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Permit (53) f,,,,,, --,'.„,F,1`"4 4' MASTER PERMIT IICITY OF TIGARD � �� I • COMMUNITY DEVELOPMENT 9 / /2 "'i/ Permit#: MST2016-00393 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2016 TIGARD Parcel: 2S 106DB08000 Jurisdiction: Tigard Site address: 13354 SW SATSUMA AVE Subdivision: RIVER TERRACE NORTHWEST Lot: 80 Project: River Terrace Northwest, Lot 80 Project Description: New SF.2/1/2017: REPRINT to add 220 sf patio cover. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1254 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1655 sf Garage: 464 sf Front: 8 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Total: 2909 sf Value: $356,220.61 Rear: 10 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: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 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: 5 201-400 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 Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2909 Owner: Contractor: WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) BY POLYGON WLH LLC 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 ATTN GAST,FRED VANCOUVER,WA 98660 109 E 13TH ST VANCOUVER,WA 98660 PHONE: PHONE: 360-695-7700 FAX: Total Fees: $33,234.53 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 R R 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: ,'-X _- Permittee Signature: (7/V «-70 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 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Tom H. DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED JAN 19 2017 FROM: Angela Grajewski CITY OF TIGARD COMPANY: Polygon Northwest BUILDING DIVISION PHONE: 971-212-2144 By. RE: Jw Sol-SU na frve1 MST2016-00 (Site Address) (Permit Number) Northwest River Terrace Lot 60 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Yes: Descri tion: Copies iscr>fptiQn: „FS. .. �_ . ..max.. 0 Additional set(s) of plans. 3 Revisions: add covered patio 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: Please pay fees owed with Trust Account. per buyer selection o ISIN nlitw SE O � . Routed to Permit Technician: Date: — 3 o - ) 7 Initials: Fees Due: ] Yes ❑No Fee Description: Amount D e: . S 1�r p) w rev,a%) $ $ $ Special Instructions: Reprint Permit(per PE): Yes ❑No Done Applicant Notified: ,41--A6/0-- Date: e9-jt v/i//7 I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 I • 74 g City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT T 1 c u D Building Permit Review — Residential Building Permit #: /7J 7-020 /E, • 1903 9 3 Site Address: /'g397l 7G0 g. .2 /9 e Project Name: ie/v-er- -Te/rvc e /U , i Lot #: 'i 7 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 4).04) g --)e_ Jerir site address/suite# exists and active in permit sem. riv River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached Sit Plan Elements: flgpio ree(3)copies of site plan sting structures on site yRe plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished Vawn to scale(standard architect or engineer scale) ort elevations Vorth arrow }Utility locations(required for new,may apply for additions) 'e address,project or subdivision name and lot number it ri,cation of wells/septic systems plicant information(name and phone number) .'�. sting trees to be retained with drip line,and tree Pli ko t dimensions and building setback dimensions irotection measures Plot area,building coverage area,percentage of coverage and V.6 .Keet tree size,type and location Prpervious area (applicable if R-7,R-12,R-25&R-40) Street names operty corner elevations (2 foot contour lines if more than 4 foot differential) Olean Water Services—Service Provider Lette (lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified V No Received: ❑ Yes ❑ No Pr ublic Facili�ti Improvement(PFI) Permit: Jequired: trt Yes,applicant was notified ❑ No Applied For: es 1:1No,stop intake g Land Use Case#: P/)/?Q ) 6 'S � O ,,�8�p V/Zoning: l' d �,, C) Required Setbacks: Front s Rear /0 Side `'� Street Side • Garage c [/Landscape Requirement: c(7 _ fi of Coverage Maximum: 00 % uilding Height: Maximum Height -_&4/ Actual Height toj'4 isual Clearance P Easements • 4nsitive Lands: CI Yes No Type ti), Urban Forestry Plan ❑ Conditions "Met"prior to issuance of building permit Notes: )i i. c,L. i - ✓7Cr A pecm..i i:Ss1 /LC..e Approved By Planning: Date: 'P A� Revisions (after Building Submittal only) ��Reviewer Date Revision 1: Approved ❑ Not Approved CAL4,_ `CCAwui I -d-3 17 Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved j--.