Permit CITY OF TIGARD MASTER PERMIT
`' i COMMUNITY DEVELOPMENT Permit#: MST2021 00305
Date Issued: 11/03/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA21000
Jurisdiction: Tigard
Site address: 16561 SW DARWIN LOOP
Subdivision: ROSHAK RIDGE Lot: 210
Project: Polygon at Roshak Ridge,Lot 210
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: 1093 sf Basement: 862 sf Left: 3 Parking Spaces. 0
Height: 26 Bathrooms: 4 Second: 1410 sf Garage: 400 sf Front: 8 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3365 sf Value: $463,195.62 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 5 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
Fum<10OK: 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 add'I 500 sf: 6 201-400 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:
NEW SF VB R-3 3365
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 Geo Tech Report Required
VANCOUVER,WA 98660 VANCOUVER,WA 98660 Prior To Pour
2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $26,118.80
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: Ho-U 9 Va.w De,We pt: Permittee Signature: Of't'Apt9.1.A. ,
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 L' l' ?/O
W7 2t
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Date/BReceived Permit No.: mSfQ(1`.6
ilh • 13125 SW Hall Blvd.,Tigard,OR 97223 •`. Plan Review [ t•`
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 00 2) Other Permit:5 2011'cote
1'1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARL)
pL) D. Ready/By: !Al See Page 2 for
Internet: www.tigard-or.gov llllfl 'of led/Method: /7 ,r ` A Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. n
® 1-and 2-family dwelling ElCommercial/industrial Valuation: $ �.{ �j I�6 ( (/
` I
Number of bedrooms:
❑Accessory building ElMulti-family
❑Master builder 0 Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 4-iS1(PS
Job site address: 16561 SW DARWIN LOOP New dwelling area: 3,365 square feet L Lb
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: ,�400 square feet (DC\�
///
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: `I ��� square feet l$6Z
Cross street/directions to job site: Deck area: \2p 0 square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge ( Lot no.: 210 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Construction/Type: SFU /Elevation plan: 222603BR Valuation: $
Projected start: February 2022 Existing building area: square feet
Deferrals:deferral of payment of transportation&park SDCs to occupancy. 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:
® APPLICANT 0 CONTACT PERSON U9 BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 510
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:(360)946-8674 Fax::( )360 693-4442
E-mail: permitsubmittals@taylormorrison.com-0AlamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
a
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 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: D/a't/.,CY Ishii 4 eey.zi. t This permit application expires if a permit is not obtained
(J within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Omar Alami Abouhafs Date: 07/26/2021 Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
. .
Mechanical Permit A.pplic•I$1- CEIVED FOR OFFICE USE ONLY
city 25 Of Tigard Received 4 �2( 'v► Permit No.: IY) i_
llatel8 IV� )1 l�'(i ltA
14ii 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 '� Tr'-
, Y
Phone: 503.718.2-139 Fax: 503.598.I960 bate/By: Other Permit:
YI{ihRli Inspection Line: 503.639.4175 CITY OFTIGAf1Li Date Read B Iwir
Y Y H See Page 2 for
Internet: www.tigard-or.gov Notified/Method- Supplemental Information
BUILDING DIVISIOI
TYPE OF WORK COMMERCIAL FEE* 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 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
I j Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning l 46.75
Job site address: 16561 SW DARWIN LOOP
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,0004 BTU(ducts/vents) 54.91
Suite/bldg.apt.no.: Project name: Polygon at Roshak Ridge Heat pump 61.06
` Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
"""`" Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Polygon at Roshak Ridge Lot no.: 21 Other. 23.32
- Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplaceiinscrt 33.39
- Flue vent for water heater or gas
New construction-Type SFU fireplace 23.32
Log_lighter(gas) ,_ 23.32
Wood/pellet stove 33.39
Wood fireplace/insert _ 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other. 23.32
' Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
v._-- — equipment 33.39
Address:703 Broadway St.,Ste.510
___e Clothes dryer exhaust 33,39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH,LLC
S14.15 for first four;S4.03 for each additional
Contact name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway SL,Ste 510 Gas heat pump
— Wall/suspended/unit heater 1
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 I Fax::(360)693-4442 Fireplace
Range
E-mail:pernnitsubmittals(dtaylOrmOrriSOCI.COm Barbecue ■.
"AkCONTRACTOR 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(S90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) -
_ State surcharge(12%of permit fee)
CCB bc.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO—
�A: , I)u L days after it has been accepted as complete.
