Permit (93) CITY OF TIGARD .gyp; "1I MASTER PERMIT
�� �
COMMUNITY DEVELOPMENT , /�` Permit#: MST2016-00069
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Date Issued: 04/28/2016
Parcel: 2S1080001504
Jurisdiction: Tigard
Site address: 15361 SW SEINE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 57
Project Description: New SF. 6/14/2016: REPRINT permit to reduce bathrooms from 4 to 3. 10/21/2016:Add NC
and 2nd water heater.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1566 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 2144 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Yes
Total: 3710 sf Value: $455,330.76 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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 2 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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
Fum<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: 7 201-400 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 3710
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: $35,378.85
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thr4.•h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued I AlIAteir'-jam Permittee Signature: &'V -7�t.:-/(-y' %7C.1kJ
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Meelta.nerinitA_EalrigiL_i. CEIV
'City of Tigard a ltaa p 1: txs in r c l'
INf��.....,-*:-13mSV Ilan Blvd.,.ILgnrd,Ott a7 3 SEP 2 0 2016
=w �. fD�� / �11T�c� --411 &�r
• hone: 50331$/439 F . 503.598.15260_ *Mei Perraft.,
f G A R D ::.7nspec 503.639A 175
CITY OF TIGAR(
Date a� taa:. i�v Page 2rar
lnat rrat. ww .fir x!- €. av3UIL BUILDING DIVISION dr"ec ?.''1'."d:
Supplemental.Intnrtnatic n
TAPE OF WoRli C'ONEMERrML FES"SCR DULE ilSECHECKLIST••
Mechanical permit fears"are based on the value oldie work
14 Ne‘s eraiiStrite ort . 0 Additio ter tiimir gineemeritr bmwd,indicate the v due{founded to;he nosiestdollar)of all
0 Dttinolititan 0 Other tncelamical materials,tyu pmeut,labor"overhead.and prc t"tf,:
CATEGORY OF COaNSValue:
TIfCCTIO� '.
12 SIDEd�1EALEQUIP31E 1'!SiSTE ISF1Esa-
0 1-and 2-fandly dwelling fl Cf#t Met iallirdtistrial 0 At gty buildina Forspechulinformation useeher4li3x
El lith.-family 0 Master builder 0 Other I Description Qty. Fa,
'fetal
. " 1 la fcoolint a
f C I,, C p, •
Air aid nalnu 1 46,75 1
Job site address: } 3(p) 5 w l/� _ Furnace I00.000 B 3alitettr"vesits)
1
City/Stahl:Tigard,OR 97224 Furnace 100,000+BTU idoet outu .91
Heat pump ._... . 6i.t)ti
Suitet`b1dg apt.no.: J 1'rojeat name 'Polygon at 13u111lraunta oDuct work 2332 i
Crass stretUdireetions to job site; 1-1ydranic hot:wafer systeirt 2312
Residential boiler<radiatoror
liidrainic} 2.3,32
--
Unit heaters track:foe,aacttdectric),
in-wail,in-dai1,suspended. . 4t:.:=5
Fluezvent fbr atri=or shove ( 2332
Subdivision::Polygon at Ball lllotintalrr Lot no,: c t1b 2I l
()Thor fuel oliatat c
Tax ninpipitrcel no.; Water heater a 23 32
DESCRIPTION OF's%ORK {ins Frye =`in 33,39 9 . �,.
C{ (. Flue vent.for writerh ter or. as
U n 1 I t, =lace 23.32 1
/', •l log lir aa1 23.:32
("t ood/ t atat .. 3139 I
i1
_WOW lirelataa t`t tY 2332
aanevnirt trz�ert 23.s
-
• Other 2.332
to PRO14:41T t144,1441tit: 1 TENANT 1
Ffn-1 orameutalexhaustandventilation
MOM:Polygon WEB,.,.LEC ; , Ronne hood other kitchen
equipment 33,39
_Address;l East 13treat ClathesiFerexha t
33..x9 1
City talc JP:Vataenuver, VA 98660 1 Single-duct ict liattt!(bathrooms;
toilet cotaap�a ntr,tatalidy rooms) 2332 1
Phone:(360)69$-7700 I Roc( 1 Attic/crawly 'cc fans 2332
—
APi'LICAT
_. Ci CoTAC7I F~JFrlt 'aa
Business name:Polygon aL11,.1,1..1 ly artl Pitain x ,.
$143$for Rot four;54.03 for each Oiiiti6nat ....
Contact nano:Angela ela r ewskr Farrah,eta. 1
Address:109 Fast 13th Street Baas heal pump
Wailtsus,ended/Milt beater
City/ "t IP:Vancouver,WA 98660 iYntxn hooter, t
Phone:(360)695-7700 Fax: (360)693-4442: rorniane
., ,c lir
named;Ant Gla. :rajorskl pniygonhomies eem Buitimue
CO TT1t TC)R
13tasiness name:Apes Air EEC Other:
MECHANICAL PERMIT FEE -'
tidress'I$OI.M NE f''Avg-
CityiState 1P:Vancouver,WA 98686Minimum patrarnt f (MOM 1
Plana me(25%of*mit fee) 1
Phone:(360)34 11)9 I Fax:(36.1)3264761rte satrzda z tI u of penult
CCI3 tic 203031 TOWPERMITPEAMIT FEE
Authorized signature: .
,. Dale:
,le
IhI sresdr2p
d€ treTlspi Cubsarcpnt ;.anUr;thpfaSnn
vr ahn t
,
'"`ek¢ Priat Mite:
t:'ag r r s ss .,;, .ir_R 1'thtimp t t:cta:; 44046r:1'g.i i.,4n4;?..Ik.fAkil”
pttricatfi-ernitt Appliciatvne-, --4---,r-...1%. ,F,-:::r°1 I "( ()I I R 1 1 ,1 ()NIA
City of TigardRecetuI
IIII
,, Duttilny
nk" ':1—"I' 4- e'-' _a ‘,•00$12
13125 S%) 'Han Blvd.Tigard,OR 97223 Q F p 1 t.., ZO 10 p.R.,.,...
Phone 503.718.2439 Fax: 503.598.1960 '-'-' - ' DittoBv ita4ed Psnsn 1
Inspection Law 503.639A 175 ,,.. ...„, ,,,,,w, 1-4::,,:,\.P,,,;,:'! Ready DidoeBy 0'...
