELOPMENT Lf /> Permit#: MST2016 00085 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2016 Parcel: 2S1080001504 Jurisdiction: Tigard Site address: 15407 SW MISSISSIPPI CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 82 Project Description: New SF. 8/4/2016: ADD sump pump for storm water. 10/28/2016: Add NC and 2nd water heater. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1591 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 1836 sf Garage: 682 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3427 sf Value: $420,023.29 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 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 2 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Sump pump for storm water 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: 4 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: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3427 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 Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $34,780.05 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 thro •, -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ®� //277-e,__ Permittee Signature: Q'l /9121e---./ ('' %7C/kJ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application Oi x of"I'i andRECEIVED �, .... ,1 rx � . 131 Hats 131sd..tlgard, R 1x223 erAfteta ; sti3 7111.2439 Fax503398t0 2 0 2016 sir Ota/ trig: I lc,A t&t� inspection Lint: 503.639.9175 Date uc.rd.`t3s': t fr' Internet: www.tiganbor.gov nbor.i3oy S S Patine t r CITY OF'WARD *3atitxcderlt ratpptettritttadlnratttnarisstt �i't,(I[ G (oi\j1Sint,l Ty... QV COMME*CI L FEW'SCHEDULE-. ;SE CUECKLISI Mechanical permit fixs*arc based on the value of the pork iNew construction Li Addiitionlalteration/repl cenutnt3 L p pt�performed,ttndtcate'the value(rounded to the nearest Jolla/1-0f ail Demolition 0 Other: mechanical materials.k ail meat,labor.nterhead,and relit Value:$ CATEGORYOF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES', 01-and 2-fartyiydwelling 0 commmiairmastthi 0 Accessxtry building For special information MU'checAtut Multi-family 0 Master builder 0 Other: f criptaon Q1y 1:74.. T rtal ' iJos Sft INFORMATION # D LOCATION ttnetu s "�1 n Airconchftonin, 46.75 Job site address: SW V I V I S S S 1 11 Furnace 100.000"8'`tt tductssmuts1 46,75 City/State/ZIP:Tigard,OR 97224 Furnace 100.000+Bit)(duos/vents) 59.91 bleat pump 61.06 Suite/bldg./apt no.: Project name:Polygon at Bull Mtiuntaln Duet work 23.32 Cross street/directions to job site. ily°dre nze hot water systetrt 23.32 Residential boiler(radiator or hy=dronic) 23 332 Unit heaters(tirei tjpe not electric), in-wall in-duct,suspended,etc.. 46.75 flues em for an't'of above 23.32 Subdivision.Polygon at Bull Mountain Lot no..:rOther 23;32 Other fuel appliances; Tan naapiparccl no.: Water heater [ v°L 23..�� 33 C11.IPFION OF WORK Om fireplacclinsert 3339 Flue vent for water heater at Sas a II I ri Mt 1 Al A . Iirepiace 23.32 Log ligiaicr L .l 23.32 ------- t+ liet strove 33 9 • '/ 4t'cernd 13rxutlaeraiiaxrt 23.32 Clioutcyninertnuelvent 23.32 OWNER 7. PROPERTY ther:; 2332 Q TENANT Ens ironmentat exhaust and ventilation: Name:Polygon WI../1,LLC , Ranee hood'other kitchen ui rncni I 33.39 Address:109 East Edea Street i Clothes dryer exhaust ' 33.39 City/State/ZIP:Vancouver,WA 911660 angle-duct exhaust(bathrooms, toilet ea e pamneals,utility rooms) I-4 2132 Afkc'cras is :ee fans _3.32 Phone:(36Q93-7' Fax:( ) APPLICANT Other. IIIIIIIngl Business name:Polygon on WI„I8,LLC furl piping: $19.16 tor fuse fear .03 for each additional Contact name:Angela Graiewski Furnace.etc. 1 Address:109 East 13th Street Otis heat pump Wallas t-ded/unit heater al CityiState ZIP:V ancotn er,WA 98660 Water heater Phone:(360)695-7700 I Fax: (360)6934442. FirOlatv 11111111 �e I-rna l:Angela,Graj i'i-pu33gonhomes,eom Barbecue CONTRACTOR Clothes 'et ens MN liminess name:Apex Air E Other MECEL41e1CAL PETIT FE Address:104 NE 72.«e Ave Subtotal CityState ZIP:Vancouver,WA 986116 MinitnUut permit fee($90.001 Plan review(25%of permit reel;) Phone:(360)342-8109 i Fax:(:360)3264169 State surchar (32%ofp inn lee) t CCB he.:203034 TOTAL PERMIT FEE This permit atrptirekas expires iia Permit lc not bhtained u;Min IRO days after it haas forst arcepted.as rarrrptetr. Authorized signature; * Fee mithednims set 3sy Tri-County building led try.Soviet beard i Print name"."Ti f Date: 4-3' i 1-Bv 3 r Prrs:i :it:":c_Pnxnts,& 0401 LI SPX 4413-4t -.:.-1 t)M,It ti . .. s e tr c.e.11_"Permit•A h c ..ifiECEIVSD 1tilt()Iktt1.tSt.fl\1.k C3ty of Tigard t Received IIate393 ee d- PenAdli !-(% /6.--e'(/,%, 7, ..SWOR97z23S E P 2 0 2 016 pias illi ieK Phone:11 503,718.2439 Fax 503,59B.t9 f1 13atetTl Felatest Permit#; lnspeetttinLinc 03.fr3 :.1/75 CITY OF TIGARD R illowati° iuri --- 2for litlarttet: sy evi`tigard'0rlt)v BUILDING DIVISION Na611ed,741ethad: Supplemental Infor eatian TPF.OF O _` _ . ,-y �1 F x Please check all that apply(submit 2 sem of phew st sileans checked) 13 E NewconstructionAdditii n ttlterallen re-placeirlent Bc;s-ice or teed X43 amps or more 0 8uildirig:trvm three stcrrttx. 0 Demolition 0 Other: Where the:available faalt cumin ®Marinas and boatyards, iC Al E0R i'.OP CONSIR IJ FI'(' - exceeds 10,000 amps at 150%flits or [3 filming buildings. I I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to mend,ar exceeds 14,000 0 Coaniiercia1-We agricultural amps for all other installations, buildings. 0 Molt!furtlily 0 Master builder 0 Other: 0 Fire pump. (3 Installation of 150 KVA or stem "'1O I 01 ATIO,1N1 A1M) LOCATION ,...7.", t<mergency system. larger separately derived ` A 1 ©Addition of new motor load of system. Job# Job site address/5Li u, 5w M i SCJ Ssi QQx C 10011P to more. 0 A E',"1-2" "1-3" Ct 'StateiZIP:Tigard,OR 97224 0 Six or mom residential units, Recreation. 1}> ©Health-care facilities. 13 Recreational vehicle parks. Suite/bldg./apt. 6. �n!@ r !? l_'I Fla r4,„ lrcations. Supply voltast for more than g.: pt. Project rtaltle: y11( j' fx ..1„,;,- L�jii�i ll' ��64.- ' 1.,' �l j Service or feeder 600 amps or snore, 6 offs nomtnal.m Cross streeta'directions to job site: C✓ : =FEE;$:00D. .lr ' "" . .. - .. Description 1 Qs,. 1 Each f, road 1', • New residential single-or multi-family dwelling unit Subdivision:Pi lioyon Q 'bl" 1 u+,.,, ;/t la Lot#:ez Includes attached garage. Tax map/parcel#; 1,000 sq.ft,or cess 168,54 4 ': " .:DiS II'TIOtM"EDF 9i O '_ Ea.add'1500 in,ft.or portion 33,92 1 y /l1oc V✓ n+ Q Limited enery,residential (with above sq.fl.) 75,00 2 Limited energy,multi-family 75.0o 2 <<3'>1{tlP1?Ptt"dl "y4E I C1imAl►l - residential(with above sq.ft) Name ADVL Land Holdings,LLC Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Address:7600 E Doubletree Ranch Road. 200 amps or less 100.70 City/State/ZIP;Scottsdale,AZ 85258 201 amps to 400 amps 133.56 2: Phone:(602)694-4031 Fax:( ) 401 amps to 600 amps 200.34 2 Email: . . Owner installation:This installation is being made on property that I own which is not 601 amps to 1,000 amps 301.04 2 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: i , Temporaryy services or feeders installation.alteration,and/or e ►. AI'P 7*Aly'':: , l];t's*4TA`t"f i'E7d5 111 ,- relocation 1 Business name:William Lyon Homes,Inc.. . 200 amps Or less 5936 1 . Contact name:Angela Grajewski 201 amps to 400 amps 125.08 2 Address:109 East 13th Street 401 amps to 599 amps 168,54 2 City/State/ZIP:Vancouver,WA 98660 Branch circuits-nem,•,alteration,or extension,per panel Phone:(360)695-7700 i Fax::(360)693-4442 A.:.Fee for branch circuits with above service or feeder fee, 7.42 2 Email:Angela.Grajewski®polygonhomes.corn each branch circuit B.Fee for branch circuits wr`r}m .1 r 1r(3.T'ii ei � _.;i, :.„ . service or feeder fee,first 5 . : 618 2 Business name:alanteda electric branch circuit Each add'/branch circuit. 7.42 ', 2 Address:3415 ne 44th . Miscellaneous(service or feeder nait-intluded) City/Stale/ZIP;ilinilt Rar'''f'jail..../4' yt, ,4 Z /4, 2./3 Each manufactured or modular. &7.84 ... 2 dwelling.service and/"or feeder Phone:(503)3192.192 I Fax:( ) Reconnect only .. -- ' , Email:solarpdx@me.com Pump or irrigation circle 67.84 ' 2 CCB Lie.: 199188 1 Electrical Lie,: c923 I Suprv.Lie.: y f7 l5 Signor outline lighting 67.84 Suprv.Electrician signature,required: Signal circuit(s)or limited-energyy Jparte}.alteration,or extension. Ser Page Print Vie' i/ /2017,‘.../(. Date: Each addif:nal inspection over allowable in any of the aboi'i Additional inspection(1 hr/ton) s 66,25/hr Authorized signature Print name: •f > r, ►.- Date`'- 23 /-2 lnvesitgatiozi(I hr min) 11 913011 hr . . UuSLfi ?} ,siuiC PssraitAyy Fra D&E.doc Roy 961.17P015 4404S13T01/D5/CQMAVEB . : , ... . : . Plumbing Permit Applituting- , ...: . . . .. . Building Fixtures 11n.71.41, ,e CPel*it-Wr/";2e)/6+.0 dOP :Date/Dyf , .,..., 13125 SW Halt Blyd,Tigardi OR 97223 #6W-1 ' Ig:: Phone::5017181439. Fax 503:59040'. '"-- ' '.- . • .blin...i3e7' Other Pormit'No.: .. ' . . Inspection Line: 503.639 75,41 "': '..:: .,''''-: . " ' ,' • TiGAFD Date Read/By: Anis. RI See Page 2 for 1 Internet www_tigard-orgov Notiflea/Metbed: Supplemental Information 1. .... T'• .''''Y'*FAP'''...<*- :iiiii-iiiii*oitii6- 4-4st-,:,1;':•,:;..•.::2'•:::71.•if.:;.:''.'.1:V?: •--,::,:P4,:-,,•,,q,',:,*.-:•:,' ::aiiiItiii;iiifilea,-3:;:-? ..•;,71,. .0 New cons•trnetion I 0 DeitiOlitiOn . For spechd informaYyn use glierklist • - • - • • pescrifitRyt 'Qty. 1 8a. I Total 0 Additionlalteration/replacement 0 Other:-.. - New I---2-,family dwellings(includes 100 ft for each;utility connection) . .. -. •:4.;:i.j.,A:,•. :,,T.,:*,:..:,......-.?i-,.,•i;:;:.E.::,..k,itoiLiiity.6**0,oforoo:05cit,.1%.: .1, .,,,,,.,.,.::•,:.:1:: •. FR(I)bath 31170 El.I-and 2.