Permit n CITY OF TIGARD MASTER PERMIT
• COMMUNITY DEVELOPMENT Permit#: MST2021-00306
S Date Issued: 09/23/2021
T!C;A Ft.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA21100
Jurisdiction: Tigard
Site address: 16555 SW DARWIN LOOP
Subdivision: ROSHAK RIDGE Lot: 211
Project: Polygon at Roshak Ridge, Lot 211
Project Description: New single detached house. 5/3/22: REPRINT to show that deferred SDC fees have been paid.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 5 First: 1211 sf Basement: 763 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 4 Second: 1715 sf Garage: 485 sf Front: 8 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3689 sf Value: $509,862.34 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 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
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
I NEW SF VB R-3 3689
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 Geo Tech Report Required
Prior To Pour
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $48,943.78
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
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Issued By: Jr A Permittee Signature: %C.- __ CAIIPR I
Cali 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 lob site at the time of each inspection.
CITY OF TIGARD MASTER PERMIT
a • COMMUNITY DEVELOPMENT Permit#: MST2021-00306
Date Issued: 09/23/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25107AA21100
Jurisdiction: Tigard
Site address: 16555 SW DARWIN LOOP
Subdivision: ROSHAK RIDGE Lot: 211
Project: Polygon at Roshak Ridge, Lot 211
project Description: New single detached house. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES PAID
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 5 First: 1211 sf Basement: 763 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 4 Second: 1715 sf Garage: 485 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3689 sf Value: $509,862.34 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckllw 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: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'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-vamp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y
Other: N Other Description:
Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3689
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 Geo Tech Report Required
Prior To Pour
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $40,439.98
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
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Issued By: HoU,y V041/DC,Wege, Permittee Signature: ON, Apr li,ii4 v.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
I
Building Permit Application t3-7/Z7/Z j
t Residential RECEIVE1 FOR OFFICE USE ONLY
Received
City of Tigard 2 Z �'� Permit No.: ccflO21-60
g -i' ,' Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review _
Phone: 503.718.2439 Fax: 503.598.19 Date/By: 9 j I ?j ,I s Other Permit:
TIGARD Inspection Line: 503.639.4175 V�' ! OF Huh'. Date Ready/By: �; iet See Page 2 Tor
Internet: www.tigard-or.gov Z I'Lnln)(] rll\1�"" .,tified/Method: /�, Supplemental Information
TYPE OF WORK REQUIRED DATA: -AND 2-FAMILY DWELLING
la 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ bori
® 1-and 2-family dwelling 0 Commercial/industrial
/��23 1
❑Accessory building El Multi-familyNumber of bedrooms: 5
❑Master builder 0 Other: Number of bathrooms: 4 '/
JOB SITE INFORMATION AND LOCATION Total number of floors:3 Li)77
Job site address: 16555 SW DARWIN LOOP New dwelling area: 3,689 square feet /7/5
City/State/ZIP:Sherwood,OR 97140 Garage/catport area: 485 square feet /�
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet l/l/,L//
Cross street/directions to job site: Deck area: lie) square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 211 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Construction/Type: SFU /Elevation plan: 222803BR Valuation: $
ojected start: January 2022 Existing building area: square feet
deferrals:YES-deferral of payment of transportation&park SDCs to occupancy. 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:( ) New:
® APPLICANT 0 CONTACT PERSON 6'9 BUILDING PERMIT FEES*
(Please refer to fee schedu!)
Business name:Polygon Homes WLH LLC
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 510
City/State/ZIP:Vancouver,WA 98660 Total fees due upon application:
Amount received:
Phone:(360)946-8674 Fax::( )360 693-4442
E-mail:permi1submittals@taylormorrison.com-OAIamiAbouhafs 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:( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB hc.:207247 Total fee due upon application: $201.60
Authorized signature: Qhtevt,.Aieuste .cY veG4 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: 07/26/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applica; ECEIVE FOR OFFICE USE ONLY
Received 1�1�(t�s.,�
City of Tigard • Datusy: Q 2 2 t Kr P-"Nu,: 1'N1 2021—c1b3Ob
'1 13125 SW Hall Blvd.,Tigard,OR 97223 t` ' t N
Plan Review 1. 9 2I
Phone: 503.718.2439 Fax: SD3.598.1960 �/ r` Date/By: otherPersost: Q -Q020E7
T I t'rA h I i Inspection Line: 503.639.4175 `'I 1 1 OF TI GARD Date Ready/BT heck: 0 See Page 2 for
Internet: www.tigard-orgov Notified/Method: Supplemental Information
BUILDING DIVISION'
TYPE.OF WORK COMMERCIAL FEES SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other. mechanical materials,equipment,labor,overhead,and profit.
Value:5
CATEGORY-OF CONSTRUCTION RESIDrrrnA.EQUIPMENT!SYSTEMS FEES•
1: I-and 2-family dwelling ❑Commercial(mdustrial 0 Accessory building For special information use checklist
I j Multi-family ❑Master builder El Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/tooling:
AJob site address: 16555 SW DARWIN LOOP Furnace
conditioning0, 0 46.75
Furnace IOO,000 BTU(ducuhcals) 46.75
CitylState/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(duets/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
Subdivision: Polygon at Roshak Ridge Lot no.: 211 Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplacelmsest 33,39
— Flue vent for water heater or gas
New construction-Type SFU fireplace 23.32
Log lighter(gas) 21.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER TENANT Other. 23.32
— Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility roams) 23.32
Phone:(360)695-7700 Fax.( ) Attic/crawlspace fans 23.32
el APPLICANT. [ ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLE,LLC Fuel piping:
514.15 for first fear;54,03 for each additional
cr,nract name: Omar Alami Abouhafs Furnace,etc-
Addresss:703 Broadway Sc.,Ste 510 Gas heat pump
Wall/suspended/unit beater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
__ Range
E-mail:peereiteubmittalsgtaylormottiSOn.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)
Phone:(360)270-1590 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
�--(I days after it has been accepted as complete.
Authorized signature: '""" • Fee nedrodology,set by Tn-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r.lnnilMnAP.,mr,surr p..mn a,.,.WI is An.- ..n ncr-r•r n�rrn,.mrcv
' Electrical Permit Annlicatio �� L l A 1. ,,� i i ( III1 '1 OyI \
City of Tigard :ff2l t it Permit a ►1 V 4► I—11)3C:icz;>_
t3125 3W Hall$Ivd.,Tigard,OR 97223 Plan
Review-
a Phone: 503.718.2439 Fax 503 598 1960 Daterny Related Permit a: (�l2�oZl-002�6
Inspection Line: 503 639 4175 JP{OEI IGNHi Reedyfat&RY June 21 See Page 2for
'i 1 L.v.k El' Internet: µ µw.ligard-or.gov Notified/Method. Supplemental Information
TYPE OF w44.DING DIVISIQP Pf hlv x�vnFw:
®New construction ❑Addition/alteration/replacement Neese cbe<k an that apply(submit a sets ofplaas w/aema checked):
El Demolition 0 Other: ❑Service or feeder 400 amps a more 1]Budding over them stories.
where the sAndeble fault current ❑Marinas and boatyaMt
CATEGORY OF CONSTRUCTION exceeds 10600 mops at 150 voles or 0 floating hoildmpe
lJ 1-and 2-family'dwellingd,or exceeds 14.000 0 Cgmnnettiai-ass agiicalnaal 0 Commercial/industrial 0Accessory building teas to am+m
❑Multi-family El Master builder ❑Other: amps for all other amtatbnms hmla uta
❑Fire pmap. ❑InsWlaaim of I50 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emerrensysystem_ Luger separately derived
Job#: Job site address:16555 SW DARWIN LOOP ❑Addition af sew motor load of sxso
IOOIIP or more. ❑"A,"1;."I-Z"."1-3",
City/StatrJZIP: Tigard,OR 97140 ❑sin a mom msidm"ai snits oempancy
❑health-care facilities ❑Recreational vehicle peeks.
Suite/bldg.apt.#: Project name: Polygon at Roshak Ridge ❑Hazardous locations D Supply voltage far more rhea
❑Service or feeder 600 amps or more. 6110 volts nomiaaL
Cross street/directions to job site:
uacrielioa I Qtr. I rich I Teed I •
New residential single-or mold-family dwelling unit
Subdivision:Polygon at Roshak Ridge Lot#: 211 includes attached garage.
