Permit (166) 114 ,a
CITY OF TIGARD MASTER PERMIT
'Ill
. COMMUNITY DEVELOPMENT Permit#: MST2019-00063
13125 SW Hall Blvd.,Ti Date Issued: 04/16/2019
TG(;, i+. and OR 97223 503.718.2439 9
Parcel: 2S 107AA00300
Jurisdiction: Tigard
Site address: 14227 SW 168TH AVE
Subdivision: ROSHAK RIDGE Lot: 3
Project: Polygon at Roshak Ridge, Lot 3
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1119 sf Basement: 140 sf Left: 3 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1062 sf Garage: 422 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Yes
Total: 2321 sf Value: $295,094.05 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 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: 3
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: 4 201-400 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 2321
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Geo Tech Report Required
Prior To Pour
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $34,801.68
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 throug 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: e..>—X.-�' Permittee Signature: ',G-✓' %�-66/l9
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.
l .V r
L (... -_\--
f "Building Permit Application
% Residential � ���® Received FOR OFFICE USE ONLY
City of Tigard a n(� Permit No.. (^
. DateB . , kC( MSTX,tq- t l'IN .
° 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 0 6 2019 Plan Review 3 s / Other Perini s 1_
Phone: 503.718.2439 Fax: 503.598.1960 DateB : 1` ./�cR-
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy: �>/ J:'� Iuris: B1 See Page2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: j ". l Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMTLY DWELLiNG
®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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ C4) Del Li
LA❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 2-7`t
2
Job site address: 1(,f (2,7"1 S V V t-C r New dwelling area: 2321 square feet 'O(0Z
City/State/ZIP: !!�� • V/ K Garage/carport area: square feet
� � �l�a� y22, i l IC?
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area:"4.< square feet 11-1 C)
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Polygon at Roshak Ridge Lot no.: 3 Permit fees*are based on the value of the work performed.
t
Indicae the value(rounded
to the nearest dollar))of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Ne/A A 1 Valuation: $
C Existing building area: square feet
New building area: square feet
El PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon WLH LLC Type of construction:
Address:703 Broadway Street Ste 510 Occupancy groups:
•
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New:
® APPLICANT : 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WLH LLC (Please refer le fee schedule)
Structural plan review fee(or deposit):
Contact name:Amanda Gavin
FLS plan review fee(if applicable):
Address:703 Broadway St.Ste 510
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Phone:(360)695-7700 Fax::(360)693-4442 Amount received:
E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic 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:703 Broadway St.Ste 510 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: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ane: Date: 9-) �� *Fee methodology set by Tri-County Building Industry
Service Board.
l:\BuildingWermits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit ApplicatiTiECFOR OFFICE USE ONLY
City of Tigard �� Received
Permit No.:
1 ° 13125 SW Hall Blvd.,Tigard,OR 97223 ApR p 9 2019 Plan RPlan Ry:
Phone: 503.718.2439 Fax: 503.598.1960
Review Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIG R� Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov V 1 I otified/Method: Supplemental Information
BUILDING DIVISIO qi
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
.1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
tif Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: \L-t22.1 5W WS-n-1 Pru5 Furnace 100,000 BTU(ducts/vents) 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:Roshak Ridge Duct work 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 23.32
Subdivision:Roshak Ridge Lot no.:
Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other 23.32
Fuel piping:
Business name:Polygon WLH,LLC
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Apex Air LLC Other
MECHANICAL PERMIT FEES*
Address:18004 NE 72nd Ave Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)342-8109 Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lic.:203034 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Tim Hay Date:04/08/2019
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
•
Electrical Permit Application RECEIVE. FOR OFFICE USE ONLY
City of Tigard ReceivedApp 1 4 2nqJ
DateBy: Permit#:
'A 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review -
- Phone: 503.718.2439 Fax: 503.598.1966`f"y OF TIG`'t�+ci Date/By: Related Permit#:
'lil.i>~,N.0 Internet:n www.: 503.639.4175 BUILDING DIVI7Ib,.�1`Readyd/Me/By: tarn: I H See Page 2 for
Internet: www.tigard-or.gov tJ y t / oti Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings,
® 1-and 2-family dwelling 0 Commercial/industrial p Accessory building less to Bound,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: 47;11 5V0 l ,, ❑Addition of new motor load of system.