›.3--17 renisvu c04t ci eo4-;o vr.c.i.o . l:\Building\Forms\B1dgPermitRvw_RES_O91216.docx w Building Permit Submittal Original Submittal Date: c:2/��/ Site Plans: # Building Plans: # Building Permit#: Er-Enter building permit#above. Workflow Routing: Er-Planning engineering ` rPermit Coordinator '$uilding Workflow Sign-off: la Sign-off for Planning(include notes from planning review) Route Application Documents: a Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. rr Building original permit application, site plans, building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: <0� >• / Date: /0/3//k, En/ "meting Review gi Slope at building pad: as a ❑ Conditions "Met"prior to issuance of building permit N ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 0 No N. Assess Water Quantity Fee in-lieu: ❑ Yes 0 No LIDA Facility on lot: 0 Yes ❑ No ❑ NOT Approved� by ngineering: Date: Notes: &..4. ._„.) sw43s- y4� mi, 'M'f'r /',?4,,-`' •-242. rtf-4 F :-'N Approved by Engineering: igiZ 2 Date: /�-mss"- '—/- Revisions (after Building Submittal only) eview r Date Revision 1: Approved 0 Not Approved �Z (-Z7-/7 Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review 1 ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date-Sem-t-e-Aiq#:HFrai> '/lam ," Revision Notice 2: Date Sent to Applicant: l� Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: [ Yes ❑ N/A Tigard Trans SDC: ( Yes ❑ N/A Parks SDC: 'Yes ❑ N/A ;: ❑ OK to Issue Permit Approved by Permit Coordinator: C,k .0 L Ca',tit° Date: ft -1 - (4o (,K . w- 14 la`s - 1oa- 1:\Building\Forms\BldgPermitRvw_RES_091216.docx A. A City of Tigard IIa COMMUNITY DEVELOPMENT DEPARTMENT s T i G A R D River Terrace Building Permit Review Addendum r t z m Building Permit #: /k,S 71o,'(, - p v 3 53 Site Address: 16a,512.-- a) _ayTsl,0 /i0 Project Name: ie/Ver �-�cp AJ toto -- Lot #: ) (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan Distl tct Design Standards (18.660.070.1.); Is the project subject to the plan district design standards? Fr Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing façade 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. 5 dee Balcony w/ access 2 Window Projection Vertical Wall Offset a p ft. deep min. 2ft., 5 ft. wide min.2 ft.,6ft.wide Gabled dormer ❑ ❑ ❑ ❑ 2.Eyes on the street: a minimum o 12%of each street facing facade must include windows or entrance doors. Percentage Shown: / ., j$ d 3. trances:At least one entrance must meet both of the follo standards: Max. 8 ft. setback from long street- facing wall Parallel to street,angle no more than 45° from street, or open onto porch Entrance opens to a porch: Yes 0 No /' If es,all the following apply: b/ .ft. min. rt/ e street facing entry ft.max. roof above floor of porch .. depth min. ti30.%min. e orch roof coverage g 4. Ictailed Design:All buildings shall include a min. of five of e following elements on all street-facing façades: �' overed porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep all offset min. 16 inches 0/Donner min. 4 ft.wide Roof eave min. 12 inch projectionoof offset min. of 2 ft. ❑ Roof shingles either tile or wood Q,able,hip or gambrel roof design ❑ Roof pitch oriented south min. 500 sq. ft. [�forizontal lap siding min. 3-7 inches wide ❑ Accent siding min. 40% of street façade YQ Window trim min. 2 '/z"wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street façade 5. Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: t2( loser to front or side lot line, than longest street-facing wall. ❑ Yes No. If No (Check one): extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. /ay ay 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) ❑ -foot wide garage door ❑ 40%max. of street façade 50%max. of street façade with 7 detailed design elements Notes: Approved By Planning: 4111W- —..1- C Date: JAM I:\Building\Forms\BldgPermitRvw_RES_RT_062216.docx flpi CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016 00393 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2016 Parcel: 2S 106DB08000 Jurisdiction: Tigard Site address: 13354 SW SATSUMA AVE Subdivision: RIVER TERRACE NORTHWEST Lot: 80 Project: River Terrace Northwest, Lot 80 Project Description: New SF BUILDING Floor Areas Reauired Setbacks Required Stories: 2 Bedrooms: 4 First: 1254 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1655 sf Garage: 464 sf Front: 8 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 2909 sf Value: $351,310.21 Rear: 10 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: 100Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 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 add9 500 sf: 5 201-400 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: OTR SF VB R-3 2909 Owner: Contractor: WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) BY POLYGON WLH LLC 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175 ATTN GAST,FRED VANCOUVER,WA 98660 109 E 13TH ST VANCOUVER,WA 98660 PHONE: PHONE: 360-695-7700 FAX: Total Fees: $33,004.62 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2321987 or 1.800.332.2344. _ J Issued By: 'Zd4 t Permittee Signature: Ar.1 '87,4./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 G C� ` ?o �Q ': n5 €mot)_ I FOR OF—FICE I S1 0\l 1 A Received /� /` /art_ G!/ Peimt CityNo- 25 of Tigard032016 Dar zi I' /6„.. 17 ~6 gFEB��� Plan Review prhet Permit 1 --40.3. 2 111 13125 SW Hall Blvd.,Tigard,OR 977�� 10-)O_ ) C tS4 IQ f 0.3. a . Phone: 501718-2439 Fax: 503.598- _ DateBy: has: 'H See Page 2 for Inspection Line: 503.639.4175 tr���� tt t��p �W � � D ND � /ete Ready/By: //y ��p 1 i/_i Supplemental Information TIC, t t Internet www-tigard-or-gov r7 iJ �Le i3t`� P ; .a ' /(_ . /t� t L� Permit fees*are based on the value of the work performed. ®New construction ❑Demolition Indicate the value(rounded to the nearest dollar)of all El Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the T F t_ work indicated on this application. _ ti p .C"atB J Y0t „ -_ Valuation• . ) 3) S i ® 1 ❑Commercial/mdustnal LA I and 2 family dwelling Number of bedrr ooms. ❑Accessory building ❑Multi-family Number of bathrooms: 2 ❑Master budder ❑Other ', t 'rig z` k- -i C p `a t ,lttii' Total number of floors: 2 3 / Q< sd .vii square feet I New dwelling area:��©�` q Job site address/335f �jl f jl0//sv i dike r/ ..' (---- rt area: square feet ---- City/State/ZIP:ap nSoerwood,OR 97140 k� - L. ) \c'S Project name: � Covered porch area: �eq- square feet Suite/bldgJapt no.: J l[ Cross street/directions to job site: Deck area: 0 square feet ) 1 Other structure area: •i square feet ' • P. � It # � , � B& z t , _ ,. s , > Subdivision: I Lot no.: (.‘:, Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the - ril ' work indicated on this application- �� Valuation: New Single Family Detached Construction Existing building area: square feet New building area: square feet y-;�r Z iib' � '- 'S�� z,T ,,F-.';''Ate. Number of stories: -- Name:Polygon WLH,LLC Type of construction: Address:109 E 13th Street Occupancy groups: City/State/Z1P:Vancouver,WA 98660 Existing: Phone:(360)695 7700 Fax(360)693.4442 New: .ss - ,,. Ste' ,, ..�7 y-f i.-727 ;t17:7:::7:71:1 -.: '1 - . ,. P�F r ', '� ; �`'�' �- `3 D 4 '��u� S°��� - �-I'-� -�.'�-'�_ ..-.v` ,f3`y f� � � ' Business name:Polygon WLH,LLC Structural plan review fee(or deposit): Contact name:Maggie Gordon FLS plan review fee(if applicable): Address:109 E 13th Street Total fees due upon application: City/State/ZIP:Vancouver,WA 98660 Amount received: Phone:(360)695.7700 I Fax::(360)693.4442 E-mail:maggiegordon@polygonhomes.com Commercial and residential prescriptive installation of .:` k ; ��~`<' f4 ..4-7,-.,,,_ ,.._ _,.N .' .._?