Permit CITY OF TIGARD MASTER PERMIT
.� ' • COMMUNITY DEVELOPMENT Permit#: MST2019-00220
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2020
T r i;Ali 17 g Parcel: 2S107AA13400
Jurisdiction: Tigard
Site address: 16775 SW SUNSHINE COAST ST
Subdivision: ROSHAK RIDGE Lot: 134
Project: Polygon at Roshak Ridge, Lot 134
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1254 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1655 sf Garage: 464 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2909 sf Value: $366,750.25 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: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckfiw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 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
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 2909
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
PHONE: 360-695-7700 PHONE: 360-695-7700
FAX:
Total Fees: $36,411.66
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 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: \1"-V a\r\ •-.1"-)'Q' Permittee Signature: c-l1'1 cpp ' th V"-\
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.
, ,
I Building Permit Application \____ _, ` R L
Residential RECEIVED FOR OFFICE USE ONLI'
Cityof Tigard Received Permit No..
g FEB 06 2019 DateBy: 5\ \\G S T ST2OVg (333.
■ 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review(.1
U (l S Other P wjk��—
Phone: 503.718.2439 Fax: 503.598.1VITY OF TIGARD Date/By. l
Inspection 503.639.4175 BUILDING DIVISION DateReadyBy: • s; H SeePage2for
TIGARD p
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
/D// 17 v I_ & — - 74'L - 77NS9
TYPE OF WORK QUIREDDATA:1-AND2-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.
Valuation: $ i
-750
® 1 and 2-family dwelling 0 CommerciaUindustrial
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 33-7 3
Job site address: 5 i) U1 U S lc,7v--. comet-ct- New dwelling area: /Al Of square feet ,♦pc
City/State/ZIP: CV; UV- �19 Garage/carport area: 'AWL--
square feet 1 Sgribit
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area:3+�j. square feet
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.: I N Permit fees"are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
\\ V/n���n b (S-I 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 Street Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New:
2 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to feeschedule)
Business name:Polygon WLII 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
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:permitsubmittals@polygonhomes.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
tY and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lie.:207247 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Amanda Gavin Date: ?.,I S/ +�/l *Fee methodology set by Tri-County Building Industry
f Service Board.
I:1Building\Pemuts\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED D Pe�iN°�Sr ,,q—CO
- 13125 SW Hall Blvd.,Tigard OR 97223 Plan Review ``-
Phone: 503.718.2439 Fax: 503.598.196FEB 0 c 2019 Date/By: Other Pe mit
TIGARD Inspection Line: 503.639.4175 V Date ReadyBy: Eris: RI See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD NotiSed/Nlethod: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* 'SCHEDULE —USE LHLCKLIST
- ` Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commerciallindustrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE.INFORMATION AND LOCATION Heating,/cooling: 1
q In Air conditioning I. 46.75
Job site address: I I211 5 5W S'U l V lS VII V'!Q.. LOow jj - 9- Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP: r�M 0 V �-1 7'D Furnace 100,000+BTU(ducts/vents) 54.91
1 Heat pump 61.06
Suite/bldg./apt.no.: Project name:Polygon at 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
,, I Other 23.32
Subdivision:Polygon at Roshak Ridge Lot no.: IV{ Other fuel appliances:
Tax map/parcel no.: I 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
Other: 23.32
E PROPERTY OWNER ❑ TENAN C Environmental exhaust and ventilation:
Name:Polygon WLH LLC Range hood/other kitchen 1
equipment 33.39
Address:703 Broadway St.Ste 510 ' Clothes dryer exhaust I 33.39
City/State/ZIP:Vancouver WA 9860 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:(360)693-4442 Attic/crawlspacefans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH LLC S14.15 for first four;34.03 for each additional
Contact name:Amanda Gavin Furnace,etc.
Gas heat pump
Address:703 Broadway St.Ste 510
WaWsuspended/unit heater
City/State/ZIP:Vancouver WA 98660 Water heater
Phone:(360)695-7700 Fax :(360)6934442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other.
Business name: U MECH9NICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signa ` Fee methodology set by Tri-Cowry Building Industry Service Board
k
r Bu 1d aA Print name:Am da Ga ' Date: O�15/1 I`*/1
440
L Pam a MEC Pe mApp_n4l 113ac d -0617T(I t/02 COM WEa) I
, Electrical Permit Application E C E I V E D FOR OFFICE USE ONLY
City of Tigard Received Permit
II • 13125 SW Hall Blvd.,Tigard,OR 97223FEB 06 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: Anis: I 0 See Page 2 for
T[GARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method Supplemental Information
e
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑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.
E 1-and 2-family dwelling ❑ 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 ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
s ' 'us 5W r /m4 I / 0 1001 Addition of new motor load of system.
Job#: Job site address: J ( loOHP or more. ❑"A","b","1-2","1-3",
City/State/ZIP: -1-I wn Olt) 1911 ❑Siix or more residential units. 0❑ mare facilities.
0OCreanon
Recreational al vehicle parks.
Suite/bldg./apt#: 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 SCHEDULE:
Description I Qty. I Reel. I Total I
New residential single-or multi-family dwelling unit.
Subdivision:Polygon-at Roshak Ridge Lot#: \i9)-1 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less I,. 168.54 4
Ea.add'I 500 sq.ft.or portion ?j 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.)
Renewable Energy 0 See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH LLC 200 amps or less 100.70 2
Address:703 Broadway St.Ste 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 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
El 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:Amanda Gavin B.Fee for branch circuits without
service or der fee,first
Address:703 Broadway St.Ste 510 branch 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::(630)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ermitsubmittals PofYgonhomes.com Reconnect onl
67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:TBD Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr mitt) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(V.hr min)
ELECTRiCAl PERMIT FEES
Suprv.Electrician signature, quired: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized sign TOTAL PERMIT FEE:
��-- This permit application expires if a permit is not obtained within 180
Print name: avin Date: 9-1<' 1 f/' days after it has been accepted as complete.
• Number of inspections allowed per permit.
•I:\Building\PernutslELC PermitApp_ELR_ERE doe Rev 06/17/2015 440-615T(11/05/COM/WEB
, Plumbing Permit Application
Building Fixtures RECEIVEDFOR OFFICE USE ONLY
- City of Tigard FEB 0 6 2019 Received Permit No. -7-r�.r � r�
71 • 13125 SW Hall Blvd.,Tigard,OR 97223 Date By ��S v Q(ACk Wc}o V
Phone: 503.7182439 Fax: 503.598I(� OF TIGARD Plan Review
Inspection Line: 503.639.4175 BUILDING DIVISION DDate/By: OtberPermtNo.:
T[GARD Page 2 for
Internet: www.tigard-or.gov NotiReady/By:
ediM hod wtis: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special inforn align use checklist
Description Qty. Ea. I Total
❑Addition/alteration/replacement ❑Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑ Commmercialindustrial SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath ' 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑ Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: W--v-A S SVrcvi v f, ( I1/A(�'- Catch basin or area drain 18.76
an UV�'I Doting leach line,or wench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.: Project name:Polygon at 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:Polygon at Roshak Ridge I Lot no.: \' Fixture or item:
Tax map/parcel no.: 1 Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve I 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 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:(360)693-4442 Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WIT{LLC
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Amanda Gavin
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
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: y�nV4 _ Water piping/DWV 56.29
Address: Other: 25.02
City/State/GIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
1- State surcharge(12%of permit fee)
Authorized si afore: TOTAL PERMIT FEE
Print name:Amanda avin Date: a This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1-113uSthnglPerrnitsIPLMU-PetmitA.pp.doc 10/01/09 440-4616T(10/02/COM/WEB)