Permit Plumbing Permit Applic. it] 1 CEIVED
Building Fixtures 1 milt ()Eli( l: I si t)Nl.l
SEP LOZ! Received
Cityof Tigard MST2021-00112
g Date/By: ��/ �� `�� Pennit No.:
13125 SW Hall Blvd.,Tigard,OR 97;� a
■ Phone: 503.718.2439 Fax: 503.5-.1199oOF TIGARD Plan Review ci -// ^ A ' /
Date/By: d 1 H(� Other Permit No.:
Inspection Line' S03 639 4175 3UILDING DIVISION I I{,q}t t) Date Ready/By t" Juns S See Pagel for
Internet www dgard-or gov Notified Me[hod�� ZQ Supplemental Information
TYPE OF WORK t42. -w- ',' p 0+47'4-71,,-._FEE* SCHEDULE
❑■ New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONS''IltvcTION SFR(1)bath 312.70
01-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kjtchen 25.02
❑Master builder ❑Other: ✓
Fire sprinkler(1729sq.ft.) Page 2
JOB SITE INFURIATION AND LOCATION Site utilities:
Job site address:14346 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-2 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
Stone sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:11173 Fixture or item:
Tax map/parcel no.: 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 I d TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Taylor Morrison
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 MI,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 I 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: /`'--t--.--4-7/----) TOTAL PERMIT FEE 1 4 c( 41,
Date:8.25.2021 This permit application expires if a permit is not obtained within 180 days
Print name:Gavin Thomes after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1_\Budding\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(1 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities �� lee(ea} Total Square Footage: Permit Fee:
Footing drain-l"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
Storm&Rain Drain-1st 100' 62.54 Valuation: Pet it Fee:
$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
Other eC Ion ' Fee(ea) 'Total each additional$100.00 or fraction thereof,to
l�, 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
Quantity 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
Baptistry/Font ❑ Any new commercial building with water service 2"and
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
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El 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
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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
' _1111
~'4 COMMUNITY DEVELOPMENT Permit#: MST2021-00112
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2021
Parcel: 2S107AA17300
Jurisdiction: Tigard
Site address: 14346 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 173
Project: Polygon at Roshak Ridge, Lot 173-ADU 2
Project Description: New attached ADU 2 of 2.
BUILDING
• Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 720 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 3 Second: 1009 sf Garage: 398 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1729 sf Value: 6230,956.74 Rear. 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bck9w 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: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<10OK: 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: 3 201-400 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/voll: 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.
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ADU VB R-3 1729
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: $25,893.98
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
hOAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198717� or 1.800.332.2344.
Issued By: Holly y V Dew 011.
PermitteeSignature:ege 0wA l'f' ar
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.
r
.
III City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
Building Permit #: (V1Sl-'20ZA- 00111-
Site Address: 14346 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 173
Planning Review
Proposal: New attached ADU Apt w a
CIVerify address/suite# active in Accela. El In River Terrace: ❑ No Q Yes, River Terrace Review Addendum
Site Plan Elements: erosion Control
0. copies of site plan on 8-1/2"x 11"or 11 x 17"paper 1 letained trees with drip line and tree protection measures
G P rawn to scale(standard architect or engineer scale) footprint of new structure(including decks)and FFE
0 orth arrow 'L7tility locations&easements(required for new and additions)
elite address,project or subdivision name and lot number r,idewalk/driveway approach
II.kpplicant information(name and phone number) (,ik' ocation of wells/septic systems
12 .t dimensions and building setback dimensions itreet tree size,type and location
AILquare footage of buildings to be demolished _jtreet names
11/4
II xisting structures on site r"orner elevations(2'contours if more than 4'differential
I, of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? L'IYes o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es o
0 Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑r No Received: 0 Yes ❑r No
ElWater Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ° No Received: Yes R° No
ElSDC Exemption for ADU applied for: Yes ❑r No Received: Yes u No
ElPublic Facilities Improvement(PFI)Permit:
Required: ElYes,applicant was notified ❑ No Applied For: ❑r Yes ❑ No,stop intake
0 Land Use Case #: ADU2020 00015 ❑ Zoning: R-4.5
❑° Required Setbacks: Front: 8 Rear: iti2 IF Side: 3 Street Side: N/A Garage: 3
$ Building Height: 1. Max. Height-. 30 Actual Height: 25.5
IT'I Landsca e Area: 0 iIt % tO Lot Coverage Max: 3/Pt
Entrance • Set back no more than 8'from street-facing wall El Parallel to street or offset 45 degrees or less
Windows • Minimum 12°/0 of area of all street-facing facades
rage Gara e door is behind widest street-facing wall ❑Yes ' , e of the following is met:
Door extends no more than 5'from wall and there' re porch extending beyond garage.
►\Ill
nds no mare than 5'fr n there is a 12 sq ft.window above garage on 2"floor.
CIGaradoor width - 50%or less of facade 60%or less and includes 7 of following:
re porch - Recessed entrance ffset 1'Roof eave ❑Roof offset
ElFire shingles - Lap Siding Roof itch Ga , brel roof Dormer
Accent siding Window trim LI Window recess Window prole ' ❑ Balcony
❑ Visual Clearance ElUrban Forestry Plan
❑ Sensitive Lands: ❑ Yes I,j No Type:
ElConditions met prior to issuance of buil • permit
Notes:
❑ Approved By Planning: _______ Date: 2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw_RES_122419.docx
1
Building Permit Submittal l j
Original Submittal Date: 3/L (2 1
Site Plans: # 3
Building Plans: # ?J
Building Permit#: 126. 1 buildintevrmit#above. may/
Workflow Routing: Planning Engineering ermit Coordinator .2 Building
Workflow Sign-off: 13 Sign-off for Planning(include notes from planning review)
Route Application Documents: aEngineering: (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: ,r -� Date: 3 _ci U
En: 'neering Review
4 lope at building pad: 75/
Il Conditions "Met"prior to issuance of building permit ,/1/9
ErEasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility: �y
Assess Water Quality Fee in-lieu: ❑ Yes L"J No
Assess Water Quantity Fee in-lieu: ❑ Yes rg,No
Er
LIDA Facility on lot: ❑ Yes No
u Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 14:4/
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:
SDC Exemption: ❑ Received Does not a�jly
SDC Fees Entered: Wash Co Trans Dev Tax: Yes U N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Yes ❑ N/A
LIDA 0 Yes 012'N/A
OK to Issue Permit
Approved by Permit Coordinator: /k0 Date: 4((p(201_4
I:\Bui(ding\Forms\B1dgPermitRvw_RES_122419.docx
City of Tigard
illt COMMUNITY DEVELOPMENT DEPARTMENT
River Terrace Building Permit Review Addendum
II(..;ARI.)
Building Permit #: (Ac 071 - 00112-
Site Address: 14346 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 173
(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 ❑r No (Per MMD2020-00044)
culation: 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 :.. 5 ft.deep Gable. .ormex
ft. deep min. 2ft.,5 ft.wide min. 2 ft.,Eft. wide
■ ❑ ❑ 0 0
2.Eyes on the str • : a minimum of 12%of each street facing facade must include windows .. entrance doors.
Percentage Shown:
3. Entrances:At least one w ante must meet both of the following standards:
❑Parallel to street, . gle no more than 45° from street,
El Max. 8 ft. setback from longes Meet- facing wall
or open onto por
Entrance opens to a porch: El Yes II o
Iff j es,all the following apply: ❑25 sq.ft. ' .
LJ One street facing entry ❑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:
0 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 1 ormer min. 4 ft.wide
❑Roof eave min. 12 inch projection ❑R.. offset min.of 2 ft.
