Permit Plumbing Permit Application %/ f I-t o
Building Fixtures RECEIVE
Cityof Tigard Received MST2021 00424
g Date/By: r//3i()/�1 ie/)- Pennit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 9 9A91 Plan Review I 'J
G Phone: 503.718.2439 Fax: 503.598.1960 NOV1� Y t7 LUL! y `�/)3/ 1 4� Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 y y ® See Page 2 for
I 1 t'ART) Intemet www.tigard-or.gov CITY OF TIGARD Date Read/B : luris.
Notified Method: Supplemental Information
T'Y'PE',OF Wo'.RK8'. kb,
G DIVISION FEE* SClIEDI1LE
❑■ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
■ 1-and 2-familydwellingSFR(2)bath 437.78
❑ ❑Commercial/industrial .
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(1228 sq.ft.) Page 2
' JOS SITE INFORMATION" +t Site utilities:
. r Catch basin or area drain 18.76
Job site address:16660 SW Townsville St.
r I - 110 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.: l Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:217-ADU Fixture or item:
Tax map/parcel no.: BackFlow preventer 31.27
D:1 ,5CRllPTION 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
'PliOVEft.TY OWNER ❑ nNA 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
0 APPLICANT' `'° `CONTACTPERSON , " 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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing, LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( 503 )492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
�-� State surcharge(12%of permit fee)
/
Authorized signature: r tc--_.77 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Gavin Thomes Date:►►/'�2Q21 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l:ABuildingAPermitsVPLMU-PermiiApp.doc I0/01/00 445.4616T(1 11/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Fee tea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-I st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100` 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
I�ee e� each additional$100.00 or fraction thereof,to
Other Inspections or Fees Itttal 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) I 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
❑ Any new commercial building with water service 2"and
Baptistry/Font 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 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric'or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
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: -Lay/Bar non-food related
-Bradley
Coin/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
Water Extractor fees assessed for the sewer increase must be paid before the
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
,IP' 1 COMMUNITY DEVELOPMENT Permit#: MST2021-00424
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2021
Parcel: 2S 107AA21700
Jurisdiction: Tigard
Site address: 16660 SW TOWNSVILLE ST
Subdivision: ROSHAK RIDGE Lot: 217
Project: Polygon at Roshak Ridge, Lot 217-ADU
Project Description: New attached ADU. NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1228 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 2 Second: 0 sf Garage: 275 sf Front 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 1228 sf Value: $174,454.24 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 LaundryTrays: 0
Y Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: Storm Sewer: 100
Tubs/Showers: 2 Garbage Dis 1 Water Heaters: 1 0
g P Water Lines: 100
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Catch Basins 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 3
Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1
Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0
Gas Outlets: 2
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add]500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N SecurityAlarm N
Vaccuum System: N Garage Opener: N All
Other N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ADU VB R-3 1228
Owner: Contractor:
TAYLOR MORRISON NORTHWEST 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: $17,374.12
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
QS9-nnl-nnin fhrni;nh naP QS9-nnt-Mon Vni,may nhinin o nnn„of fhu ridoc nr riirarf n„ectinnc fen ni INC h.r rsllinn col Y39 10R7 nr 1 Finn 149 91,14
Issued By: j-ticU.y Vo- Der W6 C. Permittee Signature: Otti Apptic-a4-LovI.,
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
Residential is D
. City of Tigard Received/,/y�gA � ,�7 /y/, 7
g EP y: v Q Permit No.: fV�-W Z
13125 SW Hall Blvd.,Tigard,OR 97223 C�- 2 1 2021Date/By:
DPlan Review ��
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: I O��� �j( � Other Permit. ��jZ
T I G A R D Inspection Line: 503.639.4175 CITY I OF N t�9i Date Ready/By: `� 7y '�. ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION ie ethos: �i' Supplementallnformation
TYPE OF WORK REQUIRED DA A:I-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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. '_J C f
❑ I-and 2-family dwelling 0 Commercial/industrial Valuation: $ I 1 Lii (.1, , a
7
❑Accessory building 0 Multi-family Number of bedrooms: 3 !
❑Master builder IN Other: ADU Number of bathrooms:2
JOB SITE INFORMATION AND LOCATION Total number of floors:! 1 SDI
Job site address: 16660 SW TOWNSVILLE ST New dwelling area: 1228 square feet 1 L2.9
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 9.-7 Sr—Tquare feet
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 217 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: /A -n o 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.
