Permit CITY OF TIGARD MASTER PERMIT
11111 8 . COMMUNITY DEVELOPMENT Permit#: MST2021-00053
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2021
Parcel: 2S107AA15400
Jurisdiction: Tigard
Site address: 16698 SW SUNSHINE COAST ST
Subdivision: ROSHAK RIDGE Lot: 154
Project: Polygon at Roshak Ridge, Lot 154
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1024 sf Basement: 0 sf Left 3 Parking Spaces: 0
Height: 29 Bathrooms: 3 Second: 1349 sf Garage: 406 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2373 sf Value: $310,381.96 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
Other Fixtures: 0
Diywell-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 Woodatoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add?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:
NEV SF VB R-3 2373
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510
VANCOUVER,WA 98660 VANCOUVER,WA 98680
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $41,434.89
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 503.232.1987n
or 1.800.332.2344.
Issued By: Ho *ii VADe Uege Permittee Signature: OwAppl Zatia
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 $_al I-j I ,
Residential RECEIVED FOR OFFICE USE ONLY
Cityof Tigard Received/� Alf—
mar )�} /�/�/t
g FEB 17 2D21 Date/By:D2/ .WSJ- Permit No.:MST`O2 k O53
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev ew l �f /
■ Phone: 503.718.2439 Fax: 503.598.1960 DateBy: 3/41 !it SI�)`� r/ Other Permit li R2021'I 04-2
1( A lc U Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: / / ( !Alaila See Page 2 for
Internet www.tigard-or.gov BUILDING DIVISION ified/Methud: L ' Supplemental Information
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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. o/_
Valuation: $ 2 1 7l ��i 1(F'
® 1-and 2-family dwelling 0 Commercial/industrial 1 r 1
❑Accessory building El Multi-familyNumber of bedrooms: 4
❑Master builder ❑Other: Number of bathrooms: )3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 a.7-79
Job site address:16698 SW Sunshine Coast St New dwelling area: 2373 square feet r51-1
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: 406 square feet I V Z
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
' Other structure area: square feet
i
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: 154 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.
New Single Family Valuation: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Polygon Homes 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:( )360 693-4442 New:
la APPLICANT ❑ CONTACT PERSON U9 BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Polygon Homes WLH LLC
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
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: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes 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 Iic.:207247 //�� Total fee due upon application: S201.60
Authorized signature: OPP/4 ,, .4 CJBLL/,.a6,e1— This permit application expires if a permit is not obtained
rJ within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Omar Alami Abouhafs Date: 02/15/2021 Service Board.
I:1Building\Permits1BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COMIWEB)
Mechanical Permit ApplicaRECEI v E® FOR OFFICE USE ONLY
Cityof Tigard FEB 17 2021 Received
Date/By: Pem il No.:M ST21)2I-000 53
" 13125 SW Ball Blvd.,Tigard,OR 97223 -
i '7 Plan Review
Phone: 503.7I8.2439 Fax: 503.598.196 Date/By. Other Permit:
ne. ,r.l7 Tnspecuanline: 503.639.4175 LITYOFTIGARD Date Ready/By: tors:
Internet: www.tigard-or.gov NotitiedlMethod: H Sec Page 2 for
BUILDING DIVISION Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*arc 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 ❑Other. mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY.OF CONSTRUCTION RESIDENTIAL EQUIPSIENT/SYSTEMS FEES'
®1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
I J Multi-family ❑Master builder 0 Other: Description I Qty. Ea. Total
JOB STFE INFORMATION AND LOCATION Heating/cooling:
Job site address: 16698 SW Sunshine Coast St Air conditioning I 46.75 ,
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Polygon at Roshak RidgeHeat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
bydronic) 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.: 154
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
LEIPROPERTY OWNER ❑ 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 rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 2332
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH,LLC S14.15 for first four;54.03 for each additional
Contact name:Tonj a Morris Furnace,etc.
GAddress:703 Broadway St.,Ste 510 heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
E-mail:permitsuhmittals(dtayl0rmOrflSOn.Com Range
Barbecue
.14 CONTRACTOR Clothes diver(gas)
Business name:Pro Healing&Cooling Other.
MECHANICAL PERMIT FFFS*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/LIP:Hillsboro,OR Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 150
e� `' ,. �f ,., days after it has been accepted as complete.
Authorized signature: C4�a �� L ' Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r-lrpriIAn\Vmm.AMFC P..m:I0.nn Neel IS Arc AAA ASln II m.6^n1.1117cnv
Electrical Permit Application FOR OFFICE USE ONLY y^
City of Tigard RECEIVED DaceB� Permit M Sr202 .-000 3
. • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 FEB 17 B 2021 Date : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Inns: H See Page 2 for
TI GARP Internet: wwwti rd-or. ov Notified/Method: Supplemental Information
g TY OF TIGARD pp
TYPE OF WO ^j r PLAN REVIEW
F{ #N IJI V ISION Please check all that apply(submit 2 sets ofplans w/items checked):
®New construction ❑AddltlOn/eltet acc2iTleee"tfhllttt 00 y(0 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.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
snaps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 16698 SW Sunshine Coast 1001IPormore_ ❑"A"."E","1.2","1-3",
City/State/ZIP: Tigard OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Polygon at Roshak Ridge ❑Hazardous locations. ❑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 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Roshak Ridge Lot#:154 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.)
Renewable Energy 0 See Page 2
[I PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes 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:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:permitsubmittals@taylormorrison.com 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 El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes WLH, LLC above service or feeder fee, 7.42 2
each branch circuit Contact name: Omar Alami Abouhafs B.Fee for branch circuits without -
se
Address: 703 BroadwaySt., Ste 510 branch it feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Vancouver WA 98660 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360 )816-7800 Fax: :( ) Each manufactured or modular 67.84 2
dweEmail: permitsubmittals@taylormorrison.com econne service and/or feeder
R
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 ❑ See Page 2 2
Address: 1915 E 5th St., Ste D
panel,alteration,or extension.
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)314-4915 Fax:( ) Investigation 11 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:paul@portlandelectric.biz Inspections for which no fee is
CCB Lic.: 194066 Electrical Lie.: C760 Suprv.Lic.:
49208e ' specifically listed(%,hr min) 90.00/hr
Suprv.Electrician signature,required: //�� ���� -Q ELECTRICAL PERMIT FEES
lit CC.SI' JsJ� _ Subtotal:
Print name: Alex Shalya Da 1 O/3O/2O ❑Plan Review Required(25%of permit fee):
,,/ot � -- 00 -- 00 ,,.. f� --- State surcharge(12%ofpermit fee):
Authorized signature: XS LWl.CIL144., TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
Print name: Serqey Mishchuk Date:10/30/20 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:IBuildinglPermin/ELC_PermitApp_ELR_FnF.doc Rev 0647/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 lcva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr I
charged at an hourly(I hr nun)
Inspections for which no fee is 90.00/hr
specifically listed(Az hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 Number of inspections aniseed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:1auilding\Pemms\ELC_PernutApp_ELR_ERE.doo Rev 06/17/2015
r
Plumbing Permit Application
Building Fixtures RECEIVE ' FOR OFFICE USE ONLY 7�'I^/� r
City of Tigard ReceivedPermitNo.:MST2I.2J 1JJ7
III • 13125SWHallHlvd.,Tigard,OR 97223 Date Rev
Phone: 503.7182439 Fax: 503.59$.1960FEB 1 2021 Plan Review Other Penult No.:
Dare/By:
TIGARD Inspection line: 503.639.4175 Date Ready/By: turfs: H See page 2 for
Internet: www.tigard-orgov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WOR8UILDING DIVISION FEE' SCHEDULE
®New construction ❑Demolition For special&rformalion use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 1001L for each utitityconnection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312,70
,I-and 2-family dwelling ❑Commercialiindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16698 SW Sunshine Coast St 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
Suile/bldgJapt 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:Roshak Ridge Lot nc 154 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/StateZEP:Vancouver,WA 98660 Solar units(potable water) 6154
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittalst(polygonbomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37,52
Business name:G&B Plumbing&Sons Inc Water PP E r in 'D1'V 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 Lie.:184372 Plumbing Lic,no.:pb634
State surcharge(12%of permit fee)
Authorized signature: j� i TOTAL PERMIT FEE
This permit application expires if a permit Is not obtained within 180 days
Print name:Steve Fowler Date: 10/30/20 after It has been accepted as complete.
"Fec methodology set by Tu-County Building Industry Service Board.
t1Bu0iva\PamitsTLMU-PemitApp.doc 10/0149 4441-4616T(I0PoLCOMWEB)
City of Tigard �h I2i
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A RD Building Permit Review — Residential
Building Permit #: M 3Y 2O2( 'O00 ,3
Site Address: 16698 SW Sunshine Coast St
Project Name: Polygon @ Roshack Ridge Lot #: 154
Planning Review
Proposal: new house
® Verify address/suite # active in Accela. ® In River Terrace: ❑ No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: ®Erosion Control
[ 3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper flRetained trees with drip line and tree protection measures
®Drawn to scale (standard architect or engineer scale) XFootprint of new structure(including decks)and FFE
[XNorth arrow XUtility locations&easements(required for new and additions)
(]Site address,project or subdivision name and lot number ®Sidewalk/driveway approach
DiApplicant information(name and phone number) rtalLocation of wells/septic systems
®Lot dimensions and building setback dimensions X Street tree size,type and location
n®Square footage of buildings to be demolished Z Street names
na]Existing structures on site 7E1 Corner elevations (2'contours if more than 4'differential)
6(1Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? 4/A❑No
impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? EYes ❑No
• Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: El Yes,applicant was notified ® No Received: El Yes El No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ® No Received: ❑ Yes ❑ No
® SDC Exemption for ADU applied for: El Yes $1 No Received: El Yes ❑ No
® Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified D 1C No Applied For: El Yes ❑ No,stop intake
® Land Use Case#: PDR2015-00002 ® Zoning: R-12
® Required Setbacks: Front: 8 Rear: 10 Side: 3 Street Side: na Garage: 20
® Building Height: Max.Height: na Actual Height: 2°
® Landscape Area: 20 % ® Lot Coverage Max: 80
Entrance back no more than 8' from street-facing wall ❑ Parallel to street or offset 45 degree
Windows ❑ minim ° of area of all street-facing facades
Garage El Garage door is be st street-facing wall ❑ Yes e of the following is met:
❑ Door extends no more ' om wall and there is orch extending beyond garage.
❑ Door extends no more than 5'See RT Addendum t.window above garage on 2nd floor.
❑ Garage door width is El 12'o 0%or ade ❑ 60%or less and includes 7 of following:
❑ Covered pore cessed entrance ❑ Wall of se 'Roof cave ❑ Roof offset
El F s ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip, rel roof El Dormer
Accent siding El Window trim ❑ Window recess ❑ Window pr ❑ Balcony
® Visual Clearance ® Urban Forestry Plan
l Sensitive Lands: ❑ Yes ® No Type:
® Conditions met prior to issuance of building permit
Notes: lg
I- Approved By Planning: Oeitivtebti
Date: 24/2021
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
C\Building\Forms\BldgPermitRvw_RE S_122419.docx
Building Permit Submittal
Original Submittal Date: 02/l7/2O2/
Site Plans: # 3
Building Plans: # 3
Building Permit #: arEnter building permit#above. /
Workflow Routing: [ Planning [Engineering E'Permit Coordinator 17 Building
Workflow Sign-off: [r 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.
R.-Building: original permit application,site plans,building plans, engineer and
beam calculations trust details,if applicable,etc.
Notes:
By Permit Technician: . Date: 0 ZD
Engineering Review
riV"Slope at building pad: 3/1:
I,.,.,/Conditions "Met"prior to issuance of building permit ////41
Yd Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yeslo
Assess Water Quantity Fee in-lieu: ❑ Yes
LIDA Facility on lot: ❑ Yes No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 0-
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Permit Coordinator Review
NI 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:
SDC Exemption: ❑ Received „Pi Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: J" Yes ❑ N/A
Parks SDC: ' Yes ❑ N/A
LIDA ❑ Yes N/A
X. OK to Issue Permit
Approved by Permit Coordinator: Pr/W3
d Date: 212 3 f 20 2 I
I:\Building\Forms\BI dgPennitRvw_RES_122419.docx
City of Tigard
111 ® COMMUNITY DEVELOPMENT DEPARTMENT
N .
T I G A R D River Terrace Building Permit Review Addendum
Building Permit #: MST 7O2( -OW 53
Site Address: 16698 SW Sunshine Coast St
Project Name: Polygon @ Roshack Ridge Lot #: 154
(New dwelling=subdivision name;Addition or Alteration =last name of owner)
Plannir 1?evieW ofltiver Purace Plan District Desiin Standards (18.640.070.1.):
Is the project subject to the plan district design standards? IN Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing façade 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
® ❑ ❑ ❑ ❑
2. Eyes on the street: a minimum of 12% of each street facing façade must include windows or entrance doors.
Percentage Shown: 15%
3. Entrances: At least one entrance must meet both of the following standards:
MIParallel to street, angle no more than 45° from street,
® Max. 8 ft. setback from longest street- facing wall
or open onto porch
Entrance opens to a porch: ® Yes ❑ No
If yes,all the following apply: ® 25 sq.ft. min.
® One street facing entry Iii 12 ft. max. roof above floor of porch
® 5 ft.depth min. Q 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:
! Covered porch min. 5 ft.wide x 5 ft. deep Et Recessed entry area min. 5 ft.wide x 2 ft. deep
® Wall offset min. 16 inches ❑ Dormer min. 4 ft.wide
® Roof eave min. 12 inch projection ® Roof offset min. of 2 ft.
❑ Roof shingles either tile or wood It 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. 21/2"wide by 5/8" deep
❑ Window recess min. 3 inches for all street facing 0 Bay window min. 5 ft.wide by 2 ft. deep
O 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:
No closer to front or side lot line, than longest street-facing wall. A Yes 0 No. If No (Check one):
0 May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
O 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)
O 12-foot-wide garage door 0 40%max. of street façade
® 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: O ,t vtpbti Date: 2/18/2021
1:1Building\Forms\BldgPermitRvw_RES_RT_121417.docx