❑Roof shingles either tile or wood El Gable, . p or gambrel roof design
['Roof pitch oriented south min. 500 sq. .. ❑Horizont., ap siding min. 3-7 inches wide
❑Accent siding min. 40%of street fa .e ❑Window trim • ' . 2 1/"wide by 5/8"deep
ElWindow recess min. 3 inches for •.i street facing El Bay window min. ft.wide by 2 ft.deep
O Balcony min. 5 ft.wide x 3 ft. .eep with inside access ❑Attached garage is 3 'u or less of street façade
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.
O 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 y,age that faces the street with a min. area of 12 sq.ft.
Width: heck one)
❑ -foot-wide garage door ❑40%max. of street facade
II 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: Date: 5 2
.41400:14"--""='_...—
I:IBuilding forms\BIdgPermitRvw_RES_RT_121417-docx
City of Tigard • COMMUNITY DEVELOPMENT DEPA t kftVh
■
I Water Meter Fixture Unit Worksheet ; LKI
�T16A PD ', 0i�YUF11� ivi
For New Buildings BUl aNG Div ,O;,I
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
LOCATION: City of Tigard—City Hall WATER METER SALES:
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 01/01/202.1.
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 3/4"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.
I:/Building/Forms/WaterMeters_010121 New.docx Page 1
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: 14342 SW 165th Ave(SFU)- 14344 SW 165th Ave(ADU 1)- 14346 SW 165th Ave(ADU 2)
Subdivision Name: Polygon at Roshak Ridge Lot#: 173
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'l 1 x 1 = 1
Kitchen sink 1 1 1 3 x 1.5 = 4.5
Laundry sink x 1.5 =
Lavatory 5 4 5 14 x I = 14
Water closet, 1.6 GPF 3 3 3 9 x 2.5 = 22.5
Bathtub/whirlpool x 4
Shower stall x 2 =
Bath/shower combo 2 2 2 6 x 4 = 24
Total Fixture Unit Points: 85
Fixture Unit Points:
1 to 30=5/8" 37.5 to 89= 1"
30.5 to 37=3/4"
Meter Size: I" Meter Cost: .$ 24,886.00
******************************************1 **************#***************************
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:
I:/Building/Forms/WaterMeters 010121 New.docx Page 2
.' .
Building Permit Application tom- '-, --
--- - r
Residential
ry �J C �f FOR OFFICt: rst:OALl
R�AP 1 G 2021 Received .7
2 ./21 'Jr' MSt 207 t-60112
City of Tigard DatePermit No..
't 13125 SW Hall Blvd.,Tigard,OR 97223 -. . - Plan Review /(�
., �( �1 I Ti $;-ti_J' �Y Other Pennit: v(-�U��
Phone: 503.718.2439 Fax: 503.598 1960 DanRev: 11I' '/
TIGARIlf Inspection Line: 503.639.4175 -)''G DI\f'-:,ON Date Ready/By: / uru ® See Page for
Internet: www.tigard-or.gov N ed/Method / �/ � �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. 2 q 1
0 I-and 2-family dwelling ❑Commercial/industrial
Valuation: $ Jd' I5(i
Number of bedrooms: 3
❑Accessory building ❑Multi-family
❑Master builder NI Other: ADU1, Number of bathrooms:)4 3
JOB SITE•.INr1OI.MATlO\ AND LOCATION Total number of floors: 2 '1(o- l
Job site address: 14346 SW 165th Ave. New dwelling area: square feet l Otii
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: 398 square feet-7 a,0
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
3 Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge Lot no.: 173 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
7 work indicated on this
DESCRIPTION OF WORK � ' I application.
