Permit (18) CITY OF TIGARD MASTER PERMIT
11„, ii
s.. „_, COMMUNITY DEVELOPMENT Permit#: MST2017-00038
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/14/2017
Parcel: 2S106DB12800
Jurisdiction: Tigard
Site address: 17391 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 128
Project: River Terrace Northwest, Lot 128
Project Description: New SF.4/12/17: REPRINT to add patio cover.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 948 sf Basement: 0 sf Left 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1130 sf Garage: 380 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2078 sf Value: $254,572.66 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 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: 3 201-400 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 2078
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Fire Rated Eaves-Both
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 Sides
STE 1 2 Ersn Cntrl 503-639-4175
SCOTTSDALE,AZ 85258
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $31,890.90
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 0 952-001-0090. 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: S7--r - y iL a/1101
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. f
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
111 ii.
Letter
Transmitt l
a e ter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
APR 3 2017
FROM: Angela Grajewski
CITY OF TIGARD
COMPANY: Polygon Northwest BUILDING DIVISION
PHONE: 971-212-2144 By://k'
y: ,/
RE: 17391 SW Shadow Trails ST MST2017-00038
(Site Address) (Permit Number)
River Terrace Northwest Lot 128
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
I Copy Description Copies: Description:• ,:e, ,„
0 Additional set(s) of plans. 3 Revisions: e
0 Cross section(s) and details. 0 Wall bracing and/dr 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.
add d,»e'k'due to terrain
`o earl I1 `
NOV -'/ \ �..__. y A la,: FO' ,FFICE USE NLY , 1..
Routed to 'ermit Technician: Date: Lid _ Jcj --i )- Initials: -f
Fees Due: F/ Yes ❑No Fee Description: Amount Due:
y
i , , ,� �)ol, �V: e%v- $. f/),C7-0
z
$*
v
Special
Instructions:
Reprint Permit(per PE): 1Yes ❑No Done
Applicant Notified: ate: I by by
Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
r ,
City of Tigard
■
COMMUNITY DEVELOPMENT DEPARTMENT 1
Buildingg Permit Review — Residential
1IGARD
Building Permit#: /f tc )/ 7 —0903 r
Site Address: f i 6\N (CiYGtr iJ Tr ut to tf
Project Name: 121Vor TPXtdicf, NDttrniV e5+- Lot #: 11435
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 1` W1.- -7Z. flea) tfir-–7&r' pa-6`o Ciiut''f
.x'Verify site address/suite#exists and active in permit system.
ARiver Terrace Neighborhood: 0 No X Yes,See River Teirace Review Addendum Attached
Site Plan Elements:
.Three(3)copies of site plan 0` sting structures on site
.Site plan mug k on 8-1/2"x 11"or 11 x 17"paper ►--' ootprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) floor elevations
North arrow (Utility locations(required for new,may apply for additions)
Site address,project or subdivision name and lot number Location of wells/septic systems
IICLk.pplicant information(name and phone number) Existing trees to be retained with drip line,and tree
Jot dimensions and building setback dimensions protection measures
of area,building coverage area,percentage of coverage and i! Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) 1Y treet names
Property corner elevations(2 foot contour lines if more than
4 foot differential)
Clean Water Services–Service Provider Letter ofatted prior lto 9/10/1995
P Received:9/10/1995):
❑ Yes 0 No
Required: ❑ Yes,applicant was notified K No
Public Facilities Improvement(PFI)Permit
Required: ❑ Yes,applicant was notified 'No Applied For: 0 Yes ❑ No,stop intake
tkr-Land Use Case#: Pp9- s GTx,
1fi1 Zoning: POI
R uird Setbacks: Front leo Rear 10 Side Street Side l�N/ Garage
Landscape Requirement: 10 %
Lot Coverage Maximum: 42300 % '
Building Height Maximum Height NIpt Actual Height ±28
Visual Clearance
-Easements
XSensitive Lands: 0 Yes No Type
S.Urban Forestry Plan
"Conditions"Met"prior to issuance of building permit
� /r�/
Notes: 1, ty\1s IM V' but f*W 10 U S`r ACA1/1R L
Approved By Planning: _ T/A 4 , / Date: ( 22-
Revisions
ZRevisions(after Building Submitt .nly) Reviewer (wG reel i lms D to
Revision 1: .Approved ■ Not Approved fivv, c,e- 1recs
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:1Building\Forms\BldgPermitRvw_RFS 091216.docx
f y
Building Permit Submittal
Original Submittal Date: 12,/Ao /7
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing. lanning Cp.-Engineering Permit Coordinator AI''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.
Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 441/4j(EirzAjZ
Date: /7/07/2
Engineering Review
Slope at building pad: �!
conditions"Met"prior to issuance of building permit 4./ I r
0 Easements(encroachments)per engineering conditions of approval and plat
D Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot 0 Yes 0 No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 77-
Revisions(after uilding Submittal only) Review r Date
Revision 1: Approved 0 Not Approved 4 1/"24-17
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
proved,NOT Released: `% ' —ate: //3/1
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
)213SDC Fees Entered: Wash Co Trans Dev Tax: es 0 N/A
Tigard Trans SDC: es 0 N/A
Parks SDC: Yes 0 N/A
k ilK to Issue Permit
pproved by Permit Coordinator: 1//rDate:007
I:\Building\Forms\BldgPermitRvw_RES_091216.docx /16/4 -111/1,1/