Permit (90) ,� CITY OF TIGARD MASTER PERMIT
°a ! COMMUNITY DEVELOPMENT Permit#: MST2017-00403
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2017
Parcel: 2S 106DA02100
Jurisdiction: Tigard
Site address: 13205 SW 169TH AVE
Subdivision: RIVER TERRACE EAST Lot: 21
Project: River Terrace East, Lot 21
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 97 sf Basement: 0 sf Left: Parking Spaces: 0
Height: 32 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 12 Smoke
Dwelling Units: 1 Third: 562 sf Right:
Detectors: Yes
Total: 1221 sf Value: $161,914.53 Rear: 5
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 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: 0
Other Fixtures: 0
Drywell-Trench Drain:
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 1221
Owner: Contractor:
WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY POLYGON WLH LLC 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
ATTN BAKER,JASON VANCOUVER,WA 98660
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $22,879.96
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 =;2-801-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19877orr1., L ,
8000.332.23344.
Issued By: -- V�Permittee Signature: O `i--r1/" f e,1---770 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.
Permit A lication Z-. .10 T A I
Building pp
,- ,1 9 '1�� E FOR OFFICE I SE ONLI
City of Tigard EEewt'0
`JJUN 222017 Da (820/`�13125 SWHallBlvd.,Tigard,OR 9 23 , �} ether Permit: Uv3�
Phone: 503.718.2439 Fax: 503.598.1960 , " �"
l Date/By: )J —1../' � -j' ��� 7-
• Z.
r t c ,I:I; Inspection Line: 503.639.4175 b ILI t 1G "i iSOrhtefReda/Md Bhd:/ /f/ 7 ' / JurisH Se
e Page 2 for
Internet www.tigard-or.gov Supplemental
Information
'9-,L.. /vie,, e,L E
.a =
}^- v -. ,,„`7- r€:,-f-.-i. izr_;tn -i sN'-f-,a C o :1.!1'-:S
' 4 -p ° e,-,g;-:-,),44z%-l'',71:s
®New construction 0 Demolition Permit fees*are based on the value of the work performed
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other. equipment,materials,labor,overhead,and the profit for the
t TM work indicated on this application.
•* • Valuation: $
? 1-and 2-family dwelling 0 Commercial/industrial (y S
—eit061-- "ill
Multi-family Number of bedrooms: Z '611 '7 1 9,
❑Accessory building /
0 Master builder 0 Other: Number of bathrooms:
" *, N Total number of floors: J 6
Job site address: /3205- S 1 tolvi New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: („}w n square feet vT L 7
Suite/bldg./apt.no.: I Project name:River Terrace East Covered porch area:3 6,square feet r co,.
.
Cross street/directions to job site: Deck area: 7� square feet G9 7
er �v I
tur�arrea: 7 square feet
Subdivision:River Terrace East I Lot no.:ZI 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
� - r work indicated on this application.
_ —, te ,
Valuation: $
Existing building area: square feet
New building area: square feet
il` 1 ),7 r a _ 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:( ) New:
6 � � ,. N , _ iii 8 lay
'' "
...-:�. " =� _. r.. ..,:3�'�a' -°aai �� .'.:qr'" �s. . - . .e : „+"�,°
Business name:Polygon WLH,LLC Structural plan review fee(or deposit):
Contact name:Nichole Thorpe
FLS plan review fee(if applicable):
Address:109 East 13th Street
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Amount received:
Phone:(360)695-7700 I Fax::( ) ", , ;-"";-,-,4';',--..:",2'7---,,-,
E-mail:Nichole Thorpe
d� Commercial and residential prescriptive installation of
„ , z � ,,, ` 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.
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 lie.:207247 Total fee due upon application: $201.60
Authorized signature: , / 0717 ---- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Date:06/16/2017 *Fee methodology set by Tri-County Building Industry
Print name:Nichole Thorpe Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
, .
