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Permit CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2019-00011 Date Issued: 01/23/2020 T t G Al R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DA19200 Jurisdiction: Tigard Site address: 13172 SW 165TH AVE Subdivision: RIVER TERRACE EAST 2 Lot: 231 Project: River Terrace East No. 2, Lot 231 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 4 First: 2779 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 18 Bathrooms: 3 Second: 0 sf Garage: 595 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes Total: 2779 sf Value: $364,616.25 Rear: 10 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 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: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 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'500 sf: 5 201-400 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 Ecom asin Y Other: N Other Description: p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2779 Owner: Contractor: WILLIAM LYON HOMES INC 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 PHONE: 602-694-4031 PHONE: 360-695-7700 FAX: Total Fees: $36,161.96 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 Notifi - ion Cent= ose les are set forth in OAR 952-001-0010 through O'- 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 4.232.1*17• 141 332.2'44. c Issued By: ' s` Permittee Signature: "6'" �l�f 4` 1 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. C 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. R 74 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGAR ID Building Permit Review — Residential Building Permit #: tMS ,1CA- xC ., Site Address: /3/7a SW 165t- 4vQ Project Name: iiT ./j ✓e r rLo,r�-a C-e a.L o /1- /G-. Lot #: (- 3 ' (New dwelliylg=subdivision name;Addition or A,teradon=last name of owner) Planning Review Proposal: /U ScR Erryerify site address/suite#exists and active in permit sysy m. XJ River Terrace Neighborhood: ❑ No 'Yes,See River Terrace Review Adden dum Attached Site Plan Elements: JIhree(3) copies of site plan -O�Exts g structures on site to plan must be on 8-1/2"x 11"or 11 x 17"paper l i ootprint of new structure(including decks)with finished .ciDrawn to scale(standard architect or engineer scale) floor elevations North arrowAEtt-tility locations&easements (required for new and additions) -12Site address,project or subdivision name and lot number —dewalk/driveway approach „D.-Applicant information(name and phone number) onof wells/septic systems Er6>t dimensions and building setback dimensions -El-Existing-trees to be retained with drip line,and tree 'BStage of buildings to be demolished protection measures Lot area,building coverage area,percentage of coverage and ,,,ErS- eet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) et names rr operty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced?-E r es ❑No 017 , t 4 foot differential) If yes,is a storm water quality facility shown? DYes 9iNo 1:71-Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ..51....3/6,-applicant was notified C1 No Received: / _D-Yes ❑ No g-Public Facilities provement(PFI) Permit: Required: IIes,applicant was notified ❑ No Applied For: pp -ED Yes 0 No,stop intake 2 LandUseCase#: P 7t"? ad/6_ 60007 P--Zoning: 12-4( 5 Q-Required Setbacks: Front /2 Rear /U Side , Street Side y Garage �6 [2---Landscape Requirement: ,)D .,h of Coverage Maximum: <0 D. Building Height: Maximum Height 3 0 Actual Height j ) -ErVisual Clearance -0--Sensitive Lands: ❑ Yes -No Type r6 ban Forestry Plan CI Conditions "Met"`pr•or to issuance f building permit otes: Co/7i, 7. ns 7C, i0 �C�/o✓'i'o T/ © X54-0 ,cP 'Approved By Planning: /g (J1-(1--- Date: C 2-1"I1 Revisions (after Building Submittal only) Reviewer Revision 1: 0 Approved ❑ Not Approved Date Revision 2: 0 Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES 061417.docx Building Permit Submittal I. Original Submittal Date: i _ Site Plans: # Building Plans: # Building Permit#: a Enter building permit#above. /Ef Building Workflow Routing: 2/Planning EngineerinEg 'Permit Coordinator Workflow Sign-off: CR'Sign-off for Planning(include notes from planning review) Route Application Documents: I Engineering: (1) copy of permit application, (1)site plan, (1) building plan and original plan review routing form. Di-Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ' ---k4k Date: l 1-4, 11c7k Engineering Review ,2" Slope at building pad: I [ CO ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ,Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes q No Assess Water Quantity Fee in-lieu: 0 Yes Alli No LIDA Facility on lot: 0 Yes o .2- Final Plat Recorded: ❑ NOT Approved Engineering: Date: b Y � ring: Notes: V. T �t �.(„ 4i IL Pt NC., It 1,551-(.6.... .El Approved by Engineering: _LADate: Z 7 / 11 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review ❑ C ditions"Met"prior to issuance of building permit A roved,NOT Release : ��/0d )ate: /1 1 / q P Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revisi otice 2: Date Sent to Applicant Re ision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: 'Yes 0 N/A Tigard Trans SDC: ��Yes 0 N/A Parks SDC: Yes ❑ N LIDA 0 Yes C A OK to Issue Permit �.� Approved by Permit Coordinator: /(iiiDate:a' l I:\Building\Forms\B1dgPermitRvw_RES 010118.docx City of Tigard 1111 et COMMUNITY DEVELOPMENT DEPARTMENT I TIGARD River Terrace Building Permit Review Addendum Building Permit #: "MST2rc,\C _ t k Site Address: 1317 S t) / 5+L A L.e Project Name: R;vee- Tev'r ce Fg574 /)o. Lot #: a3/ (New dwelling=subdivision name;Addition or Alteration=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? ❑ Yes ❑ 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.,6ft.wide Gabled dormer ld"i ❑ ❑ .B' 2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: ZS X 3. Entrances:At least one entrance must meet both of the follo7ing standards: [�/Max. 8 ft. setback from longst street- facie wall U 1 arallel to street,angle no more than 45° from street, /e g or open onto porch Entrance opens to a porch: Yes ❑ No — If yis,all the following apply: LU sq.ft. min. ,'pne street facing entry ���12 ft. max.roof above floor of porch IFV5 ft. depth min. lsd' 0%min. porch roof coverage 4. Detailed Design:All buildings shall include a min. of five of e following elements on all street-facing facades: Covered porch min. 5 ft.wide x 5 ft. deep © Recessed entry area min. 5 ft.wide x 2 ft. deep ❑ }$Jall offset min. 16 inches ❑ Dormer min. 4 ft.wide g.Roof eave min. 12 inch projection 1❑ of offset min. of 2 ft. ❑ Roof shingles either tile or wood [ 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 facade ❑ Window trim min. 2'/2 wide by 5/8" deep ❑ Window recess min. 3 inches for all street facing ❑ y window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ©/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: _, Nooser to front or side lot line, than longest street-facing wall. ❑ Yes I 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. w ❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story above the garage that faces the street with a min. area of 12 sq.ft. Width: (Check one) ❑ 12-foot-wide garage door V410%max. of street facade ❑ 50%max. of street facade with 7 detailed design elements Notes: f Approved By Planning: J l41,j Date: 1--1.1-1 9 I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx li1 1C1 Building Permit Application. LOT- Q:. „. . Residential RECEIVED FOR OFFICE USE ONLY Date/By:aeived 1 ' `(1ST q_co... t1 71 City of Tigard Received Q S Permit No. `l] l OL]i v�J`' ° 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 2 4 2019 Plan Review Phone: 503.7182439 Fax: 503.598.1960 Date/B : 31 ( ' ate Other . . r� 0_ `a,) TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy Juris: la See Page 2for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: i,S ?l At_. Supplemental Information TYPE OF WORD REQUIRED DATA:I-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 ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ / /(1 1 tii hi( I ❑Accessory building ❑Multi-family Number of bedrooms: ; ❑Master builder ❑Other: Number of bathrooms: ?' J JOB SITE INFORMATION AND LOCATION Total number of floors: I Job site address: 197 l]1 S W 'W St Pt�I jl,( New dwelling aarea� square feet City/State/ZIP:Tigard,OR 97007 �✓ Garage/carport area: Sargre feet Suite/bldgiapt.no.: Project name:River Terrace East Covered porch area: square feet Cross street/directions to job site: Deck tii square feet CAN Other structur area: a9 3 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:River Terrace East Lot no.: ;I Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the 1 n p V` (lDESCRIPTION OF WORK work indicated on this application. V I 'CJU -F12-- Valuation: $ Existing building area: square feet New building area: square feet Il PROPERTY OWNER ❑ TENANT Number of stories: Name:ADVL Land Holdings,Inc. Type of construction: Address:7600 E Doubletree Ranch Road Occupancy groups: 1 City/State/ZIP:Scottsdale,AZ 85258 Existing: Phone:(602)694-4031 Fax:( ) _ New: ® APPLICANT° ❑ CONTACT PERSON BUILDING PERMIT FEES* (Plrocn refer to fee schedule) Business name:Polygon WLH,LLC 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 _ Amount received: Phone:(360)695-7700 Fax::(360)693-4442 E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of 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: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. I I .-1/ I r^ *Fee methodology set by Tri-County Building Industry Print name:Amand avin Date: "I I Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) , Mechanical Permit Application ECENE 1 FOR OFFICE USE ONLY City of Tigard Received gcP/ Permit No ,y ° 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Gl ✓/S% ���Q�/ Phone: 503.718.2439 Fax: 503.598.1960 JAN 1 7 2 20 Plan Review Other Permit: Inspection Line: 503.639.4175 Date/By: TI GARD p CITY OF TIGARD Date Ready/By: Turis: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: SupplementalInformation UILUNG DIVISIO TYPE OF WORK COMMERCIAL FEE*SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ® New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: %%VI 2, 5 vkj tueni Air conditioning 46.75 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 1 61.06 Suite/bldg./apt.no.: Project name:River Terrace East 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:River Terrace East Lot no.: 23` 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 4 is e P vr MST 209-000 (( 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:ADVL Land Holdings,LLC Range hood/other kitchen equipment 33.39 Address:7600 E Doubletree Ranch Road Clothes dryer exhaust 33.39 City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(602)694-4031 Fax:( ) Attic/crawlspace fans 23.32 ® APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name:William Lyon Homes,Inc. $14.15 for first four;$4.03 for each additional Contact name:Tonja Morris Furnace,etc. Address:703 Broadway St Suite 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 polygonhomes.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:Performance Insulation&Energy Services Other: MECHANICAL PERMIT FEES* Address:13939 SW Tualatin-Sherwood Rd. Subtotal City/State/ZIP:Sherwood,OR 97140 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)707-6078 Fax:( ) State surcharge(12%of permit fee) CCB lie.: k Cl q 4.45 TOTAL PERMIT FEE This permit application expires If a permit Is not obtained within 180 ,\ days after it has been accepted as complete. Authorized signatur : —,i ,• * Fee methodology set by Tri-County Building Industry Service Board Print name:'1 V\2\p ,I `t'• .. % Date: SI 2I il Electrical Permit Application RECEIVED FOR OFFICE USE ONLY City of Tigard Received Ilqlq 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : _ 1 111 1 7 2020 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 JAN Date/B : Related Permit#: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: loris: E7 See Page 2 for c, Internet: www.tigard-or.gov Notified/Method: Supplemental Information . . _ a I TYPE OF WOR" PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ETService or feeder 400 amps or more 0 Building over three stories. El Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® less to ground,or exceeds 14,000 0 Commercial-use agricultural 1-and 2-family dwelling ❑Commercial/industrial 0Accessory building amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: _ ❑Fire pump. 0 Installation of 150 KVA or JOB SITE;INFORMATION AND LOCATION ❑Emergency system. larger separately derived 311 ry ' ,t , u p ❑100Addition of new motor load of system. Job#: Job site address: 1 4— W5r1+ 1ooI1P or more. ❑"A","E","t-2","I-3", City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:East River Terrace 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:East River Terrace Lot#:i'51 Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'/500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 Change contractor on MST 20M.000\t (with above sq.ft.) 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: 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 ® APPLICANT ❑ 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, 7.42 2 each branch circuit Contact name:Tonja Morris B.Fee for branch circuits without Address:703 Broadway St,Ste.510 beraanor feeder fee,first bnice ch circuit 56.18 2 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 dwelling,service 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 Ave. Signal circuit(s)or limited-energy ❑ 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((hr min) 66.25/hr Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 199188 Electrical Lie.: c923 1 Suprv.Lie.: 48715 specifically listed('�2 hr min)74. r`'' s ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: (--e"'" -. Subtotal: Print name: Kirk Rood I Date: 05/09/2019 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: /c i JL /240ne (, TOTAL PERMIT FEE: This permit application expires if a permit Is not obtained within 180 Print name: Kirk Rood Date: 05/09/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. l43uildsgTennits`ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB 1 Plumbing Permit ApplicationI ED Building Fixtures i1_.1 City of Tigard JAN 2 1 2020 Reeaised Permitxo: `� DateAl �1 / 7`oeGi// v 13125 SW HDU Blvd.,Tigard, Pian RevtEW I' Phone: 503.7182439 Fax• a TIGARD Daffy OtberPernritNo.: Inspection Line: 503.63941 L I DIVISION T t G A R DData Ready/By:' : H See page 2 for Internet: www.ttgard-orgov. Notified/Method:: .. Supplemental Informettoa. TYPE OF WORKFEE* SC1HEDIJLE El New constniction I 0 Demolition -- For special information use checklist klist Description IQtY• 1 Ea. I Total 0Addition(aiterationlrcement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SPR(1)bath 312.70 TR 1•and 2-family dwelling I 0 Cotinmercial/industrial SFR(2)bath 437.78 ❑Accessory building 1 Multi-family SFR(3)bath 500.32 D Master builder Other: Each additional bath/kitchen 25,02 Fin sprinkler( sq.It) Page 2 JOB SPIE INFORMATION AND LOCATION Site utilities: lob site address: (3II 2. 5IA) /6,571.4 Catch basin or area drain 13.76 Drywall,leach line,or trench drain 18.76 City/State/ZIP;Tigard,OR 97224 _ Footing drain(no.linear fl.: ) Page 2 Suite/bldg./apt no.: i Project name:�t titl°r 14-rfTl;C,4E '3 -it 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 R.: ) -Rage 2 Water service(no.linear ft.:. ) Page 2 Subdivision:'10er "Terfta.t t Gast.. 41 Z. Lot no.: 2Nre or item: Tax map/parcel no.: Backflow proventer - M.27 I�ESCRIYTtON OF WORK Backwater"valve 1251 Clothes washer 25.02 031A,a,h' t , D/^' (CtA` MST201-414°W1 Dishwasher 5.02 IDrinking fountain 25.02 I Ejectors/sump 25.02 ® PROPERTY OWNER - ❑ TENANT Expansion tank 12.51 Name Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Bose bib 25.02 Phone:(360)695-7700 I Fax:( ) Ice maker 12.51 ® APPLICANTo I] CONTACT PERSON Inierceptodgrense nap - 25.02 yg WLH,L1 C gas(value: ) Page 2 Business name:Polygon Medical: S Primer Contact name:Tonja Morris ' 12.St 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 I Fax::(360)693.4442 Tub/shower/shower past 12.51 E-mail:Pesmltsubmlttals®polygodbome:.corn Urinal 25.02 . CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: C. ,r 2 'ffi,v /it „Water piP B� 56.29 Address: /20 ..4 X'. Other: 25.02 City/State/ZIP: (Ol4e �J% j r. Subtotal / l Phone:C.-/,� 2,J s`45.$)L-/ Fax: [�`� Minimum permit fee: 572.50 G /J i� ) Plan review (25%of permit fee) CCB Lie:: Plumbing Lie.no, of r State surcharge(12%of permit fee) Authorized signature: '''7'1------"-:-.. rv, .- TOTAL PERMIT FEE Print name:9t1 /at(f. (,.4, .4-11 Date: This permit application eaptres If a permit is not obtained within 180 days - attar It lir bean accepted as complte. f Fee methodology set by Tri-County Building Industry Service Board. I:\BuiktirgiPecmitsuPLMU•PcrmrtApp.doe 10101(09 l; 4-10-46161(10/01/COM/wEII) 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: " UsjO\I\ k\5 DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED MAY 62019 FROM: \\NM('+r1 S CITY OF TIGARD BUILDING DIVISION COMPANY: 0 PHONE: lb ' r - c\- - uO By: _ RE: 131'12 S W U Lor-3 T11 kg Ms-c 2p S-boo' \ (Site Address) (Permit Number) Alyea\6a-9-.PEc EPs-c # 2 - LITC 22)1 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. X Revisions: fa E Pi Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: St\tt3 . Et:)E12C ,t - "•16_ACtifi ` 0 : 6 by, FOR OF ICE USE ONLY Routed to ermit Technician: Date: . c7 Initials: Fees Due: Yes ❑ No Fee Descflpti : Amount Due: V` $ v- $ ..� ..• $ 1/ Special Instructions: Reprint Permit (per PE): ❑ YesNo ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions 061316.doc