Permit CITY OF TIGARD MASTER PERMIT
N-----. ... Permit#: MST2021-00153
COMMUNITY DEVELOPMENT Date Issued: 05/18/2021
T I G A R f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17000
Jurisdiction: Tigard
Site address: 14262 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 170
Project: Polygon at Roshak Ridge, Lot 170
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1527 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 29 Bathrooms: 3 Second: 2187 sf Garage: 705 sf Front: 8 Smoke Yes
Right: 5 Detectors:
Dwelling Units: 1 Third: 0 sf Ri 9
Total: 3714 sf Value: $494,881.29 Rear: 15
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 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0Bckflw 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: 4
Fum>=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'I 500 sf: 7 201-400 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 Y
Ecompasing:
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3714
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 PHONE: 360-695-7700
FAX:
Total Fees: $47,029.37
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: Holly VourvDPiWerge Permittee Signature: On'AppiUcatov
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 "8"4(1512,1
Residential R EC I V : FOR OFFICE USE ONLY
Received/y� �f�,
City of Tigard APR ,i r ,,,,; DateBy. « 2021 - Permit No 2(J'l "t O i2J3
11111 ■ S50 Hall Blvd.,Tigard,OR 97223 Q t { e Plan Review 5 J3 era re pro 00 qS7
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: / Z' Other P
I.,t_q,,ll Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: .,, /^ ElSee Pagelfor
Internet: www.tigard-or.gov otiFieM 1,Nethod: ., Supplemental Information
r UI;!D!NCI DIIVISK,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 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
work indicated on this application. p
CATEGORY OF CONSTRUCTION 2 1
Valuation: $ 9 (1 $Q6I
® 1-and 2-family dwelling 0 Commercial/industrial ) t
0 Accessory building ID Multi-familyNumber of bedrooms: 5
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:2 LI 4 19
Job site address: 14262 SW 165th Ave New dwelling area: 3,714 square feet 2L1 dr
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 705 square feet I,rj D�
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: -2$9.,`LyFt 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 I Lot no.: 170 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 residential construction: SFU Valuation: $
Elevation: 222900BR Existing building area: square feet
Scheduled construction start: July 2021 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:( 360 946 8674 Fax:( )360 693-4442 New:
® APPLICANT ❑ CONTACT PERSON 6:9 BUILDING PERMIT FEES*
(Pteore refer to fee schedule.)
name:Polygon Homes WLH LLC
Structural plan review fee(or deposit): 15/•,9?
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 4taylormorrison.com_OAlamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic 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:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:207247 Total fee due upon application: $201.60
Authorized signature: Qyrtq.L iiazyrto 46etM t. This permit application expires if a permit is not obtained
U within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 04/14/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
'
1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicati{(�EC E IV E FOR OFFICE USE ONLY
�t Received ` '/� (-opt/
City of Tigard Permit No.: M J`i(}/2 1 �W{53
lig 't 13125 SW Hall Blvd.,Tigard,OR 97223 APR 1 r enn Date/By:
Phone: 503.713.2439 Fax: 503.598.1960 t,. Plan Review Other Permit:
Date/By:
Yltihl;I� Inspection Line: 503.639.41?5 CITY OF TIGARD Date Aead/B : lurk: -
Internet wvnv.tigard-or_govNotiied/MUlud H See Page 2lar
Supplemental Information
BUILDING DIVIS101';
TYPE OF WORK cafe ERCIAL FEE° SCHEDULE-USE CHECKLIST
Mechanical permit fees*arc based on the value of the work
/I 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:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
►_ 1-and 2-family dwelling 0 Commercial/industrial ❑ Accessory building For special information use checklist
I j Multi-family ❑Master builder ❑Other. Description Qty. Ea. Total
JOB STTE INFORMATION AND LOCATION Heating/cooling:
Air conditioning I 46.75
Job site address: 14262 SW 165th Ave Furnace 100.000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name Polygon at Roshak Ridge Heat pump 61.06
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
shdivision: Polygon at Roshak Ridge Lot no.: 170 Other. 23.32
cv
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK " Gas fumiacchnsert 33.39
Flue vent for water heater or gas
New SFU fireplace 23.32
Log tighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimp /liner/flue/vent 23.32
PROPERTY OWNER El TENANT Other: 23.32
• Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
t
Address:703 Broadway St.,Ste.510 t r 33.39
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/crawlspacefans 23.32
0+ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
S14.15 for first roar;54.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Gas
Address:703 Broadway St.,Ste 510 hear pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water beater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmlttalsi taylormorriSOn.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(590.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
tt days after has been accepted as complete.
th Auorized signature: �Q'' ��'(' it
Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
I mnftd.a.Pmmlr,UFr oremu 4r,n a11111 a A, inn nn+r n r n�.rn,.m•co.
Electrical Permit A licatio EC E V FOR OFFICE USE ONLY
City of Tigard Received µ S1 Zij 2l-06 t 53
D 1 npn- n�By PermrtK
• 13125 SW Hall Blvd.,Tigard,Oft 97223 tit 0 1. a ,. Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 1)arcln Related Permit n:
InspcdimmLioe 503634.4175 CITY OF TiG ,RD Oatr/By Loris: 1Zl See Page afar
interact: w .tgmd-or.gov Notified/Method: Supplemental Information
•
TYPE OF W PLAN REVIEW'
®New construction ❑Addition/alteration/replacement Please check all that apply(submit j secs of plans w/items checked):
❑Service or feeder 400 amps or more la Building over duce stones
❑Demolition 0 Other:
where the available taut current ❑Manna and boatyante
CATEGORY OF CONSTRUCTION exceeds 10,000 amps in 150 volts or 0 Floating buidmps
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Ion to ground,or exceeds 14,000 ❑commercial-rase agricainrs!
amps' 0 Multi-famly 0 Master budder 0 Other um as other Installations bailmn{n.
❑Fax pump. ❑Installation of 150 XVA or
JOB STYE INFORMATION AND LOCATION . I,Fovegeney system larger separately derived
Job#: Job site address:14262 SW 165th Ave ❑Addit moe new meter bad of xyat.111.
100ITP or more. ❑.•A"._k_..1 Z„«l_3•,
City/S1ateIZIP: Tigard,OR 97140 ❑six or morn residented units occupancy
❑Hcalth-carc facilities ❑Recreational}.hick parks_
Suite/bldgiapt.#: Project name: Polygon at Roshak Ridge ❑Itatardoin lonntrrms Q Supply voltage for more than
❑Service or feeder 600 amps or more. 600 vuits non uat
Cross street/directions to job site:
FEE SCHEDULE
"_ Description I Ott, I Each I Total 1 •
New
si -or
Subdivision:Polygon at Roshak Ridge Lot#: 170 Includes aresitttached ntial gage.multi-family dwelling unit.
1,000 sq.It or less 16854 4
Tax map/parcel#: . Ea.add'I 500 sq.It or portion 33-92 1
DFSCRIPIION OF WORK Limited energy,residential 75.00 2
New construction.Type SFU (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
. ® PROPERT1i' OWNER ❑ TF.NANI' Renewable F.ner);y Q See Pale 2
Services or feeders installation,alteration and/or relocation
Name: Polygon Homes WLH LLC 200 amps or leas 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 601 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Email: 0AlamiAbouharn@laylormorrison.com-PermitSubmittals@taylormorrison.eom relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 5936 I_
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 I r El CONTACT PERSON Branch circuits-new,alteration,or extension,per Darrel
A.Fee for branch=Mita wcth
Business name: Polygon Homes WI.H LLC above service or feeder fee, 7 4,
met branch circuit
Contact name: Omar Alamo Abouhafa B.Fee for branch circuits without -
Address: 703 Broadway St,Ste 710 service far, rs�
branncech circustitit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Phone 360 )946 8674Miscellaneous(service or feeder not included)
( Fax::( ) Each Immufactumd or modular
dwelling,service and/or feeder 67.84 2
Email:OAimniAbouhafs@taylormorrison.com-PennitSubmittals@taylormorrison.con R«o,n«r only 67 84 2
CONTRACTOR Pump err Irrigationcacle 6784 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Sips]circuit(,)or limited-energy
p See Page 2 2
Address: 105 Dresden St
panel,aheratrory or extension.
CttY/State/Z1P: Astoria OR 97103 Each additional inspection over allowable in may or the above
Additional inspection(1 hr min) 6625/hr
Phone:(503 3118 0563 Pat:( ) Investigation(1 hr min) 90.00/hr
Industrial I 1hin 78.18/hr
Email: David�a�' m Pan!wallaccwires.co ( rm )
Inspections for which no he is 90 OOI hr
COI t.ic.:224868 Electrical Lie.:C1441 Suptv. Lie.: 6363S specifrcany listed Chbrmin)
- -. - ELECTRICAL PERMIT FEES
e
Suprv.Electrician signature,required:
subtota
Print name:'D}4t7 ad1 Date: g(AiZ r _El Plan Review Required(25%of permit fee?
State surcharge(12%of permit fee)
Authorized signature LJCle — TOTAL PERMIT I f;L
Print name: This permit application expires Us permit is not obtained within tall
n tQ -, .�r DatC: dnya afterIt tax been glimpsed as complete.
�S� ..-- ' Number of inspections allowed per permit
L'Eaildngltnttla 1l&_hrniiAppMt ERF,.dre Rev 06117,2011 1'0-16151711✓llSICOMWF33
r.
Plumbing Permit Applicatio_"t t, -,-
Building Fixtures APR 1 ":: FOR OFFICE USE ONLY
City of Tigard ReceivedPermit Nu .4S1-Z02I.a 0(53
IN r�
n 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TI GAi ly tD Daie/BrP(an Review
e' Phone: 503.118.2439 Fax:� 503,598. !) D'NG D!VISONDate/gy, Other Permit No.:
Inspection Line 503.639.4175 _' '
T IGARD Date Ready/By. funs: R1 See Page 2 for
Internet: www.tigard-or.gov Notiried/Met od: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special iafonaation use checktist
Description I Qty. I Fa. I Total
0 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
Xl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building .41i-Multi-family
Each additional badekitchen 25.02
❑Master builder 0 Other: Tire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14262 SW 165th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Surte/bldg./apt.no.: I Project name:4440.k•liii ePolygon 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.: 170 Fixture or item:
Tax map/parcel no.: Backflow presenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New SFU 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 Fixturclsewer 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/State/ZIT: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
@a
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water piping/DWV 56.29
Address:P.O.Box 92 Other. 25.02
City/State/ZIP:Se Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
CCH Lic.:184372 Plumbing Lie.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: "IiTOTAL PERMIT FEE
Print name:Steve Fowler Date: 1 O/3OI20l Thir 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 kBuildmg‘PcrmitstPLIAU-PerraitApp.doc 001/04 440-0616T(IONJCOWVWEn1
Plan # 2229 CAO (.5K
Floors 2 Large
Bed rooms 5 Small (?4?)I
WC 3
LAV
Tub 1- Basement
Vent 1st Floor i5 7
Water Heater ( 2nd Floor 21(37
AC .SzSJ 3rd Floor
School 17 R-3 Total 3-7 141
l J co a_sd_ 1 * Garage —7 05
2l O�� Total LI I E{ (1
U6
^ #for Elec
eizvkc--c...41) Drc.-k- 2-4 ci
ZY1
Zko
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
IN
Building Permit Review — Residential
TIGARD
Building Permit #: 1,1 ST-20 21-00 I S3
Site Address: 14262 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 170
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
13 copies of site plan on 8-1/2"x 11"or 11 x 17"paper JRetained trees with drip line and tree protection measures
LXIDrawn to scale(standard architect or engineer scale) ®Footprint of new structure(including decks)and FFE
®North arrow X Utility locations&easements(required for new and additions)
®Site address,project or subdivision name and lot number X]Sidewalk/driveway approach
p I(Applicant information(name and phone number) f.ocation of wells/septic systems
XLot dimensions and building setback dimensions [ Street tree size,type and location
fquare footage of buildings to be demolished RStreet names
IMExisting structures on site 5il Corner elevations(2'contours if more than 4'differential)
®Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? C(jA ❑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: ❑ Yes,applicant was notified XI No Received: ❑ Yes ❑ No
%l Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified X No Received: ❑ Yes ❑ No
® SDC Exemption for ADU applied for: ❑ Yes Z No Received: ❑ Yes ❑ No
® Public Facilities Improvement (PFI) Permit
Required: ❑ Yes,applicant was notified 6(7 No Applied For: ❑ Yes ❑ No,stop intake
® Land Use Case#: SUR20015-00004 ® Zoning. R-4.5
g7 Required Setbacks: Front: 8 Rear: 15 Side: 5 Street Side: na Garage: _0_
E] Building Height: Max. Height: 30 Actual Height: 29
® Landscape Area: 20 % ® Lot Coverage Max: 80
❑ Set back no more than 8' from street-facing wall ❑ Parallel to street or offset 45 degree
Windows 12%of area of all street-facing facades
Garage ❑ Garage door 'dest street-facing wall ❑ Yes ,one of the following is met:
❑ Door extends no m h extending beyond garage.
❑ Door extends no m�See River Terrace Addendum dow above garage on 2"d floor.
❑ Garage door width is 60°/u or less and includes 7 of following:
❑ rc ❑ Recessed entrance ❑ Wall offset ve ❑ Roof offset
Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gam r Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection
f(1 Visual Clearance $C7 Urban Forestry Plan
® Sensitive Lands: ❑ Yes ® No Type:
® Conditions met prior to issuance of building permit
Notes:
® Approved By Planning: 1V) dlN b Date: 4/19/2021
Revisions (after Building Submittal only)PTV)
Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Bui lding\Forms 1BldgPermitRvw_RES_122419.docx
Building Permit Submittal r
Original Submittal Date: 11/1 5/2a2a
Site Plans: # ,J
Building Plans: # 3
Building Permit#: ff-Enter building permit#above.
Workflow Routing: [Planning Engineering B—Permit Coordinator E'Building
Workflow Sign-off: A—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
2/Building:
plan review routing form.
[ Building: original permit application,site plans,building plans, engineer and
beam calculations a st details,if applicable,etc.
Notes:
By Permit Technician: Date: D V0Q/212-/
Engineering Review
Slope at building pad: „3 2
Et/Conditions "Met"prior to issuance of building permit
Er.Easements (encroachments) per engineering conditions of approval and plat ///,..
J Water Quality/Quantity Facility
Assess Water Quality Fee in-lieu: ❑ Yes ['No
Assess Water Quantity Fee in-lieu: ❑ Yes re�/,�No
�LIDA Facility on lot. ❑ Yes ItQ No
Lod'Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: �/2�� ,/
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
III pproved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Ilr* DC Exemption: ❑ Received 'LQ Does not apply
VA SDC Fees Entered: Wash Co Trans Dev Tax: /Yes ❑ N/A
Tigard Trans SDC: MA es ❑ N/A
Parks SDC: p/J Yes ❑ /A
LIDA ❑ YesL/I N/A
OK to Issue Permit
Approved by Permit Coordinator: '�-- — 4 - Date: 94/A-/
I:\Building\Forms\BI dgPerm itRvw_RES_122419.docx
City of Tigard
II " COMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD River Terrace Building Permit Review Addendum
Building Permit #: 1•45T2D2t-00I 53
Site Address: 14262 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 170
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planninr 1 eviep of1>iiver Itrrace Plan District besi o Standards (18.640.070.1.):
Is the project subject to the plan district design standards? ® Yes 0 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 Gabled dormer
ft. deep min.2ft.,5 ft.wide min.2 ft.,Eft.wide
N ❑ ❑ IX N
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 16%
3. Entrances:At least one entrance must meet both of the following standards:
® Parallel to street,angle no more than 45° from street,
Ix 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. rain.
® One street facing entry ® 12 ft.max.roof above floor of porch
® 5 ft. depth nun. ® 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 ® 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 nun. of 2 ft.
O 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
0 Accent siding min. 40%of street facade 0 Window trim min.2'/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access 0 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. LJ Yes ❑ No. If No (Check one):
O May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ 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 ® 40%max. of street facade
O 50%max.of street facade with 7 detailed design elements
Notes:
Approved By Planning: ATM G ,?tivtelX(/ Date: 4/19/2021
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