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: PermitNo.W 7020/7.-I:491/473
iii ul 13125 SW Hall Blvd.,Tigard,OR '7223 ;' '
Plan Review II Phone: 503.7182439 Fax: 503.598.1960 bate/By: Other Permit
TIGARD
Inspection Line: 503.639.4175 , , Date Ready/By: Aids: El See Page 2 for
Internet www.tigard-or.gov -, Noed/Method: Supplemental Information
*4-.4M00:11: Wibi:471.40kkiiitt4i#6114,5gritgltn#1, grt-9104-4-44iWg-0,410.14-kig*.: ge,
Mechanical permit fees*are based on the value of the work
El New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
-47-91P,A4v7:71. 7.311Kr4. fttii6_71*A10.7141,-70:fiiiO4. ----AgiraZ L., ...r.:VI:liibbilliXtrliiiiiiiglifiSkiiiiiii$77--'1`, 1•;;"
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For spedal information use checklist
qMuIti-family 0 Master builder 0 Other: Description Qty. Ea. Total
OrleV-RgaV::- Ykogo:tiwoa.age.:R. Efeatingicmling:
Air conditioning 1 46.75 46.75
Job site address: 1 7-110 - SW .0 Orth 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 Walt 23.32
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 23.32
Subdivision:River Terrace East LotOther 23.32 no.:2.1
Other fuel appliances:
Tax map/parcel no.:
Water heater 23.32
::;:g•XTZ40.1:44140i4: ****117,..-...i*O.„,*01*- 444:;V:t1:1474X3403-11 Gas firePlacermseit 33.39
' - Flue vent for water heater or gas 1
/1/1 SIM 1. ..6 b9-03 fireplace 23.32
_ ,
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
AMS
2332EIDthrnienronmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other ldtchen
equipment I 33.39
Address:7600 E Doubletree Ranch Road
Clothes dryer exhaust t 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, 1 L
toilet compartments,utility rooms) 1 2332
Phone:(602)694-4031 Fax( ) Anickrawlspace fans 23.32
-/Witgift.k.i?.n'..2 .•;iiV4W:Ei'-.6*tir*TIXES01"..ii::4ii?,inti Other 23.32
Business name:William Lyon Homes,Inc. Fuel piping:
514.15 for first four;$4.03 for each additional
Contact name: i CArt D .e,-11A0(ve, Furnace,etc. 1
Address: y7, Dytaapj oi 3 Svikc. sl 0 Gas heat pump
Wall/suspended/mit heater
City/State/ZIP:Vancouver,WA 98660
Water heater
Phone:(360)695-7700 Fax:(360)693-4442 Fireplace 1
AAr - Range
Elnall:ANY1 bk :-Vtovv40001-sr . ti Barbecue 1
s::,31?' 414.:174.1A1,:f4.1,!.:t:;. :.-,1:-..!;' .0:. gtO,.*"..,'7.4:?-1 "!...:::f:Si??.?.rli,e-- :M-:: Clothes&Yet(Fes)
Business name:PV1\AMVOok WTIQiOnel
. rj 01 17Other.
:•:AMJ.-1 Zi.I1:9..**111
Address: IOW W •Pii\ OtR Dr, sumf., Subtotal
City/State/M: k :ASbtprD i( . ,c:t an ,vrinimum permit fee(890.00)
Plan review(25%of permit fee)
Phone: )1443. sioeut Fm 61/) elk l'i 1''' S'O-1S- State surcharge(12%of permit fee)
CCB ha.:2_00IDDI TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after ft has been accepted as complete.
Authorized signature: /14C4 ,e4V.„....10-- * Fee methodology set by Tri-County Building Industry Service Board
Flint name. 144.d/ '11 019.(? Date:
TABuiltimaermitiguDIC PermitAtro 040113.doc 44n-4617T fl 1 ftwermmumo
Electrical Permit Applicatiah
- FOR OFFICE USE ONLY
City of Tigard ! Becelved �r.,�
13125 SW Rail BlvdTigard, teted. Permita:/7s% � ��;
OR 97223 Plan Review
Phone; 503.718.2439 Fax: 503.598.1960 Date/9 Related Pemrit a:
Inspection Line: 503.639.4175.