*n4 P-v6 100HP or more. ❑"A","E","1-2","]-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal,
Cross street/directions to job site: FEE SCHEDULE
Description I Qty, I Each I Total I :
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: 3 Includes attached-garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: _
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
►e PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2
Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary 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 59.36 1
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 168.54 2
APPLICANT12
'- 0 CONTACT'PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee,
7A2 2
each branch circuit
Contact name:Jolene Smith B.Fee for branch circuits without
Address:703 Broadway St,Ste.510 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 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
dwelling,service and/or feeder 67.84 2
Email:permitsubmittals@polygonhomes.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Portland Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 1915 E 5th St,Ste D panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:pawl@portlandelectric.biz ,14-71-52‘1,5 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic; 4_ 9.025 specifically listed(rV2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �� ._ Subtotal:
Print name: Alex Shalya Date: 04/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: f / l,l..Q1.CJ/1.l.L , TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: MISHCHUK,SERG Y ti Date: 04/08/2019 days after it has been accepted as complete.
° Number of inspections allowed per permit.
Plumbing Permit Application
Building Fixtures EIVE FOR OFFICE USE ONLY
City of Tigard p Received
Il - g u i J Date/By: Permit No.:
l 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ur i IGANDate/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DJVIS`g l`Read/B Juris: 0 See Page 2for
Internet: www.tigard-or.gov i� j� Ready/By:o tfied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
®New construction ❑Demolition
Description Qty. Ea. Total
❑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-famil Y dwellin SFR(2)bath 437.78
g ❑Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ''Multi-family
❑Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t L.11.:2-1 S liJi i 6O F3-711. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Roshak Ridge 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:Roshak Ridge Lot no.: 3 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 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:permitsubmittals@polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Waterg�I in WV 56.29
Pip
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:
__ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Steve Fowler Date:04/08/2019
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
1
City of Tigard
IIIN COMMUNITY DEVELOPMENT DEPARTMENT
11
l 1 c A u o Building Permit Review — Residential
Building Permit #: S T -00Cc-c
Site Address: 422i SW i t.o g-f yl Ave,
Project Name: c)d1UG9y1 (�,osh�,.<< R�� Lot #: 3
(New d g=sub vision name;Addition or Alterati last name of owner)
Planning Review
Proposal:
JVerify site address/suite#exists and active in permit system.
Li–River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three(3)copies of site plan Existing structures on site
Bite plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished
t)rawn to scale(standard architect or engineer scale) floor elevations
, North arrow 7gcJtility locations&easements(required for new and additions)
;Site address,project or subdivision name and lot number Sidewalk/driveway approach
-Applicant information(name and phone number) 'ALocation of wells/septic systems
XLot dimensions and building setback dimensions Existing trees to be retained with drip line,and tree
1\
quare footage of buildings to be demolished protection measures
Lot area,building coverage area,percentage of coverage and XStreet tree size,type and location
impervious 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? e1No
4 foot differential) If yes,is a storm water quality facility shown? }}L�l�� No
1i. Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
ig Public Facilities Improvement(PFI)Permit:
Required: X Yes,applicant was notified ❑ No Applied For: ,K.Yes ❑ No,stop intake
.Land Use Case#: PD9 2A 15-00002. [Sl)12,2_,DtS—CfarDD'4
2t Zoning: 12—VZ
.1K Required Setbacks: Front a Rear 0 Side 3 Street Side Np- Garage 3
kLandscape Requirement: 20 %
X Lot Coverage Maximum: op
0,0
Building Height: Maximum Height NM' Actual Height±267
NiAVisual Clearance
Sensitive Lands: ❑ Yes No Type
"Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: Date:____ oillac,:e2. 2-0
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw REs 010118.docx
1111-4
Building Permit Submittal
Original Submittal Date: a I L I k ci
Site Plans: #
Building Plans: #
Building Permit#: Er Enter building permit#above.
Workflow Routing: R'Planning C/Engineering 2 Permit Coordinator Q'Building
Workflow Sign-off: L ' Sign-off for Planning(include notes from planning review)
Route Application Documents: g Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
EY Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: A-. _".._ Date: , ,-(3,,k ko,
Engineering Review
Slope at building pad: s-D 75
❑ Conditions "Met"prior to issuance of building permit
El Easements (encroachments)per engineering conditions of approval and plat
,O Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Er No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes Lt' No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes: LL;PC 17' 1-- Pc,. f$13 i i '-6 1 t &Z-4/Lt t`-4. `t4D 15 .-
a Approved by Engineering: itt, ` L� Date: Z i 7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
Approved,NOT Released: )1 :2/01 8 )z1
Notes:
Revisions (after Building Submittal only)
Revisio I 1 otice 1: Date Sent to Applicant:
Re on Notice 2: Date Sent to Applicant:
-vision Notice 3: Date Sent to Applicant:
fI SDC Fees Entered: Wash Co Trans Dev Tax: VYes ❑ N/A
Tigard Trans SDC: V2IrY ClN/
Parks SDC: Yes ❑ /A
LIDA ❑ Yes N/A
OK to Issue Permit
ApprovedAk- j
Permit Coordinator: Date: 4( /b y
I:\Building\Forms\B1dgPermitRvw_RES_010118.docx
Ar.