SFU:New home construction Elevation:221100B/221000B Duplex Valuation: $
Type:Duplex_Projected Start:November
p202J1-1� � Existing building area: square feet
4 0al e de SD( f eecn tin Le CW +Y6PI 17-9 'OCCA:pairJ New building area: square feet
® PROPERTY OWNER ❑ 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:
2 APPLICANT 0 CONTACT PERSON U9
BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer to fee schedut¢)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 710
City/State/ZIP:Vancouver,WA 98660 Total fees due upon application:
Phone:(360) 695-7700 Fax::( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver, WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( )360 695-7700 Fax:( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247
/�_ /_ /, Total fee due upon application: $201.60
Authorized signature: 0144 ,,c'e z h1,G 46t91.G tid.- 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: 09/17/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applies '_ r
FOR OFFICE USE ONLY
City of Tigard Reee;ved
� Date Ity: Perm;tlVo, S , u '++I
4"' l ra 13125 SW Hall Blvd.,Tigard,OR 97223 tl ry��� i
Phone: 503.718.2439 Fax: 503.598.1960 !s - G Plan Review
Date Ily. Other Permit:
TltrPrltl� Inspection Line: 503.639.4175 t Date Readdiiy lurk: 0 See Page 2 for
Internet: www.tigard-or.gov
CITY TIGARD s >
Notified/Method Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*arc based on the value of the work
New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead;and profit.
CATEGORY OF CONSTRUCTION Value:S
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
j Multi-family ❑Master builder x
❑Other: ADU Description I Qty. I Ea. ( Total
JOB SITE LNFORMATION AND LOCATION Heating/cooling:
Job site address: 16660 SW TOWNSVILLE ST Air conditioniu• 46.75
Furnace 100.000 BTU(ducts/vents) 46,75
City/State/ZIP:Tigard,OR 97224 Furnace 100,0001 BTU(ducts/vents) 54.9!
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 I 2332
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.: 21 Other: 23.32
Other fuel appliances:
Tax trap/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
-
Flue vent for water heater or gas
New construction,new Single Family fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
.
Wood fireplace/insert 23.32
Chinmeylliner/flue/vent 23.32
® EN
PROPERTY OWNER ❑ TENANT Other. 23.32
' - Environmental exhaust and ventilation:
Name:Polygon WLII,LLC Range hood/other kitchen
-' equipment 33.39
Address:703 Broadway St.,Ste.510
Clothes dryer exhaust 33.39
City/Slate/ZlP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
. - toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
112 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Polygon W7I1,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway SL,Ste 510 Gas heat pump
WalUsuspendedlunit heater
City/State/ZIP: Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals%taylorrnorrison.corn Barbecue
CONTRACTOR __ _._-
� _ __ _ Clothes dryer(gas)
Business name.Pro Beating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
--. Subtotal
City/State/ZIP.Hillsboro,OR Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( )
CCB lie.:209001 State surcharge(12%of permit fee)
[ TOTAL FERMI FEE
This permit application expires if a permit k not obtained within 180
��, t days after it has been accepted as complete.
Authorized signature.
' Fee methodology sec by Tr:-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20 I
Itq,,;+rrii„etc.,,,,,,.cs„MFC v.rn,t,n,.r nnnr 11 a,• .,•n.,_,+r r„mom,.-r,s.m.�u.
E
Electrical Permit ApplicatioECt
tiN(Ill li I t I UN] 1
City of Tigard q Retched �,
• 13125 SW ball Blvd.,Tigard,OR g722,S E P 2 ? 20 7.! I>xmDv Permu>i .r - C$J i. ' H /''
/y yy
a' Plane: 503 7l8 2439 Fax 503 598.1CZ I 1/V 1 8 , Phut 111
Related Permit it
Inspection Line 503 634 4175
j' " 0Internet: wwwtigard-or gov Ul1.U! !r ill�1' lie cthocJ.
Ready DaterTly- Iu"` Page 2 forSuppl mental Woman.'
TYPE OF WORK PLAN REVIEW
®New construction Cl Addition/alteration/replacement Please check all that apply(submit j sets of plans w/ecros checked).
0 sit see or feeder 400 amps a more 0 Building ow:three stones
❑Demolition ❑Other:
CATEGORY OF CONSTRUCTION whom the ss"'1abk fault cwrcot 0 Manna,and boatyard
exceeds 10,000 amps at 150 colts or 0 Flooring building'.
❑1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to mom,or exceeds 14,000 0 Commercial-age agrurulmral
®Other: ADU amps Ito all other installation buildings
❑Multi-family 0 Master builder
❑Pon pump ❑Installation of 150 K VA or
JOB SIFE INFORMATION AND LOCATION 0 Emergency system. larger separately,derived
Sob#: Job site address:16660 SW TOWNSVILLS ST ['Addition are moms load of system.
30011Pormore. ❑-A`-E-•'1 2 "1-3•
City/State/ZIP: Tigard,OR 97140 ❑sox a more resideetral taut. occupancy
❑Health-cae facilities. ❑Recreational s•ehtcbe parks.
Suite/bldgJapt,4: Project name: Polygon at Roshak Ridge °Haratdous locataers 0 supply voltage for more than
❑
Crass street/directions to job site: Service feeder 600 amps a more 600 volts nominal.
FEE SCHEDULE •'
fteseriptiss I Oft. I Lark I Total I •
New residential single-or malt{-family dwelling unit
subdivision:Polygon at Roshak Ridge , Lot#I: 217 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or kss 168 54 4
DESCRIPTION OF WORK Fes.adit energy,
d s9 It or portion 3392 1
Limited ener residential
New construction.Type SF[J {wilt about sq.ft.) 7S 00 2
•
Limited energy,multi-family
residential(with above sq.ft.) 75-00 2
® PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation Name: Polygon Homes WLH LI.0 200 ampsins
or 100.70 2
Address: 703 Broadway Si,Ste 710 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Vancouver,WA 98660 trot amps to 1,000 amps _ Sot 04
Phone;(360 )946 8674 f Fax: 2
( ) Over 1,000 amps or volts 552.26 2
Email: OAlamiAbouhafs(taylormorrison.coru-PermitSuhmittal lormorrismeem Temporary services or feeders installation,alteration,and/Or
�taY relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less I 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701, 201 amps tn400 amps 125.08 2
Owner signature: 1
—
_--_------ Date. 401 amps to s9S amps 168 54 2
0 APPI.iL'A ' _� ❑ CONTACT PERSON
Branch circuits-new,alteration,or extension, r panel
Business name: Polygon A Pee for pinch mauls with
Homes WI.H LL.0 above service or feeder fee,
Contact name: Omar Alami Abouhafs
each branch circuit 7 42
B.Fee for branch circuits maroon
Address: 703 Broadway Si,Ste 710 service or feeder fee,first
branch circuit 5618 2
City/Statelz P;Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Phone:(360 )94tS 8674 Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email:OAiamiAbonhafs@ytaylormmTison.tom-PcrmitSubmittalsitaylormorrison-coal dwelling,sconce mid/or feeder67 84 2
Rccnnna.:r arty 67.84 2
CONTRACTOR Pump or urn gooier circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67 84 2
Address: 105 Dresden St Signal circuit(s)or linvted cnagy
panel,C /StatelZlP: Each additionallui ,or ru m 0 See Page 2 2
ftY Astoria OR 97I03inspection over allowable In any of the above
Phone:(503 3118 0563 Additional inspection(1 hr min) 66 25/Iv
Fax:( ) Invesogatieo(1 hr min) 90.001 hr
mail:David@wallaccwires.com Indusvial plant(I hr min) 78 18/hr
-
CCB Lie.:224868 --' Inspections for which no fee is 90 0p/hr
Electrical Li •C 1441 Su .L' .• 6363S specifically listed(K hr min)
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
_�_
Subtotal
Print name:D19t7 Date: it A /z r ❑Plan Review Required(25%of pemtit fee)
State surcharge(12%of permit fee)
Authorized signature TOTAL PERMIT i t L
This a acatiea expires. - -----..---
Print name: �/ ^ / permit PP Ua permit is not obtained within 18U
•T'�i 44R�er�s Date: i f/// day&after It has been accepted as complete
t d/(h t t Numbv of mspec-nom allwse d s permit
tBui IPeimitAblk-Pmat ELR EREtke Rev 06'17/2015 4 046151111K151COWV/Ell
Plulllbin2 Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
W25 Of Tigard JLP 2 2S1 I Received :criov�0
r 13 i25 SW Hall Blvd.,Tigard,OR 97223
Date/By: Permit No.:
tlli Phone: 503.718.2439 Fax: 503.598'}q[� Plan Review
Cif i Y OF TIGARD Date/Byr Other Permit No.:
TIGARD Inspection Line: 5d3.639.4175 B)JJl l ih�rlt,g
nrirM Date Ready/By: tuns: Q See Page 2 for
Internet: www,tlgafd-aCgov ��' �� Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
AO New construction ❑Demolition For special information use checklist.