-family eh-veiling 1:1(eintpcitialiindtistrial SFR(2)bath 437.78 •-__. - :SFR(3)bath 500.32 0 AceeSsory building .. a M4.11i4luility: - - Each additional'bailf/kitchen. 1501 ' 0 Mastetbuilder 0Other:. - Fire sprinkler( . sq.ft) Page 2 ...- _ .''-..!'-,'14:••;•-'-:•:1::1::;:i. .k.t,.',:• -•:'10iiiiii'le*Ailiiiiklloiiiliaiiii:-,Liieileibii-70;''.•';•W ;-'''.-0-4 :-: Site knives: • . • _,,,,r,--,',•,:...:-,•-,-,:,, ,e :.. : " ,,..,.:-..c....,,,,, :.,...-" ',.' .:-' ':'-:.:' ' . ...,,.. • ,.. " • " Job site address" . Catch basin.or arta dram • . • ' i S q bi 3\1\1 t\ltiessk%1\?y )..-k- . - --- - 18,76. - DrvWell leach-line or trench drain ••• ,.. . . la76 1111111111 City/StateiZIP:.'11g,aid.OR 97224 ... _. Footing drain(no,linear 0:: ) Page 2 ,I • Suite/bldg./apt.no Project Ilanle:P°1Yg°0#Bull Mountain Manufactured home Militia 50.03 Crosseet/direetiona to job site: ' Manheles 111,76 . . Rain drain connector18.76 , . .. .... • " , -Sanitary sewer(no.linear ft; I Page.2 ,• • -- " • Sti:inn - - - -. • sewer(no.linearfl.:. ..,..) 1- Pace./ • . . „ .Water service(no,linear ft.; ) P I age2 ' . . Subdivision;Polygon at B011144Ountitio • -Lea.no.:82_ Fixture or itemi . . .. . Tux Inapt/parcel no.: Backflow preyenter, 31,27 - . . .. .. . '=I'T•7.-a'l:4t-1':'-:!:etiig.din':A:bli:6F-4bRik:::'' c.i3 ;-,A,, Backwater yalye 12-.51 .. 25.02 . • /9-AA Z ("-:-- .9-7-&-74. /-tg-.- L--7Z-X--' ..- Dishwasher 25.02!. . Drinkinn foninain 25_02 . . EjectorSiSurtm 25.02 1.,,,::-.t.,_,•;,.;:i.51.44,01,Aterl,504.,Ntit, :.,,,,,,,.,.;:::,:,,!..,„.5 ,s„.,, :.,„F:.[2,41-74:kst: ,:4,„-;,, „..._. Expansion tank1.2.."1 . ; ' . .Fixtureisewer cap >5,02 Name:Polygon 1;y141,LLC ., . ._ • Floor drain/floor sink/hub '. I 25.02 Address:::169 East 1;36 sfreetI. 7. " Garbage disposal , 25,02 1 city/StatelZlp:.Vatienuver,WA 9660 , ' Hose bib 25_02 . ... - ... . . .. . . .. Phone:(360695-710 Fax ( ) ke Maker 1/51 1 , 1-.177:1':• ..lik.1%tei,aktr. :tir.:-;-.....-:•14--%.:,7-4.'. a•Advilfc-vikokstiiii....,,,,-.4- Interceptor/grease trap 25,02 - . - Medical Ombra:$ ... - t Page.7. Business name:Piiiygnit WM-LLC . Mediegas - ------- ) .... Printer • 12.51 • I Contact name:Aogeln GrikiewAl .. ' goOf.drain.(CoMmerciaTh IZ5:1 Address:.109 East 13th Street. .Sinkkasinilayator,ii 25,02 . . City/State,,ZTP:-Vanconyerr,WA-98660 Solar ImitS;Ipotable watery 6154' Phone:(360)695-7700' fax ':-PO)69. -4442 „nib/shower/shower pan : -1151. E-mail:.AogeIn4rajewski@polygothonteskconUrinal .25,02.1 .. .. -,, :I.ater closet • ig--,4?:-,F041 . ZtWi:24..iii0iti--&-.6i-ti,. ., 3,.x...7,-t-__w.,:,Ar:J074 .„ . . ._ . . 25.02 . .. . .. :ae ..-r4..,,liti.:,..,, ,-(::(04-h:•:::. fAr., 14,,,.V.Iir,' " ...'‘.:;,,,,i'r.reitlt-:',:1,:,..• ,..,,,A,:,--,-,..,:,,Z.7- wAte.t.heater : 1 ...31.52 V.I.0 . Business name:BDL Pluniking"LLe. . . : . 56. 5,-:. ... . Water Address::PO But 85 • Other: 1 .25.02 ---. • . .. . . .. city/State/Z1P:corbett OR 97019. . _ St0totat • , • • Phone!(503)' 51,-..3903... Fax ( , ) . • . Minimumpermit fee; $72.50. .. . . . . . Plan rev h..-w- (2.5%of permit fee) , C.CB Lw-f 186115 Plumbing Lie:no P131582 • - - • :State surcharge(12%of permit.fee) . . • A011101'40 signature: ti 1TOTAL PERMIT FEE ,,Date iii/IL,II(ft 1 . Timis pqrmitapplication expires if a permit AO 0 ob(aitt ..wit4ip.1q8 days I Print name:.Braddon Canter '' .1 idler ithas..bgen accented ai 6miplefe. *pd methodology sit by Tri-County Budding Industry Sirs-ice Board. lAfkiiclingTermitATENILT,.PennitApp.doc 10/01/09. 440,4616T(10/021,C,QWWEB) - „ 41 II CITY OF TIGARD MASTER PERMIT III 2 4 �!� et COMMUNITY DEVELOPMENT Permit#: MST2016-00085 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2016 Parcel: 2S1080001504 Jurisdiction: Tigard Site address: 15407 SW MISSISSIPPI CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 82 Project Description: New SF. 8/4/2016: ADD sump pump for storm water. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1591 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 1836 sf Garage: 682 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3427 sf Value: $420,023.29 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 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Sump pump for storm water MECHANICAL Fuel Types Air Conditioning: N 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: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3427 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 Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE: PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $34,539.87 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: .0`.. �l-l/�”-2-..