Permit CITY OF TIGARD MASTER PERMIT
°. COMMUNITY DEVELOPMENT Permit#: MST2019-00174
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2019
T[ '�R ' g Parcel: 2S107AA00800
Jurisdiction: Tigard
Site address: 14291 SW 168TH AVE
Subdivision: ROSHAK RIDGE Lot: 8
Project: Polygon at Roshak Ridge, Lot 8
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First 1174 sf Basement: 140 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 555 sf Garage: 437 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1869 sf Value: $242,271.65 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
0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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 addl 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 1869
Owner: Contractor:
POLYGON WLH LLC POLYGON WLH,LLC 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
3 1 Hour Fire Rated Eaves
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX: 360-693-4442
Total Fees: $33,693.58
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 throw- *AR 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. - PP- 1 1- ' Permittee Signature: OA/ r// A 45L-77c),4/
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 LO I S
Residential RECEIVE, FOR OFF ICE USE ONCE
Clty Of T1ga1Cd Date/By:Received J Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 2019 y ' �� ��� ` -� ��
g Plan Review i n/� Other Permit �� ,
Phone: 503.718.2439 Fax: 503.598.1960
Date/By:: /71�
CITY OF TIGARD y 1
TIGARD Inspection Line: 503.639.4175 Date Ready/By: s- ��.y(�_ Juris: H See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: �/ /0.YfT Supplemental Information
(.'I9'`
/301 y6'a
TYPE OF WORK REQUIRED DATA:1 AND 2-FAMILY DWELLING
®New construction ❑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
CATEGORY OF CONSTRUCTION work indicated on this application.
I® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ eVt(D„/a,
0 Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 2-3o Ce
Job site address: 1426tI $W 1(p12;TH NVEE New dwelling area: I8b9 square feet 555
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 43, square feet 1 I-7 LI
Suite/bldg./apt.no.: Project name:Roshak Ridge Covered porch area: ` square feet I a
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Roshak Ridge Lot no.: 8 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
DESCRIPTION OF WORK work indicated on this application.
` ikoi� ASE
Valuation: $
, Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ ,TENANT Number of stories:
Name:Polygon WLH,LLC Type of construction:
Address:703 Broadway St.,Ste 510 Occupancy groups:
City/State/ZIP:Vancouver WA 98660 Existing:
Phone:(360)695-7700 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WLH,LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Tonja Morris
FLS plan review fee(if applicable):
Address:703 Broadway St.,Ste 510
City/State/ZIP:Vancouver WA 98660 Total fees due upon application:
Phone:(360)695-7700 Fax::( ) Amount received:
E-mail:permitsubmmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Polygon WLH,LLC 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.:204238
Total fee due upon application: $201.60
Authorized signature: 4. This permit application expires if a permit is not obtained
--.......... ,* . within 180 days after it has been accepted as complete.
_ Print-name:-Tonja Morris_ ---- - - 1 0447404=9
*Fee methodology set by Tri-County Building Industry
Service Board. -
gilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
I
Mechanical Permit ApplicatiRECEIVED FOR OFFICE USE ONLY
City of Tigard Received 1�
Permit
= " 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 2019 Date/By: "T" C -t-- �U1
Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD
TIGARD Date Ready/By: ions: 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1241 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
I I Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
"l2a� 5t.�1) � n r Air conditioning 1 46.75
Job site address: t
�D PluE, Furnace 100,000 BTU(ducts/vents) I 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 1 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other 23.32
Business name:Polygon WLH,LLC Fuel piping:
$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 muthydaksravt by T= mrr&i.ding-lockery Serviec Bund
Print name:Tim Hay Date:04/08/2019
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
DocuSign Envelope ID:64B6A0DO-C609-4D21-95CE-110FIC4447911=1\ /E
Electrical Permit Application j/ C FOR OFFICE LSE ONLY
City of Tigard MAY 2 2019 DateBea Penrith: t .----`))-C\CI.. %
'A 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
3 Phone: 503.718.2439 Fax: 503.598.1966ITY OF TIGARD Date/B : Related Permit t:
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Juris: ® See Page 2 for
1ILiALI-C_1 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
�: /i �i �r '�/? / DT Tc ✓iii
�"�,�'` iY 'u ii ..,.y, > , ,...,i4L7[..s�;. ,igili • ', A' ..i. _ .'r;,r{ a v' ..1,4"r1 .RtiE' ,..r`,/✓*4,,f„
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Budding over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
te' 'CATT11GCB'Y.OF+ CONSIRUCTION woo 0 amps at 150 volts or ❑Floating buildings.
Z 1-and 2-family"dwelling ❑Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
/f'4 /// JOB SIT .1NFo1R1I3Ano1 o'1, ji i/ t" ❑Emergency system. larger separately derived
I�ZA 1 g ❑Additioo oforw motor load of system.
Job#: Job site address: "� W `� 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: ; .." FEE SCHEDULE /y ;
"" "
Description I Qty. Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot 4: 6 Includes attached garage.
1,000
or
4 4
Tax map/parcel 4:
Ea.add'1 500 e ft or port n ' ' 1
1 1 5
sq. io 33.92
, ,",DE$(�„�, SON; F WORK ''. Ifei.. Limited energy,residential 75.00 2
(with above sq.ft.)
r Limes dentiited a til muabove q. ft.)ily
75.00 2
Services or feedersinstallationinstallation le Energy El See Page 2
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
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 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
r: i Branch circuits—new,alteration,or extension,per panel
"i14 IGN �^ CONTACT PEON' A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee,
7.42 2
each branch circuit
Contact name:Jolene Smith B.Fee for branch circuits without
seAddress:703 BroadwaySt,Ste.510 branch
or feederstfee,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 67.84 2
dwelling,serviceand/or feeder
Email:permitsubmittals@polygonhomes.com Reconnect onl
67.84 2
,,,� i�.%!., .,.. .. CONTRAT , IV / Pump or irrigation circle 67.84 2
Business name:Portland Electric Sign or outline lighting i 67.84 ; 2
Signal circuit(s)or limited-energy
Address:1915 E 5r''St.,Ste D panel,alteration,or extension. 1:1See 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:paul@portlandelectric.biz Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee Is
90.00/hr
CCB Lic.: 194066 Electrical Lie.: C760 Suprv.Lic.:. (►"S s cifrcall listed '/z hr mm
rte. , ... ZLEC;TIH. "°i 1t %SE S
Suprv.Electrician signature,required: ,R
Subtotal:
Print name: Alex Shalya Date: 04/08/2019 ❑Plan Review Required(25%of permit fee):
,,� . /- / / State surcharge(12%of permit fee):
Authorized signature: S�/z TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: MISHCHUK,SERGE Date: 04/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC PenmtApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application- . .` A
Building Fixtures FOR OFFICE USE ONLY
MAY 2 2u19 Received
. City of Hall
PermitNo.:l(\t��----D.�`��(Li9'(_�
q 13125 SW Hall Blvd.,Tigard,OR 9��Y OF 1 tUARD Date/By: ��\ ��,, t-1
Phone: 503.718.2439 Fax: 503. Date/By:an Review Other Permit No.:
�Jf�t�'ING DIVISION
T I GARD Inspection Line: 503.639.4175 Date Ready/By: 7uris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description Qty. I 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
ix 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
IDAccessory building Multi-family SFR(3)bath ) 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,(. jc ( Ski.) t(obi 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.: 1 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 I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer l 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
Clothes washer A 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 0 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 WaterPitpin DWV 56.29
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
Plan review (25%of permit fee)
CCB Lic.:184372 Plumbing Lic.no.:pb634
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler Date:04/08/2019 This permit application expires if a permit is not obtained within 180 days
*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)
City of Tigard
71 IIII COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A k o Building Permit Review — Residential
Building Permit #: MS-TP-CDC)\ -y-.
Site Address: Dill ' ..1 1,6? Atli.
Project Name: P L(Av. aA- oiL,GL 'adic Lot #: g
(New&veiling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pro osal: laiJ S F PGA _IO B �J Si,
Ll1 Verify address/suite#active in Accela. LTJ In River Terrace: ❑ No Qces,River Terrace Review Addendum
Sit lan Elements: rosion Control
3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper tained trees with drip line and tree protection measures
III rawn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE
12 orth arrow )i'ty locations&easements(required for new and additions)
address,project or subdivision name and lot number idewalk/driveway approach
plicant information(name and phone number) ` .cation of wells/septic systems
Lot dimensions and building setback dimensions Cl treet tree size,type and location
•.are footage of buildings to be demolished eet names
0 .xisting structures on site Gomer elevations(2'contours if more than 4'differential),�,re/
Ir Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Vies ❑No
im ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑KES.IJNo
El/Clean Water Services—Service Provider Lette of platted prior to 9/10/1995):
quired: ElYes,applicant was notified LJ No Received: ❑ Yes ❑ Nornit t„
L.td' Public Facili�tie�mprovement(PFI) Permit: 10-1 W
Required: [ Yes,applicant was notified ❑ No AppliFor: C3' Yes ❑ No,stop intake
Oland Use Case#: pop-01s-0QOOZ [ Zoning: 1`Y L O
Di : equired Setbacks: Front: IL Rear: 0 Side: 3 Street Side: iv}
Garage: 3
c3uilding Height: Max. Height: f A Actual Height: V. '
Landscape Area: Z. % Ga'Lot Coverage Max: ,"i%
Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
�" ;J Windows ❑ Minimum 12%of area of all street-facing facades
Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
R ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
-( ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
R fik ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance 0 Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding /. Window trim ❑ Window recess ❑ Window projection ❑ Balcony
isual Clearance11 Urban Forestry_P
Sensitive Lands: ❑ Yes I. �'No Type:
Con C u
t '
on1s net prior to is ance of building permit .
(6 y
N es: iv vu, -3 t. cr r i v�ltt> iter-+} i3;iJ:�.ct
Approved By Planning: Date: S�- ` I 1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPernutRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: a I 1C1
Site Plans: #
Building Plans: #_.�/
Building Permit#: El Enter building permit#above. / 2/
Workflow Routing: ['Planning 2 Engineering a Permit Coordinator L/ Building
Workflow Sign-off: [(Sign-off for Planning(include notes from planning review)
Route Application Documents: [ Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
[/Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: \t( kCt
Engineering Review �J
AEI-, Slope at building pad: 6—0 /
AEI Conditions "Met"prior to issuance of building permit
Zr Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 4f1 No
Assess Water Quantity Fee in-lieu: 0 Yes . No
LIDA Facility on lot: 0 Yes 2-No
Afr Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:
'Approved by Engineering: AI Date: 5 (470
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: 24'es ❑ N/A
Tigard Trans SDC: L�/Yes ❑ N/A
Parks SDC: [K Yes ❑ A
LIDA ❑ Yes N/A
K to Issue Permits 1' " 'I
Approved byPermit Coordinator: �''(/ "
PPDate: -f ((
I:\Building\Forms\BldgPemvtRvw RES_022819.docx
c.-2-1
City of Tigard
p COMMUNITY DEVELOPMENT DEPARTMENT
■
TI n Rc, River Terrace Building Permit Review Addendum
Building Permit #: V,(\STT \C\- CSC,\�
Site Address: H2-11 "il 16 ` A .
Project Name: 5��t^ 2A-, - I2�,�.k �i � Lot #:
R
(Ne welling=subdivision name,Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dist7ict Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? IV Yes ❑ No
3 Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
ement 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 nun.2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
S 0 ❑ 0 ❑
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 2.1,7-6/ ) t . ,,
3. Entrances:At least one entrance must meet both of the folio g standards:
Max. 8 ft. setback from long t street- facing wall [ Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes,all the following apply: Q/ sq.ft. min.
EZ pne street facing entry ,i ft.max.roof above floor of porch
ft. depth min. Li130%min. porch roof coverage
4.Retailed 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 r ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep
❑ S,a1l offset min. 16 inches ❑ Dormer min. 4 ft.wide
In'kOof eave min. 12 inch projection j f S 0 R.of offset min. of 2 ft.
❑ Roof shingles either tile or wood I! Gable,hip or gambrel roof design rtr
❑ Rpof pitch oriented south min. 500 sq. ft. L.J4f rizontal lap siding min. 3-7 inches wide
Accent siding min.40%of street facade r S ❑ Window trim min. 2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing g":-"-Attached
❑,�,�B-ay window min. 5 ft.wide by 2 ft. deep
1:1 Balcony min. 5 ft.wide x 3 ft. deep with inside access [l i ttached garage is 35%or less of street facade PA
'� 5. Garages and Carports:May face the front or side lot line on a corner lot.
IA Setbacks:
No closer to front or side lot line, than longest street-facing wall. ❑ Yes ❑ No. 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.
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
Ll above the garage that faces the street with a min. area of 12 sq.ft.
L Width: (Check one)
M,! ❑ 12-foot-wide garage door 0 40%max. of street facade
O 50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: t <. :IL Date: S
BBuildingTorms\BldgPermitRvw_RES_RT_121417.docx
Electrical Permit Application=, . ' i �`_. FOR OFFICE USE ONLY
City of Tigard yy Received
�\,Slr4 Permit 1, -,C 1C�-C-i\SLA.,
111 'i 13125 SW Hall Blvd.,Tigard,OR 97223 l i:j I .i- ?h i C 1' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 , ' ` Ready Dae/By: Jam: I 63 See Page 2 for
TIGARD
o Internet: www.tigard-or.gov -,!..1 t Notife thod: 1 Supplemental Information
TYPE OF WORK 4
, -, \ ' PLAN REVIEW r E'`,
®New construction 0 Addition/alteration/replacement • \CA
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.
❑Demolition ❑ Other: e\' 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 Accessory 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 SITE
INFORMATION' �AND,LOCATION � 0 Emergency system. larger s
e a
tateiyderived
❑Addition of new motor load of system.
Job#: I1ob site address: 1 {ZQ l W tloa-1-14 tE
100HP or more, ❑"A","E,"t-z","1-3",
City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. ❑rRecreational vehicle parks.
Suite/bldg./apt.#: _ I Project name:Polygon At 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 J Qty. I Each ] Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge I Lot#: g Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft,or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Ee JCSr CN1 1MST .b t'R-Ob fl (with above sq.RJ 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY-OWNER 1 ❑ 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 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
Branch circuits—newalterationor extension,per panel
, ,
El APPLICANT 0 CONTACT PERSON 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 brancheice or feeder fee,first 56.18 2
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
dwelling, and/or feeder
Email:permitsubmittals@polygonhomes.com Reconnect only
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 -_------2-'
Address:3415 NE 44th Signal circuit(s)or limited-energy 0 See Page 2 2
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 I Fax:( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/lir
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 1 Electrical Lie.: c923 I Suprv. Lic.: 487V% , specifically listed(%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: e
ors. TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1.\Building\Permits\ELC_PermitApp_ELR_ERE:doc Rev 06/17/2015 440-4615T(11/05/COM/WEB