Interact xn**-Idgliril-01 gns k.J 1 i 1 L'' ".„ '.-,:': --..;,-.‘r t Notified/Mahod
1 „•::::'::::1.,:'-?:2.7i...31'1;V:','..'!. ::::4'2,4..r.--. .5,...„.„.„
New construction ii Addition/alteration/replacement Pe4,
leas_ cecn ail Os*milds tit 8 sea°futons wlumis obeebedY
U Service or feeder 400 amps or more 013w,i-, ova free norms
0 Demolition 0 Other where the available fault current 0 Mamas mid hamlet*
k ' 1::;7:4".:v-7:'....?....:-1.1.7,.' ”" -,• .7.::"*I'-':', :77.;02:-7•Y'l:IF,::77.enalegitattar.alt exceeds 10,000 amps at 150 volts or 0 mining buildings
1-and 2-family dwelling 0 Commerciallindustrial 0 Accessory building less to ground,or excernk 14,000 0 Commercial-ism wet/band
amps for all other installations buildings
0 Multi-family 0 Master builder 0 Other: 0 Fire pimp 0 Installition of 150 KVA or
•'''':i:, :.:25.15Ater:'77.' .,_.' ''...,:....z,.i2,:-'''',-:',,..-.,,L'TZ.I.'14..f":,;',?'zli.'1"71211?.10-14.'4740,,Llig 8 Fzeirt.ncyofsro::ofor load of system
ck7wed
Job 4: Job site address: 15•2)10k ¶J )salr\e, be.... o
100HP Or more. 0"A"."P',1-2","1-3",
0 Six Of more residential units oocuPanc7
City/State/ZIP:Tigard,OR 97224
0 tonal vehicle perks
014ealth-care facilities.
Suiteibldgdapt 4: Project name:Polygon at 1441017r biAAI 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more 600 volts amount
Cross street/directions to job site:
"Nbil YklafeTIAP-7,iii127';`.'77'':1,:.,..i:75;Rstsikoge
Destription Qtv. Each Tend • ,
New residential single-or multi-family dwelling unit.
Subdivision: Polygon at Wiest"e p,(Ai( 0\47, 1 Lot 4: SI Includes attached garage.
1,000 sq.ft or less 168.54 4
Tax map/parcel 4:
-. ./ .7 ;t7„,/,17:.....:,7 ''. ',''.:..Z2"2:'7',!.,:' . .-:..'t'L. c5. ,';',*.;,L,ii4.4(,;r:2;:: ,1';..,::1'[.:5:71 i.47..11'.:;:',V,,..li': Ea.ald'l 500 sqft or portion 3392 1
eon , c dr &frpico, Limited energy,residential
(with above sq.ft.) .
75.00
2
Limited energy,multi-family
75.00 2
Name:ADVL Land Holdin. LLC &Mit As Renewable Energy 0 See Page 2
Services or feeders installation,aIteration,and/or relocation
Address:7600 E 0 .uble Ranch Road APPLICAKYI nu amps or less 100.70 2
City/State/ZIP:Sco .i e,AZ 85258
201 amps to 400 amps 133.56 2
Phone:(602)69.-4031 Fax:( )
Email: 401 anms to 600 amps 200,34 2
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 sale,lease,rent,or exchange,according to ORS 447,449,670,and 701,
Over 1,000 amps or volts 55226 2
Owner signature: Date:
.!::: 47--;..T.7,-;;44,;;:;::.a03.. Temporary services or feeders installation,alteration,and/or
.34- relocation
Business name:WithaurbrosrHettnese4se, -1: esi nOn (dt.. ...+1 t Ur.. 200 amps or less 59 36 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-new,alteration,or extension,per panel
Phone:(360)695-7700 Fax: :(360)693-4442 A Fee for branch circuits with
- above service or feeder fee,
7.42 2
Email:Angela.Grajewski@polygonhomes.com each branch circuit
5618B Fee for branch circuits wit/sow
2
branch circuit
Business name:Warned*electric
Each addl branch circuit 742 2
Address:3415 ne 44th
Miscellaneous(service or feeder not included)
City/State/VP: Rory,'javve/4,,9/2. /4" 2'4.7- /3 Each manufactured or modular 6784 2
dwelling,service andror feeder
Phone:(503)3192192 Fax:( )
Reconnect only 67 84 2
Email:solarpdx@me.com _
Pump or irrigation circle 67 84 2
CCB Lie.: 199188 Electrical Lie,: c923 Suprv.Lic,: 1/f 7/,5 ,
sign or outline lighting 67 84 2
Sum.Electrician signature,required:
i./ panel,alteration,o„cliemZendslnergY 0 See Page 2 2
Print name: t i ic 2,40pe.."(
Date: ...C.:A-?/" Each*additional inspection over all able in any of the above-
Additional inspection(1 hr tom) 66 25hr
Authorized signatip.u.vm,
Print name: Dat5-1/
2,3/14 investigati°n(1 hr min) 90 00;hr
I
i 4keildioglPennittiliik_ ,ELR_ERE doc Rev 0611 MO 15 4404615R i 1109CONVWEB
Plumbing PermitApplieutinn
---,r,tj ,r_:,, •,„, :-.... ,::.
Building Fixtures. FOR OFFICE USE ONIA
.4 bin SW Hall:131yd_Tigard OR 97223 LI'. I- ° (-u'u ' ate/13Y'Plan:Review Penalt Nvi1se,,;20/6...._°0 DR
Phone 5017.15243.9.: Fax 563,59f,), R., „,.--,:,:„ ,,, •'..,::::' , Other PnnifIsla..:
inspeotim1:.),t::
Line: 503.639.4175 -., . 1 --,- •.'--- , ' • ,"• '- ' ',- Ready/By-
T I G A R D , • w .„ hiri>, 0 gee Page 2 for
Internet ww.tigara-or.gov. --- -•- " - NotificaA4,,thods Supplemental Information .