TIGARD ReadgDateBy: kris: is See Pagezfor
Internet .www figura-orgov Notified/Method: Supplemental faformation
_..-..1-'711'—'17,--- ..:*-am y-�.'f ��1,'X-e r�t1 r2.‘at9--4a� ;#:e�a - - -,�. -4 �E.cY r �M1 e+
®New construction azo-�'� ��C`V�(�'S�i°3�k`z �cy�,,may
0 Addition/alteration/replacement please check all that apply submit z sots of plans w/Items checked):
Q DtaDolition 0 Other
13 Service or feeder 400 amps armors Building over three st ries.
Det v x Tr r r sr where the available fault current ❑laminas and boatyards.
amps at 150 volts or °Floating buildings.
-and 2-family dwelling 0 Commesclalliidlistrtal 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agrioulaaat
Multi family Q Martel builder Q Other smps
for all other installations. • building' s.-
y ;fa ❑Fire pump. 13 tnataltatinn of 150 KVA of
w--r f_ -?.3 . ...-,e o l!y�., �gt%ni5--i r-. i:ri .x"3"4 ❑Emer gency system• larger separately derived
Job# Job site addrer s ❑Addition ofnew motor load of system.
M IOOHP or more. Q"A",`E","12","1-3",
City/StatelZiP:Tigard,OR 97224 ❑Six or more residential units. =mare*
[Wealth-care facilities. ❑Recreational vehicle parks.
Suitebldg/apt#: I Project name:gid TramE r1 ❑xa=raena tocattions. ❑supply voltage for more than
Cross street/directions to job site:
❑CoQ m feeder 600 amps Drumm 600 volts nominal
1 : e
Description
•
Qb: i Zarb Total I ..
New residential single-or multi-family dwelling unit
Subdivision: 1Z-Ater 1L -a/14, "L W+- fit# 2-J Includes attached garage.
— 1000 sq.R or less
1 168.54 4 map/parcel#:
Ea add'1500 ft or
"`? 5 •r 31ai M Q 2 ,. T sq.esdeportion 3392. 1
` fir, a�f ^ � Limited enargq residential
(with.above sq.it) 75.00 2
Limited energy,multifamily 75.00 2
residential(with above sq.it) _
•v^ L.41+�:•a `X59? d �v.'�.z'y,. x .' Y_ . �'$--'�t F __ Renewable Energy ❑ See P
'k.,:r -rt 7"_'7r_.1.1,�1 -uv 1' fv- Page
Services 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 13336 y
City/State/ZIP:Scottsdale,AZ 85258 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over 1,000 amps or volts 55226 2
EmailTemporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 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 16854 2
Cts"t. t'�y f�h'I €17", ;T,:' :''ter L' _."_ 1.,,-� sL Zel---1? l it-../.71,% Branch circuits—new,alteration,or extension,per panel
Business name:William Lyon Homes,Inc. abo feser i ch dies weer
1,, above service or/ceder foe,
Nicho�.�Thrirp " branch 7.42 2
��ntme' B.Fee for branch circuits without
Address: 103 (�urOrk. c St Sett,-. S la service or It e'firs
t
56•/8 2
City/State/El:Vancouver,WA 98660 Each add'I branch circuit 7.42 2
Phone:(360)695-7700 Fax (360)693-4442 Miscellaneous(service or feeder not included)
//,�� Each manufactured or modular
Remail , h (Cs 1 !1 1 ` . dwelling,service and/orfesder 67.84 2
;.; X44 tN p 0 , `e$ j m RA Recons trial y 67.84
Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sigaor outline lighting 67.84 2
Signal Address:,(,.(,OZ `l ci.k (" e_ ` S, '.1 t -, til n panel,alteration,or extension or limited-meg:I ❑ See Page 2 2
City/State/ZIP::' k ( �C ?J} w� t�17' Each additional Inspection over allowable In any of the above
Phone:(253 321-�s7�alif4 p' I Additional inspection(I br min) C 66.25/In
Fax:( ) Investigation(1 hrmin) 90.00/hr
Rmail•bdaniels@gveeusa.eom Industrial plant(I hr mitt) t 78.I8/hr
Inspections for which no fee is
CCB Lin.: C1158 I Electrical Lie.: 208174 I Suprv.Lin: 44965 spm" listed '4 1n min) 90.00/
Supra.Electrician signature,required: 11 , , - _ L '1. tf {fir a' `. `
L t Subtotal:
Print mime Joan?Albert Date: 4/26/2016 0 Plan Review Required(25%of permit fee):
•
_ State surcharge(12%of permit fie)
Authorized signature: - TOTAL PERMIT FEE:
`• Print mime $111 Daniels This permit application expires If a parmftis not obtained within ISO
r;_ Date 4/26/2016 days afterketene been accepted as complete.