1,000 aq.IL.or less 168 54 4
Tax map/parcel#: Ea.add'I 500 sq.R or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
New construction.Type SFU (with above sq.II)
Limited energy,multifamily 75.00 2
residential(with above sq.it)
• ❑ TENANT Renewable Energy 0 See Page 2
_ PROPERTY OWNER
Services or feeders insta ladoo,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway Si,Ste 710 201 amps to 400 amps 133.56 2
•
401 amps to 600 maps 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 552.26 2
- Temporary services or faders installation,alteration,and/or
Email: OAlaoniAbouhafsitaylomiorrisoaeom-PermitSubmittals®tayl,rmorrison.com relocation
Owner installation:This installation is being made on property That I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature:_._.. _. Date: 401 amps to 599 amps 168.54 2
0 APPLJCLNT El CONTACT PERSON Branch circuits—env,alteration,or extension,per panel
Business name: PolygonA.Fee for branch circuits welt
Homes WI.H LI.0 above service or feeder fee, 7.42
each branch circuit
Contact name: Omar Alarm Abonhafs B.Fee for branch circuits withwtt
service or feeder fee,first Address: 703 Broadway St.,Ste 710 56 t R 2
branch circuit
City/Slate/ZIP:Vancouver,WA 98660 Eachadd'I branch circuit 7.42 2
Phone: 360 )946 8674AllisaUaaeons(service or feeder not included)
( Fax::( ) Each manufactured or modular 67.84 2
Dual OAlamiAbouhafs(taylormorfison.com-PerinilSubmittalst4gtaylormorrisoacom dwelling,service a`ra+°`f°aaer
Rceomoct only 67 84 2
CONTRACTOR Pump or mogation cycle 67.84 2
Business name: Wallace Electric Sian or outline liplttmg 67.84 ' 2
Address: 105 Dresden St Signal cireud(s)or limited-energy El See Page 2 2
panel,ant-ration,or extension
City/StatefZCP: Astoria,OR 97103 _Each additional inspection over allowable in any of the above
Additional inspcctioa(I hr rain) 66 25/lu
Phone:(503 3118 0563 liter:( ) Investigation(I hr min) 90.00/hr
Email: David@wallacewfres.com Industrial plant(I In min) 78 18/hr
Inspections for which no fee is 90.00/hr
COI l.ie.:224868 Electrical Li ' C 1441 Su rv_I: .• 6363S specifically listed OS hr min)
ELECTRICAL PERMIT FK :
Suprv.Electrician signature,required: 644_,...---^— Subtotal
Prim name:Thri.lj est ,.. Date: 2r lL JZ f ❑Plan Review Required(25%of permit fae): .
6,4 1 t( / State surcharge(12%of permit fee):
Authorized signature ://!1+_" TOTAL PERMIT FEE:
Print name: �„ _lD U.�u.� Date: tf�f /Lf .This days
after
att eit has been ere amenpires It a permit is mpkte. within fro
taildrogWermas'd76e�'errait�4App ELa mE.dex Err 0677f1015 4d0-l4l55T(1I/6YCOHAVE0 f inspections allowed par permit.
Plumbing Permit Application..
Building Fixtures ECEIV FOR OFFICE USE ONLY
Received tic
City of Tigard b 2 2 Permit No.: m�?02,'�O�l.�J
a 13125 SW Hall Blvd.,Tigard,OR 97223 Date
an Review
0- Phone: 503.7182439 Fax: 503.598.1'� TY OF�1IIUA" � Date7By Other Permit No.: ." KtL"„I--007Cr--,
T l G A fin Inspection Line: 503.639.4175 I ' Date Ready/By: rwis: 68 See Page 2 for
Internet: www.tigard-ocgov 3UILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition Forspecfal information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility comection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
l-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building Multi-family
Each additional bathlldtchen 25.02
❑Master builder 0 Other: Fire sprinkler(`sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16555 SW DARWIN LOOP Catch basin or area drain 18.76
Dxywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bIdgJapt.no.: I Project name:iitfalaabfiig+Poygon 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 R: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Polygon at Roshak Ridge I Lot no.: 211 Fixture or item:
Tax map/parcel no.: Backdlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New construction-Type SFU Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02 1
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) 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: Omar Alami Abouhafs
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZI: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@polygonbomes.com Urinal 25.02
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:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler - Date: Of3O/ZO This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology act by Tri-County Building Industry Service Board.