__-_ Permittee Signature: 41./(1 /me- /C1-77Cl// Call 503.639.4176 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. , 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 a Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov TO: Daly DATE RECEIVED: DEPT: BUILDING DIVISION a A ,4i t FROM: All Gra ,okj JUL 26 1016 COMPANY: _k I= r 5 POIOn tAiL H.rL ,C 3 < ,�,5g a � dSd�� ILD; x PHONE: G(1) --31 -a-iu �'� a� � i ;'y: By: RE: G 5407 5 vk) plc ss%sst t o LASTcP0(0 - oOO g (Site Address) (Permit Number) PO Vf\ 04 64( V Bar roject a or subdivision name and lot numb er) ATTACHED ARE THE FOLLOWING ITEMS: rt Additional set(s) of plans. Cross section(s) and details. Revisions: Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. V Other(explain): Add S ,� v q QA d aria ' REMARKS: vl/ � c&rn P Routed to Permit Technician: Date: Fees Due: es Initials: ❑No Fee Descri tion: Amount Due: t,—ei° /• l (/i $ CPS. , D ` d 3 . 0-6 Special 7- "L- $ Instructions: ,. .,F,D� Reprint Permit(per PE): 0 Yes I o Applicant Notified: ❑Done i9 G,&-.. Date: ,-//9-f 4.-- 7/ /jb Initials: . 4/ - I:\Building FormsgransmittalLetter-Revisions.doc 05/25/2012 `065P-V — _ CITY OF TIGARD MASTER PERMIT 11111. s • COMMUNITY DEVELOPMENT Permit#: MST2016-00085 Date Issued: 04/28/2016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 251080001504 Jurisdiction: Tigard Site address: 15407 SW MISSISSIPPI CT Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple Project: Polygon at Bull Mountain, Lot 82 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1591 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 1836 sf Garage: 682 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 3427 sf Value: $420,023.29 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 Rain0 Storm Sewer: 100 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: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Tvoes Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temu 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: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr. Occupancy Group: Square Feet: NEW SF VB R-3 3427 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 Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 PHONE PHONE: 360-695-7700 FAX: 360-693-4442 Total Fees: $34,421.85 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 OA 52-001-0090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: ( A //G/e1-77n,t/ Call 603.639.4176 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. Building Permit Application �- ��' '' RECEIVED FOR l E Received � City of Tigard 8 Date/By ,/9 /� , Permit No.�(' 9/1„-doors 11 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 2016 Plan Review /, �' `/�/ /� p' s , Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 4 jar i'6 abet Pte'��'1 a�260' i' A I , t,l Inspection Line: 503.639.4175 CITY OF TIGARD a ReadyBy: See Juris Internet: www.tigard-or.gov BUILDING DIVISION Notifed/Method: Supplemental Information s m... • : s ' 7 Ti mom..a '1 " 1''t°t ° k 9 4 $J>& 2 i4 r '`'?';'-iii:,-;- 8 ,':°:.,-,W,-;;;;,<:' ®New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the zr a t • a r •^6 work indicated on this application. 41 ■■ . Valuatio�• ® 1-and 2-family dwelling ❑Commercial/industrial S tta`LA , II ❑Accessory building 0 Multi-family Number of bedrooms: 4 Number of bathrooms: ❑Master builder 0 Other. `'a.s� j --.4,1-:- r E c;',“` 3 '�i E e s t .y Total number Of floors: 2 - 4 0 • _ Job site address: 1 5k-i„o I i f 1 NAZW,p 1, 0 New dwelling area: - 4 square feet City/State/ZIP:Tigard,OR 97224 M t SS I S S 1 P P i Garage/carport area: Lo .2 square feet Suite/bldg./apt.no.: I Project name: Pc\ ( 1jfl 01 �,)r\ �n Covered porch area: I square feet 13 Cross streetldirections to job site: J Deck area: lb�`` square feet S Other structure area: lri 2,0 4 square feet - • e ,,, 1' f .. tit e tI h ° sy r ,FF 1 Subdivision:Polygon at Bull Mountain I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the -".---1- --,-'' ,, - work indicated on this a..lication_ neW J 1�3 , . ,.1u t �,� 9 -., ' a. ...., Valuation: $ Existing building area: square feet New building area: square feet - r s r t `_ x.- Number of stories: Name:Polygon WLH,LLC Type of construction: Address:109 E 136 Street Occupancy groups: City/State/ZIP:Vancouver,CA 98660 Existing: Phone:(360)695.7700 Fax:(360)693.4442 New: -. _ Business name: pa l OL n C Structural plan review fee(or deposit): Contact name: a f y{, C7 01cC FLS plan review fee(if applicable): Address: I 0 Ct V54-h Total fees due upon application: City/State/ZIP: V air)0Cr W Pi C\' t tO 0 n Amount received Phone:e,4,0) t9 0,. . --4_1-00 I Fax::(��e) U Q3.U222, E-mail:maggie.gordon@polygonhomes.com -d �.. E. Commercial and residential prescriptive installation of z° �. 1 � : roof-top mounted Photovoltaic Solar Panel System. Business name: b 6r) I \n c Submit two(2)sets of roof plan with connection details �I ,� and fire department access,along with the 2010 Oregon Address: \0 a l3 - I Solar Installation Special Code checklist. City/State/ZIP: \J(1..0 COU\Cir A q SV/(.9 0 Permit Fee(includes plan review $180.00 ` _ , `� and administrative fees Phone:61,710) b Q5.lC) Fax:(50D) l0Q3 . i"t�L State surcharge(12%of permit fee): $21.60 1 ,,t�/CCB lic.:204238 Total fee due upon application: $201.60 vv' Authorized signature:- , f 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 Print name: Date- 1 —2,1 71.0 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) a EC 1:01t..Ut.1.1cE t_41j tD\Ll -: Mechanical Permit A'pplicafioRECEIVE�: twat14,°-H57;20/6 d5 , N.... city of`Tlgard 8=2U16 ived ., . 