4 lardtdlagtPamimVt C PmrdtApp ins.>a E dor Heti 06t1vzo15 - * Number oficapeotions allowed pap
s ti s. 41e46151111I/GS/CD1GrWSg
...
Plumbing Permit Application ...
Building Fixtures FOR (.)I 1 R- il t
City of Tigard
Datt/By: .
•
Pennftwrti..ST"."-(217-0e)Ve3
11 -- 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.7182439 Fax 503498.1960 Date/BY: OtherPenuit No.:
,,,"r`'-':-:,,, Inspection Line: 503.639.4175 . ' pate Ready/By: ` Judo Si See Page 2 for
''.'`" Internet www.dgard-orgov Notiftedtfvfethod: Supplemental Infoaluatiott
..:f.ATIL:!!''''',:-.1K:s:In3"'.. ''';'.*7--TISAr*efi*:::..t.- .?.;':.'1.:.:.:.'i...:::::-:;:f..$12::::::072.i:•: '..,:Lyit.::1-5t.:7;11.;':4:-::•q:-7 ;..!F.'-h**4 ;*;.7-.• . .. '
CI New construction 0 Demolition For special frtformationuse checklist.
' .Description I Qty. I Ea. I Total
0 Additionlaitemtiontreplacement 0 Other: New I-2-family dwellIngs(includes 100 R.for each utility connection)
••,.,7,:f=::21.:.*:.:-'4: .i," 44160-Itifir.74**00/t-,::A:::-.11::-;;;!6"-I-lt t„A':::E: SFR(I)bath 312/0
_I-and 2-family dwelling 0 Commercialimdustrial SFR(2)bath • . 437:78
: SFR(3)bath . t ' 500.32
0 Accessory bulkling It(Multi-finnily
. : Each Rational baildidtchen 25.02
0 Master builder 0 Other Fire sprinklert____sq.ft.) Page 2 '
-4, - :filVit4-4474 0101t,70.0.44117'010:07.4$•*•-0:*:''c: ' •.7:.r::":.-...:: Site utilities. ,-
lob site address: i'52,0 -- N _ __ ___ Is.., Catch basin or area drain 18.76
I b_
. Drywall,leach line,or trench drain . 18.76"
city/StatefZIP:Tigard,OR 97224
• _ Footing drain(no.linear ft.: ) Page 2 .
• Suite/bldg./apt.no.: Pwieet name' lailltri-P_XY/1 t Eag-i- 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: K\frir TeArace_. eAS4-- Lot no.;74 Fixture•or item:
Tax map/parcel no.: Back ow preventer I ' 31.27
•-*I"K4:1;:i1 :4,7i:;:: Backwarvaive 12.51 :
25.02
Dishwasher : 25.02
Drinking fountain 25.02
Ejectors/mita 25.02
0fti1****7?:..1:::..., Ai... -...-,5,_ . Eo-bitiwor.',.....:::;:, aPosion tank 12.51
FiallreSOWCT cap 25,b2
Name:ADPL Land Holifingsi LLC
Floor drain/floor sink/hub 25.02•
Mir=7600 E Doubletree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02 f
Phone:(602)694-4031 Fax:( ) lee maker 12.51
:: i : ::: _::, .,..:iiiitt *ea cwr. . 1.,-;-,-: interceptor/grease trap 25.02 •
Medical gas • 1
Business name:William Lyon Homes,Inc (value:5 ) Page 2
Printer , 12.51 .