i 1:nBtuiidmg'Pvmus1PLMU-PerottApp.doc 001,09 440-0616T(IwN2/COMW®)
Plan # 1,22)6036g o , Ap.,_ FC.�, ut���.`
Floors Large ` ,� • — \ f.C,/(td t�
Bed rooms Small Co a'�'' eN
WC y LA9.
LAV 62
Tub Basement 7(03 P-'e'A1 0 Y. G U 0--c -..
Vent ta 1st Floor Q.. 1 I �,�/ Zit ��
Water Heater I 2nd Floor ( 1 ‘C- `�
AC ,�,5 3rd Floor
School ( `s �6) R-3 Total 3(P�-
T; r� P�D L� Garage SS
c� O f1 (s Total y 1"7L1
p.�Lic_ 1 2:3_4 #for Elec !
t% fedit-- . "yzs i- is Y„LA-- 51,wwS k, -G4r,i,6,_ ,e_
2 v\.J A +\1 �..1 c 0 lr.-/-KT� -F� r 6-r 3
v3 ya( ,j -AiDt, y, mL`ss.% 1 . ? .)-- Pr7 pr-g
`1) '0,•..e..Af .•\,-Is V
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
rIGARD Building Permit Review — Residential
Building Permit #: N.SA 2dLA•60 o
Site Address: !t0.5-r ' civd DAI2&tJ N)
Project Name: i.y(p5k1 , -- R(0(,L Lot #: 'V I)
Planning Review
Pro sal: /U� �m�
Verify address/suite #active in Accela. Affr In River Terrraac • 0 No es, River Terrace Review Addendum
Site Ian Elements: rosion Control
opies of site plan on 8-1/2"x 11"or 11 x 17"paper 0'`Y ed trees with drip line and tree protection measures
IFbi.awn to scale(standard architect or engineer scale) I—Footprint of new structure(including decks) and FFE
l arrow I 'C tom'locations&easements(required for new and additions)
l j address,project or subdivision name and lot number ZSidewalk/driveway approach
IQ .plicant information (name and phone number) l L h of wells/septic systems
+l . Zit tree size,type and location
1 II S...re footage of buildings to be demolished �S met names
Pt.. .sting structures on site 111Corner elevations (2'contours if more than 4'differential)
F4 Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ID No NA
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes o
Clean Water Services—Service Provider Letter of platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified !� No Received: ❑ Yes El No
11W11ater Meter Fixture Unit Worksheet—Additi9rfs,Remodels and ADUs
equired: ❑ Yes,applicant was notified No Received: CI Yes ❑ No
;DC Exemption for ADU applied for: Yes- Received: ❑ Yes ❑ No
Of Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: n❑ Yes I: No,stop intake
nd Use Case#: 5(iB2o1S--Qaaay Zoning:
.equired Setbacks: Front: if Rear: /0 Side: 3 Street Side: Al A Garage: 20
wilding Height: Max.Height: Mrk- Actual Height: '2 7
IV-Landscape Area: '2 c7 % .2 of Coverage Max:
Set back no more than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less
Windows 0 Minimum ° f area of all street-facing facades
Garage ❑ Garage door is behin reet-facing wall ❑ Yes ❑ No,one of the following is met:
S pot- El Door extends no more than 5' r and there is a covered porch extending beyond garage.
S¢ M ❑ Door extends no more than 5' from wall an is a 12 sq ft.window above garage on 2nd floor.
�j QM I
,,�p�cJ ❑ Garage door width is ❑ 12'or less ❑ 50%or less of a El 60%or less and includes 7 of following:
iirg "` ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1' o e El Roof offset
❑ Fire shingles 0 Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel ro Dormer
❑ Accent siding Window trim ❑ Window recess ❑ Window projection ony
usual Clearance Urban Forestry Pl
lJ nsitive Lands: ❑ Yes No Type:
on lions met prior to issuance of building p .t
4proved
By Planning: ���"�" Date: -7' Zc 2
Revisions (after Building Submittal on1' Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
1:1Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: / f 2g Z
Site Plans: # 3
Building Plans: # 3
Building Permit#: VEnter building pe above.