131.5 SIN iall131tid:;Tigard,Olt 9720 MAR : .Permit:: Phone 503.7182439: Fax. 563598 1960 _TM . Inspection Line. 503:639.4175 CITY OF TIGAR e domalli ? see YnEe toe i SupPiwgenlst Infotatiba "et x tvngard org°" BUILDING DIVISI• � - � s '' r - ' - .., r . z Mechanical perttfs*are based.on the value of he work- '' _ m Nei constructiono med_Indicate the value.(rounded to the nearest dollar)of all 0tgl Oche itmlattexatlanireplacemettt' anical materials,egttiprncot labor,.ovcttteacl.and profit. �]I}etnolthcln 0Uhler C f»:,--CAEEGDRV AF iCOOSi'R Ul i.. .. �7'Tf - �k .... n� _ .�.._. , RFSID Qom .• �ISYSFEMS FEES" ; For ipcdat ixformoliox use.clircklisL (8 1. ;gild 2:fntnily dwelling 0 Corptnercia}liitdustrial 0 Accessoty blinding Q I I Total Multi-fau►il • []lvlaster builder 0 Other Descnp5°° I 1 Air txaid a ling :- � l 4W4—:014*. *0-03911: -_ onus � �� t)8 51T1v,` _ ._.. . . i46.75 Job-site addresr , V't Cia,l�� 1 , I )1/!'✓. t l../V furnace 001160 WU(du cnts) I 1 46.75 lank=100.660+:3T11 Otsasecnts) ( 54:91 GZZu • alt/* -rl Srd OR p Heat pmssp 61.06 5iiiteibliig.laf t.•ilo. l Projeat.naine: pp`�J� C gni\\ m Duct work 2332 J HYdrmnc hot wales system 2332 4os5 SttCe!/dtreCtioas io.)ob site: idcntia1 boiiler(radiator or • hvdrot+ie) 2332 Untthtarax( 10.: 14.,1194 0e9triC), ill tvSll:7QiluCt,.susPfnded-etc. 46.75 . Flue(veitfforarfyof. above 2.332. `Other- .. 2332 /'� Lo no.: 7) Sttbd.., .._ : .. Qtker fuel Appiban Taz-m-ap,lQclu�o.� .r. - VsIrr 1eafer iv2tcrargas 2332 ..-. g3Y 11FCRx'3 04f1i5PSG : fr � i .Sert: 3339 futiplacc I 23.32 yog ii WrIt> ) 23.32 ... Wood/prlc t stove' 33.39 ooil;SrePlaca�ttiser , thiiiiiie•lineefliWvent ?3 32 • .', � :�$5 €3V ER 1. . . ,..... '-,.I3 1:_ ntiicatal cal gust and venblaiiott: 23.32 Flange hnodlather 3dtchen Nsme l�tilygon Narthwes# mi e 1 3339 Address; It/9 E Sik St Ciotbesdtyer;rxriaust 1 3339 • . ._..__ ._..._.. . $tngle+dtlat r_tihamst _ • it} FLIP *1 er, A 98661 ,toilet compatfatads.:uttlitg.rotims) • 4 2332. (360)$6 780b Fsx ) sea tans 2332 y .wt,r ..' 2332 -Fuel PTI0:: $mss aa*nr E©tygoa NorthwestSid-lS far first four.S4.03 for.each additional B niaoe:etc: :1 C4xitact'ntuna: . __.: Gasaitatpitmp.. Addr;ess;.109 E 13°1 St _ vtfallisospende3hiitit heater _ VVater'Ficater t•Alit. tabrJ7.IP•.irsn_conver,.WA:98661 ::::PI 1 ott (360)816.7800 fax ;( ) - ._. . .. 1 iiitibecisc :11itthiess iiirai indersen'Hcatiu8,IncY..�._. Ai�II�'— "::. �'-�- _... Sabtotsl 16,2$5 SW:83t°AvC.Stt 410 ... .. . NSmimtitn•prxrnit fee(590.06) C1[}fSt cJZIP I"tgaiy1,131t:47324 Plan review(25%of:pemil fee): Phone x(503)9924 , Fate(503)536-6615, :State.ilitcharge(12%of Permit fix). TOTAL P>: IIT.FEE. GC$1ic s 16._ . Thd permit aPplirabon ecplm'1f a permit isnot obtained*Ohba ISO days alter it T;a lacca setepietl as rna,Plete. *: l=ee methodology set by Tri-County Building Industry Serie Board Autftortzed sign/tare: -m_: PrintnariiC ArtAliderkeri I Date:11)20/2015 I ..-P- F-'0401 t �USEGIi.doc 4404i7r{t irco osirwEB) cnmthp A • Electrical Permit Applicati :()R OFFICE USE ONES City of Tigard ° 1 INECEIVED Received Permit No/1572_61/6'''',000 efts- ....__ 13125 SW Ilall Blvd..Tigard,OR 97223 Ph 8 2016 Datediy: Plan Review ,. Phone' 503.718.2439 Fax: 503.598.1960P/IAR Datemy: ()alter Perin'' ..\ Inspection Line: 503.639.4175 Date Ready/By: Jobs 12) See Page 2 fur I 1(. Pl) Internet: www titlard-or.e.ov CITY OF TIGARD Notified/Method: Supplemental Information ISIG DIVISION.• .- •.- ......, , . .,,,,,., ,, , 1,_..,,, .,„_,.._ ,,,,,,,,,,,,,, :;.77.41WSP-Ir"174-7.ilTis-UT17.1 -:S7;411';'-it lItilatAktrn , 1, ,..• :,:-.::::,.,........:. •::' :'•!---". ,,,='. ••:'-:!•=.!,„' =•', ,...,=••:•:-.;;."-..•-•=tPLAISI,A6V1E,Y,.k='ff-,• ,—- .-' ''' •••:' 1 New construction 0 Addition/alteration/replacement vm icasc check all that apply(subunit 2 sets of plans w,ites checked below) 0 Service or feeder 400 amps or more 0 Madding user three stories 0 Demolition 0 Other: ..'here the available knelt current 0 Marinas:Old boats rut , H.KiA*-,Zra:::•,..'t CATEGORY OF tom-tit:6610 .. • . •• . ,.... . •-.-•::., : excec(Is 10.000 amps at 150 s.olts or 0 Floating binlilings less to ground.or exceeds 14.000 0 Commercial-use agricultural Eg I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all(ulna installations buildings 0 Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 75 KVA or ,i,,,,;,,.. • • - r r I ; 0 Emel gene),system. larger sepaialel (lensed ssstem ':.7.,:.;' 41;7:70 : #iiit:::Alit-g?,*4..1:*. Tikk:'4,0,04111::fl,:` ..