�-,1_ roof-top mounted PhotoVoltaic Solar Panel System. `� Submit two(2)sets of roof plan with connection details Business name:P is ovr A,I.C �O/LL-/t9/-J ofaAi liklI //VC and fire department access,along with the 2010 Oregon Address:109 E 1311 Street Solar Installation Specialty Code checklist Permit Fee(includes plan review $180.00 City/State/ZIP:Vancouver,WA 98660 and administrative fees): Phone:(360)695.7700 Fax:(360)693.4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 This permit application expires if a permit is not obtained Authorized signature: !/�� within 180 days after it has been accepted as complete ' l *Fee methodology set by Tri-County Building Industry Print name:Maggie Gordon I Date`:12711/15 J Service Board. 1:\Building\PermitslBUP-RESPermitApp.doc 02/24/2011 440-46137(11/02/COM/WEB) 1 A RE FivFD _ri1 - i1 ptirit, «,Inc.._" X032016 _ ,: pied ,/� 13123 SW Heil Bi 3'ignrd,OR DatejB: Permit '! } s/ Al t Photic 503.2182439 Fox 3 Freeneeiew s t� ), 044104 Femtt ff: t �n Lina:503.639.4175 r I t , +1 Internet mists hp'G.or got3i ;t 1 i �'"-r 9 x nn mat i tar M.• rpooloctico M,' 11,t}ta.W O 4 d; r 1,'''t Nest,constritelion 0 Addiiionfalcarati i/replacement r1a r ek a that appy trete eira sae°robinswxt seheeked): CI Demolition 0 Qt(tp Qservice or taader408 amps or Kansa 0 Building°vac! neat,les, ^ whew the weinabG rwh men:at El Minimi and bcctq>rds, CAlr Ol'k OF COl lffiMCTION _ exceeds topgno amps 6t ISO tents or El rioninghundlass. ;N 1 anti 2 family duetting 0 Commercial/industrial ❑Accessory building 1 to group orcx+ as 14,00a ❑Cbmieecd4=wo a6dtuf ural t �1°101f1-iffitntty �Other � ., snips fioan:ot er tnztollations. bw'rdmgs. t: [�Masterbuilder 3{3it'SITE cisme' pump. QI�mlLitlalpri54KYA:x I i1�1vt J4ik1UJIH'i4t+1D idStl7t[Y t Elnageacpyy,gm,, targersepauatetydet cad debt; 7obsiteaddress: (( a. IllAddaialctllewmwarivadof system. µ I itarttPtmmoFc. [l A',"E;^1.3;7-3',, Cityl"at4telZlP:Sherwood OR 971140 Qsix rxn,araresidewiai units, occupancy. Suitt bld 1 t.6 I_Inealdlroaretacillti ; t7ttesootioaalvadepacks. 8$P I Project name: lanarardnes roratioos El sappty valtaaoformart Onto iossstreet/directions'tajob site: EfScruiceort dr66Oam sarmow. 000vobscamant. t FES ,, -, necsiotlaa 1 Orr..t Each "T Teta i s New residential single-or earn-tainlly dwelling oats, Subdivision:Rivet Terrace I Lot 6:c includes attached gouge: Tax map/parcel 8; 1,0004it.or less I 168.54 4 E&ES Fi4kN OF 4v osuc Ea.add'1500 sq.ft.orportion 4� 3992 1 Limtrd energy residcatiat 7500 New Single Family (with atiavesq 111 Limited energy,multi-familyr residential(with above sq.ft} 7500 .2 , t'Rti TYf" Relieve-4bl*Energy ;., 1 fl T t to SeePand/ Services or 1" t-rs lostallanon,alteration,and/or relocation Name:Polygon Homes 7.40 amps or line 100.70 2 Addresm 109 E 136 St 201 amps to 400 moors 133.56 3 City/StatetZI :Vancouver WA98660 401 amps 98660 20034 2 ��4 601 mil;lot,i amps 301.04 • 2 Phone:(360)695-7700 1 Fax( ) Over i,000 amps orvotts 552,7.6 2 Email: Temporary services or feeders inatailaGon,alteration,and/or' Owner installation:This installation is beingmade on prox00 ampsso intended forsale le 8 property that I own which isnot 200 or less 5rj , ears tett;or exchange,according to ORS 447,449,670,and 701. 20t amps to 400 amps 125,0a Owner signature: Date: 401 amps to 599 amps 168.54 2 o APPLrCANT !s 'C3 CONTACT PERSON Branch cireaits-new,aitarxdon,or ezttgtsioa,'er pend A.Fee ler branch*writs with u,. Business name:Garner Electric Washington LLC abate service or feeder fee, Contact Liam Gilt Daniels each breach circuit 7 d2 2 i B.Fee a•brallet)eirceltssarreore Address:6101 Nit St dohtes Rd serve:or fcaicr tee,fast` i Monti circuit 56.16 2 City'StateeiIP;'Vancouver WA,9866I Elettadd'Ibranch nreait 7.42 2 Phone (253}320-1657 Fax ( ) M>xretlaarena(service or feeder oatinclndsd} Y,, Eatlta anttPacWre$or modular b7.