New Single Family-!Accessory Dwelling Unit(ADUL) valuation: $
A/76V C.-kV Cu/f'(t ry—ai� �/ gm4.. is ��( _ Existing building area: square feet
Pl... ! 1V! fJ ! /Y �/N New building area: square feet
j PROPERTY OWNER - ❑ TENANT - Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:7C3 Broadway St., Ste 710 Occupancy groups:
City/State/ZIP:Vancouver, WA 98660 Existing:
Phone:(360)946 8674 Fax:( ) New_
g APPLICANT 0 CONTACT PERSON 8 BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer lo 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 dlie upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:( 360) 946 8674 Fax: :( )
E-mail. I rmitSobmittals(d?taylormorrisor coin.OA!ami�ll ouhafs:n)ittylormorri'oi.r,:nm r'IOTOYOL T JC SOLAR PANEL S%STEM FEES*
— --: —
--- --_- .. --- ------.....----- • -_ .-_ i 1 -•- ' st) frtscrparQ veaila,io i of
r r.NTRA1 foul tup 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 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: $201.60
Authorized signature: 0/444:14- .cY ,n/6tP This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 03/08/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
. - r- .---- ----,A.y,z,,...,.0.I.;,,,rv,,,etwkr,-,...•*ftw...:„,r.,m,,zo...,.( ,. ,,,„
1).1cifliArtical Permit Application iEcElvt- .s..440.4.,i,l,tiab,:ziEotcovitoffsgort,..t.:ki.;:i$,4**,m,04,.„
......
r Pt.rnit NT} 10 1202 1••• 00(I
A r3 41
i125 SW Hall Blvd„Ttgard,OR 9'7223 M i-1 IN / ,?Ur,RtYttlY
.7'..' Phoue, 503 71R2439 Fax: 503,598.1960 , , Drowgiy. Other Penult: (pg 202(-Ciriff i
:nspec:',on Line: 503.639,4175 ., Ci TY OF Tl: AFiL Date Rndray; --% .. - .Juris Eil See Page 2 for
TJamo. www.teard-or lerg: - --- BUILEP.NG, DI'] 0 44.,-;46'idikettied- ' ' '' ' ' ' ' ' Supplemental Infarination
.......
TYPE. OF WORK COMMERCLAL.PEE* SCHEDULE - USE.CiECITLIS"--T71
Pt Mechanical nit fees based on th value of the work
New c nostruction
0 Derno:ition 0 Other:0 Addition/alteration/replacement -
i)e *are e
performed.Indicate the value(rounded to the 11Carert dollat).orall
mechanical materials,equipment,.labor,overileari, nd profit.
CATEGORY OF CONSTRUC'CION Value.
. • .S .
- -----
mnDENTIALsoutfusNr/SYSTEMS FEES*
. _
I-and 2-farroly dwelling E1 Commercial/industrial El Accessory building i Far special information use cherish:is
r--- .
Mult-farnily n Master builder M Other: ADU 2 i Description Qty. Ea L Total
JOB SITE. LNFORMAT1ON AND LOCATION Llieaticy/cooling: —
1 Air candttioni.z 1—T 46.75
Job aite address: 14346 SW I65th Ave.
1 Furnace 100,000 BTU Olner$/verus) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ductelueott) 54.91
_..„,,...................„...,....„ I Heat pump 61.06
SliitalsOldgJapti.00.: i Project name: Polygon at Roshak Ridge
Duct work 23.32
Cross strettUdireutions to job site: Hydrouic hot water system 23.32
-----I Residential boiler(radiator or
hydroencl 23.32_
Unit heaters{fuel-type,not electn4
in-Wall,itAuct,suspended,etc. 46.75
Fltielvent for ELEIV of above 2332
L
SubehoiStor: Polygon at Roshak Ridge Lot no.: 173 Otlxr 23.32
---- ___ -- Other fuel appliances:
Tax nuipiparcel no.: Water beater 23 37
• -
DESCRIPTION OF WORK Gas fireplacehnsert 33.39
Flue rent for water heater or gas
New Single Family -Accessory Dwelling Unit(ADU 2) fireplate 5332
Log lighter(gas) 23.32
_ -1 Wood/pellet stove , I ._ 33.39
,..Wood fireplace/insert i 23.32
Chienneyilinerifluetahnt I 23.32
Other 1 23 32
PROPERTY OWNER. _I a CI TENANT
. Environmental exhaust and ventilation:
Name.Polygon Will,LLC I Range hod/Other kitchen
• ' equipment 33.3'9
. _.
Addzess:703 Broadway Si.,Ste.510 -
Clothes dryer exhaust 1 39
'
City/State/2PP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
_ — --- ._.......... toilet eompants,utilityrootns) 23.32
Phone:(360)695-7700 Fax.( ) Anwicrawlspace fans 23.32
APPLICANT
0 CONTACT PERSON Tithes:
l piping: 23.32 --
Put
Business nthne'Polygon ViL11,LLC
_ shit 15 for first four 54.03 for each additional
Contact name:Tonja Morris Furnace,etc.
[ i
Address:703 Broadway St.,Ste 510 Gus heat punp
I Wallintspendedtunit beater
City/State/ZIP Vancouver,WA 98660 I
Water beater
Phone:(360)695-7700 Fax::(360)693.4442 Fireplace
Range .
E-mail:permitsubmittaisgtaylormorrison.com _____ _ _
Barbecue - I
I
_Ii---_---- .
CONTRACTOR Clothes&yet(gas)
I
LOCIer.
Bu ea siness rause:Pro Beating&Cooling II MECHANICAL PERMIT FEES.
Address: NW-Alocick Dr,Ste. 1 104
Subtotal
City/State/ZIP:Hillsboro,OR NItnittunte permit fee($90.00)
_._..._ Plan regtew(23%of permit fee)
Phone:(360)270-1590 Fax ( )
Slaw-surcharge(12%Of permn fee)
CCB bc.:209001
TOTAL PERMIT FEE
This permit application expires if s perinit is ton obtained within lad
&&.,a... huitzt-n- days after it bas been accepted as complete,
Authorized signature: . Fee enethotinlop sec by Tn.-County Building industry Servizt Board
1'
, Print natter Elia Duran Date 10/30/20
YAR.41etiort1PernwaNA1'1+.exno.k ram 11 einr ....os.r.e,-rr es
•
Electrical Permit ApplicahunECEIVED FOR (Ii I ii I 1 ',I m ry 1 1
City of T `c 7J tests \S7r? 1-ciU\1Z
t u 13125 SW Halt Blvd.,Tigard,OR 97223 iiFV( , ;; 202, Phn Review
• 8 Phone: 503,7182439 Fax: 503.598.1960 p Related Permit..
or
T1cas v Inspection Line: 503.639.4175 , 'Y O ( `R` Los:
_
intuiT • www.tigafd-or.gov �/�I�rT� 1pJ�,Yn- rr�l l7Afi/V� Nelifiallsikdiod.
S See entalage 2 Inf
ILDINC 01V',S10% Supplemental Information
TYPE OF W PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please cheek all dui apply(submit i sear of plans whims chocked):
0 DemolitJtxt 0 Service or feeder 400 amps a 0 Building over three atones.
❑Other: where the avm hble fault curter 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at'so vela or 01 looting bwidurga
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building len w ground,or exceeds 14,000 ❑commercial-use agnesdn sal
0 Multi-family 0 Master builder ®Other. ADU 2 amps for an Who installations buildings
❑Fire pare. ❑Ina Wlataar of 150 rCVA or
JOB STYE INFORMATION AND I..oCATior4 ❑Emergency system larger separately derived
Job#: Job site address: 14346 SW 165th Ave 0 Addition of new motor load of system.
i001IP or mare. ❑A",-E-,"1-2","13",
City/State/ZIP: Tigard,OR 97140 ❑sue m mrxe residential units ommarcy
-- ❑tteatrh-eare facilities. ❑Recreational vehicle parks-
Suite/bldg./apt 8: Project name: Polygon at Roshak Ridge 0 Haaardona locate= 0 Supply volume for more tea„
0 Service or feeder 600 pops or more 600 cults nominal
Cross street/directions to job site: FEE SCHEDULE
Description I Orr, 1 Kush 1 Tow I •
New residential single-or multi-torn dwelling unit.
Subdivision:Polygon at Roahak Ridge Lot#: 173 Includes attached garage.
Tax map/parcel#: 1,000 aq.fl or ass 168.54 4
Ea.add'1500 ari.ft.ur portion 33.92 1
DESCR/I TION OF WORK Limited energy,residential
75.00 2
New construction. Type: ADU 2 (with above eq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.) _
® PROPERTY OWNER f ❑ TENANT Renewable Energy ❑ See Page 2
Name: Polygon Homes WLH LLC Services or feeders installation,alteration,and/or relocadea
200 amps or low 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 Ent amp to 1,000 amps 301.04 2
Phone:( 360 )946 8674 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feedtra installation,alteration,and for
Email: OAiamiAba111a1s@tayltxmon ison.cotn-PeimitSubmi s taylormorrisoiLcom relocation
Owner installation:This installation is being made on property that I own which is not 200 amps Of less 59.36 i
intended ler 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
Br
APPLICANT 1 - 0 CONTACT PERSON anch circuits-pew,adten w
tfoo,or extension,per ad
A.Fee for branch circuits with
Business name: Polygon Homes WLH LLC above service or feeder fee, 742 2
Contact name: Omar Alami Abouhafs r branch anrouit
B.Fee for branch circuits without
Address: 703 Broadway St.,Ste 710 service feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Vancouver,WA 98660 Each add'I bred,circuit 7.42 2
Phone 360 )946 8674Miscellanea=(service or feeder not included)
( Fax::( ) Each manufactu nd or modular 87.84 2
Email:OAlamiA dwenwg.service and/or feeder
bolrhefs(djtaylormarrison.tom-PetmitSubmittals@taylormorriaon.tom Reconnect only 67.84 2
CONTRACTOR• Pump or imgation circle 67.64 2
Business name: Wallace Electric Sign or outline lighting 67.34 2
Address: 105 Dresden Si Signal circuit(s)or limited-energy ❑ see Page 2 2
_ panel,actuation,or etemsion.
City/StatefllP: Astoria,OR 97103 Each additional Inspection over allowable in any of the above
Additional inspection(I lumen) 66.25/br
Phone:(503 308 0563 Fax:( ) investigation(I br min) 90.001 hr
Email: David vallacewires.tom plant(1 brain) 75.latlrc
inspections fur which no fee is
CCB Lie.:224868 Electrical LiiC 1441 6363S specifically listed(55 he min) 90 nru hr
Suprv.Electrician signature,required: E[EC17tICAL PERMIT.FEES
Print name: 0Subtotal
(�jllV a Date: I�/� /�f 0Plan Review Required(25%of permit ice): _
1 ! State surcharge(12%of permit fee):
Authorized signat TOTAL PERMIT FEE Print flame: 6b i Date: I T s permit application expires it a permit is nett sleaued wins tar—
bitu lAifGl�t days after It has Imes accepted as complete.
tROiebog7amittlE7.C_PermitApp era ERE lee See 06/17/2015 151(1 t/051COid+WID • Norbert of inspections allowed per permit.
.. • 4
• Plumbing Permit Applicatiego cc-,
i -t .......v,
Building Fixtures
7'''"...1:4''''' .-::':.:1'' :'-40R;;OFFICE:Mgt`ObitV.-:v,„?..:n.-7::::'.:
,
. ,, City of ligard ' Deto'By- /2/ 21 iur— ' P.cr4'it N°' Msrzozi -ooil 2.
13175 SW Ball Blvd Tigard OR 97'1, -- e,
I a. - - I - ' - ' IYI Or TkARL) Plan Review
Other POSMV 340...9,6442202.1 ''‘XCIO 75—
Phone: 503./18.2439 Fax: 503 598, - .(7,..
ul N ntvi,D.oN DMe 51'`
Inspection Line: 503.639.4'175 Da '- '' - '''''' ' Ready Dam By:
Iltill-stiltp Mtn: 1 0 Son Page 2 for
Internet:. www.tigard-or.gov Nottfieblvicthost Supplemental information
TYPE OF WORK FEE* SCHEDULE
I. .4 New oonstruedon ' 0 Demolition For special inforaration use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 1 0 Other: New 1-2-family dal-elk:As(includes WO ft.far each utility connection)_
CATEGORY OF CONSTRUCTION SFR(1)bath i
, 312 70
...___
' SFR{2)bath 1 437 78 Is and 2-family dwelling 0 Commerciakindustri a 1 I r-------- I i SFR(3)bath i 500 32 :
II Accessory building -Multi-family 1.--
' Each additional bathikitchea 25.02
0 Master builder EFA Other ADU 2 i
I Fire sprinkler( sq.ft) MI Page 2 I
JOB SITE INFORMATION AND LOCATION Site utilities:
Jobslic address: 14346 SW 165th Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain NM 18.76
City/State/ZIP:Tigard,OR 97224
Footing&ton(no.linear ft,: ) allinil
SuitetbkigJapt.no Project name: Polygon at Roshak Ridge Ntanuina„,,red home utilities 1111111111E21 -
Cross streendirections in job site: Manholes - ' . I18 76 _
Rain drain connector 18.76 i
Sanitary sewer(no.linear it: ) j Page 2
Storm sewer(no,linear h.: ) MI
I Water service(no,linear/4: ) MEI
Subdivision: I Lot nc 173 Fixture or item;
Tax map/parcel no.: 1 Backflow preventer 111112111111111111111.
[ Backwater valve iliI6EnMIIIIIII
DESCRIPTION OF WORK
Clothes washer MIS 25'0 Ili:
New Single Family-Accessory Dwelling Unit (ADU 2)
Dishwasher 25,02
Drinking fountain 25.02
1-
Ejectoralsump 25.02
El PROPERTY OWNER 0 TENANT Expansion tank 12.51
_------
Fixturelsewer cap 25.02
Name:Polygon WLH LLC
Floor dtaindloor sink/hub 25.02 1111111111
Address:703 Broadway St.,Ste 510
• Garbage disposal = 25.02 I 1
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 I
Phone:(360695-7700 Fax:( ) Ice maker IIIIIIIIEIIIIIIIIIIII
HI APPLICANT 0 CONTACT PERSON I Inteineptor/gretise trap 25.02
i Medical gas(value:$ ) Page 2
Business dame:Polygon WEIL TLC ,
t
I Prima' 111111111133 .
Contact name:Tonja Morris i
Roof Main(commercial) IIIIUIESNIIIIIIII'-
Address:703 Broadway St.,.Ste 510
Sint:Amain/lavatory '• ' 25.02
City/State/ZIP: Vancouver,WA 08660 Solar units(potable water) I 62.54
Phone:(360)695-7700 Fax: :(360)693-4442 Tub/showertshower pan 1111.011133 1
E-mailPermitSubmittals@taylormorrison.com,OAlamiAbouhafs@taylormorrison.corn Urinal 25.02
Water closet 1111 25.02 IIIM
CONTRACTOR
Water heater 1111111111121
Business name:G&li Plumbing&Sons Inc
Water piping/DWV 11111 56 11111111
Address:P.O.Box 92 Other IIERMIIIII
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 I Fax:(971)727-8170 Minimum permit fem.. $72.50
i Plan review (25%of penny fee) IN
(CB Lie.: 184372 Plumbing,g Lin no,:pb634 '
1 State surcharge(12%of permit fee)
Authorized signatur7s:-It—C-1-Ctt '
; TOTAL PERMrr FEE MN
Pont name:Steve Fowler Date: 1 0/30/20 This permit application expires if 4 meant is net obtained volatile I SO days
after it has beta accepted as complete
*Fes motrodolon set by To-County Building Industry Service Board,
IADuidtnetivaitCPLANU-PerramApp anc t00.1.19 440.46 i6T(IWP.X.CWWEI;)