-'. •' . - :..: 0 Addition of new molar lint('of e-_--, Th 10011P or 1110FC occupancy Job no.: Job site address: 1 5.4Gq- z.-_,...., mntovApp 1 0 Six or mitre residential units 0 Recreational t chicle!talks City/State/ZIP: -'9C ( oR q-az1.....\ 0 Health-cal e l'acilitics 0 Supply xollage for nun e dein 0 I lazardous locations 600 t"Its nominal Suitc/bIdg./apt. no.: Project name:y„4.1_50-„, 0..A--- 2,,,\ ry-q-n p Service or feeder 600;mps or inure 1,',:."...,7'.7t, i 7,.::.': ;'`,-7.' ..: :.--*PCSMEintit.',,,--,.;., 7 •I .•',-• '. ' Cross street/directions to job siie: Description I Qty. 1 Fee. I Total 1 • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 5-2, ,1.000 sq ft.or less f 168 54 4 Ea.addl 500 sq.II or portion 6 33 92 1 Tax map/parcel no.: limited energy.residential-'-'.''ORkT,,,•••,, ,4W4A-4?1, 45,6t:;§0,iff,tof4:145)k*trlie;."!!,7 ' '.:.'• •..-• ':' 7' :''''.- (with above sq.It) 1 75 7 00 _ Limited energy.multi-family 75 00 2 i New electrical service and wiring - residential(with above sq 11) Services or feeders installation,alteration,and/or relocation 200 amps or less 100 7(1 7 _ ,-:•,,,....:;,, ,:iiei:AtfiszjitiiiiiliA.Tye.pvi44.41u;:_-:;:;,._,„:,:, ...,-,..,,,,,,,.,.,:.zr.,-.4.1341ENAAT....::.„i. ,,,..„...:..,::,-;„;,,.. 201 amps to 400 amps 133 56 5 _ 401 amps to 600 amps 200.34 1 _ Name: PO4/ .71r-N. 601 amps to 1,000 amps 301 0 ,4 _ Address: k 00% o1/4 _r\ 54- 0.r,.000 amps or volts 551 26 , _ City/State/ZIP: \,)0„110,ecLyer \-0 o Temporary services or feeders installatio .alteration,and/or tpc vi-3,..,,Ac) nrelocation 1 I Phone:ti1)) tg Ct5----45.415D Fax: 4D ) U2(15,qui1/442_, 200 amps or less 59 36 • t 400 15 C/ , 1 Owner installation: This installation is being made on property that I own which is not 201 amps o amps 2 8 i 1 _ 11 I intended for sale, lease,rent,or exchange.accordine to ORS 447,449. 670.and 701. 401 amps to 599 amps 68 54 Branch circuits-new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits with above service or feeder fee. ,...,±4-Ai2,4-g" .74:014,-.. #14,7*r.,tfz:,' ?)",,is,q•••J.,.-,f.'.::,.:''' ,,,i'...!:tilboOl:AF:r:',i.1140,01.1:;,:r?• F,',.,,,.... . 742 , each branch circuit Business name: NT-1 ip 13. Fee for branch circuits without service or feeder lee.first 56 18 7 Contact name: rn • t/ li V EIJI branch circuit Each add.1 branch circuit 7 42 Address: s 0 --, I Miscellaneous(service or feeder not included) City/State/ZIP: an Cou • ' LA-) '11" f 2 'le 6 Each manufactured or modular dwelling.service and./or feeder 1 67 84 1 , Phone:( ) Fax: :( ) Reconnect only 67 84 1 , - - E-m . M,:.;!--....a':•.;.8-,.. S91; • ... lO?.., ' •' ' .c0 Pump oor rourtrliignaetiloignhctiinrcgle 67 84 ' _, , . t„ t .. P! ..-TRACT •.- ; ., ,: ',, s • .'.. .' - •.:- .' Signal circuit(s)or limited-energy Business name: Simply Electric panel.alteration.or extension l'age 2 ',I . v. 2 Each additional inspection over alloahle in any of the above Address: PO Box 822408 Additional inspection(1 hr min) 66 25/hr Investigation(I hr min) 66 25/hr City/slate/ZIP:Vancouver,WA.98682 Industrial plant(1 hr min) 75 I XI hr l'hone:(503)849-8202 Fax:(360)314-4945 Inspections for which no fee is 90 00/I - specifically listed(',/:hr min) CCB Lie.: 204615 Electrical I,ic.: , 067 Suprv. Lie.: 4394S ".'--:‘ •' •':-.4.=:•-;tLECTRitt'A.E.-PEItliltriFEES ' i ,--, subtotal Suprv. Electrician signature. required: (.....A..(414...., f-.5 plan revie‘k (25%of permit fee) Print name: Victor Zarzhitsky Date: 11117/2015 State surcharge(12%of permit Ice) TOTAL PERMIT FIT. Authorized signature: This permit application expires if a permit is not obtained within IMO days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per pet mit I Butldtrtg+Pecrn04\ISI.C-Pcrtn ii App Elm 07,01;10 -140,41,151.111,,WCONliWEli • Plumbing Permit Applicatio Building Fixtures DECEIVED FOR OFFICE 1 SE O\Ll City of Tigard MAR 8 2016 ei PmnitNo.: 'Y'��/FJ WOES > Y 13125 SW Hall Blvd.,Tigard,OR 97723 Plan Review _arOther Permit No.: Phone: 503.7182439 Fare: 503.5934Q� InnLine: 503.639.4175 k/VEYOF TIGARD ) . a"' BY 0 See Page 2 for 1" s Irternetwww bt r -0g ` BUILDING D VIS10 NethodSlemental'"Information _ ,r- r.--— . ,,..-c ,„: ` grt” ` =' • t � Z #1 .�_..,r-,--..-*-io. -` �"`����� '=-'� FJ- _-`.. �r ,, ,,,-. _ ; � � For tial in information use checklist rt New construction 0 Demolition Deception j Qty. I Ea. i Total ❑Addition/alteration/replacement ❑Other New 1-2-family dwellings(includes 100 R for each utility connection) 312.70 ,,:-� -�- i f=_:-_, �- -� SFR(1)bath aY ----- -,---•‘-----,-.�„a�-ir )_ n . q 3 1 ' P,!- :.�-- Sts.: r,;_ r , �-.�: Hr .ate' �.:a ._ SFR(2)bath 437.78 �[1-erne 2-fffini1Y dwelling 0 Commercial/industrial SFR(3)bath 1 50032 5�t3'L ❑Accessory building • ❑Multi-family Each additional bath/kitchen 25.02 • ❑Master builder 0 Other. Fire sprinkler(-_sq.ft) . Page 2 - '" 'r' -z a i. tltis: 1 � t- ' } 1ieutii azlitIc-ii.: -, - 1- ! --+_. -\)-. .