&t 2; Email:bdaniel dwdting s rvicy and/or feeder i s�gweusa€cum Reecomeet nub. CONTRACTOR 67,84 2 1 Easiness name;Garnier Electric Washington,LLC Fwnporirrigatiatcitric 67.84 2 i Sign or amine ligroin& 671.4 2 Signal wirerit( r aAddtnts:6101 NE St Johns Rd Owletlite..talor c densmQ Sec I2ge2 , City/State/ZIPVancouver WA Slit 61 •Erich additional Inspection over aitowablc In atiYafthiC above Phone(253)320-1457 Additional inspcalen(1 hr teat) 66.25/M Feu { } Investigation(I hrm'vt) 90,00/be , ' Email:hdanielsOgwerrsa.fiom Industria plat('hu min) 78.18/hr t Inspectiotsforwhlchaofeeis 9Q00itu CCB Lic,;01158 I Electrical Lie,:208174 - 1 Suprv.Lie..:44965 aarra•realty listed(5i t r mini F Suprr co clan sigoahrre,tegaired j r l� � ��L�L l=i pli:l'$IU► 1&&fi j i _,w r t Subtotal: Print nante:loan PAlbert pato: ta11 Qman Review Required(25%ofperrnhl4): . (1256Authorized signature State surchargeTOTof P fY2MIT FEE Print' 'Bill Ti+isPs ulappticetloseroticaIfpp�trnittsnotebtelittdwihini i ?. D iv t c j(,, an"' pied as q mphte it t 1oI I. YxartaritWsiLetaaaY t5aul aSP++m3ntET.0PaiaiAPP LR_.l E.dx Rbv UeJl7 at5 • Number oriaspwtdnasi dewed nor pemul 44a.1635i!11rbSICONIAYEa:: t ]]jjjjjj1 1. 3 i. I • Plumbing Permit Application Building Fixtures RECEIVED �/� �[y Received PrnoitNo.tt 77,2c/6`-0 5 / City of Tigard FEB Date/ay. 2.3 le 13125 SW Hall Blvd.,Tigard,OR 97223 E 0 3 2016 Plate ew Other Perrntt'3o.: Phone: 503.718.2439 FaX 503.598.1960 nattBy: Otb )� See Fage3 for Inspection Line: 503.639 4175 cityOF (' 1 ! § Date Ready/By I i C1} D "�-t ` °y' Noutied/Method. Supplement t Information' Internet: w��vw.tcgard-ar.gov 1 � ,�.. -, , ���,�, orb �«, "A �- v; , 1.:':,,t;.,,,,'., ' ;i .' t� ` �' ;..fes ` ,* • ' — - -, ". s .. �>`,"» For special information use checklist" • New construction • Demolition Description I Qty: f E . I Total • Addition/alteration/replacement 1 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) .r � „�, a.> .- * s <,,. $,e ... SFR(Zy bath bath 31270 437.78 al 1-and 2-family dwelling • Commercial/industrial 500 ��-{{ SFR(3)bath 32 D Accessory building El Multi-family Each additional bath/kitchen ! ❑Master builder 0 Other Fire sprinkler( sq.ft.) Page 2 A,, Job site address: v )91+•QQ�'? �� . . � ttrench City/State/ZIP: ` mac OR (Y- `q� ,• ' e 2 , ��SuiteJbldg.lapt.no>: Project name: � ,, ! i Manholes 18.76 Cross street/directions to job site: . Rain clrain connector 18.76qanitary sewer(no.linear ft: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft: ) F'age 2 Subdivision: Lot no.: 51CPackflow • prevenicr �® Taxmap/parccl no.: g':'f4t:ggiigttigi',4PWE'-a!:gita.'fttAttIZGIZ,lt4jRi*jA,M*,•Ae'..altt-W clothes washer 25.02 Dishwasher 25.02 Drinking fountain i 1 ` ® ,. tank `: &1 39 '' .w �., '... �u � Fixture/sewer cap 2$.02 Name: Qo W ... drain/floor2$_02 -. Address: \ 4/ e-7\-4\J N Gathaae disposal ® 25.02 City/State/ZIP: j itJIIr' ia t ) a• / > ib 25.02 Pltotte.{ 01 •q - 1C) Fax:( ) � � � 25 U2 . Ice maker III 12.51 .tet s 4 " �1m q .. Medical gas(value:$ ) • Paget Business name:. 1,..- r.ay..4.y ,,,e Y I ...L.rt.\ Y"S y ,l._ ,w 12.51 Contact name: NI L KI/. . iK.r ;1!1 . . . Root-drain(commercial) 12.51t Address: t I 1;2,`7 c, .. . .. . .: City/State/ZIP: •-�ve —j.-/\/ C ci-)isower tlpan 12s1 Phone: '#( ) g---3 Fax::( ) •. Urinal 35:02 {� ar sl 25.02 E-mail: , ., C. fi`r`s+ Y t- �' 0. 1 .a �'" � '� :, �1 .a- annr ` � : Water heater 3752 „ • s 6 5 :29 Business name: t tp /- r.[ XYt EA," P(1.4.1`V'11!ai i�f, t,A..--e....,. Watcr 25.026 l Other. ®, Address} 7 Subtotal citytStaterzlP: a)_.t'., j^a,,Ici'i c on Minimum permit fee. 72.5t} Phone:( ) i !' Fax:( ) Plan review (25%ofpern it fee) CCB ^�fest.,,,, Plumbing Lie.no State surcharge(12%n of permit fee) - ,. TOTAL PERMIT FEE Authorized signature: permit k appitcation if a mitis not obtained Rrttiilr!188 days I Print name: _ r 1 Da c/lir i aster it has been accepted as complete £ C�- L{ 1 }, t 'Fee methodology set by Tri-County Building Industry Service Board. latandmE'PemistPLMLi-Paaritkpp-der 10.01/09 490-46I6TOOMICOM/WEB) • . Mechanical Permit Annlicat:lit C .. (.1 -tEIVED City of Tigard Received ,1111 13125 SW Hall Blvd..Tigard,OR 97223 FEB 0 3 2016 Daleilly: Platt Review Pernik No.:/is 7,.- 0(6...00:3?,..3 • r Phone: 503.718.2439 Fax: 503.598.19fLO_ , ,, , „ , _ r Datelay: Other Permit: : ,,,,. 1, Inspection Line: 501639.4175 (AiY U1-- II(.--Ii-NHL) Date Readv/By: Anis: if See Page 2 for ' Internet; www.tigard-or.gov BUILDING DIV;SroN NotifiediMelhod: Supplemental Information i '':-.::::;,:,':'''.',..,,-; ''''.'3.FW::.34.'.7''Vii15,41744:Vt.T.**04t,!;5,"',41,:"Ai,t4',7:4:".,,...Z.:" ,-.7,:•?N!!tiq':,''it,,,11:Z:.':',. ';.;;,:2"g0,:t4L.,10:04*Olkt:4 :—.:::::Eir„.i.4.4*.:: ::,?;:„Iii;::;!"_„::;,:.K. _,'''' Mechanical permit fees*are based on the value of the work tgi New construction LI Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all D Demolition 0 Other: mechanical materials_equipment,labor,overhead,and profit. , Value:S ,•,,,,Jr,..17,..,. • ,,,t ..! ,* ,,t1,,. • ....,!N'',,,,,t,,,,!.1 :,'.',..':.,:i ES) I-and 2-family dwelling 0 Cotrtmercial/industrial 0 Accessory building. For special btformallos use thecklist. 0 Multi-family 0 Master builder 0 Other Description - Qty. Ea. Total .;,•...:;.. .:&•,34:,;-,:- .,...14:44.Ziiititititiii: t4tgA7.-:54'. :,:r4.,. '.V.'. II eatiagitmliar. iM2rr.7.,.... .4, ,T7Ter-,--'----TA•Y.,•-'-'''"C:.-..'.-?'"°4-F-°-.1- .. ir co -a'.n1 _ne Am Job site address: \' '? -o...k -.:.. 1,.)„ ,50. 3,t_ry\al Furnace 100,000 BTU(ducts/yenta) 46.75 CityiState/ZIP: t)-\9_,(1.A.RDQIV oR 01-tto I Furnace 100,000+BTU tdamsivcntsi 54.91 ._lleat pump 61.06 I Suitelhidg./apt.no.: Project name:River Terrace n Duct work 23.32 I Cross street/directions to job site: Hydronie hot water system 2332 Residential boiler(radiator or hydronic) • 23.32 Unit heaters((lel-type,not electric), in-wall.in-duet,suspended,etc. 4675 Rue/vent for any of above 2332 Other 2332 Subdivision:River Terrace Lot no.: f310 _Other tuel appliances: . Tax map/parcel no.: Water heater 23.32 -;'r'''''.' '''''f''''-''''''''''''''''''' ' ' "''''' ''''''''' ^•' '""'''' ''''- '''''''.- '"'''''''''' '' '"` '''-"' ''''''''' '''!'''' 1 Flue vent for water heater or gas HVAC I fireplace . 2332 • Loa lighter(gas) 23.32 l Wood/pellet stove: 3339 Wood fireplace/insert 23.32 . Chirrinewlinerillutdvent 23.32 Enmel exh23.32 f','...:::',1:4:hrt....Alt.:'41 -27-4444 .;',4:4 '44:, '1'::454% '-':'-':-,.; •:*:-''*;''''-7-1".‘*''''''''''''''2::'-:.*-.‘;'.';''''''''''''c""I';'4'. nvirontaaust and ventatilion: Name:Polygon Range hood/other kitchen equipment 33.39 Address:109 E I3t/'St.Suite 200 Clothes drt,er exhaust 3339 City/StatetZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms. toilet compartments,utility rooms) 2332 Phone:(425)586-7700 Fax ) Attiderawispace fans 2332 , ., 2332 '..--r.;ff.':,,...-t.-bgw.'-;r,'. .'0:'...w.,,avr.tit.i-'•::%':-..'7,,..--,-,''',''w37ex:it •...t.`, .'' ' : ,:."11.' ,..5, ,,,,,, -..,,,""''.:-•'-,.,-,rr-,- Fuel piping: Business name:Apex Air LLC $14.15 for first faun S4.03 for each additional Contact name:Strict Hay Furnace.etc. Address:2210 W.Main St.Suite 107-272 Gas haat pump I Wall/suspended/unit healer City/State/ZIP:Battle Ground,WA 98604 , Water her Phone:(360)342-8109 Fax:::(360)326-1769 Fi-.replace Range E-mail:statiltigapexairen.com Barbecue ..,,,,,,,;.,::5:p',-,,:f4..-;',.:;<=eft-_,..;:.'.7. ,::,..ri.;F;i:12,;;;4:',:.,•47,1- 76.,:'g r.1f'!.;..71-.;•,t.'.-i**:**,41*,' ''."*1,7,4*.4".At.:-..,..tr.4.1,*,...,•' Clothes dryer(ens) 4:-..T.',:"a4T.,,Tie.;:f:4-7-7,7,.---,P. --!..,F,I.'''''',<1,:',47.... .e 4,2-,-'".1,,,....,,s-j6fe:r,, ,v;...,,..4,,„-.Tr-,,• .et4.,;-,1,.,7,-,....p.„,,,,,,„,,,,,, ..._, : f Other Business name:Apex Air LW : ' ' ' ' — ' -1.4,t '•••'.?..r.-,i;a- ',,,,:.:*. ',,,,,,t-, .!''',V, 4',, Address:220W.Main St.Suite 107472 , Subtotal . : City/State/ZIP:Battle Ground,WA 93604 :Minimtun permit fee(S90.00)Plan review(25%of permit fee) Phone:(360)342-8109 Fa.x::(360)326-1769 State surcharge(12%of permit fee) CCB lie.:203034 Ar , r „,, _ • _ TOTAL PERMIT FEE This permit application aspirin if a permit is not obtained within 181) days after it has beta accepted as complete. Authorized si: .. . - f ' : * For methodology id by Tri-Comity Building indosay Service Board ).....