VO**.VPki:.:40:':.-:* 0SA::cOPP4::,- - -,F,:.:'i•--,....::' .;.V...-',...-7''• :
.111:140.*construction
•
0 Acld4i.onl4tei.ation/r.dplacernent .. I
i 0 Doininitinn
0,O1Nr.:;. - • • Forel
For speciatinformatipy use OeckEhlist
I
pescriiniOn „. I *Qty. I . '
• New 1-1-,fainny dw.e.ning (includes 100 ft for each utility connection)
_•' -4)'. -4..**660*.ofV.0mtiololop:1? -rtt,,,.-:i .,f,,,t-:,,,::::,,.,..Q: : FR CO bath 312.10
' • 437 38'a
El,.i.;.and 2-family clWelling El Cnnuneitiaitindnattial . SFR(2).bth
- -. 1 :SFR(3)bath 500:32
0 Accessory blinding. D.MvitUfaiiiily
- .
Each additional'bath/kitchen 202
..
0 Master bunder0 Q0-107: • Fira.spdhkler( sq:ft) Pnw:.2
. . ,.. .... ,_._„.,. . „._ . _.......
:.1-.%.,--...::•:,::::•?,•-V•',.''"!'-ti0.1itgiti*fiiiTitik'Aiiir LOCATION,T ,';'-',--''!''''-:#4'•::-.'.- Site utilities.
. Irib site addressf ir-,zi, 1 sw sekAe. ot - : ca,.„,sir,of aita drain18_16. . .
Dry•Well.Jeach:tine;.pr trench drain 1S.7:
cit-yiState/ZIP.Tigard,OR 97224 --;
• .. 'Footing drain(no,linear A:.: ). • Page.2:
Snitethidglapt.no Project/lame:Polygon at Bull Mountain Manufactured home nth ilieS. 5a03 '
Cress:StreettdirectiOnS to job site.: ...: Manlibles 18,76 •
.
Rain drain connector 18.76
.
. • , Sanitary sever(no.linear ft.: ) Page.2
•
• - • • • ..Sidon solver(no.linear it:: . . ) a2.0-2
•
Water service(no.linear IL; ) I Page2
: :r-:•:
Subdiision;Polygon.at Bull Mountain LOt.i10....., )7 Fixture or item:
- • .
. .
Backflow*venter 3L27 .
Tax mapiparceim.: • , - . . . . . .
f., ,:::'•-•t..11-i ,,-?'-5-v,--:::•, ,,i,-:q-li,, ,.,;, c-13 , w ,:4,.F‘:7,,,,,te,4;:.:::,-„4grmm.;;,.:-,:g.•.::1•,,,-0.. packwateiTyalye 12
• : -Zil.:=5--. .'1.•,11'-. . .:..ii•i4 !P.,?- 1.1,-.1.::!-1,7•17i',:-,-..!;_:::17KT'`.4.:r.....,-,7:!;•..z,.,..4.:!-:::• ,•,..,..:..:,‘,1,.:,. ft, . .
Oothes.washer . 75.02
2-2?--- et4-7-E-Z- //-&-e--- -.--/-7,—.. .. Dishwasher 25.02
. . ..
Prinking foinitain 2542
. .
Ejectim-SiSutop 2507
- -•
i,itiliiitti,,ii*,46i..4.„. g....?_,:.!.,...-4:: :.:4;,..„,z.ti.i.,.:ta...ii,i.-tJ.e..: - , Expansion tank i 12.al
., Fixture/sewer cap:' I 75.07
•Name;Polygon Ny.4,LLC,'
'
: . . . I :7-5 02 1
Floor drainaloorsinkthab ...: . f
Addres-K 109 fast 13t5 Street ::-. Oarbaae disposal , 25.02
.
City/State/4f 'Vancouver,WA 9%60- Rose bib 25.02
._..
Phone:(340)0954700 Fw,,( ) Ice Maker ' 1151
.,.,. ,. ..,.. , „...,... ,,,,. .,„...„ ....„.„. ••-., —i
,:-;:i4:t''44-''':::''•:•;:tV-Igli:.'' ‘41 ,•4•4;;_.::':•`•;1?...Z,-4;t1::"I''..Eretilsi'atrtlEligt*:••:•••••:iiiP lulCrcePl9r/17:45c trap . 2502
... . . . I.
., . .
. - :
Business name:POlygOil WLI-1,1.1C Medical ns(value:$ ) Page 2... ..... .. ., ..
Primer • 12.51 i
Contactual:tie:Angela Grajewahi
. . . .. •'• :Roof-eh:4in(coramot-ciaTh . 12-51
Address:149 Eait1,3th S.Ireet. Sink:/hasiti/lavalorY 75.07
.. „
• .
City/StatealP:'Vancouver,WA 98600 Solar units(potable Water) . 62.5q
• _ .
Phone:(360)-69 -7700 Fax:::'(300)693-4442 :.Tilti/showerlshower pan. , 12,51
"---.- . - • •' Urinal 2502
E-mail:Aingcla.firajewskipolygolihomes,com ... .. .
, .•-'''''''''':,,;1.i,-'',,,,,...,,,-,,,, , aid closet 25.02
- -
t::4',•;i:'. .'..e.'174a?:':,61I-nottitZ.",'"V•1V:• .-'.,1•-• •••--:;,,,st: .•:1W.; . . • •.. . . -.. .
.,',Vi.:,,',....,7,1,,-..i. -,:.;,,,;:,,::,:4•,.:46,-,7.:: •-„,b.T,::-.,,,•:-.-... .707*-:.,,,,, 1/471-Atil.,::!--,..„,:7-,os-•.r.:.:'-.:,,,•.,,,,,,v-v:,•••,,••:•:,,.-c.,-. •watetheater :. .1. . .31-52 •/.7•624
Business name:BDL Pluttibilig•LLe -: Waterpiping/DWV
. . .. . .
. ...
• ..
Address:k0 Box/35 - Other. ... . . 25:5,2619: 7:
.. •
City/State/ZIP:Corbett OR 970.19 .. Sobtotel
Minimum e $725-o,,
• . . - • . . . .
• fe :
Phone;(:.563)• 51,3903.... Fax ( , ) - :
... .. ! . . ..
Plan review (25%of Remit fee)
CCD Lie.;180345 - :Plumbing Lie,nO.:::P1J1582 .. .. . •
. . • State surcharge(12%of permk:fee) I .
. . . .
AuthPrizedi.g..nature.: 6.,..a .iikre..„.z.,,e-' TOTAL PERMIT:FEE .1 i
Priiit nameBrandin;itianter t 1")* 8 1 I, •11• • •I : This permit appheahowespires if a perish.ii nn;obtained:within 180 days
:: : 10 (0 1 id:Wr ithasfiggn uc:cepted as tnniPlefe. .
'''Fd nUthodidIngy set by Tri-County Building Industry Seivii:n BOA.
. .
Vall.liidinecrmit4LNITMennitApp.d00 10/ti/ti 446-4616r(T002fCOMAWR) -
CITY OF TIGARD MASTER PERMIT
314 — - ., ,I -...,- ,, -,. -41 .:.
COMMUNITY DEVELOPMENT .!' .• Permit#: MST2016-00069
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 /S/ -��, Date Issued: 04/28/2016
Parcel: 2S1080001504
Jurisdiction: Tigard
Site address: 15361 SW SEINE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 57
Project Description: New SF. 6/14/2016: REPRINT permit to reduce bathrooms from 4 to 3.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1566 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 2144 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Yes
Total: 3710 sf Value: $455,330.76 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
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: 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: 7 201-400 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 3710
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: $35,239.47
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 througgh AR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33332.2344.
Issued By: Permittee Signature: //17 % r/L�` O A/
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.
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
=. Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATi\.!.' el 1
DEPT: BUILDING DIVISION
MAY 172016
FROM: Angela Grajewski/Chris Walther ci IV Of 116ARD
COMPANY: Polygon Northwest BUILDING DIVISION
PHONE: 503-312-6213 By
Zal
RE: tr-)31,1 SW Seine Drive MST2016-000 /55 CC
(Site Address) (Permit Number)
Polygon at Bull Mountain LOT 5/
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
0 Additional set(s) of plans. 3 Revisions: WIC/4th bath change
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: Removal of 4th Bedroom bathroom into Walk-in Closet
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: 6 l �,J 1 C Initials:
Fees Due:,Fp Yes ❑No Fee Description: Amount Due:
P✓' PI Cv fcV $ JOS
,4o/f,ti , e$ 9/. err)
$
Special (3J � e sJ Lmcsi (3.) nt'c/s//o uu> S (3)
Instructions: os6-7$l(/J L4-u.,ud,27 Sin//e-� (.11j i'6JA 7' /—jf#v
Reprint Permit (per PE): y Yes Li No lone
Applicant Notified: 41-is 6i( Date: 6/jy k, &7709-i L Initis
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD MASTER PERMIT
III 3 .7 COMMUNITY DEVELOPMENT Permit#: MST2016-00069
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2016
Parcel: 251080001504
Jurisdiction: Tigard
Site address: 15361 SW SEINE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: Multiple
Project: Polygon at Bull Mountain, Lot 57
Project Description: New SF
BUILDING
Floor Areas Reauired Setbacks Reauired
Stories: 2 Bedrooms: 4 First: 1566 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 32 Bathrooms: 4 Second: 2144 sf Garage: 661 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3710 sf Value: $455,330.76 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 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
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
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: 7 201-400 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 3710
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: $35,127.79
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 throu h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By Permittee Signature: z9/Ifz9/If ,6�e��0.',v
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.
Building Permit Application /o / 7 /._s a a•
r4 s"1 . REG:�VES FOR OI'1I( 1_ t SL O\L1 `.
City of Tigard FEB 2 9 2016
Received
Y.3/a//b I' ermitNo'�%�Q/d-OGlTc4o� 9�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan vy/� Other Permit: 6—OG�IS3
Phone: 503.718.2439 Fax 503.598.196Q^l � , RD DateBy: `7 f S��� �wl��
Inspection Line: 503.639.4175 "'�� 't T' l�` Date Ready/By: Juris: H See Page 2 for
I c !,(:1' t i h 1! 3 otified/Method: Supplemental Information
Internet: www.tigard-or.gov �l.E t��,; , ���` ,;�l`�
gl d r�z
4....-.. d is»� .�,ti„� 'M,.m ... � 'a �®«. .,. --
,.
. .. �',.
-.:�
®New construction DemPermit Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this applic. '..
Valuation:,r • $ r _
® 1-and 2-family dwelling ElCommercial/industrial L . - —1 �
❑Accessory building ❑Multi-family Number of bedrooms: 4
❑Master builder f 5i 0 / , .Other: Number of bathrooms:
Total number of floors: 2 .
rr '
� 1 . � _-w
Job site address: ( V \ C , I�Q New dwelling area:' 116,,,,,,e. square feet
V
City/State/ZIP:Tigard,OR 97224 Garage/carport area: • . square feet
Suite/bldg./apt.no.: I Project name:PD\..i(3-on �L .)\\ Irl Covered porch area: , t square feet a ' 1Cross street/directions to job site: J Deck area: SI square feet 's
Other structure area: 4ri square feet
s. • 5:_=:‘,„ ,te 4 *,
Subdivision:Polygon at Bull Mountain I Lot no.:O� performed.Permit fees*are based on the value of the work s_,,
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
1\ r n.� s work indicated on this ...lication.
n2u�. .��,.. �!1 t� ' 1�.\ !. ., ... �, Valuation: $
Existing building area: square feet
New building area: square feet
E 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:
t ..� E ri-� -y ^d,—s
Business name: 0 c . ,)L I n C. Structural
or(
ctural plan review fee(or deposit): _■
Contact name: M a f . `-e (O1 C 0—f
�y FLS plan review fee(if applicable):
Address: 1 0 a i ' ✓-,
City/State/ZIP: \Cisr)00,,AQ or W 0\s�to Total fees due upon application: _•
Phone:6•40) V Q 5, —41--DO I N;,() U(6-1222 Amount received:
Fax:
E-mail:maggie.gordon@polygonhomes com
ercial
d
dential
tallation
t ,-_ roof-top op mounted Phot Voltaiprescriptive
Solar Panel System.of
Business name: v b I a.o1 w LA \n C Submit two(2)sets of roof plan with connection details
J and fire department access,along with the 2010 Oregon
Address: 10 q , "a v, f Solar Installation S.ecial Code checklist
City/State/ZIP: V cif)cower p Q p(.0(00 Permit Fee(includes plan review $180.00
Phone:F)\,3) b a 5.-3' C) Fax:(310D) .0Q3 �� age(12adm%ofpermtrative fees
State surcharge(12/o permit fee): $21.60
6VCCB lic.:204238 Total fee due upon application: $201.60
Authorized signature:- I 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 —Z1:.1LD Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
. Electrical Permit Application ` `y: q t�.