---7-- ( ma Ca jai basin or arca drain 18.76 - Job site address: I 1/4-k 05 ���� Drywell,leach tiny or trench drain 18.76 City/StatelZlP: ��r� [�, `_ G 1 Footing drain(no.linear R:___) Page 2 Suite/bldgJapt.no.: I Project name: \ D\\,9 C CJN)\ I Manufactured home utilities 50.03 l J Manholes 18.76 Cross street/directions to job site: 18.76 Rain drain connector Sanitary sewer(no.linear ft.:_ j Page 2 • Storm sewer(no.linear ft.: Page 2 • n Water service(no.linear ft: Page 2 Subdivision: I Lot no.:$2_ Future or item: Backflow preventer 1 3127 2)` '(. l- Tax map/parcel no _ • , Backwater valve ( 1281 2.ej ti -•=•-.--..;.; r Y Y• r _ •• �' � '=_ �F`r -.:. y_.- •,,,,,•-=-..1.•,•-- --,!2--_- Clothes washer I 25.02 a5,0Z � - Dishwasher 1 25112c9a0 2 V/ t , S �X�/}s `b� 114-4-14?Vt-,5-- Drinking fountain 25.02 r (/l/t! Ejectors/sump 25.02 �,r, ti. -a r "L Expansion tank 12-51 _ >._ ° r - -` Fixture/sewer cap 25.02 Name: P011,05-n Floor drain/floor sink/hub 25.02 H - G, 2 .02 Address: C � � 5 1-'t ' `J-� ` `�► /� Garbage disposal � 5 25,dL City/StateZIP: C�..n e D 1�C )Q( k + q Wit Hose bib 1 25.02 7 Cj,011. Phone: y,►r i,C1 +•-O Fax ( ...) Jr-,y . - `Ice maker. I 12.5 1 2-c5, ..r ......4)L,-,.4., '' Interceptor/grease eese . a -i _e .,r. , _, 25.02 Business nth 3� _ ki jim,bivis (,J. _Medical gas(Vele:S PagePunt 12.51 _ Contact.name kerzylaon (Wel tit Roof drain(commercial) 12.51 Address `i).Qsink/basitt/laveRory 25.02CityCity/State/ZIP: v 76) 1 Solar units(potable water) 62.54 QQ2Tub/sbower/showcr pan a 12.51 Z5-O Phtxte:���.w22 ) � ✓-1(�d Fax :( ) —_ E-mail: 25.02 0-) ci W1tW closet 25.02 g."'---..z.:,.;--'-.--:..-. 1 _ .z.-.7:,,,„-, }, : -' =� �A/ _ _- Water heat= 1 37.52 ?) T•� Business name: � -s Water piping/DW V • 5629 r'� Other:Other: 25.02 f: n Subtotal Address: ` City/State/ZIP: fa J OK. Ci/6E' Minimum permit fee: 572.50l Phone:) . —.3903 d3 Fax ( ) Plan review (25%of permit fee) CCB L.io.: L r Q /�3/ (,�' Plumbing Lie.> 1582_ State surcharge(12%of permit fee) Gam "T TOTAL PERMIT FEE Authorized sigaatra� _ __ This permit application expire'I a permit is not obtained withinithie 180 days - Print name:, r' ��:_- ( i ] Dec: ` / /51 This it has been accepted as complete. •Feee methodology set by Tri-County Building Industry Service Board f:lauidinecmedPiMU-PcnnitAPP-dot 10/01/09 440-4616T(futl2 OMJVFB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Residential Building Permit #: //S 7',20/ °e-5-- Site enSite Address: 15407 Ski MisJ;ss ;pp; C4 • Project Name: Po u„ a-f- 13 uJ ( M o u .,4-a; Lot #: ea 0 a (New dwelling=subdivision name;,Addition or.alteration=last name of owner) Planning Review Proposal: ►\ w) CF6Z Verify site address/suite# exists and active in permit system. N/ rl v c�e S i/1,1 h re u in►.-ie,_,4__s- Et 4_S Et River Terrace Neighborhood: El No Yes,Le ,_444640=c1.4 -ldcle4ar asl}.4 Site Plan Elements: three (3) copies of site plan /t Existing structures on site I'Site plan must 12e on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure (including decks)with finished [RlDrawn to scale (standard architect or engineer scale) floor elevations ®North arrow . Utility locations(required for new,may apply for additions) L Site address,project or subdivision name and lot number gtocation of wells/septic systems Eff.Applicant information (name and phone number) )'Erosion control(including drainage-way protection,silt fence L Lot dimensions and building setback dimensions design,location of catch basin,etc.) tot area,building coverage area,percentage of coverage and .kStreet names impervious area (applicable if R-7,R-12,R-25&R-40) (Street tree size,type and location 5Property corner elevations (2 foot contour lines if more than Existing trees to be retained with drip line,and tree •• 4 foot differential) protection measures 'Clean Water S rvices—Service Provider Letter (lot platted prior to 9/10/1995): Required: 'es,applicant was notified L.No Received: ❑ Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: Yes,applicant was notified ❑ No Applied For: K-Yes ❑ No,stop intake Lel Land Use Case #: Su-0 R 0 15 - p 00 0 2A Zoning: R-4 • S ®' Setbacks: Front a p Rear (E Side 5' Street Side I S Garage a v P3:1 Landscape Requirement: OD 3 0 % Lot Coverage Maximum:ell 70 0 Building Height: Maximum Height 30 Actual Height 30 21 Visual Clearance gl Easements ;ZI, Sensitive Lands: ❑ Yes g No Type gi Urban Forestry Plan ❑ Conditions "Met"prior to issuance of building permit Notes: RUA"— Cor'18;-1-o?NS pr;oc +0 b (dingy �r M;� 1S . Approved By Planning: C kue- a . u Date: .