Permit CITY OF TIGARD COMMERCIAL MANUFACTURED
STRUCTURE PERMIT
111
COMMUNITY DEVELOPMENT
Permit#: CMS2019-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2019
Parcel: 2S107AA23600
Site address: 16870 SW ROCKHAMPTON LN Jurisdiction: Tigard
Project: Polygon at Roshak Ridge Subdivision: ROSHAK RIDGE Lot: 236
Project Description: Sales trailer across(2)lots at site addresses: 16870&16882. Work for ADA accessibility ramps,covered porch,
building modifications,and all trade permits to be under separate permits.
Contractor: MODSPACE CORP Owner: POLYGON WLH LLC
13132 N WOODRUSH WAY 703 BROADWAY ST STE 510
PORTLAND, OR 97203 VANCOUVER,WA 98660
PHONE: 866-322-0120 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Investigation Fee 07/31/2019 $90.00
0
Class of Work: ALT Type of Const: VB Investigation Building 12%State 07/31/2019 $10.80
Occupancy Group: B Surcharge
Stories: 1 Height: 15 ft Investigation Fee 07/31/2019 $90.00
Project Valuation: $0.00 Investigation Building 12%State 07/31/2019 $10.80
Surcharge
MH State Admin 07/31/2019 $30.00
MH BLD Permit 07/31/2019 $275.50
Floor Areas: 12%State Surcharge-Building 07/31/2019 $33.06
First Floor Area: 910 Erosion Control w/Development 07/31/2019 $80.70
Second Floor Area: 0
Third Floor Area: 0
Total Area: 0
Required Setbacks:
Left: 0 Right: 0
Front: 0 Rear: 0
Required:
Parking Spaces: 5 Fire Sprinklers: No Total $620.86
Smoke Detectors: Yes Party Wall: No
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans.This permit will expire if work is not started within 180 days of issuance,or if work is suspended for more the 180
days.ATTENTION:Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95?-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 •8 ,.r 1.;$$.332.2344.
a
Issued By: `F Permittee Signature: ` ,`4 ?`�
Call 503.639.4176 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 t`he pr.ject.
Approved plans are required on the job site at the time of each inspection.
Manufactured Structure
Placement Permit ApplicatiolfECENE$ FOR OFFICE USE ONLY
City of Tigard 8 2019 Date/By:vee7/2, ly -- 1 YJi.
Permit No.:
Pr
13125 SW Hall Blvd.,Tigard,OR 97223 JUL 1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 D Date/By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 (�ITY OF T IGAR Date Ready/By: I / .pais. Fa See Plan Submittal
Internet: www.tigard-or.gov 'NG DIVISIO . .tified/,-t !i • Requirements
Jar.% .J id/r,.
JOB SITE INFORMATION OWNER INFORMATION
Site Address: oticia, sW'AcciotstvrimptbiQName: nLdVI VInTrni✓S liO(A{
Park Nail /(o k� S� S ' LO
Subdivision&Lot#: TNC) till-A 1e- q CD�E Address: 103 R)ro�
Directions to inspection site: City: , / ke_tkAU.eaz I State: co A I ZIP:gi ((o 0
1 6,—,--..s „2_ ,. c, •3 7 Phone: O.(A5-7710 I Fax:
Is property inside city limits? 0 Yes 0 No E-mail•-J InA i+{,011A,44a11 S I 0 011 horn es 0901
LOCAL GOVERNMENT APPROVALS
Zoning Sanitation
Signature: Signature:
Jurisdiction: Jurisdiction:
Date: Date:
MANUFACTURED PLACEMENT PERMIT FEES
Cost(each) No.of Sum
(1) Installation/re-inspection Items
(a) Placement(includes placement,electrical feeder,30'of water/sewer connection). $ 275.50 $
(b) State surcharge at 12%(of placement fee only). $ 33.06 $
(b) Re-inspection(includes inspection and 12%state surcharge). $ 100.80 $
Placement permit to be obtained only by homeowner,or Oregon-licensed manufactured dwelling installer.
(2) Electrical
(a) Service and/or feeder(new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor
performing work.
(3) Plumbing
(a) New water service(for services over 30 lineal feet). $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain(for services over 30 lineal feet). $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon-licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee(State of Oregon). $ 30.00 $
(b) System development fees(sewer connection,storm water,parks development&traffic impact). $ See Permit&System Development Fees
SUB-TOTAL $
SET-UP OR INSTALLATION CONTRACTOR APPLICANT tt ,,���
Name: / Name: i � i ( ♦ W CAA
,
�,„, 5 GG1`t �Ui, Cit
Address: A �lJv��� S / G Address: --1, i C
l3I3 6 •
City: 644-An,/ I State:a/ I ZIP: 17 0 City:t IL.veLVAQUAA.1€.12_ St-
Phone g�z (�( Fax: Pho :_ --(CLS`-� 7 60 Fax: ('�yy�
CCB No.: LGl 5----
- MDI No.: Ma� jl:. -t-4SUI�M%110 i el .. r`�P�\M t C I A
SKIRTING CONTRACTOR A
Name: I hereby certify that the information above is true and correct.