PP FOR OFFICE t SE ON 1.1
111111 Cl2}�S of Ti andDatCi`'C1l ` 6 &FEB9
•J g F�D 2016 Datc;ny: Permit N �.
• 13125 SW I tall L3h d.,Tigard.OR 97223 Received
Bevies•
II Phone 503.71 8.2439 Fax: S03.59R.19C>�f ) O F -� i'"-, _r 1.Daleniy: Other Permit.
Inspection Line: 503.639 4175 • El
11(..\I:I) p r• (.yiLi ;:.`.i`.' y)itaur. lane
)lilted/Metlncl: huts
ScePuKc2for
Internet: www.tigard-Or.LOV Supplemental Information
®New construction ❑Addition/alteration/replacement Blease check all that apply(submit 2 sets of plans vv lams checked helm.)
❑Service or reeder 400 amps or,more 0 Building user three stories
0 Demolition 0 Other: 4 where time availalle I:urlt currem 0 Marinas and boatvaids
4 t i CATEGORY (71r'`-:.CONSTRUC1i'Y�']N -: exceeds 10.000 amps at I50 volts or ❑Floating buildings
a-,e: . z; +� ,. _. ..:_ ..,o 1"; �" r'' less toround.or exceeds 14.000
B 0 Conunerc nal-uu apnnJu,ral
® I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations buildings i
0 Multi-family 0 Master builder 0 Other: 0 Fire pump 0 Installation of 75 K VA or
.:
I
0'.'•' larger..' o_r rte„ motor load of A .
Job no.: Job site address: JL .i q IU01IP or more. uccup:mc)
( n/� I-v t_ ❑Six or more residential units 0 Recrcanon:0,ehlcle parks
Oily/Stall.'/LII': -r,car- ♦ OR c 1- _ ❑llcahh-circ lacililics ❑Supply soltage for more than
���nnn ❑I t v odour locations 600 sobs nominal
Suite/bldg./apt. no.: Project name:(U4.19, 0A-- 1-30\ l fl )4_n ❑Service or feeder 600 amps or inure
]
SFr SC(HEpIJLE ,.
Cross street/directions to job slit:: DescriptionI Qty. I Fee. I Tota) I •
New residential single-or multi-family dwelling 111111.
Includes attached garage.
Subdivision: Lot no.:0.-- ---
_Loon sy 11.or less 1 t> 54 4
^Ea.add'I 500 sq.IL or portion 7 33 92 1
Tax map/parcel no.:re ' /a �a �t Limited energy.residential I
xt• #`�
� tet2
-1"+n� s-'i""- O r•Lg`[]
_. • jY R:viigliK'�... - (with above C ft I 7�00
Limited energy.multi-Iamity 75 nnI
New electrical service and wiring residential(with above sy Il) -
Services or feeders installation,alteration,and/or relocation
200 amps or less 10)70
r ~ .ROPP11 IER ' , 'Ci TENAi ' - 201 amps to 400 amps 133.56
r��� 401 amps to 600 amps 2(x).34 2
Name: Y 1 '
`, 601 amps to 1,000 amps 301.04
Address: , b CA t6� • '�y Over 1.000 amps or volts 552 26 _
City/Slate%../_IP: J O_r1,0,0 &Y€.( W P _i g( �( 0 Temporary services or feeders installation.alteration,and/or
w ` �/�fl/lC� relocation
Phone:bpi)) l� q5,-7-f v a1 - j� Li D Fax: 0 ) 2(x1 amps or less 59 36 1
v v which
amps to 400 amps 135 Ux
w
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease. rent.or exchange.according to ORS 447,449.670.and 701. 401 amps to 599 amps 16x 54
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
above service or feeder lee.
,i 41j ' ,.: --®; .OTA rP SO1M £
each branch circuit 7 42 -'
Business name: P-0---
V — .' B.Fee for branch circuits without
service or feeder Ice.lint iI x 6
Contact name: m • ° 1 \ (-Or. branch circuit -
Ij Each add'I branch circuit 7 42
ss
Addre :
i • 1 _ Miscellaneous(service or feeder not included)
City/Slate/71P: 1 CCU '^ • Each manufactured or modular
Ce
dwelling"service and/or feeder 67 84
Phone:( ) Fax: :( ) Reconnect only 67 84 1 2
E-mail:m Vr ADigCnh� „/) C+-inn sign
orutlin irrigation circle 678J
t ` ,, � 11` 0 .w, r.Ci mac/ Sign or outlinelightingG7 x4
'` CTO Signal circuit(s)or limited-energy
Business name:Simply Electric panel"alteration.or extension Page 2 j , 2
Each additional inspection over allowable in any of the above
Address: PO Box 822408 Additional inspection(I hr min) 66 25/hr
City/State/%1P:Vancouver,WA.98682 Investigation(I hr min) 6635/hr
Industrial plant(1 hr min) 7x IX/hr
Phone:(503)849-8202 Fax:(360)314-4945 Inspections for which no fee is
90 00/hr
'— specifically listed(V:hr min)
CCB I.ic.: 204615 Electrical Lie.: . 067 Suprv. I.ic.: 4394S
P ' •ELEC7'RIC*1."P01}7IT'FEES .
/ Subtotal
Suprv.Electrician signature. required: �fG4,
' Plan review (25%of permit fee)
-
Print name: Victor Zarzhitsky Date: 1 117/2015 State surcharge(12%ofpe ntit lee).
TOTAL.PERMIT FIT —
Authorized signature:
-
This permit application expires if a permit is not obtained within ISO
( days after it has been accepted as complete.
Print na1nC: I Date: • Number of inspections allowed per perrim
I JIu,Id,ns'recmiiar:I.C-Pconit App clot,07,01;10 '140...11 s'rl 1 rut' ONIAVH0
Plumbing Permit Application rt_.- ‘ !=
Building Fixtures FOR OFI ICF 1 SF ON L1
2016
Dateat d Permit No rJ 7�/6 2900&7
City of Tigard FE3 2 Dir
IN 13125 SW Hall Blvd.,Tigard,OR 97223 t� -,r Plan Review Other Permit No.
Phone: 503.7182439 Fax: 503.598.19 i V } ` ~t' Date/By: Otic Si See Page Z for
Inspection Line: 503.639.4175 >` v`s:. v i' Lite �= Supplemental loformatioa
I Irdt:ntet www trgard-0r gw ethod_ , _ ��--,.r:�---
ma - -g.'�. -..,-5 '.- -'411,7t;,-7.-- ---,,
�."���� = �
.7,-_,...,:.,r,- , �gi 2 ;z l,-,_-;,-, :.may X '_^cam
e ioFor special information use checklist
1:New construction ❑Demolition Description I Qty. I Ea- I Total
El.4ddiUadaltcration/rcplacanent 0 puler- New t-2-family dwellings(includes 100 R for each utility connection)
L v ` 312.70
1 - _,f� i- h `r= gr 3:` I '?';"5.. a'� SFR(1)bath
e �
s s � i 437.78
►:- -.,. ..:���,- _---:_ - SFR(2)bath
p[1-used 2-family dwelling 0 Commereialfindustrial SFR(3)bath t 500.32 50(9t-5'2,_
0
0(9t-5!.-
❑Accessory building • 0 Multi-family
Each additional bath/kitchen 25.02
~❑Master builder ) 53 .. 0 Other Fire sprinkler(__sq.ft) Page 2
- 0...7.,..,----7.,t1,--_,....=-0,,
--7. "`�-F ir ...-_-,r - 10-.. - 1 „,„„„,_..,..,-„,-..a„.,...„„-,„,„
r ��' -x '„ i ,_: Site_wives.
:-. .,- `t �-'.,12" ',: a 18.76
7.5,:t1:.--,.. ."-?-: 1 Catch basin or area drain
lob site address Q �r^G�^ y u •
Drywelt,leach line,or trench drain 18.76
City/State/Z1P- T1� o S \_ 17-21 ` - Footing drain(no.linear R: ) Page 2
Suite/bldg.apt_no.: I.Project name: Po\y C LJJ'l\ 1/ - l I Manufactured home utilities 50.03
l Manholes 18.76
Cross street/directions to job site: 18.76
Rain drain connector
Sanitary sewer(no.linear ft.:-__) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear R: ) Page 2
Subdivision: 1 Lot no.:-.Future or item:
- Backflow preventer I 3127 N,1j1
Tax map/parcel no j _-.i Backwater valve
( 1251 12.5
" --_- =- clothes washer I 25-02 05•0Z
-_ __ � =_�-.�= - - �- - � __ Dishwasher i 26.02 e9177.02
Ve/v,/ 0.0ibjl (- 14.4_14440i t Drinlong fountain 25.02
Ejectors/sump 25.02
1'= - . c ion tank . 1231
..-..2' �,.� _- ---- -. --_ _ --_---,----,7.---...,..„ _• Fixture/sewer cap 25.02
Namp
oN Q 1 `� Flora drain/floor sink/hub 25.02
Address: C v 1 t-� ' 5 ` `f� (� Garbage disposal 25-02 2 ,CfL
City/State/ZIP: r e o\,Q� �A.9' ` q ai t Hou bib I 25.02 7c.),Ort,-
,.-
Phone:
Q Ice maks 1251 j'Z ,
` t r k e11`I I� ! Fax( .). -r 25.02
-; �G , fir. _2 w< Interceptor/grease$8p
�.A' � =+ `',77 c "� =' sem/ �- _ - - Medical gas(value:S ) 2
Business nam= 3'p� V/imlN����C,it -Primer 1251
Contact nt� �q ut#-(fin (L1 Ji �` Roof drain(commercial) 12.51
Address: :!0, /' �j _7 Sink/bacin/lavatory 25.02
City/State/LIP: '�� 161 1 Solar units(potable water) 62.54
Pt>oat=o2 )351 2aad3 Fax:( ) 2 Tub/shower/shower pan a 12.51 .5.09.
✓-[
Urinal 25.02 -
E-mail: • • ,i�? '1 ',MA- Wats clasct ( 25.02 �-/)
w5n ;�` _ ;, .: _ r - s Water heater l 37.52 y�•✓v
Busies name:-.13.1)4,# - /iVt_� Lt L Water piping/DW V 5629
-� Other. 25.02
Address: g"-P,N
y/Sta ['�� O C/1b ' Subtotal
City/State/ZIP: E Minimum permit fee: S72S0
Pbone:'13) ..:. / -.3903 RUC( ) Plan reviewperof permit 30 -
ee)
` f B634..5- Plumbing Lic.r i�JCJ2
CCB tic.: L State surcharge((25%of permit fee)
TOTAL PERMIT FEE
Authorized signatraz~
This peewit application expires if a permit is not obtained within 180 days
Print _ - r C� ,%�%`.. I Date:///451 after it has been accepted as complete. •
�r •Fee methodology set by Tri-County Building Industry Service Board.
1:\&nldi p.doc 10/01/09 440.4616T(10,CalCOM/WEB)
Mechanical Permit Aupl catifi".( i g l()u ctrl lc I I si 0,1.1
""—
--'' <� uvea
Clay of Tigard- Dabgay:: =gill/MIX-MI'
Fr 0 9 2016 l a .
13125 SW:Hall 81vd„Tigard,i3R"97'r� CkherPeravC.
Phone *7182439 Fax: 543398.1960 DateJ9Y- - _.
Inspection Line: 503:639.4175 ,,,, (7,1 4* DOG Beady By s B.See late liar
Internet �ueuw.tigard-or.gov e t�C l'1- t_ ,.fiedimethod: Sopplemearat information:
AIs :. r S'Fy t v _.. ..l '0 _
•
:.
.y
" S , ,
= ,.g. ee.- 6 -. - r �
Mechanical permit fees*ace based on the value of she work
Z Nei.,construction 0 Additionialte afiomtreplamincnt performed.indicate the value(rounded to the nearest dollar)of all
Mechanical materials,equipment labor.overhead,and profit
❑pemolmoo ❑Odra Value:3
fs77.77 � ..-",,;-,".77,1:::6,777r, cam" 77 ,W177, r' .,. µA.---c r� #� '�' €
Commercial!mdustrial 0 Accessory building Foripeciat information use die dist
®i atxl 2-.farhily dwelling 0Ea, Total
❑Multi-family 53 0 i [3 M builder 0 Other �iption Qty'
:.. Y 17. Head _..
" _ ¢) 1 P. —__ •
.A.tr conammung, 46.75
Sob sheaddress- ) SeNr2. 0 C- Pumice 100400 wru(doers/vents) 1 46.73
.Furnace 100.000+BTU lducts+aents) 5491
-r-, c G22u . l 61.06
Suitelbldgfapt.no Project name: o1 a t� ' r \\ in .. Duct work 23.32
Ctnasst{eef/diieoiioris to.job site: flydroaic hot wafts system 2332
RrscdenEial.boiler(raaiatos or
hydconic) 2132
. _ .. Umtbcatas(find-type, ari
not elec).
in-uii1L iii-duct,suspendu(,tic. 46.75
Floe/vent for any of above 23:32
_ _. 2332
Lot
.... .. Lo
Sss t 3uei applialiest
Ta�cmap/pttrcel io Wader iaier 2332
;' 't Gas ixupls ursirr 33-39
;� w� � � - _ .__
Flnevmt#nr water beater orgas
rffeitiMICC I 23.32
I:bgli (pas) 23.32
Weiodkielletstove 3339
Wocd:fiteptacrli6vsrri
2332
Cliiintieyfliriesilltielvera 93 31
--- Otter:
-77717.;:=4;---c:,' c ? ms s �
23.32
. .."L, -,-» .;. . .:._.k- � _ � • ,� � ronweutal exhaust and vendtatio :
Namm Polygon Northwest Range hood/ot er kitchen
1 33.39 .
Ad es 169E13*St Clotbet dryer.exbaust I 3339
Singe-duct exhaust(bathrooms,
ityl3tstesrLlP,VancoQvcc SVA 98661 • toilet-compartments,ubiity.rotiau) 4 23.32
Phone,{360)816-7800 Fax:(; ) •Auidertwkpaee tern 23.32
�a� r 2332
-_.._... _ Fuel p1Ql
Business rime Polygon Northwest • $1..-.13(or first four;54,03 far each additional
Coranctieine .Furnace,tie: I
Address:109 E 0%St WalirSuspendedhtinitbeater
YaxcAnver,3VA5+8661 ,,
Fax::( ) F°`plI I
Thrive:.(360)816-7889Range 1
Ermari: Bailment
- e a - °' ls�„2,, `=: sot csdrver(gas)•
�. Other
Business nail=Andersen Heating,Inc '''''''-:,-•=7:1:M7-7-1776 ,-.7'1t 6 . q , .- ;
-. 1. ....
.:. do,w - .�- .......
Atm.-14225 SWt'Ave.Ste CO Subtotal
Minim=permit fee 090.00)
CstylStafe2lP:Taprd,t3R:97224 Pian review(25%of permit fee)
pb .( )9924664 Fax(503)536-6615. ;Stair initfrerge(12'/s odpermit fee)
TOTAL PERMIT FEE
C B:lie. 16821 This p�application oiptris If a permit is not'bulged within ISO
days atoerit has-been acegtted as complete.
Authorized side: Fee methodology se.by rd-Candy Building Industry Service Board
Print name Art Aridtrsen
Date:11/1012013
t Apo a4ot i3.4ee 440.4irr(I Ift. .'CWMI Ea)
J
a t
City of Tigard
111 ~ COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: risiwp/6 -Opp6 9
Site Address: /S',3(,,-/ • ...wW.- am
Project .e.
Name: ��'
S- -
���: r..�h � /31-di �OL�lr1;2�-1✓t_ Lot #:
(New .i'h >=subdivision name;;Addition or Alteration= last name of owner)
Planning Review
Proposal: a, i,,,J `S14 >
Verify site address/suite# exists and active in permits tem.
tem.
'River Terrace Neighborhood: ❑ No LId Yes,See River Terrace Review Addendum Attached
Sit Plan Elements:
ree(3)copies of site plan 19I. sting structures on site
e plan must be on 8-1/2"x 11"or 11 x 17"paper 11.Footprint of new structure (including decks)with finished
4.
awn to scale(standard architect or engineer scale)
or elevations
orth arrow ,Ut��ility locations (required for new,may apply for additions)
S. e address,project or subdivision name and lot number %' cation of wells/septic systems
licant information(name and phone number) I1 rosion control (including drainage-way protection,silt fence
of dimensions and building setback dimensions sign,location of catch basin,etc.)
t area,building coverage area,percentage of coverage and AAS eet names
Ppervious area (applicable if R-7,R-12,R-25&R-40) IP treet tree size,type and location
roperty corner elevations (2 foot contour lines if more than \' : sting trees to be retained with drip line,and tree
4 foot differential) protection measures
14alean Water Services—Service Provider Lett (lot platted prior to 9/10/1995):
Pequired: ❑ Yes,applicant was notified e No Received: ❑ Yes ❑ No
ublic Facilitie Improvement (PFI) Permit:
equired: es,applicant was notified ❑ No Applied For: Yes ❑ No, stop intake
/and Use Case#: —S ,(.6. o/S- ,i
oning: 4 s--
FP/Setbacks: Front 020 Rear is Side S Street Side /S— Garage ?Q
,andscape Requirement:
0
0/0
of Coverage Maximum:
tuilding Height: Maximum Height 30/ Actual Height a?:23 a A
I�sual Clearance
`�b'�/ asements
, /Sensitive Lands: "Yes ❑ No Type Lat)-- V�/r� / j,JL'
ed.
ILQ Urban Forestry Plan
❑ Conditions "Met"prior to issuance of bu ding permit
Notes:
L= 44,46kC.' lyl 11 / ,n"). A /s.SC,c ei.€€ ,,J • Zr'v /' i'I't - 1
Approved y Planning: _ - Date: c24' o,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BIdgPennitRvw RES 012116.docx
Building Permit Submittal
Original Submittal Date: d-A2
Site Plans: # 3
Building Plans: #
Building Permit#: K}.-Enter building permit#above.
Workflow Routing: P-Planning engineering B-Pcrmit Coordinator L -Building
Workflow Sign-off: 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.
je�iuilding: original permit application, site plans, building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: _TAAM,
Engineering Review
Slope at building pad: 3l
d
I 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 g No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: IlL, 22 Date: —9-4
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: 1 Date: 3/91/
Notes: /J.G- 0-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:
eeNSDC Fees Entered: Wash Co Trans Dev Tax: es ❑ N/A
Tigard Trans SDC:
g Yes ❑ N/A
Parks SDC: )Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator:
Date: ///25//�
1:\Building\Fonns\BldgPennitRvw_RES_O 12116.docx
UPICity of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #: /`1S7 22/(o —000 6 9
Site Address: /$" j j `u se/ ,6r
Project Name: /"� Vii .511// kCz1S11 Lot #: S
(Nc ling=subdivision name;.Addition or.AIteration=last name of owner)
Planning Review River Terrace Plan District Design Standards (18.660.070.1.):
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.
Porch min. t. deep Balcony w/ access 2 Window Projection Vertical Wall 0 fset a Gabled dormer
ft. deep min. 2ft., 5 ft. wide min. 2 ft., 6f wide
❑ ❑ ❑
2. Eyes on the street: a minimum f 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: / ./ %
3. trances:At least one entrance must meet both of the foil 'ng standards:
oMax. 8 ft. setback from longe t street- facing wall Parallel to street,angle no more than 45` from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If y s, all the following apply: sq.ft. min.
1/ne street facing entry ft.max. roof height above porch
ft. depth min. 30% min. porch roof coverage
4. ".etailed Design: All buildings shall include a min. of five ofe following elements on all street-facing facades:
1/4 overed porch min. 5 ft. wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
Ii all offset min. 16 inches ❑ dormer min. 4 ft.wide
.. Roof eave min. 12 inch projection �" oof offset min. of 2 ft.
❑ Roof shingles either tile or wood Gable,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ❑ orizontal lap siding min. 3-7 ft. wide
❑ Accent siding min. 40% of street facade Window trim min. 2 1/2"wide by 5/8" deep
❑ Window recess min. 3 inches for all street facing ay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside accessAttached garage is 35% or less of street facade
5. Garages and Carports: May face the front or side lot line on a corner lot.
Setbacks:
No loser to front or side lot line, than longest street-facing wall. ❑ Yes No. If No (Check one):
ay extend up to 5 ft. if there is a covered front porch and garage does not extend beyond the front porch.
May extend up to 5 ft. where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ 12-foot-wide garage door 40%max. of street facade
❑ 50% max. of street facade with 7 detailed design elements
Notes:
t. o
Approved By Planning: ZL. Date: x
I:A Building\Font's\BldgPennitRvw_RES_RT 0121I6.docx
Albert Shields
From: Albert Shields
Sent: Wednesday, March 09, 2016 2:59 PM
To: 'Chris Walther(Chris.Walther@polygonhomes.com)'
Subject: RE: MST2016-00067, -00068, -00069
Attachments: Conditions-03-09-2016.pdf
Here's the attachment. AMS
From: Albert Shields
Sent: Wednesday, March 09, 2016 2:58 PM
To: Chris Walther (Chris.Walther@polygonhomes.com)
Subject: MST2016-00067, -00068, -00069
Chris, as you know, we still have a few more of the conditions of approval that must be met before we can release
building permits, including the 3 permits mentioned above. They will be put on Hold as Approved but Not Released. But
thanks to the packet of items you had delivered yesterday we are now down to 4 conditions that remain to be met, as
highlighted on the attached.
Albert Shields
III ii City of Tigard
2 Permits/Projects
Coordinator
`' Aber, tcard-or.go.
;503) 7188-2426
4503)624-3681-
13125 SW t aU Blvd.
Tigard,OR. 97223
1
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15361 SW SEINE DR, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
CNCL
Comments:
Inspection cancelled by contractor.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
December 16, 2016 at 7:49:48
AM
Record ID:
MST2016-00069
Inspector:
David Young
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15361 SW SEINE DR, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00069
Inspector:
Jeff Grove
Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15361 SW SEINE DR, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
699 Mechanical final
Result:
PASS
Comments:
Tel: 503.718.2439
Inspection Date:
December 21, 2016 at 9:52:43
AM
Record ID:
MST2016-00069
Inspector:
David Young
Note: no AC installed at time of final inspection. Permit required at time of installation.
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15361 SW SEINE DR, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
FA I L
Comments:
Tel: 503.718.2439
Inspection Date:
December 21, 2016 at 9:58:24
AM
Record ID:
MST2016-00069
Inspector:
David Young
Provide tempered window at upper level main bath within 5' tub/shower less than 60"
above floor. R308.4
No AC installed at this time.
All else ok.
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15361 SW SEINE DR, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS -CofO
Comments:
Correction complete, tempered window installed.
Final erosion control approved.
Street tree certification received.
Moisture content form received.
Vapor barrier form received.
Blower door test report received.
Insulation certification checked.
C of O left on site with contractor.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
December 22, 2016 at
11:56:55 AM
Record ID:
MST2016-00069
Inspector:
David Young
Inspector Contractor