Authorized signature: l� (J t • Fee methodology set by In-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
T114nikline\Pmmae\MT P.rmS[n.,n+mtl n,,, A.n.,,„-,t,,e,w,,.m,o,
Electrical Permit
RECEI V EII
Application FoR orri 'E usE ONIA-
Ci ofTigard �IlP `? '"' ?A Received
13125 SW hall Blvd.,Tigard,OR 97223��++ �/ 1)aulBv Pestttit b �" /
I Phone: 503.718.2439 Fax 503.598.196D+II 1 OF TIGARD 1lwsReview
13ate,B Related Permit#: j`(. t"(o 7(i�
lnspcctionLine: 5036394175 BUILDING DIVISION! ReadyC)etclfly hair: i1 Si scePa �"
T!t'�F ,: intemet: Www.ti and-or.goy Notified/Method. Supplemental
g Suppicmental information
1
t TYPE OF WORK
PLAN- REVIEW
r ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2,sets of plans wl ems checked)-
0 Demolition GI Other: vi
0 Serce or feeder 400 amps ot enure ❑Budding over three stones
where the:available fault current ['Marinas and boatyard.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building lesn to mound,or exceeds 14,000 Cl Commercial-use agricultural
El1ulti-family ❑Master builder amps for all other installations buildings
❑Other: 1]Fire pump
0 Installation of 150 KVA or
JOB Sim INFORMATION AND LOCATION ❑Emergency system larger separately derived
Job#: Job site address:16561 SW DARWIN LOOP El Addition of new motor load of system_
10011P ermore. ❑"A"."li" "1-2".°'I-3",
City/State/ZIP: Tigard,OR 97140 ❑six es more residential units occupancy
0 Health-care facilities. 0 Recreational vehicle parks-
Suite/bldg.apt.##: Project name: Polygon at Roshak Ridge O Hazardous locations 0 Supply voltage for more than
---- ❑Service or)ceder 600 amps or more 6°0 vroits nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I 'total I •
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 210 includes attached garage.
Tax map/parcel#: 1, sq.It or less 168 54 4
Ea.add'l 500 sq.n,or portion 33 92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft..)
75.00 2
New construction.Type SFU -
Limited 6.a.rgy,multi-family 75.00 2
residential(with above so.ft.)
Renewable Energy 0 Sec Page 2
El PROPERTY OWNERa
0 TF?lAlr I' Services or feeders installation,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 innm to 600 amps City/State/ZIP: Vancouver,WA 98660 200 34 2
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 feeders installation,alteration,and/or
Email: OAlamiAbouhafs@taylorrnorrison.coin-PermitSubmittals®taylormorrison.com relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps t .400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168 54 2
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes\VI.H LLC above service or fonder fee, 7 az
each branch circuit
Contact name: Omar Alami Abouhafs B Fee for branch circuits without
Address: 703 Broadway St.,Ste 710 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'!branch circuit 7.42 2
Phone: 360 946 8674Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular 67.84 2
Email:OAlamiAbouhafs@taylormorrison.corn-PermitSubmittals@taylnrmorrion_co dwelling,service and/or feeder
s in
Reconnect early 67 84 2
_ CONTRACTOR Pump Of rrngatiun circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Signal circuits)or Minted-energy Address: 105 Dresden St panel,alteration,orEl See pagC 2 2
extcnsiat.
Ctty/State/ZIP: Astoria OR 97103 Each additional inspection over allowable in any of the above
Additional inspection(l hr min) 66 25/hr
Phone:(503 3)8 0563 Fax:( ) Investigation(1 hr min) 90.00/tit
Email: David@wallaccwires.com Industrial plant(I hr min) 78.18/hr
inspections for which no tee IS gp 001 hr
CCB Lie.:224868 Electrical Li-- C1441 Su v-1: .- 6363S specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �`,r+�' Subtotal
Print name: L. Av•r)Lyk..4,414..
Date: JrifL At El Plan Review Required(25%of permit foe):
State surchar ge(12%of permit fee)
Authorized signatur00,,,c, TO AL Pl RMI f(7 l
Print nar11C: This permit application expires if a permit is cot obtained within 180
�--11 n 0 r 5 p 1( w,.F Date: tip. JZ-4.. days after it has been accepted as complete.