Workflow Routing: "Planning D7Engineering ❑ t Coordinator �l�uilding
Workflow Sign-off: 121'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
Anginal plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calcula ns a trust details,if applicable,etc.
Notes:
By Permit Technician: Date: g 4 4
Engineering Review
� � �Slope at building pad: 2
L"Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes a'No
Assess Water Quantity Fee in-lieu: ❑ Yes P.-No
LIDA Facility on lot: ❑ Yes
final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
1VApproved by Engineering: Date: 4 Z/
��—
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved D 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 CJ Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: yes ❑ N/A
Tigard Trans SDC: %Yes ❑ N/A GOC/c G�2 FCXY'epQ
Parks SDC: n Yes ❑ N/A
LIDA ❑ Yes j2cN/A
OK to Issue Permit
Approved by Permit Coordinator: Art Date: 011212o i
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
City of Tigard
it
i II
111111 COMMUNITY DEVELOPMENT DEPARTMENT
River Terrace Building Permit Review Addendum
TIGARD
Building Permit #: mcriva\ - 00�0 Y
Site Address: /Cr- * el‘p11/4j LCDP
Project Name: tebt yavord Ac- '+ 1r__ RIDS Lot #: Zit
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.64O.O7O.1..):
Is the project subject to the plan district design standards? ❑ Yes ❑ 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.
Porch min. 5 f eep Balcony w/ access 2 Window Projection Vertical Wall Offset a Gabled dormer
ft.deep min.2ft., 5 ft.wide min. 2 ft.,6ft.wide
0 ❑ 0 0
2.Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: "712
3.Entrances:At least one entrance must meet both of the followin tandards:
ICJ Max. 8 ft. setback from longest treet- facing wall arallel to street,angle no more than 45 from street,
or open onto porch
Entrance opens to a porch: Yes ❑ No
If yes all the following apply: 4 2(. -sq.ft.min.
`P " street facing entry Di t.max. roof above floor of porch
ft. depth min. 30%min. porch roof coverage
4. I}etailed Design:All buildings shall include a min. of five of following elements on all street-facing facades:
cci"vexed porch min. 5 ft.wide x 5 ft.deep Recessed entry area min. 5 ft.wide x 2 ft.deep
IZ W offset min. 16 inches ❑ Dormer min.4 ft.wide
wee
eave min. 12 inch projection 2 (of offset min.of 2 ft.
❑ Roof shingles either tile or wood �r7 Gle,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ' Iorizontal lap siding min. 3-7 inches wide
❑ Accent siding min.40%of street facade ❑ Window trim min.2 1"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 ❑ 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. Yes ❑ No. If No (Check one):
❑ 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)
❑ 1.2ifoot-wide garage door ❑ 40%max. of street facade
Xii 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: T/444/4 --
Date: 1-,2,a/
I:\Buildin5\onneEldgPmoitRvw_RES_RT_I 21417.do x
City of Tigard
111 _ " Parks SDC Charge (Parks)
1G^R° Notification of Fee and Payment Options
Please sign and return prior to building permit issuance.
This advises you that the total Parks SDC charge for this project is as shown below and outlines the payment
options that may be available to you. This total includes Parks SDC-Improvement, Parks SDC-Reimbursement,
and either Parks-Neighborhood or Parks-Neighborhood River Terrace charges as relevant. This form is to be
signed and submitted prior to issuance of a building permit.
City of Tigard
Date: 8/4/2021 Site Address: 16555 SW Darwin Loop
Project Polygon at Roshak Ridge - Land Use Case MST2021-00306
Name: Lot 211 or Permit #:
Tax 2S107AA21100 Total Parks $10,903
Lot#: SDC Amount*:
*The total Parks SDC amount shown above is the sum of$ 6,278 for Parks-Improvement,$1,739 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$2.886 for Parks-Neighborhood River Terrace.