= q - /!o Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:A Building\Forms\BldgPennitRvw_RES_012I 16.docx Building Permit Submittal Original Submittal Date: 3/6//k Site Plans: # 3 Building Plans: # Building Permit#: e--Enter building permit#above. Workflow Routing: g--Planning Engineering hermit Coordinator I - uilding Workflow Sign-off: Ci---Si -off for Planning(include notes from planningreview) Route Application Documents: a-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: 3/0 ::, EnOeering Review ®/Slope at building pad: 5-7,,, 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: ❑ Yes No Assess Water Quantity Fee in-lieu: E Yes ❑ No LIDA Facility on lot: E Yes No ❑ NOT Approved by Engineering: Date: Notes: Condition remain unmet that are required prior to issuance of bldg. permits. Approved by Engineering: 42 V Date: .7-/j—/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ 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: 3//-j//Iii Notes: &-"e- 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: ` DC Fees Entered: Wash Co Trans Dev Tax: WVes ❑ N/A Tigard Trans SDC: ` 'Yes ❑ N/A Parks SDC: 'es ❑ N/A OK to Issue Permit ✓ Approved by Permit Coordinator: /" '�ate: -1/2/0 1:ABuilding\Fonns\BIdgPennitRvw_RES_012116.docx 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 IIII • � " Transmittal Letter T l G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Tom H. DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVEP FROM: Angela Grajewski AUG 2016 COMPANY: Polygon Northwest '� �� PHONE: 971-212-2144ILiii� r-�' BY: RE: �V/`�"� . Site Address)? Ski (s4,iis t�7. lo( Cf MST20 l(p-000 s (Permit Number) Polygon at Bull Mountain '3'1� (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: .4 t tat0 4: w x `i es to' oil / : � „ ; i' 0 Additional set(s) of plans. 3 Revisions: add garage man door 0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis. 0 Floor/roof framing. 0 Basement and retaining walls. 0 Beam calculations. 0 Engineer's calculations. 0 Other(explain): REMARKS: . - e e : a o i • • .-- .ea ,•..-. e '443,uwil*-1Ariv,;-.-”.t'l" k ' ' ' Routed to Permit Technician: Date: m, � ' Fees Due: Yes � _ i;!..,,w;; .,.x ..,:, �- l Initials: ❑No Fee Description: Amount Due: 4 $ Xx .X XX XX 44 Special $ Instructions: Reprint Permit(per PE): ( Yes No ` ❑ Done Applicant Notified: . iC-- Date: d/y/' ,it._- „IvyInitials: eak, I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: FA I L Comments: Tel: 503.718.2439 Inspection Date: Record ID: MST2016-00085 Inspector: David Young Fix loose breaker in panel for master bath and great room. Seal all penetrations around outlets greater than 3 mm. 314.21 Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: FA I L Comments: Provide address on site for inspections. R319.1 Fix hanging recessed fixtures upper level hall. Outlet between master sinks not made up. Work not complete, not ready for inspection. Violation Summary: Tel: 503.718.2439 Inspection Date: December 21, 2016 at 9:18:41 AM Record ID: MST2016-00085 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 399 Plumbing final Result: FA I L Comments: Tel: 503.718.2439 Inspection Date: December 22, 2016 at 11:03:00 AM Record ID: MST2016-00085 Inspector: David Young Corrections from previous failed inspection not done. Master tub not caulked. Riser left side of garage not cut to grade. Inspections to be scheduled when work is complete, re inspect fee to be applied if corrections not complete at next inspection. Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 699 Mechanical final Result: FA I L Comments: Tel: 503.718.2439 Inspection Date: December 22, 2016 at 11:29:22 AM Record ID: MST2016-00085 Inspector: David Young Seal penetrations in mechanical closet in garage. Ceiling insulation falls when door opens. R703 Note: no AC installed at this time. Violation Summary: Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 699 Mechanical final Result: PASS Comments: Correction complete. Note: no AC installed at this time. Violation Summary: Tel: 503.718.2439 Inspection Date: December 23, 2016 at 11:11:52 AM Record ID: MST2016-00085 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 399 Plumbing final Result: PASS Comments: Corrections complete Violation Summary: Tel: 503.718.2439 Inspection Date: December 23, 2016 at 11:16:12 AM Record ID: MST2016-00085 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: PASS Comments: Corrections complete. Inspection scheduled on site for contractor. Violation Summary: Tel: 503.718.2439 Inspection Date: December 23, 2016 at 11:20:14 AM Record ID: MST2016-00085 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15407 SW MISSISSIPPI CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 299 Final inspection Result: PASS -CofO Comments: Final erosion control approved. Street tree certification received. Moisture content form received. Vapor barrier form received. High efficiency lighting form received. Duct seal test report received. Insulation certification checked. C of O left on site with contractor. Violation Summary: Tel: 503.718.2439 Inspection Date: December 23, 2016 at 11:24:56 AM Record ID: MST2016-00085 Inspector: David Young Inspector Contractor