All work to be ,'r ormed shall be in accordance with all
Address: governing ,ws an' •files
City: State: ZIP: 40 \SA Ifik
Phone: Fax: Authorized `'-- - ' Date
CCB No.: MDI/LSI No.: Print Name: x \0. MOT it
I:\Building\Permits\CMS-PermitApp.doc 02/27/2018
S CSS 2-oC, — 6,C)(0 /
11,
Building Permit Application
TIGARD Plan Submittal Requirements
Manufactured Dwelling
1. SITE PLAN-Three (3) copies,fully dimensional and drawn to scale,labeled with:
A. ❑ map&tax lot# 9 subdivision name 9 subdivision lot# 9 site address
0 zoning 9 applicant name 9 phone number
Size requirement: 8-1/2"x 11",to a maximum 11"x 17".
All details listed below shall be incorporated into the site plan:
B. North arrow.
C. "Drawn to scale"indicates standard architect or engineer scale.
D. Footprint of structure,including accessory structures,garage,carport and decks shall reflect actual building
dimensions,including retaining walls.
E. Finished floor elevations,all levels.
F. Garage finished floor elevation.
G. Corner lot elevations. If more than 4 feet elevation differential,plan must show contour lines at 2-foot intervals.
H. Location of all cuts and fills on the lot.
I. Driveway corner elevations.
J. Zoning setbacks (front,side and rear).
K. The location of all public and private easements.
L. The location,termination,and all invert elevations of all drainage piping(sanitary and storm) showing all
elevations necessary to show positive gravity flow to the approved drainage device(i.e.peepholes, storm lateral,
sanitary lateral).
M. Residential driveways,sidewalks will be shown on site plans and will be in accordance with the City of Tigard
standards. Driveway cuts shall not be permitted within 30 feet of intersecting right-of-way lines,nor within 6 feet
of property lines. Weep holes/drain pipes will be installed 6 feet from adjoining property lines. Multiple
driveways on individual parcels of land must have 30 feet of separation;joint-use driveways require a formal
agreement.
N. Show all erosion control devices proposed for site. Contact Clean Water Services (CWS)at 503-681-5113 for
assistance.
0. Show location of existing facilities and new or relocated structures (utilities,well/septic systems,mailboxes,
power poles,water meter,light pole,stop sign,etc.).
P. Indicate property slope directions.
Q. Existing and finished contours when slope in any direction exceeds 20% (additional requirements may apply-see
grading policy).
R. Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of
Tigard Street Tree List.
S. Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,
driplines,and protection measures must be drawn to scale and must include the project arborist's signature of
approval.
2. BUILDING PLANS-Three (3)full sets for illustrating the manufactured dwelling foundation or basement
construction(no redlines or tape-ons accepted).
Size requirement: up to 24"x 36"maximum,folded into eighths (9"x 12")with the plans inside. No rolled,
reversed or mirrored plans will be accepted.
All details listed below shall be incorporated into the building plans:
A. Scale(architectural or engineering only).
B. Cross sections of the manufactured dwelling foundation or basement(every set of plans shall contain a
minimum of two cross sections at mid-point of each direction).
C. Exterior elevation(all views shall be shown).
D. Basement wall,foundation and retaining wall sections.
E. Documentation by manufacturer,indicating that manufactured dwelling roof can support over-framing of
garage roof.
F. Driveway construction.
I:\Building\Permits\CMS-PermitApp.doc 02/27/2018
City of Tigard
III " COMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD Building Permit Review — Commercial - With Land Use
0
Building Permit #: ? li�t t 2C2-'
Site Address: /(i ,get) ftrk n L2 Suite/Bldg#:
Project Name: Pe/;%ru 04 t-eciGrr
(Na l,e/'f commercial business occupying the space. If a nt,enter Spec Space.)
Planning Review
Proposal: 7707rOra ,..q<7/1=S74 //1r _ /01—
/
lrify site address/suite# exists and activey.' permit system.
►.ver Terrace Neighborhood: VII Yes ❑ No
Uikand Use Case#: 77jf Qa/9— 066/-*
V Plan atch Approved Land Use:
!A Si Plan IIIA a dscape Plan to\ they:
V Krban Forestry Plan IcliG evation Plan
!4 Building Height: Maximum Height 13\4),- Actual Height
C1* Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
\TIW 1usiness License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
0 O ublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes, applicant was notified VJ No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: ,---- � � Date: ' o a
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: �' /,
Site Plans: # 3
Building Plans: ##
Building Permit#: E -nter building permit#above.
Workflow Routing: ing IIS -ngineering Q Permit Coordinator ❑ .Boring
Workflow Sign-off: D.-8tgn-off for Planning(include notes from planning review)
Route Application Documents: Ll-tri ilding: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
`
By Permit Technician: ,. _,e„ �_r r_., Date: �/3
/41
I:\Building\Forms\BldgPermitRvw COM WithLandUse 060116.docx
Engineering Review
R"-Slope at building pad: 2
[ PFI Permit#: /
0 Conditions "Met"prior to issuance of building permit hA
[Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
D--"v/ater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [a No
Assess Water Quantity Fee in-lieu: ❑ Yes LI--No
LIDA Facility on lot: ❑ Yes [YNo
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: ,Le—V(i‘,4
Date: 7/ods //y
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: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
vision Notice 3: Date Sent to Applicant:
'L'J SDC Fees Entered: Wash Co Trans Dev Tax: El Yes CSN/A
Tigard Trans SDC: ❑ Yes CVN/A
Parks SDC: ❑ Yes L( N/A
�OK to Issue Permit
Aj---1-3ate:
Approved by Permit Coordinator:
Vi'q
I:\Building\Forms\B1dgPermitRvw_COM_WithLandUse 070915.docx