Contact name;.thc..1()De...--r\i-Norprf_.
Roof drain(commercial) 12.51
Address:1 h3 1-,roockkoa.1% --t-sAA,1-e-, S-VO Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 : Fa=:(360)093-4442 Tublshoweshower pan 12.51
Urinal 25.02
E-mail::i.. A II - 1114 b dk, 91 Wiehor\V\bmeg.(' A fy)
25.02
:';'•',--:...At-IA:1'415}:'.....t:..p.:,,,.....,,,,. «e t.'rel'T.0,z; ...4..y,4 ...• . ,SS \,..';..-,:.,..,
Water heater • 37.52
Business name:Alliance Plumbing LLC
Water.piping/DWV 5629
Address:146W Historic Columbia River Hwy Other 25.02 1
City/State/ZIP:Troutdale,OR 97060 Subtotal '
Pito=(503)492-3490 Fax:(503)913-6438 MilliMUSTI permit fee: $7230
CCB Lk...:1114601
iPlumbing Lir.no.:PB732 Plan review(25%of permit fee)
/ State surcharge(12%arum*fee) ,
Authorized signature: i i Iii TOTAt.PERMIT FEE
Print name:Robert Dishnnin Date:5/2312016 Tbis permitapplicaton elpires Ira pore*es not oinsioed within ISO days
altar Rims bees attempted as:complete.
*Fee methodology set by Tri-Coucty Building lociesuat Service Board.
1.114elitimpermItelPLM-PermitAppAce 10/01/09 440-46i6Tfeent21CXIM/WEB)
City of Tigard
.111 w COMMUNITY DEVELOPMENT DEPARTMENT
11
TIGARD
Building Permit Review — Residential
Building Permit #: ,vfjt5 n, 00 4740.5
Site Address: 132-CS S W 16ci ein
Project Name: (ZVf - .7-cry u_ cid c f- Lot #: Z I
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
4--/IProposal: (V&V/ 5 C44-
/I
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ❑ No /re Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
/three(3)copies of site plan i ng structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
,�//Drawn to scale(standard architect or engineer scale) floor elevations
yJNorth arrow
` Utility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number „r2Sidewalk/driveway approach
,Applicant information(name and phone number) ca wells/septic systems
ileLot dimensions and building setback dimensions .Q.B.fristing-trees to be retained with drip line,and tree
quare footage of buildings to be demolished protection measures
,ZILot area,building coverage area,percenta.• of coverage and ,Street tree size,type and location
impervious area(applicable if R-7,R-1. R-25 : R-40) C treet names
l Property corner elevations(2 foot contour es if more than >1,000 sf of impervious area created or replaced? s o A/f
4 foot differential) If yes,is a storm water quality facility shown? ❑ No
/1
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified —IQ-4:4Q_ Received:
❑ Yes ❑ No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes El No,stop intake
JVLandUseCase#: 1 D� x(4.3.- 000®l , SUS 1-01(60--000041
X/— Zoning: I, Z S
PiRequired Setbacks: Front 1 2._ Rear S Side pig Street Side 3 Garage 3- (p
izr Landscape Requirement: ZQ
0/0
/`J Lot Coverage Maximum: 3 0 %
Building Height: Maximum Height `V I A Actual Height 3 18
Visual Clearance
7 Sensitive Lands: 0 Yes No Type
ZUrban Forestry Plan
Z Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: fri (24/1"4—'-' Date: 10 J I d / l
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved El Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\BuildineForms\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: (4'2177
Site Plans: #
Building Plans: #
Building Permit#: ►:' nter building permit#above.
Workflow Routing: 'ile' Planning Engineering ] Permit Coordinator 7 Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: p Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
7 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,� _ L / j�-A/�/_ Date: /7) /l
1"4/7
Engineering Review `a'
Slope at building pad: -/0
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
No
Assess Water Quantity Fee in-lieu: ❑ Yes Z No
LIDA Facility on lot: ❑ Yes !`J No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: 12 /lec Gt) 4 Date: to Z.S /7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit / )
i)?----
pproved,NOT Released: /9(d Date: >6j2-S
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 Taxes ❑ N/A
Tigard Trans SDC: > es ❑ N/A
Parks SDC: 'es El N/A
LIDA ❑ Yes /A
OK to Issue Permit
(453
Approved by
Permit Coordinator: tild Date: i1/'y f 4-'
I:\Building\Forms\BldgPermitRvw_RES_06141'7.docx
City of Tigard
Ili
III 8
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: ° 3 S w t c,c'1
41-1
Project Name: a.i ve r 'Te rr-ci La.. G-015
(New dwelling=subdivision name;Addition or Alteration=last name of owner) Lot #: L 1
Planning Review of River Terrace Plan District Design Standards (18.660.070.1):
Is the project subject to the plan district design standards?/YeS 0 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.
Balcony w/access 2 Window Projection Vertical Wall Offset a
Porch min. 5 ft. deep
ft.deep min. 2ft., 5 ft.wide min. 2 ft., Eft.wide Gabled dormer
2. Eyes on the street: a minimum of 12% of each street facing facade must include windows or entrance doors.
Percentage Shown:
3. Entrances:At least one entrance must meet both of the following standards:
Max. 8 ft. setback from longest street facing wall ;a'Parallel to street,angle no more than 45° from street,
Entrance opens to a porch: , YeS 0 No or open onto porch
z]
Ifes, all the following apply:
O/gy-
ne street facing entry 125 sq.ft. min.
5 ft. depth min• 1 12 ft.max.roof above floor of porch
/30%min.porch roof coverage
4. Detailed 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 ierRecessed en
Wall offset min. 16 inches try area min. 5 ft.wide x 2 ft. deep
Roof eave min. 12 inch projection Dormer min. 4 ft.wide
❑ Roof shingles either file or wood Roof offset min. of 2 ft.
0 Roof pitch oriented south min. 500 sq. ft. Gable,hip or gambrel roof design
Horizontal lap siding min. 3-7 inches wide
❑Accent siding min. 40%of street facade
❑ Window recess min. 3 inches for all street facingWindow trim ruin, 2 /Zit wide by 5/8"deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access 0 Bay window min. 5 ft.wide by 2 ft. deep
0 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.
Setbacks:
No closer to front or side lot line, than longest street-facing wall/Yes rR "k'o. If No (Check one):
❑ May 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 sto
above the garage that faces the street with a min. area of 12 sq.ft. ry
;i1/41.
h: Check one)
2 foot-wide garage door
r 50%max. of street facade with 7 detailed desi• elements 0
40%max. of street facade
Notes:
Approved By Planning: an."---...,- i/L—=
Date: l
I:\Building\Forms\B]dgpermitRvw_RES_RT_062216.docx
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
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. DATE RECEIVED:
DEPT: BUILDING DIVISIONr I
tOV14201i,
FROM: Nichole Thorpe
4
COMPANY: Polygon Northwest '31,11!
PHONE: 360-989-40204 By: C
7P
RE: 13213,13209 3205 3201 SW 169TH
(Site Address) La- 2,I ermit um er
River Terrace East T N1J�(2c�t I 001103
(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: Bulletin, Plan Sets
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.
Adding 3rd Bathroom Option
FOR OFFICE USE ONLY
Routed to Pe it Technician: Date: ) J--�]- ) 7 Initials
Fees Due: Yes ❑No Fee Description: Amount Due:
1 /-I r )D 1 ay-) r GV e A✓ $
$
$
$
Special
Instructions:
Reprint Permit(per PE): Yes [ No ❑ Done
Applicant Notified: Ar/ C 1-Cr 'Date: (z-/a'//2 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:
13205 SW 169TH AVE, BEAVERTON, OR, 97007 June 22, 2018 at 11 :10:55 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00403
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Previous corrections completed.
Water pressure = 65 psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13205 SW 169TH AVE, BEAVERTON, OR, 97007 June 20, 2018 at 10:57:07 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00403
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13205 SW 169TH AVE, BEAVERTON, OR, 97007 June 26, 2018 at 11 :36:36 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00403
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS
Comments:
Corrections completed
Violation Summary:
Inspector Contractor
Plumbing Permit Application
Building Fixtures ,. , .. i FOR OFFICE USE ONLY
IIICity of Tigard 4 �29 .. , -Received/
w 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �� Permit No/ G
Phone: 503.718.2439 Fax: 503.598.1960 l' ` 2 s a i r Date/By:Plan Review
T I G A R D Inspection Line 503.639.4175
� '
Internet. www.tlgard-or.gov t
s� { ()F., -.NoDate Ready/BedMeth),c-,2 od�'` � f ���� /7 G-
�' •�her Permit No.
uris I See Page 2 for
tifi
Supplemental Information
TYPE OF WORKBj ILDJN W t k )
FEE* SCHEDULE®New construction ❑Demolition For special information use checklist
❑Addition/alteration/replacement Description I Qty. I Ea. I Total
❑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 ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler(1,221 sq.ft.) its Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13205 SW 169'Ave. Catch basin or area drain 18.76
City/State/ZIP: Tigard,OR 97223 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.:21 Fixture or item:
Tax map/parcel no.: Backflow preventer 31 27
DESCRIPTION OF'WORBackwater valve 12.51
Multipurpose Fire Sprinkler System Clothes washer 25.02
Dishwasher 25.02
Permit#
MST2o11- 00403
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENANT,: Expansion tank 12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Address:703 Broadway St.Suite 510 Floor drain/floor sink/hub 25.02
City/State/ZIP:Vancouver,WA 98660 Garbage disposal 25.02
Hose bib 25.02
Phone:(360)695-7700 Fax:( )
Ice maker 12.51
►.® APPLICA=NT 0 CONTACT PERSON Interceptor/grease trap
25.02
Business name:Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name:Gavin Thomes Primer
12.51
Address: 146 W Historic Columbia River Hwy Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale,OR 97060
Solar units(potable water) 62.54
Phone:(503)492-3490 I Fax::(503)912-6438 Tub/shower/shower pan 12.51
E-mail:Gavin@AlliancePlumbing.net Urinal 25.02
CONTRACTOR Water closet 25.02
Business name:Alliance Plumbing,LLC Water heater 37.52
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
CCB Lie.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
Authorized signature: t� -7G___1 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Print name:Gavin Thomes I Date: 1/22/18 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.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09
440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
, Qty. Fee(ea) 'Totat Square Footage: Permit tee:
Site'Utilities oto 2,000 $I2I.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' 37.52 Valuation: Permit-Feet
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$1 0 00or0 a0 ction thereof,to
Qty. d$1.52 for
..,F (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
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof
(minimum charge-1/2 hour)
Subtotal:
Other Fixtures: I I
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 for Replace/ 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-Driveengineer.
New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator
tor Thru ❑ as defined in OAR918-780-0040.
Dishwasher -Commercial
❑ Medical gas and vacuum systems for health care facilities.
-Domestic
Drinking Fountain ® Any multipurpose fire sprinkler system.
Eye Wash 0 Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink 2" Submit 2 sets of plans with any of the above.
3„
4„
Car Wash Drain : ;I ometric or Riser Diagram
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-foodmeil-frelateddrelthat meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
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-my.sharepoint.com/personal/gavin_allianceplumng_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:
13205 SW 169TH AVE, BEAVERTON, OR, 97007 June 26, 2018 at 11 :36:51 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00403
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Final erosion control passed
Moisture content form received
Moisture barrier acknowledgement form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor