Permit (78) ,, CITY OF TIGARD MASTER PERMIT
== COMMUNITY DEVELOPMENT Permit#: MST2017-00301
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/21/2017
Parcel: 2S106DA03300
Jurisdiction: Tigard
Site address: 13107 SW 169TH AVE
Subdivision: RIVER TERRACE EAST Lot: 33
Project: River Terrace East, Lot 33
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 101 sf Basement: 0 sf Left 0 Parking Spaces: 0
Height: 31 Bathrooms: 2 Second: 646 sf Garage: 547 sf Front: 8 Smoke
Dwelling Units: 1 Third: 633 sf Right: 0
Detectors: Yes
Total: 1380 sf Value: $186,029.93 Rear: 5
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
Tubs/Showers: 2 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: 1 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: 2 201-400 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 SFA VB R-3 1380
Owner: Contractor:
WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
109 E 13TH ST 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $23,200.22
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 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344..80. 2 /
Issued By: % `r---C�__ Permittee Signature: 047 " i " / L/t:-�T77�tAi'
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 t--O T 33
.Extri,ielm. RECEIVED F012 OFFICE l SE 0NL1
City of Tigard JJ 14 2017 D Received ��I(7 0 Permit No s 0 c q
13125 SW Hall Blvd.,Tigard,OR 97dN Plea Review
' Phone: 503.718.2439 Fax: 503.598.1960 DateBy: V'a.1- ) Other Permit:S' [�(J�,-0()2P!
r i�- , Ez i i Inspection Line: 503.639.4175 CITY�F ��4 L. Date Ready/By: r ' Juni: H See Paget for
Internet www.tigard-or.gov BUILD{NG DIVISION Notified/Method: f/�(7 /7 Supplemental Information
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`tee � r,,6t� j ° _ '� '„ .i., ,,i < `::'. . i p- ,.,¢ E __ ,..r s . fin ea .:
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®New construction ❑Demolition Permit fees*are based on the value of the worperformed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other. equipment,materials,labor,overhead,and the profit for the
' f ;: f Ems. dFi t 4.t : r v,. .,„; t ' �:'. work indicated on tin hcation.
,»� �.o �.� 5:<«nr�
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: n )
O Accessory building 0 Multi-family Number of bedrooms: 4. t $CI, o 9 7J
0 Master builder 0 Other Number of bathrooms: 3
I°i 4r:1 h a k 3 ti i 1 r 7 C, -...;'.1 " - Total number of floors. 3 J 7
Job site address: 3 16-1 a New dwelling area quare feet
City/State/ZIP:Tigard,OR 97224 • J Garage/carport area: S Li square feet 3 3
Suite/bldgJapt no.: I Project name: ri%Jir Terrta.cc. EGASj- Covered porch area: OI{ square feet (,.6
Cross street/directions to job site: Deck
���aree(a 9 0 �f/ square feet f 0J i
Oe-Tff jctin ur eaarea: q Q square feet
z ? °ka: Y " , C Et on3
Subdivision ILVr TerfaCC,EASt- Lot no.: -7,4,;,.. - Permit fees*are based on the value of the work performed
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
<._,.' , 1 '. `' work indicated on this application.
Valuation $
Existing building area: square feet
New building area: square feet
�� �
r., -. . € ° '' ` � Number of stories:
Name:ADVL Land Holdings,LLC Type of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/State/ZIP:Scottsdale,AZ 85258 Existing:
Phone:(602)694-4031 Fax:( ) ''',:r?'--:
New:
Business name:Polygon WLH,LLC ,,. :tea, �& ,
0kt Structural plan review fee(or deposit):
Contact name: N
FLS plan review fee(if applicable):
Address:109 East 13th Street
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Phone:(360)695-7700 I Fax::( ) Amount received:
Email N( 0 . (A r I�, ^ n n i b AA 1. �_ - y F.
17, Commercial and residential prescriptive installation of
;'4' L, - ` � _ -� " roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 109 East 13th Street Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
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
Authorized signature: This permit application expires if a permit is not obtained
i within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: JI Ch �y / vliY,y Date:��� / Service Board.
I:\Building\Permits\BUP-REVSPermitAp-p..d`oc 02/24/2011 440-46131(`11/02/COM/WEB)
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Mechanical Permit Applicann .4., '1-4' FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
Daa
ig 13125 SW Hall Blvd.,Tigard,OR 97223 ��1, E� �� ((��f' n
p�Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other Permit:
T i G A R D Inspection Line: 503.639.4175 ,7,,, ti A r a i`.
� _ q t'� � ry � �., Date Ready/By: loris: H See Page 2 for
Internet www.tigard-or.gov s.t 9 t' k.- \x r Notified/Method: Supplemental Information
BUILDING DING ;SIA/?i
TYPE OF:WORK COMMERCIAL FEE*'St D'LE USE CHECKI IST ..;.
Mechanical permit fees"are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:
CATEGOYO•FCONST,RUITl9 RCO _:._RBIDETAEQUIPM
ENTSYTEMS FEES_+
0
1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For:pedal information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
..,JOB . INZ?O tMA.- AND LOCATION
Heating/cooling:
Mr conditioning 1 46.75 46.75
Job site address: 13 t 0� SW �w 1 p '{ Nei
Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR 97224 �" Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:River Terrace East Duct work 2332
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 1 2332
Subdivision:River Terrace East Lot no.: , Other. 2332
J
Other fuel appliances:
Tax map/parcel no.: Water heater 2332
t ,, ; DESCRIPTION OF WORT'; .._ fireplace/ 1 3339
Gas insert
�A r Flue vent for water heater or gas
V S 1 �k-1— CO3O t fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
is PROPERTY oV(tNER Other: ventilation: 23.32
❑..TE •NANT; r Environmental exhaust and
Name:ADVL Land Holdings,LLC Range hood/other kitchen
Address:7600 E Doubletree Ranch Road equipment 33.39
Clothes dryer exhaust i 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) Lk 2332 _
Phone:(602)694-4031 Fax:( ) ' Attic/crawlspace fans _ 23.32
:; APPLICANT' ;❑ CONTACT PERSON Other 2332
Fuel piping:
Business name:William Lyon Homes,Inc. $14.15 for first four;$4.03 for each additional
Contact name:t\),()j L V k,-11A0r9.e, Furnace,ete. 1
Address:"" �� Mar ( `S� nk- <'Sid Gas heat pump
I Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700
Fax::(360)
0)693-4442 Fireplace 1
•
- Bb1
E-mail:AO i Cik u ti —1� D e., )b�� hm s •p kill arecue
; ... C Rl __ :
Clothes dryer(gas)
Business name:r� Pn�� }1[�ry �W,� r�(���,, I'T def
Address: I�q�" N� '1("� ��1 v Vt �q �r ... .MECHA11tCAI;PERMIT.FEEta _
1oG Cr\ V J lif. l Subtotal
City/State/ZIP: t 1 Minimum permit fee($90.00)��� Plan review(25%of permit fee)
Phone:503)(_f Li 3.. 4 Fax: i 5)O�Lit'.. Sin s State surcharge(12%of permit fee)
CCB licJ:ZAp'_001
t TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: * days after it has been accepted as complete.
• � , Fee methodology set by TriCounty Building Industry Service Board
Print name:Nl 614 i/e_-111N12{-- Date:
I:VBuilding\Permits\MEC permitApp 040113.doc 440-4617T(11/02/COM/WFB)
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Electrical Permit Application , FOR OFFICE USE ONLY
City of Tigard Received
, Dateg3 : Permit 0:
1111 q 13125 SW Hall Blvd.,Tigard,OR 9p2ps‘N> 0 7, r i G A 4'11 pi.Revie,,,
3 Phone: 503.718.2439 Pax: 503.598,1969' DateA3 : Related Permit g:
Inspection Line: 503.639.4175 n,i In rt iN G 0 fv lsi u I Reedy Deasy: kik: RI See Page 2 for
TIGARp Internet www.tigard-or.gov :',-,',,,t 1-41t1 Notified/Method: Supplemental Information
--,--1:'•7=7J',-.4.-, 1::?-f?:?'---24g5:'74`.--F,'S-P.N*4 C..:.0 ZFP61g/147e,:-041,74qk"A'-%,/,*27',-":;.:-1"- W-i' '''.-;•.;?, r..,"3::-WA--wy",-_,,,,,,,,,....-
121 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plansw/Iterns checked):
0 Service or feeder 400 amps or more 0 Building over three stades.
0 Demolition D Other: .
where the available fault current 0 1%lazines and boatyards.
1 -;•=.W ' ii.e.k4*i-l'W..9,t-l'?Wt711:0::::ca--"Offil,(POIVE;- -"?;: if---•,`eg:::"*.A. .-r, exceeds 10,000 amps at 150 volts or CI Floating buildings.
El 1-and 2-family dwelling El Commercialfilichistrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for sE other installations. . buildings.•
0 Multi-family ••• 0 Master builder 0 Other: . ['Fire pump. El Installation of 150 KVA.or
1.101gW: fro... ;‘.:41:04.Le i'cotAlti: r•-•.%:,z•-cc--.----''' ,.: -,%...-..,:-,:-.-4 0 Emer stem.
' ' - — --i '' ''' '—.'''''' -.:.' "' . Li Addition of gYn motor load of larger separately derived
System.
Job#: 1 Job site address: b I 0 1 \)j. \Oil pat, ion:porn..
o Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224
01iesub-eare facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltap for MOTO than
Suite/bldg./apt.#: Project name:gtvey- T41,02 e_e Eacf
0 Service or feeder 600 amps or mom. 600 volts nominal.
Cross street/directions to job site:
ites.ipaaa - J Qty. t Each j Total •
New residential single-or multi-family dwelling unit.
Subdivision: (7--,1"- R.r Tedirret ei- -Ea*- Lot#: --5; Includes attached garage.
1,000 sq.ft.or less I 168.54 4
Tax map/parcel#:
Ea.add'!500 sq.ft or portion I 33.92, 1
111--. 1 1 r1.003Z-VO.10.5„11-0,-_-1 -,-,4,-t,,WS-4,- .-..,. 1.11-„t Limited energy,residential
75.00 2
(ASTI()II - Li 030 1 (with above sq.ft.1
Limited energy,multi-family
75.00 2
residential(with above sq.ft)
.., Renewable Energy ID See Page 2
,,,,:a;t:: .-:--t:::;trD:#•-.'11 y- 0 ,-s-a- ;,,---,-=7,--2-.- rg.r.,tiff,0....,T -z--..-------rfServices or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E Doubletree Ranch Road 201 amps to 400 amps 133.56 2-
401 amps to 600 MIPS 20034 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over 1,000 amps or volts i 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
-.
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. ' 201 amps to 400 amps 125.08 2
Owner signature:. Date: • 401 amps to 599 amps 16834 2
-,..,-,111 ,44', ..f. Va F•finr:1&'*;r:-", `''''''',” ',':FAIA4P4lati,PANI-r-477'Plai.. 0.0,1 -..1 -',.;,,, AB7reeelotelunlictisi—ne7,walittri don'or extension,per panel
Business name:William Lyon Homes,Inc. above service or feeder fee,
7.42 2 _.
each branch circuit
Contact name: hi 1 c h Dicni Ori', B.Pee for branch circuits without
service or feeder fee,first
56.18 2
Address: 103 2,i-Oacitkicm Ste SuLtA-&- l.D branch 'circuit
City/State/ZIP:Vancouver,WA 98660 4 Each add'l branch circuit 7,42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 ' '' Fax::(360)693-4442 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email;; I h Dko. 0 & p, ,4 _AL,* P opt Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC ' Signor outline lighting 67.84 2
J._.. Signal circult(s)or limited-energy
Address: 4 D7__ \ iLi laAkiNie,.ks.1 ke3i LCk\-e, \CcO panel,alteraticm,or ecnension. 0 See Page 2
Each additional inspection over allowable in any of the above2
cityistaterm:'pck 1 t 0.11,14 p 1 por. C?es--) I
Additional inspection a hr min) 6625/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) • 78.18/hr
Email:bdaniels@gweusa.com
Inspections for whichno fee is
90_00/Ir
COB Lic.: C1158 Electrical Lic.: 208174 Suprv.Lie,: 4496S specifically listed(%turnip)
o'sq,SCOLO_AZI L 7,..•,-*..,,---;•r7:: -..
,. , _. ... .
Suprv.Electrician signature,required: 't j /1 s-....
/ p,./.,-.-.24.16„..fr.. . . Subtotal:
Print name: Joan P Albert •• Date: 4/26/2016 0 Plan Review Required(25%of permit fee):
e"---- State surcharge(12%of permit fee):
••••
Authorized signature:
_ ___------- -
TOTAL PERMIT FEE:
''....., (--
This permit application expires if s permteis not obtained within ISO
*!..;. Print name: BEI Daniels Date: 4/26/2016 days after Mum been accepted as complete.
i.;.i':;.• - * Number of inspeotions allowed per permit
F;;:ii.,.'LeGulldiagIPermitalliLC PormItApp ELk ERE.doc
Rev D6/17/201$ 4404615T(11/05/COWWEE
"lel,
Plumbing Permit Applicatm _
I
Building Fixtures 1:O1t OH i c i_ I. I. O\l.'S
City of Tigard Received Permit No.:
13125 SW Hall Blvd,Tigard,O ) ,i if s, �`"�i Pian Review
Phone: 503.718.2439 Fax 503,594.1960--" Other Permit No.:
Inspection Line: 503.639.417 i r �� a 9 xi� n)° ,,
Ti(s.�t R D :',7,0��a_v+r�_�e� a € � ? � Date BendyiBy: furls: 0 See Page 2 for
Internet: www.tigard-or,gov Notified/Method: , Supplemental Information
' TOE OF WORT( +.'6CBEDVLE:
•
FEE.
®New construction 0 Demolition For special ir{far+nation use checklist
Description J Qty. J Ea. J Total
❑Addition/alteration/replacement 0 Other: New I.2-fatuity dwellings(includes 100 IL for each utility connection)
__CCATEGORY'`OF CONSTRUCTtOI!i SFR(1)bath 312.70 ,
® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 :
0 Accessory buildingSFR(3)bath 500.32
0 Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other; Fire sprinkler( sq.ft.) Page 2
_;JOB SJ INFORMATIO1 A10)LOCATION Site utilities: _ _
Job site address: 13 ( Oi 5v,} L i4cith `I v{ •
Catch basin or area drain 18.76 .
City/State/ZIP:Tigard,OR 97224 • Drywell,leach line, trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: (ZIVQr Tejyra!e.Et S.1-- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector • 18.76
Sanitary sewer(no.linear ft.:.-_._) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:.__) Page 2 :
Subdivision: R xr -ce .Ce_ eS-I-- I Lot no::33 Fixture or steal:
Tax map/parcel no.: j Backflow preventer 1 31.27
Backwater valve t 12.51
D6SC1ftFT(QN OF WO)lt[C` t
f I S 1 `l + O 030L Clothes washer 25.02
1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® a e*ipiF-1t . 1:• is TENANT_' Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer 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
►11 'J -,0 tnlcr for/grease trap 2102
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Contact name;,t 1 •--�,,. Primer 12.51
t��`G�h � 1` , Roof drain(commercial) 12.51
Address:1 b3 13 �>�� S"\-5,,�,(< O Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 �J Solar units(potable water) 62.54 i
Phone:(360)695-7700 Fax::(360)693-4442;44 ,,{+ Tubfshower/shower pan 12.51
Email ♦ ut t e • l' nal 25.02
� 1 �� ► � >• 1�M7, �l1 Urinal
_.a.. s. 6 t_ A.. . water closet 25.02 ,
Wafer heater 37.52
Business name:Alliance Plumbing LLC Water'.piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other. 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
Pian review (25%ofpermit fee)
CCB Lie.:184601 Plumbing Lie.no.:PB732 -
State surcharge(12%of permit fee) ,
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date:5/23/2016 This permit application expires if*permit is not obtainest within ISO days
after h has been accepted as-complete.
*Fee methodology set by Tri•Coumty Building Industry Service Board.
1.1Duittass aermltslPLitU-PamitAppdoe I0/O1/09 440.4eleT(10102/COMtWE8)
r
s .
City of Tigard
IIII 'I COMMUNITY DEVELOPMENT DEPARTMENT
C •
T 1 c A lz D Building Permit Review — Residential
Building Permit #: ,i7 )(7-
Site Address: i()-- SO /(C/A ,j j'
Project Name: 'V, ,— —7-eCyaCe E-C - Lot #: S'
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: / }-14) S7Vk fly_ ,274C_Cit)24_
/River
erify site address/suite# exists and active in permit stem.
Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached
Sits lan Elements:
�y�( ree(3)copies of site plan !� sting structures on site
ite plan must be on 8-1/2"x 11"or 11 x 17"paper It Footprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale) oor elevations
orth arrow VA tility locations&easements(required for new and additions)
riAl to address,project or subdivision name and lot number II Sidewalk/driveway approach
11
pplicant information(name and phone number) IP .cation of wells/septic systems
Lot dimensions and building setback dimensions r IT sting trees to be retained with drip line,and tree
al S,uare footage of buildings to be demolishedotection measures
VA Lot area,building coverage area,percentage of coverage and Pi eet tree size,type and location
iin
pervious area(applicable if R-7,R-12,R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? IYJYes CI
4 foot differential)
If es,is a storm water quali facility shown? ❑Yes LT/No ,,
Oklean Water Services-Service Provider Lett(lot platted prior to 9/10/1995): Y 61712,ve°1 Lc-9 Gonat
Required: ElYes,applicant was notified EV No Received: ❑ Yes ❑ No Gig-e_
12I Public Facilitip Improvement(PFI)Permit: P'F/<2.0/60- WO
hequired: ` Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
and Use Case#: Pb,/2_,241/Le ^ COO / 1 Q /LP- d
Zoning: - - A J ) / ` � p / /
V' "
equired Setbacks: Front 0 Rear 5 Side L treet Side 011.Garage QO
1Q andsca p e Requirement: ()
of Coverage Maximum: 00
IA Building Height: Maximum Height OA- Actual Height
110 isual Clearance
7
,I_1/ ensitive Lands: ❑ Yes [ No Type
Ltd Urban Forestry Plan
❑ Conditions "M "prio to issuance of buil g permit /
Notes: (SGV(�I/)72S S' // M.Cay— or' 7?7 02- 7SS'Ci,a2Yie
Approved By Planning: _�� w/j Date: .:0�
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
I
Building Permit Submittal
Original Submittal Date: G 11 it/?
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planningengineering rmit Coordinator Building
Workflow Sign-off: Sign-off for lanning(include notes rom planning review)
Route Application Documents: p. Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
C.'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ,
By Permit Technician: ii Date: �A
Engineering Review
Slope at building pad: c 76
❑ 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: 0 Yes KNo
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: CI Yes Ie No
El NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: d4i I 11t.-- `a) i Date: /1 tit
Revisions (after Building Submittal only) Reviewer to
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit ��
pproved,NOT Released: ��� /,:(-- ate: S/ 4-7' ;Notes: �v &f - ry\e,�- l t �Q in �t,i
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: 'es ❑ N/A
Tigard Trans SDC: 'Yes ❑ N/A
Parks SDC: '"Yes ❑ N/A
LIDA ❑ Yes (EDN/A
OK to Issue Permit
Approved by Permit Coordinator: Ala G�C��,�Q,(?L. Date: 1\t7,61 fl
I:\Building\Fonns\BldgPermitRvw_RES_061417.docx
City of Tigard
1111 1 COMMUNITY DEVELOPMENT DEPARTMENT
C
T l G A RD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: /3/o - ) /&Q-4 ie
Project Name: £j'..ex- - -e��c_e : 71- Lot #: ��3
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dist 'ct Design Standards (18.660.070.1.):
Is the project subject to the plan district design standards? Yes El 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
O ElEl ❑
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: /21- c/,
t3. trances:At least one entrance must meet both of the folio , g standards:
Max. 8 ft. setback from long street- facing wall STA Parallel to street,angle no more than 45° from street,
or ope onto porch
Entrance opens to a porch: Yes ❑ No
If s,all the following apply: sq.ft.min.
ViA ne street facing entry 17t1.5,21t.max.roof above floor of porch
F 5 ft. depth min. V30%mm.porch roof coverage
4./1Setailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
�� Covered porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep
07all offset min. 16 inches ❑ P ormer min. 4 ft.wide
Roof eave min. 12 inch projection IP 'oof offset min.of 2 ft.
El Roof shingles either tile or wood !Pi Gable,hip or gambrel roof design
❑ ' .of pitch oriented south min. 500 sq. ft. ❑ Horizontal lap siding min. 3-7 inches wide
Accent siding min.40%of street façade ❑ Window trim min. 2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
El 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:
N vc/loser to front or side lot line,than longest street-facing wall. ❑ Yes No. If No (Check one):er
May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
El 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.
Wi. : (Check one)
12-foot-wide garage door ❑ 40%max. of street façade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning:
........-_ — - fes/% Date: � �
I:\Building\Forms\BldgPem»tRvwRES RT 062216.docx
MS-C(7)-(1 \71- (`c3C\
FOR OFFICE USE ONLY-SITE ADDRESS: tLCl`-)" S w k Ci"M v€-
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
IN Transmittal Letter
G,A R i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEWED:
DEPT: BUILDING DIVISION RECEIVED
AUG 14 2017
FROM: Angela Grajewski
CITY OF TIGARD
COMPANY: Polygon Northwest BUILDING DIVISION
PHONE: 971-212-2144 By.
/VI-S7)-o l7-12 ' '--
RE: 13147,13143,13137,13129,13107 SW 169th Ave .2 5-
(Site Address) (Permit Number) .29,
River Terrace East Lot 29-33 706
(Project name or subdivision name and lot number) 30/
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description. , Copies: Description:'', r
0 Structual Detail sheets
Additional set(s)of plans. 3 Revisions: included
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.
(plans were submitted with out structual detail sheets)
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes n No Fee Description: Amount Due:
$
$
$
Special
Instructions:
Reprint Permit(per PE): n Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13107 SW 169TH AVE, BEAVERTON, OR, 97007 May 23, 2018 at 12:56:50 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00301
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Moisture barrier acknowledgement form received
Moisture content form received
High efficiency interior lighting form received
Final erosion control approved
Street tree certificate checked
Insulation certification checked
Blower door test form received
Left C of 0 on counter
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13107 SW 169TH AVE, BEAVERTON, OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2017-00301
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
No A/C installed at this time
Violation Summary:
Inspector Contractor
Plumbing Permit Application
Site Utilities
FOR OFFICE I1SE ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 9723 Date/By: iji/?��? Permit N1rll.ry ,„�� -C650l
Phone: 503.718.2439 Fax: 503.598.1960 0. Plan Review ��t No.: /<
Inspection Line 503.639.4175 �/ ;i 1,1
Dare/By: 70)___
�� j_( �_ Other Permit No.:
TIGARD p
Internet: www.tigard-or.gov W Date Ready/By:etho �/ Juris I See Page 2 for
Notified/Method
TYPE WORSupplemental Information
€1 1.,ti. ..i.,:,''..?„:,,,, , FEE* SCHEDULE
®New construction
❑Demolition For special information use checklist
❑Addition/alteration/replacement Description Qty. Ea. Total
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION - SFR(1)bath
312.70
0 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building ®Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprities:y.,382 sq.ft.) /3 ,/yfi Page 2
4011 SITE INFORMATION"AND LOCATION Site utilities: �^
Job site address: 13107 SW 169th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: I Project name:River Terrace East Footing drain(no.linear ft.: ) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
I Lot no.:33 Fixture or item:
Tax map/parcel no.: Backflow preventer
31.27
• DESCRIPTION OF WORK Backwater valve 12.51
Multipurpose Fire Sprinkler System Clothes washer 25.02
Permit# Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
►.� PROPERTY OWNER ' I CI TENANT Expansion tank
12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Phone:( ) Hose bib 25.02
Fax:( ) Ice maker
Y1 APPLICANT 12.51
❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name:Robert Dishman Primer
12.51
Address: 146 W Historic Columbia River Hwy Roof drain(commercial) 12.51
City/State/ZIP:Troutdale,OR 97060 Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:(503)492-3490 I Fax::(503)912-6438 Tub/shower/shower pan 12.51
E-mail:robert.dishman@allianceplumbing.net Urinal 25.02
CONTACTOR Water closet 25.02
Business name:Alliance Plumbing,LLC Water heater 37.52
Address: 146 W Historic Columbia River Hwy Water piping/DWV 56.29
Other: 25.02
City/State/ZIP:Troutdale,OR 97060
Subtotal
Phone:(503)492-3490 Fax: 503
( )912-6438 Minimum permit fee: $72.50
CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
Authorized signature: ��� State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Print name:Gavin Thornes Date: 12/6/2017 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 Service Board.
t:\Building\Permits\PLMU-PermitApp.doc 10/01/09
440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Residential Fire Suppression Systems:
Fee Schedule: •Qty Fee Tt tttl Square Footage.:` Permit Fee:
Site'CTtiliti+e�, � oto 2,000 $121.90
Footing drain-Is' 100' 50.03 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52Permit,Fee:
V'> luatlo>lit:`
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.each additional for the first$]O5 00or0 a0 ction thereof,to
d$1.52 for
Qty,' Fee(ea)` Total and including$10,000.00.
Other Inspections or Fees
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
90.00/hr
Additional plan review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Other Fixtures: 1 1 1 1
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type
Fixture Type forReplace/ Plan Review for Plumbing Installations
Work Performed: Capped Added Relocate
Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Dpve or ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Dishwasher -Commercialoas defined in OAR918-780-0040.
❑ Medical gas and vacuum systems for health care facilities.
-Domestic
Drinking Fountain ® Any multipurpose fire sprinkler system.
0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4"
Car Wash Drain Isometric or Riser Diagram
Garbage -Domestic-non-food 0 isometric or riser diagram is required for new buildings
Disposal -Domestic-food related related that meet the qualifications above.
-Commercial-food
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: if the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal
haps://allianceplumbing-mysharepoint.com/personal/gavin_allianceplumlng_net/Documents/Documents/Fire Sprinklers/RT/City of Tigard
Permit.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13107 SW 169TH AVE, BEAVERTON, OR, 97007
Record Type: Record ID:
Residential - Master Permit MST2017-00301
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Moisture barrier acknowledgement form received
Moisture content form received
High efficiency interior lighting form received
Final erosion control approved
Street tree certificate checked
Insulation certification checked
Blower door test form received
Left C of 0 on counter
Violation Summary:
Inspector Contractor