- .,,-,-.• , .,, • Print name:Staci hay 1,.../ Date:1/28/2016 I I tfluildt.ed\anits‘MEC PermitAppj140113 elm 446-$6177(ItinzromAYEnt City of Tigard 111 I COMMUNITY DEVELOPMENT DEPARTMENT T l c A RD Building Permit Review — Residential Building Permit #: • '7J i'c2 a /E, o03 9 Site Address: /g3.9// g O s,4Ll0,2. 0/19i/e, Project Name: v-e- i7xc e /Ur- uegi-- Lot #: c% (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Aj ' i iz( erify site address/suite# exists and active in permit sem. River Terrace Neighborhood:/7- ❑ No V Yes,See River Terrace Review Addendum Attached SityPlan Elements: vree(3)copies of site plan sting structures on sitee plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished 'awn to scale(standard architect or engineer scale) or elevations Vorth arrow }Utility locations(required for new,may apply for additions) Xpt• e address,project or subdivision name and lot number /1!'%cation of wells/septic systems plicant information(name and phone number) . '4 'sting trees to be retained with drip line,and tree • of dimensions and building setback dimensions yrotection measures Lot area,building coverage area,percentage of coverage and rif eet tree size,type and location fripervious area (applicable if R-7,R-12,R-25&R-40) VStreet names 'IVProperty corner elevations(2 foot contour lines if more than 4 foot differential) taRlean Water Services—Service Provider Lette (lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified l2 No Received: ❑ Yes ❑ No Ig ublic Faciliti Improvement(PFI) Permit: equired: V Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake Pc Land Use Case#: )1)bPr�0j �' S'I( O / f� Zoning: i C%�.�'�'� • Required Setbacks: Front _ Rear h Side '' Street Side Garage cz U �>Landscape Requirement: cQ , i2 of Coverage Maximum: 3— 0/0 uilding Height: Maximum Height - Actual Height tdi4 isual Clearance 7 Easements nsitive Lands: dEl Yes Vyo Type Urban Forestry Plan ❑ Conditions "Met"prior to issuance of building permit , Notes: ()iih30i ,_;12,21 AP MS- poor A ioe, pi,4/ 1&/Ac Le Approved By Planning: Date: ' Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved l:\Building\Forms\BldgPermitRvw_RES_091216.docx Building Permit Submittal Original Submittal Date: </�//A, Site Plans: # . Y Building Plans: # 3 Building Permit#: ErEnter building permit#above. Workflow Routing: Er-Planning =R.-Engin' eering `Et Permit Coordinator wilding Workflow Sign-off: la Sign-off for Planning(include notes from planning review) Route Application Documents: a Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ai Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: YC'' '5/4 Date: /�e3//, , B Permit Technician: En -.fleeting Review Slope at building pad: as ❑ Conditions "Met"prior to issuance of building permit Cl 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: ❑ Yes El No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by ngineering: Date: Notes: .0 _ _ 1 M ar Gam." . a.-� i ins _ Approved by Engineering: Iii/ 2 Date: /v—_s-'. , Revisions (after Building Submittal only) Reviewer Date Revision 1: Cl 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: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: - SDC Fees Entered: Wash Co Trans Dev Tax: a- Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: P--Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: C,ka'��"Qo CaLN..to Date: R7-7 -14o DK -Cur 114E-3 V`( - t4a.