III City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #: T XcAct - (Cc
Site Address: ili221 5'.4 lloS itv-e-
Project Name: PQluivin (>, hak tic Lot #: 3
(New(1ng=subdivision name;Addition or Al ation=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1):
Is the project subject to the plan district design standards?XYes ❑ 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 ft. deep Balcony w/access 2 Window Projection Vertical Wall Offset a
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
❑ ❑ ❑ ❑
2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors.
Percentage Shown: 23'30
3. Entrances:At least one entrance must meet both of the following standards:
Max. 8 ft. setback from longest street facing wall IS Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes,all the following apply: ❑ 25 sq.ft.min.
NOne street facing entry .8* 12 ft.max. roof above floor of porch
❑ 5 ft. depth min. 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:
El Covered porch min. 5 ft.wide x 5 ft. deep 0 Recessed entry area min. 5 ft.wide x 2 ft. deep
,Igt Wall offset min. 16 inches El Dormer min. 4 ft.wide
,Roof eave min. 12 inch projection Roof offset min. of 2 ft.
El Roof shingles either tile or wood la Gable,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ❑ Horizontal lap siding min. 3-7 inches wide
❑ Accent siding min. 40%of street façade jgWindow 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 El Attached garage is 35% or less of street façade
Garages and .rports:May face the front or side lot line on a corner lot.
Set; .cks: NM -MbLcoma
No cl...- to front or side lot line,than longest street-facing wall. CI Yes ❑ No. If No (Check one):
❑ ay e' end up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
■ May exte' . 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 garag'.that faces the street with a min. area of 12 sq.ft.
the (C one)
El 1 t-wide garage door Nl
e. N(l/v lOOVId ❑ 40%max. of street facade
50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: jaLai /k Date: 2-[24, /l'1
I:\Building\Porms\BldgPermitRvw RES RT 121417.docx
Electrical Permit Application ,t,., �, . ". a FOR OFFICE USE ONLY
Cityipil ofTigard Received
ii
1: W r Permit#:
g 1 Date/By: ������ �\� t� �J�1� `� „`
'r 13125 SW Hall Blvd.,Tigard,OR 97223 l
g Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503 58, 6Q , Date/By:
Inspection Line: 503.639.4175 ' ' Ready Date/By: Juris: 113 See Page 2 for
T(GA.RD Internet: www.tigard-or.gov ?I,lj},_ ' r. z'' • _ Notifi--4 Iethod: Supplemental Information
-i TYPE OF WORK ';. ,l, , PLAN.REVIEW 1' . .,,_',
®New construction 0 Addition/alteration/replacement \ e_< Please check all that apply(submit 2 sets of plans w/items checked):
' " ,^�� 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other;
i -b` where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION �. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Access() building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITEINFORMATION r AND LOCATION 0 Emergency system. larger separately derived
lK 221 �� ❑100Addition of new motor load of system.
Job#: Job site address: SW tooliP or more. ❑"A","E","1-z^,"t-3",
Ci /State/ZIP:TI ard OR 97224 ❑Six or more residential units. occupancy.
ty g 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Polygon At Roshak Ridge ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULEr
Description J Qty. I Each °I,. Total I +.,
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge I Lot#: 3 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
\CV S—ti "lq— �bl_3 (with above sq.ft.) 75.00 2
(�� �p1,u1r 6Y1 I Y�J !/V WSJ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: William Lyon Homes,Inc. 200 amps or less 100.70• 2
Address:703 Broadway St Suite 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone: (360)695-7700 I Fax:(360)693-4442 Over 1,000 amps or volts 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 1 59.36 1
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 168.54 2
'i "APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
7.42 2
each branch circuit
Contact name:Nichole Thorpe B.Fee for branch circuits without
Address:703 BroadwaySt Suite 510 branch
service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 • Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not Included)
Phone: (360)695-7700 I Fax: : (360)693-4442 Each manufactured or modular 67.84 2
dwEmail: permitsubmittals@polygonhomes.com Reconnectne, onlyserve and/or feeder
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:3415 NE 44th panel,alteration,or extension.
City/State/ZIP:Portland,OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(i hr min) 78,18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lie.: c923 Suprv.Lie.: 4871' specifically listed(''A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
•
Authorized signature: I-
""a TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kite Rood Date: 03/08/2019 days after It has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC PennitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB