Permit Plumbing Permit Applicati . ,EIVED
Building Fixtures F FOR 1oFFi ' i�: t'si ()NIA.
City of Tigard Eiew /'2 '
C) Pennit No.: MST2021-00114
13125 SW Hall Blvd.,Tigard,OR'i,912y OF TIC7AHUPPhone: 503.718.2439 Fax: 5Other Permit No.:
Ui IIG DIVISION Date/By: q fs / 4 e.!n
Inspection Line: 503.639.4175 ® See Page 2 for
7 I G A R 1� Date Ready/By: Juris_
Internet www.tigard-or.gov Notified/Method:/2/� Z/ 'CV a Supplemental Information
TYPE OF A fi `i'74-, 61f'1 " - FEE* SCHEDULE
New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I 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
■ 1-and 2-familydwellingSFR(2)bath 437.78
0 Commercial/industrial
ElAccessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kitc n 25.02
ID Master builder El Other
Fire sprinkler(16?5 q.ft.) Page 2
JOB SITE,INFORMATION AND LOCATION Site utilities:
Job site address:14270 SW 165th Ave 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.:ADU-1 I 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: I Lot no.`k,174 Fixture or item:
Tax map/parcel no.: ��YY Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name:Taylor Morrison Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway Street Suite 710 Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660 Hose bib 25.02
Phone:(360 ) 695-7700 Fax:( ) Ice maker 12.51
❑ APPLICANT' '' I CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Gavin Thomes
Roof drain(commercial) 12.51
Address:146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale,OR 97060 Solar units(potable water) 62.54
Phone:( 503)577-6535 Fax::( ) Tub/shower/shower pan 12.51
E-mail: gavin@allianceplumbing.net Urinal 25.02
Water closet 25.02
CONTRACTOR;
Water heater 37.52
Business name:Alliance Plumbing, LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale, OR 97060 Subtotal
Phone:( 503 )492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
�� State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE 1(J�,{/p 1
Print name:Gavin Thomes Date:8.25.2021 This permit application expires if a permit is not obtained within 18U days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1 A Budding V Permits VPLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee tea} Ti Square Footage: Permit Fee:'
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee'
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.Subtotal:
Commercial Fixture Work: •
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations,
Quantitj by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/F'ont greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
CIMedical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial CI Any multipurpose fire sprinkler system.
Domestic CI Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric,or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
CITY OF TIGARD MASTER PERMIT
: �2 ' COMMUNITY DEVELOPMENT Permit#: MST2021 00114
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2021
T I c;A f,T) 9 Parcel: 2S107AA17400
Jurisdiction: Tigard
Site address: 14270 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 174
Project: Polygon at Roshak Ridge, Lot 174 ADU 1
Project Description: New attached ADU 1 of 2.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 672 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 3 Second: 953 sf Garage: 287 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 1625 sf Value: $212,859.60 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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: 2
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: 2 201-400 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 ADU VB R-3 1625
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 2 Fire Rated Conditions
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $25,547.61
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
1.8�000..3�3.2.2344.
}foU w yVa. De.Wege O wl
Issued By: Permittee Signature: pptttt�tt.idYl
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 Applicatio ,„-
Residential FOR OFFI('I.I SE O\l.1
Cityof Tigard MAR 1 6 2021 Received �/29/et ,x yam - nO9 —Q kr L
g Date/Bv: ` r V{ Permit No.: �(� w "(
• 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
C` Phone: 503.718.2439 Fax: 503.598. a / erermit: 1Zt..
OF ARf� Date/By: 0001(0
Inspection Line: 503.639.4175 BUILDING i'`=',it,',1; N Date eadyBy: Jail. 61 See Page 2for
TIGARD a 7 a, ��.�, r i
Intemet: www.tigard-or.gov fled/Method: / S 161 1 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
El Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. 1,0
Valuation: $ (a( V 7 1
❑ 1-and 2-family dwelling ,
❑Commercial/industrial
El Accessory building El Multi-familyNumber of bedrooms: 3
❑Master builder ®Other: ADU 1 Number of bathrooms: 3
JOB SITE INFORIWIATION`AND LOCATION Total number of floors: 2 14i ID—
Job site address: 14270 SW 165th Ave. New dwelling area: i(Q(/ square feet 15.3
City/State/ZiP:Sherwood, OR 97140 Garage/carport area: 287 square feet r 0-1D,,,
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
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge Lot no.: 174 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.
New Single Famil -Acce •M 1 . - 'n• Unit(ADU 1) Valuation: $
�,.
Existing building area: square feet
4._,.,...rry fd/# U rd if. / _Oh Al 14 rLf/ - '
o/yriF . New building area: square feet
® PR•PERTY OWNER 1 0 TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:703 Broadway St., Ste 710 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)946 8674 Fax:( ) New:
APPLICANT ❑'CONTACT PERSONa9 T BUILDING PERMIT.FEES*
Business name:Polygon Homes WLH LLC (Please r�fertn fee schedule)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 710
Total fees due upon application:
City/State/ZIP:Vancouver, WA 98660
-'� -- Amount received:
Phone:( 360) 946 8674 Fax::( ) --
E-mail: PermitSubmittals@taylormorrison.com,OAlamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR 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 710 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 lie..207247 „//[[ Total fee due upon application: $201.60
Authorized signature: Dm a4.4 .ry0-6, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*
Print name:Omar Alami Abouhafs Date: 03/08/2021 Fee methodology set by Tri-County Building Industry
Service Board.
1.\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
,....
REC :-..--Ivil-D
, ,.... ;
ivlechanical Permit Application MAR 1 6 2021 i•OR OFFICE.USE ONLY
Rmeived 5 zei /71 i Permit No.:li3O•1"7021-00 I
City of Tigard
, , it 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TI rr 114GARD 1):1'11/Y' f 7 1" ' I
Phone: 503.718.2439 Fax; 503_598.l 960 BUILDING DIVISION:„BR7 Other Permit: SW122/321- 000*
Inspection Line: 503.639.4175
11‹..41:17i . Date Ready/By: iuris CO see Page 2 for
internet: WWW.figard-Or5gOV NaitictiNetite.th Supplemental Information
_..
_ --- _
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
_
Mechanical permit fees*are based on the value of the work • ,
0 New construction 0 Addition/alteration/replacement performed,Indicate the value(rounded to nearesa dollar)of all. '
0 Demolition D Other: mechanical mattrials„eTlipment,labor,overhe.ad,and profic___
i
--- • • Value:$
C .
CATEGORY OF CONSTRU IION _
_ _ RESIDENTIAL EQUIPMENT/SYSTEMS FEES' '
— 1-and 2-family dwelling El Commerciallindustrial 0 Accessory building For special infarmation use checklist.
Multi'family El Master builder IE Other: ADU 1 Description Qty. T Ta711-otal—
,_
JOB SITE INFORMATION AND Heating/cooling
LOCATION :
Air conditioning ( 46.75 F-
_„....,..
Job site address' 14270 SW 165th Ave. Furnace 100,000 BTU(doctsivenls) 46,75
--
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(duets/vents) $4,91 -
Beat pump 61.06
Suite/bldgiapt no.; I Project name: Polygon at Roshak Ridge -- -
1 Duct work 23.32
Cross Stre,lVdifootiOnS to job site: 1 Hydronic hot water system 23.32
--- -------------- -- 1 Residential boiler(radiator or
I ,
hydroniq 23,32 1 '
___________ .
Unit heaters(fuel-type,not electric),
I __ in-wall,in-duct,suspended,etc. - -46 75
Flue'vent for any of above 23,32
i Other;I
Subdivisic 1; Polygon at Roshak Ridge 1.,ot no.: 174 i
.. _ 1 Other fuel appliances: 23.32
1 Tax map/parcel no..: i Water heater 23.32
DESCRIPTION OF WORK I Gas fireplace/Insert 33.i9
, Flue vent for water heater or gas
New Single Family-Accessory Dwelling Unit(ADU 1) I ftre lace 23.12 _.____
Loa lighter f.a_s) 23;32
Wocad/pedet stove 33.39
i
1 ' ,Wood fireplace/Itasca , _,,_ 23.32
Chimney/liner/flue/vent 23.32
-- — Other. I 23.32
iis PROPERTY OWNER
L_.— 0 TENANT .
---- ,Environmental exhaust and ventilation:
Name:Polygon WLH.LLC I Range hood/other kitchen
I egi,.iiprnerit 3339
_
Address:703 Broadway St„Ste.510 —
Clothes dryer exhaust 33.39 City/State/ZIP:Vancouver,WA 98660 j Single-duct exhaust(bathrooms,
— __ toilet cona rttnents,unlit rooms 23.32 ,
Phone;(360)695-7700 Fax:( ) Attickrawlspace fans 23.32 i
1 APPLICANT 0 CONTACT PF.R,SON I Orb..-: 23.32 , I
-----1
— -1 Fuo_pipktg: I
Business name: Polygon WLH,LLC ,
$14,15 for first four;$4.03 for each additional I .
1
Contact name:Tonga'Morris , Furnace,etc.
heat pump 1_
; Address:703 Broadway St-,Ste 510 LOas •
— I Wall/sus end unit heater ,
• City/State/ZIP:Vancouver,WA 98660 Water heater I ,
_Phone:(360)695-7700 Fax::(360)693-4442 _Fireplace
---4 Raave ___,
i E-mail:permitsubmittals(it,aylOrMOrriSOn.COM
ec Barbue -- I__
CON __
TRACTOR Clothes d er as I.i Other
Business name:Pro Heating it Cooling
MECHANICAL PERMIT FEES' I
Address-. NW Alociek Dr,Ste.1104 I'
Subtotal _
--
Minimum permit fee($90,00,1
Cify/State/Z1P; Hillsboro,OR
--- ' Ptah review(25%of permit fee)
Phone:(360)270-1590 Fax:( )
A State surcharge(12%of iiermit fee)
CCB lic..209001 ,
, TOTAL PERMIT FEE , .1
......._ - no:,permit application expires if a permit is not obtained within IRO
e-i..,•0-.. 1) -44-n, days after it has been accepted as consplete..
Authorized signature: • F ,rnettiodolc.igy set by 7rt-Counry Building Industry Service Board
..
I Print name:Elia Duran _Hite: 1 0/30/20
i,1,15.55151inalPornutetI4Pr P.rmit A no 11411111 An^ 5505 4,5 Tr ft 5 5/555555,.5,51,57.5
Electrical Permit Applicati ECEIVED FOR cur rit t rsl (►.l l
-I' r Received — •
City of Tigard a)`t r 102 r f)atc1B 1'Z Z t Parma., �\ .I C�:;
• 13125 SW Hall Blvd.,Tigard,OR 97223
+ g Phone. 503.718.2439 Fax. 503.598.1 '+ Plan Review Refired Permit il,
Inspection Line: 503.639 4175 TIGARD t>�yiY
3iLi'`l l� Internet: www.tigard-or.gov 3DlLDING DIVISION kris: PISupplemental l torraaaaa
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2,secs of plans w/items checked)
0 Demolition 0()(ham: ❑Same or feeder 400 amps a mire ❑ Met et three stones
where the available fault current 0 Marinas and boatyard,.
CATEGOR% OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 bloating buildings
❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building leas to ground,or exceeds 14,000 0 Commercwl-use agneultunet
amps buildings
❑Multi-family 0 Master builder El Other: ADU 1 u all other Installations❑Firs pump. ❑Installaturi of 150 ICVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
❑Additwm of new motor load of systmo
14270 S W 165th Ave
Job#: Job site address: 10011P or mole. ❑"A` _k- "1 z","t-3",
City/State/ZIP: Tigard,OR 97140 ❑six or more residential wets occupancy
❑Health-ear's facilities- ❑Recreational whack parks.
Suite/bldg./apt#: Project name: Polygon at Roshak Ridge ❑Iiaztrdous locations 0 Supply voltage t«more than
❑Service or feeder 600 amps or more 60t/wilts nominal.
Cross street/directions to job site: FEE SCHEDULE
°ascription i Qt5• I Each I row I •
Ncw residential single.or multi-faintly dwelling unit.
Subdivision:Polygon at Roshak Ridge ___ l Lot#: 174 Includes attached garage.
Tax map/parcel#: l,t)00 sq.R or less 168 54 4
Fa.add'l 500 sq It or portion 33.92 1
DESCRIPTION OF WORM Limited energy,residential
75-00 2
(with above sq.t�)
New construction. Type: ADU 1 .
Limited energy,mutts-family
residential(with above so ft.) 75 UO 2
® PROPERTY OWNERRenewable Energy 0 See Page 2
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 710 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200 34 2
City/State/ZiP: Vancouver,WA 98660 Got amps to 1,000 amps —
301 00 2
Phone:( 360 )946 8674 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: OAlamiAbouhafsgtaylolmorristmcom-PermitSubmittalsttaylormorrison.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 to400 amps 125 08 2
Owner signature: Date: 401 amps to 599 amps 168-54 2
❑ APPI.It<M'r I �� ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes Wi.H LLC above service or feeder foe, 7 42
each branch circuit
Contact name: Omar Alami Abouhafs B.Fee for branch circuits without
Address: 703 Broadway St.,Ste 710 srache cit furcuriit fee,(lull brannch 56 18 2
b
City/State/ZIP: Vancouver,WA 98660 Each add't branch circuit 7.42 _ 2
Phone' 360 94b 8674 Mlseenaneons(service or feeder not included)
( ) Fax::( )._. Each manufactured or modular 67 84 2
dwelling.service and/or feeder
Entail:OAlamiAbouhafs@taylormomson.com-Perm1tSubmittals(a�tnylnrmorrison.com Reconnect r t y — 67 84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Signal circurt(s)or limited-energy
Address: 105 Dresden St panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Astoria.OR 97103 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66 25/hr
1 Phone:(503 3018 0563 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: David{thwallacewires.corrl _ Industrial plant(I hr min) 78 i let he.
Inspections for which no lee is
CCB l.ic.:224868 Electrical Li • C1441 Su _I; .• 6363S specifically listed(Fr he min) 90 001 hi
Suprv.Electrician signature,required: ELECTRICAL. PERMIT FEES .
Subtotal
Print name:
a..._e" `g:. ...' c.a. Date: Ay J't 0 Plan Review Required(25%of permit fro)
/ •
State surcharge(12%of permit fee)
Authorized signature it. ;/ TOTAL PERMIT 1 11
This permit application expires if a permit is not obtained within 180
Print Mal- :—' Date: / days after it has been accepted as eompiete.
Z({L— 7e^ �//fir�?l.__ a Number of tnspectons allowed per permit.
1''Budding cnuta'aLC_PcrnnApp_II.R 17tf.doc Rev0617/2015 410-4615T(M1/05/COMAVEB
• R ,
plumbing Permit Application
Building Fixtures MAR 1 i 2021 FOR OFhLCI' I''L ONLN
Received �/� PcrmitNo,:City of Tigard CITY OF TIGAR D Date/B 3`!�ilr:j ms-rA11-oot i q
p 13125 SW Hall Blvd.,Tigard,OR 97223BUILDING DIVISI , 1 tan Review
a'; Phone: 503.718.2439 Fax: 503,598.196p purerP-rmitNo.: (�� �^
Date/13y: ✓ (J+�" 660
-44
Iinspehan Line, 503,639,4175 Batt Ready/B Iuris 0 Sea Page 2 for
1!` `fit ? Internet: www.ti ardor,gov o'
g b Notified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
New construction l3 Demolition Far special information use checklist.
- Description __ __.___1- � Total
❑Addition/alteration/replacement 0 Other New'1 2-£aniil dwellings(includes 10�.for each utility connection)
CATEGORY OF CONSTRUCTION SF R(1)bath T I 312,70 I
SFR(2)bath 437.78 I
1-and 2-family dwelling CICommercial/industrial �� _.__..
o-'---- --- I SFR(3)bath 500.32 i
❑Accessory building Multi-family - i
Each additional bath/kitchen 25.02
0 Master builder ,..4 Other: ADU 1 - t- ___...
____ __ t Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION i Site utilities:
Job site address: 14270 SW 165t1] Ave Catch basin or area drain 18.76
Drywell,teach line,or trench drain 18.76
City/State/ZI.P:Tigard,OR 97224 ___,__.. __,
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name Polygon at Roshak Ridge Manufactured home utilities i 50.03
Cross street/directions to job site: Manholes :' 18,76
Ram drain connector 18.76
I ii
I Sanitary sewer(no,linear ft:_) I Page 2
f'
Stormsewer(no.linear ft.: ) �Page 2
Water service(no.linear ft.: .) Page 2 1
I Subdivision: ' Lot nc 174
1 Fixture or item:
i Backilow preventer 31.27
, Tax map/parcel no.: ,
' DESCRIPTION OF WORK i Backwater valve 12.51
Clothes washer 25.02
.____ Dishwasher 25.02
Drinking fountain 25.02
_
Ejectors/sump 25,02
1 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25:02
Floor drain/floor sink/hub 25.02
Address:7.03 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
4 APPLICANT 0 CONTACT PERSON j Interceptor/grease trap _ 25.02
Business name:Polygon WLI8,LLC Medical gas(value'S_) Page 2
Primer 12.51 •
Contact name:Ionia Morris ;
Roof dram(commercial) i 12,51 1
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory : 35.02
_ __—_ 1
r City/State/ZIP:Vancouver,WA 98660
.___�__--- ' ' Solar units(potable water) ( 62.54
Phone:(360)695-7700 1 Fax::(360)693-4442 Tulr'showeelshmwerpan 12,51
E-mail PermitSubmittals@taylormorrison.com,OAIamiAbouhafs@taylormorrison.com Urinal 25.02
Water closet 25.02
CONTRACTOR
-- — __ Water heater 37,52 1sS
Business name:G&B Plumbing&Sons Inc Water pipinpjDWV 56.29 4
Address:P.O.Box 92 Other 25.02
City./State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 I Fax:(971)727-8170 Minimum permit fee: S72.50
t CCB Luc.:4184372 Plumbing Lic,no pb634 Plan review (25%of permit fee)
_ I State surcharge(12%of permit fee)
Authorized signature: : TOTAL PERMIT FEE
1 Chin permit
ermit application expires if a permit is not obtained within ISO days
Print name:Steve Fowler I Date: 1 0/30/20 pp after it has beta accepted u complete.
*Fee methodology set by Tn-County Building industry Setvtce Board
1:114uicimpPomirrBt.MU.r n u,tppaec 1WO1'rr 440.46161(141/�'COM/WE11)
Y
City of Tigard
•
ili COMMUNITY DEVELOPMENT DEPARTMENT
■
T.l G n 1,D Building Permit Review — Residential
Building Permit #: S`t'O21- 00114
Site Address: 14270 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 174
Planning Review
Proposal: New attached ADU AVU $±
0 Verify address/suite#active in Accela. Q In River Terrace: 0 No El Yes, River Terrace Review Addendum
Site Plan Elements: Erosion Control
II copies of site plan on 8-1/2"x 11"or 11 x 17"paper i etained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) Footprint of new structure(including decks)and FFE
0 orth arrow sLitility locations&easements(required for new and additions)
O'ite address,project or subdivision name and lot number °iidewalk/driveway approach
IIlpplicant information(name and phone number) qk
Location of wells/septic systems
NIof dimensions and building setback dimensions street tree size,type and location
II'quare footage of buildings to be demolished Street names
( )R II xisting structures on site ..... orner elevations(2'contours if more than 4'differential
��VV II ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? °�i es o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es '' o
ElClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified ❑ No Received: El Yes El No
O Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: 0 Yes,applicant was notified ❑ No Received: Yes ❑No
❑ SDC Exemption for ADU applied for: ❑Yes ❑a No Received: Yes El No
❑r Public Facilities Improvement (PFI) Permit:
Required: ❑Yes,applicant was notified ❑ No Applied For: El Yes ❑ No,stop intake
❑r Land Use Case#: ADU2020-00016 ❑ Zoning: R-4.5
❑o Required Setbacks: Front: 8 Rear: 15 Side: 3 Street Side: NSA Garage: 3
El Building Height: Max. Height: 30 Actual Height: 25.5
N'R5] Landsca e Area: % Lot Coverage Max: �f i
ntrance ° Set back no more than 8'from street-facing wall ❑r Parallel to street or offset 45 degrees or less
Windows ° Minimum 12%of area of all street-facing facades
Garage door is behind widest street-facing wall ❑Yes ❑ No,one of the following is met:
extends no more than 5'from wall and there is a covered porch extending beyond ar
13/A Door exten s e than 5'from wall and there is a 12 s ft. e garage on 2°d floor.
ElGarage door width is — 12'or e ° o facade 60%or less and includes 7 of following:
Covered orc se entrance offset 1'Roof eave ❑ Roof offset
CIshingles — Lap Siding Roof itch hi or gambrel roof Dormer
Accent siding _ Window trim LI Window recess in 'ection 0 Balcony
ElVisual Clearance ❑r Urban Forestry Plan
❑ Sensitive Lands: ❑ Yes ILI No Type:
0 Conditions met prior to issuance of building per :t
Notes:
El Approved By Planning: ///^a— ] Date: 3 Z9 2 f
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw_RES_122419.docx
v . 4,
Building Permit Submittal /21
Original Submittal Date: 57/(0
Site Plans: # I
Building Plans: # 5
Building Permit#: nter )uildin erx it#above. ��/
Workflow Routing: Planning Engineering L7 Permit Coordinator 1:1-131.1.ilding
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: f Date: 3 2q 2/
Engineering Review
Slope at building pad:
Conditions"Met"prior to issuance of building permit /1.,)1/7
ErEasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes pyNo
Assess Water Quantity Fee in-lieu: ❑ Yes L��_.IyNo
LIDA Facility on lot: ❑ Yes l No
Li
FI Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
LI/Approved by Engineering: Date: `4"/.
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ 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:
ZSDC Exemption: ❑ Received ,r3 Does not a- ly
ESDC Fees Entered: Wash Co Trans Dev Tax: 1Z Yes N/A
Tigard Trans SDC: , Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes prN/A
OK to Issue Permit I
Approved by Permit Coordinator: G Date: 1'f(P 1202,1
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
r
.._
II i City of Tigard
, •
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #: tell5t2021-00 114
Site Address: 14270 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 174
(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 Q No (Per MMD2020-00044)
Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additio
ele -nt 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 I. 5 ft. deep Gable. .ormer
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide
I ❑ ❑ ❑ ❑
2. Eyes on the str• •t: a minimum of 12%of each street facing facade must include windows . entrance doors.
Percentage Shown:
3. Entrances:At least one e ance must meet both of the following standards:
0 Parallel to street, . gle no more than 45° from street,
El Max. 8 ft. setback from longes treet- facing wall
or open onto por
Entrance opens to a porch: 0 Yes I o
IfLes,all the following apply: ❑25 sq.ft. 'n.
One street facing entry 0 12 f ax.roof above floor of porch
❑5 ft.depth min. ❑3./o min.porch roof coverage
4.Detailed Design:All buildings shall include a min. o v• of the following elements on all street-facing facades:
❑Covered porch min. 5 ft.wide x 5 ft. deep IRecessed entry area min. 5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches I Dormer min. 4 ft.wide
❑Roof eave min. 12 inch projection ❑Re., offset min. of 2 ft.
0 Roof shingles either tile or wood ❑Gable, .'p or gambrel roof design
0 Roof pitch oriented south min. 500 sq. 0 Horizont. ap siding min. 3-7 inches wide
❑Accent siding min. 40%of street fat,.e 0 Window trim , ' . 2 1/2"wide by 5/8"deep
❑Window recess min. 3 inches for ,i street facing 0 Bay window min. ft.wide by 2 ft. deep
❑Balcony min. 5 ft.wide x 3 ft. .eep with inside access 0 Attached garage is 3 'o or less of street facade
5. Garages and Carports: ', ay face the front or side lot line on a corner lot.
Setbacks:
No closer to front o .ide lot line,than longest street-facing wall. ❑Yes ❑No. If No (Check o - .
❑May extend u. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
❑May exten. p to 5 ft.where the garage is part of a two-story building and there is a window at the se : d story
above the p. age that faces the street with a min. area of 12 sq.ft.
Width: heck one)
0 -foot-wide garage door 0 40%max. of street facade
I 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: ---1 Date: 549/202)
I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx
Water Meter Fixture Unit Worksheet For New Buildings
Please complete the following information:
Contractor Name: Polygon Home, WLH LLC
Billing Address: Street/Suite#: 703 Broadway St, STE 710
City: Vancouver State: WA Zip: 98660
Phone Number: 360 946 8674 Email:
New Meter Address: 14374 SW 165th Ave(SFU)- 14270 SW 165th Ave(ADU 1)- 14272 SW 165th Ave(ADU 2)
Subdivision Name: Polygon at Roshak Ridge Lot#: 174
Building Permit#:
Please fill in the number of each fixture as detailed on the plans. Multiply the quantity by the point value
to arrive at the point total. Add all point totals together for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
SFU ADU1 ADU2 Total
Bar sink x 1 =
Bidet x 1
Clothes washer 1 1 1 3 x 4 = 12
Dishwasher 1 1 1 3 x 1.5 = 4.5
Hose bib, 1ST one 1 1 x 2.5 = 2.5
Hose bib, each add'! 1 x 1 = 1
Kitchen sink 1 1 1 3 x 1.5 = 4.5
Laundry sink x 1.5 =
Lavatory 6 4 5 15 x 1 = 15
Water closet, 1.6 GPF 4 3 3 10 x 2.5 = 25
Bathtub/whirlpool x 4
Shower stall x 2
Bath/shower combo 3 2 2 7 x 4 = 24
Total Fixture Unit Points: 88.5
Fixture Unit Points:
1 to30=5/8" 37.5to89= 1"
30.5 to 37=3/4"
Meter Size: 1" Meter Cost: $ 24,886.00
*************************************************************************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building(Master) Permit or Plumbing ❑Yes ❑ No ❑ Other:
Meter#: Sale Date:
Receipt#: Meter Cost:
Employee Name:
1:/Building/Forms/WaterMeters_010121 New.doCX Page 2
City of Tigard • COMMUNITY DEVELOPMENT DEPA 111641 VED
111 Water Meter Fixture Unit Worksheet 'AR 1 '3 2 '
rIG\KP CI YOFTIGARD
For New Buildings BUILDING nIV1SION
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
— METER SALES:
LOCATION: City of TigardCity Hall WATER
Utility Billing By Appointment Only: 503-718-2460
13125 SW Hall Blvd. (No more than five meter sales per appointment)
Tigard, OR 97223
METER: SIZE: FEE: Effective 01/01/2021
5/8" $9,495.00 Fee includes:
3/4" $13,554.00 water system development charge,
1" $24,886.00 water meter, and
1-1/2" $73,689.00 meter installation fee.
2" $119,333.00
Note: An additional charge will apply for water meters where an"existing water main"requires a new service line to be
installed by the City to the property address and is paid by the property owner as follows:
• Up to 1"_$3,815.00
• Over 1"=Cost+ 10%
DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS
City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon
Plumbing Specialty Code to determine the size of meter needed to adequately serve new buildings. In
most cases, new residential buildings require a 3/47 meter, however, due to the size of homes built in the
Tigard area,we now count the fixture units of all homes prior to selling a meter. Buildings with 37 or less
fixture points can use a 3/4" meter. For those over 37,a 1"meter must be purchased. Use the worksheet
on Page 2 to calculate the number of fixture units.
DOCUMENTATION
Please provide the following items to the Utility Billing counter to purchase your meter:
• Completed water meter fixture unit worksheet(on back page).
• Copy of building or plumbing permit application date-stamped by building division.
• Copy of issued building or plumbing permit.
Your fixture count will be verified and your request will be processed upon receipt of these documents.
No exceptions.
INSTALLATION TIME
Most meters are installed within 10-14 business days. If your meter is not located within an existing
subdivision we may need additional time in order to verify the location of other underground utilities.
Please keep these time frames in mind when purchasing your water meter.
1:/Building/Forms/WaterMeters_010121 New.dOCX Page 1