- I:\Building\Forms\BldgPermitRvw_RES_091216.docx City of Tigard 111 a COMMUNITY DEVELOPMENT DEPARTMENT I T c A R D River Terrace Building Permit Review Addendum Building Permit #: //S 7o,' - Dv 353 Site Address: / g9 sc `j , 4"-e_ Project Name: //Ver �-�✓ ce ,e meg Lot #: -D (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan District Design Standards (18.660.070.1.): Is the project subject to the plan district design standards?V Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch min. 5 dee Balcony w/ access 2 Window Projection Vertical Wall Offset a p ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer ❑ ❑ ❑ ❑ 2. Eyes on the street: a minimum o 12%of each street facing facade must include windows or entrance doors. Percentage Shown: l , ee, 3. trances:At least one entrance must meet both of the follo g standards: Max. 8 ft. setback from long 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 es,all the following apply: 1 .ft. min. ne street facing entry rby/ a ft.max. roof above floor of porch 5 ft. depth min. 30%min. orch roof oof coverage 4. tailed Design:All buildings shall include a min. of five of jkie following elements on all street-facing facades: iz( overed porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep all offset min. 16 inches 0/Dormer min. 4 ft.wide Roof eave min. 12 inch projection oof offset min. of 2 ft. ❑ Roof shingles either tile or woodhable,hip or gambrel roof design ElRoof pitch oriented south min. 500 sq. ft. orizontal lap siding min. 3-7 inches wide ❑ Accent siding min. 40% of street facade I(Q Window trim min. 2'/2"wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade 5. Garages and Carports:May face the front or side lot line on a corner lot. Setb/acks: 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) ❑ foot wide garage door El40%max. of street facade [ 1 50%max. of street facade with 7 detailed design elements Notes: MEW'Approved By Planning: ► ,, 7, Date: A I:\Building\Forms\BldgPermitRvw RES RT 062216.docx Plumbint Permit Applica CEIVED Building Fixtures City of Tigard NOV 3 2016 may, ll S /�.. Permit No II,-003613 III • 13125 SW Halt Blvd.,Tigard,OR 97223 • Phone. 503.7182439 Fax: 503.I9$1riv OFTIGARJ PlanRevtew Other Permit No.: Inspection Line: 503.639.4175 Date/Re I , I:f) Date Ready/By. Judy H See Page 2 for Internet www.tigard-or.gov BUILDING DIVISION Notified/Metbod: Supplemental information TYPE:OP:WORK.. FEE! I ®New construction • 0 Demolition For spedal information use checklist Description I Qty. I Ea. I Total 0 Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION' SFR(1)bath 312.70 ®1-and 2-family dwelling 0 Commercial/mdustrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath ( 50032 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other Fire sprinkler(_sq.ft) Page 2 JOB SITE INFORMATION AND LOCATION c Site utilities: Job site address: /3394% SW C..J�1"SW(�, {) Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 VW DrYwell,leach line,or trench drain ■ 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldgJapt.no.: Project name:giVer-Then �? NW Manufactured home utilities 50.03 Cross street/directions to job site: �'a "Ifs' Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_J Page 2 Storm sewer(no.linear ft: ) Page 2 Aver Water service(no.linear ft.: ) Page 2 //w Subdivision: �, a, /g�wee4' -Lot no.:(86 Fixture or item: Tax map/parcel no.: 'v l J Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 CA11��1�Mame_ Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ®.`PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:ADVL Land Holdings,LLC Fixturdsewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:7600 E Doubletree Ranch Road Garbage disposal 25.02 City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02 Phone:(602)694-4031 Fax:( ) Ice maker 12.51 ®.APPLICANT . 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Angela Grajewski Roof drain(commercial) 12.51 Address:109 East 13th Street Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:Angela.Grajewski(a33polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Malmedal Enterprises Inc. Water piping/DWV 5629 Address:PO Box 207 Other. 25.02 City/State/ZIP:Banks,OR 97106 Subtotal Phone:(503)324-0759 Fax:(503-)324-0580 Minimum permit fee: $72.50 CCB Lie.:102535 Plumbing Lic.no.:34-276PB Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Carolina Malmedal Date:04/25/2016 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:1BuidingiPermits\PLMU•PcnnitApp.doe 10/01/09 440 4616T(10102/COM/WEB)