This constitutes my request to use the Parks SDC payment option or combination of options I have selected below.
[This selection can be changed up to the time a buildingpermit is issued.] I realize that SDC charges are due and payable at the
time a building permit is issued unless those charges are Deferred or are financed through Installment Payments.
D Cash.Check,or Credit Card,payment due at building permit issuance.
Deferral until Occupancy payment due before issuance of an occupancy permit.
Payment of the Parks SDC may be deferred until issuance of the occupancy permit. In requesting this option,I
understand that any deferred Parks SDC must be paid prior to issuance of a Certificate of Occupancy. For a deferral
request to be accepted both the Property Owner and the Developer must sign this request.
❑ Credit Voucher (for developer-built required public improvements, subject to approval, completion,and acceptance of
creditable improvements.)
PLEASE NOTE: Parks SDC Credits must be redeemed at the time Parks SDC Payment is due,either at the time
the building permit is issued or,if payment is deferred,prior to issuance of an occupancy permit. If you expect to claim
Parks SDC Credits be sure the improvements,any creditable payments, and your Request for Credits is complete either
before your building permit is to be issued or,if payment is deferred, before you request an occupancy permit. No
refund of Parks SDC Payments will be made if Credits are submitted more than 30 days after issuance of the relevant
building or occupancy permit.
❑ "Bancroft" or Installment Payments (separate application required.)
Oi ,4/aru'.A6a Ohraa,.A ' A6a
PROPERTY OWNER DEVELOPER
DATE: 08/04/2021 DA 1'E: 08/04/2021
I:\Community Development\Permit Coordinator\SDC Forms\Payment Option Forms
City of Tigard
11 _ Transportation System Development Charge (SDC)
TIGARD Notification of Fee and Payment Options
This advises you that the total TSDC for this project is as shown below and outlines the payment options that may be
available to you. This total includes charges for TSDC-Improvement,TSDC-Reimbursement,and TSDC-River
Terrace,if relevant.
This form is to be signed and submitted prior building permit issuance or, if no building permit is required,
then upon land use approval (TMC 3.24, as amended by Ordinance No. 21-09).
City of Tigard
Date: Site Address: 16555 SW Darwin Loop
p
Project Polygon at Roshak Ridge- Land Use Case or MST2021-00306
Name: Lot 211 Building Permit #:
Tax 2S107AA21100 Total TSDC $10,348
Lot#: Amount*:
*The total TSDC amount shown above is the sum of$6,690 for TSDC-Improvement, $386 for
TSDC-Reimbursement,plus $ 3,272 for TSDC-River Terrace,if relevant.
This constitutes my request to use the TSDC payment option or combination of options I have selected below. [This
selection can be changed up to the time a building permit is issued.] I realize that TSDC charges are due and payable at the time
a building permit is issued unless those charges are Deferred or are financed through Installment Payments.
❑ Cash, Check, or Credit Card, payment due at building permit issuance.
E Deferral until Occupancy,payment due before issuance of an occupancy permit.
Payment of the TSDC may be deferred until issuance of the occupancy permit. In requesting this option,I understand
that any deferred TSDC must be paid prior to issuance of a Certificate of Occupancy or final inspection. For a deferral
request to be accepted both the Property Owner and the Developer must sign this request.
❑ Credit Voucher for developer-built required public improvements, subject to approval, completion,and
acceptance of creditable improvements
NOTE: TSDC Credits must be redeemed at the time TSDC Payment is due,either at the time the building permit
is issued or,if payment is deferred,prior to issuance of an occupancy permit. If you expect to claim TSDC Credits be
sure the improvements, any creditable payments,and your Request for Credits is complete either before your building
permit is to be issued or,if payment is deferred,before you request an occupancy permit. No refund of TSDC Payments
will be made if Credits are submitted more than 30 days after issuance of the relevant building or occupancy permit.
❑ "Bancroft" or Installment Payments (separate application required.)
Om�+ 4 ►w',A6au�- O2ira4.,.Rlame;/lee
PROPERTY OWNER DEVELOPER
DATE: 08/04/2021 DATE: 08/04/2021
I:\Community Development\Permit Coordinator\SDC Forms\TSDC Combination Payment Option Form 112718 AMS