` Description I Qty. I Ea. J Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)_
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
l-and 2-family dwelling ❑Commercial/industrial SFR(2)bath ., 437.78
El Accessory building Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen ( 25.02
0 Other: ADU Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16660 SW TOWNSVILLE ST Catch basin or area drain 1 g,76
City,State/ZiP:Tigard,OR 97224 —
Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite!bldgiapt.no.: Project name:litacitaiiti ii'Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18,76
- Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Polygon at Roshak Ridge Lot no.: 217 Fixture or Kern: _
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction SFU
'-- — Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixturthewer 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
Z APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon W'LH,LI.,C Medical gas(value:S ) 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/ZIP: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
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: S72.50
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: O/3O/2O This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Boant.
I:1Building+PamitsSPLMU-PennitApp.dnc 10,0 09 440-4616T(10,02/COMiWEB)
City of Tigard
.114 .
COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 c:; Et l� Building Permit Review — Residential
Building Permit #: Kt ST2021-o0 (4i4
Site Address: 16660 SW Townsville St.
Project Name: Polygon at Roshak Ridge Lot #: 217
Planning Review
Proposal: New attached ADU
GIVerify address/suite#active in Accela. CI In River Terrace: El No 0 Yes,River Terrace Review Addendum
Site Plan Elements: )rosion Control
12: copies of site plan on 8-1/2"x 11"or 11 x 17"paper _tetained trees with drip line and tree protection measures
el 0 rawn to scale(standard architect or engineer scale) ,Footprint of new structure(including decks)and FFE
IS orth arrow 'L,Jtility locations&easements(required for new and additions)
ISbite address,project or subdivision name and lot number Sidewalk/driveway approach
0'pplicant information(name and phone number) _Location of wells/septic systems
0 ot dimensions and building setback dimensions ,3treet tree size,type and location
N.quare footage of buildings to be demolished street names
I'xisting structures on site °,2orner elevations(2'contours if more than 4'differential
IS ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ° es o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? LJi'es ° o
0 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified 0 No Received: ❑Yes El No
ElWater Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ° No Received: Yes H No
CISDC Exemption for ADU applied for: Yes 0 No Received: ❑Yes No
El Public Facilities Improvement(PFI) Permit:
Required: ❑Yes,applicant was notified 0 No Applied For:
pp ❑Yes ❑ No,stop intake
El Land Use Case#: ADU2021-00013 0 Zoning: R-7
Q Required Setbacks: Front: 8/12 Rear: 10 Side: 3 Street Side: N/A Garage: 20
❑r Building Height: Max.Height: N/A Actual Height: 24
❑. Landscape Area: 20 % El Lot Coverage Max: 80
Entrance 9 Set back no more than 8'from street-facing wall El Parallel to street or offset 45 degrees or less
Windows .. Minimum 12%of area of all street-facing facades
Garage r Game door is behind widest street-facing wall ❑Yes ❑ No,one of the following is met:
Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2"d floor.
0 Gara e door width is I 12'or less ❑ 50%or less of facade ° 60%or less and includes 7 of following:
Covered porch Recessed entrance ❑r Wall offset B 1'Roof eave Fire shingles Lap Siding
Accent siding ❑ Roof itch CI Gable,hi ,or gambrel roof ❑Dormer
Window trim Roof offset
Window recess Window projection ❑o Balcony
❑ Visual Clearance ❑o Urban ForestrxPlan
❑ Sensitive Lands: ❑ Yes u No Type:
0 Conditions met prior to issuance of building perm't
Notes: ,
0 Approved By Planning: s Date: G/ OS
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BIdgPermitRvw_RES_122419.docx
J
Building Permit Submittal Original Submittal Date: &/21�2C2/
Site Plans: # 3
Building Plans: # 5
Building Permit#: Enter building]plerrmit#above. n n
Workflow Routing: �I'lanning LY�ngineering R Permit Coordinator atsuilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: 1ThEngineering (1) copy of permit application,(1) site plan, (1) building plan and
original plan review routing form.
Building: original permit ..p,cation,site plans,building plans,engineer and
beam calculations and ri st .etails,if applicable,etc.
Notes:
By Permit Technician: % //015511%-- Date: e0,7
Engineering Review
fa
Slope at building pad: /d/
121 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 I No
Assess Water Quantity Fee in-lieu: ❑ Yes LJ No
LIDA Facility on lot: ❑ Yes ErNo
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:mte
Lid Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer ate
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
p,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:
DC Exemption:OS El Received Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A See -.CC1( t-4
Tigard Trans SDC: ZYes ❑ N/A ��
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes /gN/A
0 OK to Issue Permit
Approved by Permit Coordinator: Date: 10) 12l
I:\Building\Forms\B1dgPermitRvw RES_122419.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
G A R D River Terrace Building Permit Review Addendum
Building Permit #: (Sf2O7J -cJ3 (-(Lq
Site Address: 16660 SW Townsville St
Project Name: Polygon at Roshak Ridge Lot #: 217
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.L):
Is the project subject to the plan district design standards? ❑Yes ONo (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.
Porch 5 ft.deep Balcony w/ access 2 Window Projection Vertical Wall Offset a
ft.deep min.2ft., 5❑ft.wide min.2 ft.,6ft.wide Gable. .a er
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 e ance must meet both of the following standards:
❑Parallel to street, . gle no more than 45° from street,❑Max.8 ft. setback from longer trees-facing wall
or open onto por
Entrance opens to a porch: ❑Yes o
If es,all the following apply: ' Cl25 sq.ft. in.
LOne street facing entry 0 12 f ax.roof above floor of porch
❑5 ft.depth min. ❑3►/o min.porch roof coverage
4.Detailed Design:All buildings shall include a min. o v• of the following elements on all street-facing façades:
0 Covered porch min. 5 ft.wide x 5 ft.deep I Recessed entry area min. 5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches g w ormer min.4 ft.wide
❑Roof cave min. 12 inch projection ❑R. • offset min.of 2 ft.
ElRoof shingles either tile or wood ❑Gable, .ip 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 0 Window trim • ' .2 1/2"wide by 5/8"deep
0 Window recess min.3 inches for •. street facing ❑Bay window min. ft.wide by 2 ft.deep
0 Balcony min. 5 ft.wide x 3 ft. .eep with inside access ❑Attached garage is 3 'o 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.
0 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 t,.age that faces the street with a min. area of 12 sq.ft.
Width• heck one)
0 -foot-wide garage door ❑40%max. of street façade
50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: — f� --_ Date: 9/23/21
1:BuildineForms BldgPennitRvw_RES_RT_121417.docx
City of Tigard
11,1 Deferral Until Occupancy Request
TIGARD Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
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).
Date: 11/3/2021 Site Address: 16660 SW TOWNSVILLE ST
Project Polygon at Roshak Ridge Land Use Case or MST2021-00424
Name: Building Permit#:
Tax Lot 2S107AA21700 Total Parks
#: Lot 217 Amount*: $5,839.00
TDT N/A Total TSDC $2,134
Amount: Amount*:
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $ 1,909.00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$4,727.00 for Parks-Improvement,$ 1,112.00 for Parks-
Reimbursement, and either$ N/A for Parks-Neighborhood or$ 0 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT,TSDC, and Parks SDCs, as provided above,
until occupancy.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option, I understand that any deferred TDT,TSDC, and Parks SDCs must be paid prior to final
inspection or issuance of an occupancy permit.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be accepted both the Property Owner and the Developer must sign this request.
Property Owner: Omar,Wa/u-..egeo i,264.• Date: 11/3/2021
Developer: Om 4,"Mam .469u4a. Date: 11/3/2021
Permit Coordinator: 16Vallto 0eAfrIebib Date: 11/3/2021