fir^ 7 ! • Number of inspections allowed per permit
1:41eildin5Peraali'd:L.0 nnl PetApp_E R rRE.dac Rev06'17Ct61} 44C.4613T(i1$57COMWFB
Plumbing, Permit Applicatio
iECEIVEI
Building Fixtures J�: FOR OFFICE USE ONLY
City of Tigard r „I OF TIGARD
n pr Received
° CITY
1 I IGARD DatefBy: 1 2 r N� Pennil No.: M(�c]��(./yl
n !3125 SW Hall Blvd.,Tigard,OR 97223 n ,plan Review - -- '--- ' v, r�.+ �. w
z Phone: 503.718.2439 Fax: 503.598.WILDING I�IVISI\eP`DatelBy: Other Permit No 5ll �.tnl_O 2C 1'
TIGARD Inspection tare: 503.639.4175 Date Ready/By. Turin: El See Page 2 for
Internet: www.ligard-or.gov Notitied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
- - - Description 1 Qty. I Ea. 1 Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
XI-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
0 Accessory building -Multi-family -
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16561 SW DARWIN LOOP 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.: Project name:efilesslavekslitiekaePolygon 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.: 210 Fixture or item:
Tax map/parcel no.: Backflow 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
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank _ 12.51
Name:Polygon%'LH,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:S ) Page 2
Contact name:
Omar Alami Abouhafs Primer 12.51
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:permitsubntittatsg.polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
--- Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water piping/DWV iP m 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: 572.50
Plan review (25%of permit fee)
CCB Lie.: 184372 Plumbing Lic.no.:pb634 State surcharge(12%of permit fee)
Authorized signature: l}� --,��+��,1 TOTAL PERMIT FEE
Print name:Steve Fowler I Date: 1 O/3O/2O This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
IrtBuilding\PermitstPLMU-Perrnanpp.dnc 10/01/09 440.4616700'02/COW0rE11i
City of Tigard
IICOMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD Building Permit Review — Residential
1:, 1/1 7{3:+.°IIMAs"R11,1` 'IONII INVIR3t. tf TIOZ/PUTAM; MMEZIR>#II€ dA a;iLTritK32wFt :16JN3""MI{Rir.',o,lleiMWIMV/P.d;'sa<ceat,.efriiri tg-M7M':0PW1&tW?'I. :';
Building Permit #: MS'cllp'Z\-OD
Site Address: 16 5 , 1 SW T» i ) LQO
Project Name: PQL?'C_. )N A 1-2,&St+Ak.. IR..1PG6 Lot #: 210
Planning Review I
Propo al: N G A o u SE
Verify address/suite# active in Accela. In River Terrace: ❑ No ❑ Yes,River Terrace Review Addendum
Sit Plan Elements: I2"�rosion Control
Z,_li,/33 copies of site plan on 8-1/2"x 11"or 11 x 17"paper 0' ERsined trees with drip line and tree protection measures
2 Drawn to scale(standard architect or engineer scale) [ FFootprint of new structure(including decks)and FFE
North arrow i_duglity locations&easements(required for new and additions)
25e address,project or subdivision name and lot number Sidewalk/driveway approach
` pplicant information (name and phone number) NA iLocation of wells/septic systems
L%Lot dimensions and building setback dimensions X.-met tree size,type and location
NPSquare footage of buildings to be demolished .Strut names
sting structures on site orner elevations (2'contours if more than 4'differential)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? '' es ❑NoOA
1
7Ifrvious area(applicable if R-7,R-12,R-25&R-40)
yes,is a storm water quality facility shown? ❑Yes .
Clean Water Services—Service Provider Letter t platted prior to 9/10/1995):
wired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No
2 Water Meter Fixture Unit Worksheet—Additi9pe,Remodels and ADUs
Required: ❑ Yes,applicant was notified ini No Received: ❑ Yes ❑ No
% h al .i C Exemption for ADU applied for: ❑ Yes ❑ No Received: ❑ Yes ❑ No
61 Public Facilities Improvement (PFI)Permit:
quired: ❑ Yes,applicant was notifiedo Applied For: ❑ Yes ❑ No,stop intake
L/1 and Use Case#: sl�� (S=� �{ Zonin : R— }�zo � g
ICJ quired Setbacks: Front: ' Rear: /D Side: 3 Street Side: kbtk Garage: W
I PI :uilding Height: Max. Height: Actual Height: 2v0
►4 Landscape Area: 20 % Lot Coverage Max: i?r) %
e ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 de ss
Windows ❑ 12%of area of all street-facing facades
Garage ❑ Garage door d widest street-facing wall ❑ Y No,one of the following is met:
❑ Door extends no mo an 5'from wall and ' a covered porch extending beyond garage.
/ .A ❑ Door extends no more than and there is a 12 sq ft.window above garage on 2"d floor.
NA ❑ Garage door width is ❑ ess ❑ 50 o s of facade ❑ 60%or less and includes 7 of following:
❑ Covered Recessed entrance ❑ Wall o ❑ 1'Roof eave ❑ Roof offset
re shingles ❑ Lap Siding ❑ Roof pitch ❑ Gab e, ' or gambrel roof ❑ Dormer
❑ Accent siding 'Window trim ❑ Window recess ❑ Win o'ection ❑ Balcony
isual Clearance LEI Urban Forestry 5an
sitive Lands: ❑ Yes No Type:
Conditions met prior to issuance of building permit
Note
VApproved By Planning: Date: 7/24)A
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: E Approved El Not Approved
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans:
Building Permit#: ❑ Enter building permit#above.
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator El Building
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1)building plan and
original plan review routing form.
❑ Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date:
Engineering Review ,,//
Slope at building pad: /yj�'e. 1X't. 2l'fe
Conditions "Met"prior to issuance of building permit 4//i4
LAY Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes ,��No
If/Final
/ LIDA Facility on lot: ❑ Yes L� No
lJ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
LC/1 Approved by Engineering: Date: S� Z
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 apply
pSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Delon-Jl'1
Tigard Trans SDC: yf Yes El N/A p/r1VekVA
Parks SDC: / Yes ❑ N/A
LIDA ❑ Yes N/A
OK to Issue Permit Approved by Permit Coordinator: U Date: 015 F202uI
1:\Building\Forms\B1dgPermitRvw_RES_122419.docx
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:
City of Tigard
{ r
, ,IINCOMMUNITY DEVELOPMENT DEPARTMENT
T 1 G R l7 River Terrace Building Permit Review Addendum
1
Building Permit #: 'A(5cf01\- t'J
Site Address: I (0Cia ( Sin.) 1 'i9-P(AJ) J LOU?
Project Name: `pot,y :)13 lcr`�t 1 k . PADGE Lot #: 210
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.0701):
Is the project subject to the plan district design standards? ❑ Yes Li 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 ft. deep Balcony w/ access 2 Window Projection Vertical Wall Offset a Gabled dormer
ft.deep min.2ft., 5 ft.wide min. 2 ft.,6ft.wide
❑ ❑ ❑ ❑
2.Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 7 1 V.�0
3.Ent ces:At least one entrance must meet both of the foL�1 llowi g standards:
Max. 8 ft. setback from longest street facing wall arallel to street,angle no more than 45° from street,
�� or open onto porch
Jr Entrance opens to a porch: Yes ❑ No /
Iff ye the following apply: Y� 2255 q.ft.min.
rr U street facing entry h'122 .max.roof above floor of porch
IIPI' ft. depth min. Id'30%min.porch roof coverage
4.De ailed Design:All buildings shall include a min. of five of thefollowing elements on all street-facing facades:
fenvered porch min. 5 ft.wide x 5 ft. deep E Recessed entry area min. 5 ft.wide x 2 ft. deep
Of W offset min. 16 inches El Do er min.4 ft.wide
JerR
oof eave min. 12 inch projection ' ' •. offset min.of 2 ft.
❑ Roof shingles either tile or wood �n Gable,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. IQ 5prizontal lap siding min. 3-7 inches wide
❑ Accent siding min. 40%of street facade Window trim min.2 '/2"wide by 5/8"deep
1 ❑ 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. I4 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)
foot-wide garage door 40%max.of street facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: Date: 2—e
I:\Building\Forms\BldgPennitRvw_RES_RT_121417.docx
City of Tigard
■ Transportation System Development Charge (SDC)
T I G A R D 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:
8/4/2021 16561 SW Darwin Loop
Project Polygon at Roshak Ridge - Land Use Case or MST2021-00305
Name: Lot 210 Building Permit #:
Tax Total TSDC
2S107AA21000 $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.
El Cash, Check, or Credit Card, payment due at building permit issuance.
x❑ 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.
Cl 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.)
Dom-.A&a�u..46eu/ted, D),.A '46ozziadd-
PROPERTY OWNER DEVELOPER
DATE: 08/04/2021 DATE: 08/04/2021
I:ACommunity Development\Permit Coordinator\SDC Forms\TSDC Combination Payment Option Form 112718 AMS
City of Tigard
Parks SDC Charge (Parks)
TIGARD
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: 16561 SW Darwin Loop
Project Polygon at Roshak Ridge - Land Use Case MST2021-00305
Name: Lot 210 or Permit #:
Tax Total Parks
2S107AA21000 $10,903
Lot#: SDC Amount*:
*The total Parks SDC amount shown above is the sum of$ 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 building permit 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.
❑ 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.)
Dow.)..4 '.46tu Dom,4&nu'.4eew
PROPERTY OWNER DEVELOPER
DATE: 08/04/2021 DATE: 08/04/2021
I:\Community Development\Permit Coordinator\SDC Forms\Payment Option Forms