Permit Plumbing Permit Application immilimimcimiliiiiiii--,
Building Fixtures Cityof Tigard R E C E i Y E D Received
g Date By: /�--� Permit No.; MST2021-00427
13125 SW Hall Blvd.,Tigard,OR 97223 s� 30/� -V'I
ry ry Plan Review
Phone: 503.718.2439 Fax 503.598.196Ha�R 9 2OL Date/By: /49//13/4i) 41.4 Other Permit No.:
Inspection Line. 503.639 4175
I I G A R D Date Ready/By Juns H See Page 2 for
Internet www.tigard-or.gov Notified/Method
� Supplemental Information
TYPE'OF WO IT -l'TIGAR�3 ' ,FEE* SCIIEDULE
0 New construction [ D,lino')i{ion' DIVISION 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 Ct�TRUCTION SFR(1)bath 312.70
1-and 2-familySFR(2)bath 437.78
❑ wellin g 0 Commercial/industrial
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(2023 sq.ft.) Page 2
JOB SITE INFORMATION A Site utilities:
Job site address:16618 SW Townsville St. i ,42 -�•_ Catch basin or area drain 18.76
�4 /�a'11 1 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.: I Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Stone sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:215-SFU Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
- Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a'PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Taylor Morrison
Floor drain/floor sink/hub 25.02
Address:703 Broadway Street Suite 710 Garbage disposal 25.02
j City/State/ZIP: Vancouver,WA 98660 Hose bib 25.02
Phone:(360 ) 695-7700 Fax:( ) Ice maker 12.51
jI
❑ APPLICANT UI CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Gavin Thomes
Root drain(commercial) 12.51
Address:146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale, OR 97060 Solar units(potable water) 62.54
Phone:( 503)577-6535 Fax::( ) Tub/shower/shower pan 12.51
E-mail: gavin@allianceplumbing.net Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Alliance Plumbing, LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( 503 )492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
g �f, State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Gavin Thomes Date.I l/9(2021 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.
I:A Building V Permits VPLMU-PermitApp.doc 10/01/09 440-46I6T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qiy. Fee(ea) Tomil 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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other * or Fees Fee(eat Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1 45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing ICnstallalfinns
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 ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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"
Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
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\Pl,MF_PermitApp.doc 08/04/2011 2
Ilk
CITY OF TIGARD MASTER PERMIT
* COMMUNITY DEVELOPMENT Permit#: MST2021-00427
TIARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2021
G
Parcel: 2S107AA21500
Jurisdiction: Tigard
Site address: 16618 SW TOWNSVILLE ST
Subdivision: ROSHAK RIDGE Lot: 215
Project: Polygon at Roshak Ridge,Lot 215-Primary
Project Description: New primary dwelling with(1)attached ADU. NO FINAL INSP UNTIL DEFERRED SDCs ARE PAID
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 82 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1941 sf Garage: 456 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2023 sf Value: $293,700.62 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 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: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 '
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 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: 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'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/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 2023
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 Fire Rated Conditions
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX
Total Fees: $24,770.85
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
qc7-nn1jin1n 1hrniinh r1Ap qa7-nni neon Yntr rnnw nhtnin n nnn,of the neloe nr Airnni nileefinnc in nl Mir by Tallinn Sill 717 10147 nr 1 Rnn 119 914d
Issued By: Ho(Cy V0.w D�VJeg2 Permittee Signature: Ow AY�Y� lti
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.
3uildin;; Permit Application Nill--- 2/ S-
b-cj f 21 2
Residential FOR OFFICE USE()Nix
Cl of Tigard ECEIVED Received
By: v , �� -j7
JgDate/By: �! PermitNo. L14 a 13125 SW Hall Blvd.,Tigard,OR 972Plan Review 2202,1 TPhone: 503718.2439 Fax: 503.598.1960 Date/By: tD7412/
4 £ Other Pe
T I G A R D Inspection Line: 503.639.4175 S E P 21 2021 Date Ready/By: l ais: I ® See Page 2 for
Internet: www.tigard-or.gov Nd/Method:/G / TjG Supplemental Information
CITY OF TIGAF�D '�1'
TYPE OF WOJILDING DIVISION REQUIRED DA A:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. �f�O 7
® 1-and 2-family dwelling ElCommercial/industrial Valuation: $ C I 700
❑Accessory building El Multi-familyNumber of bedrooms: 4
❑Master builder 0 Other: Number of bathrooms:3
JOB SITE INFORMATION AND LOCATION Total number of floors:2
Job site address: 16618 SW TOWNSVILLE ST New dwelling area: 2,023 square feet q(4 I
City/State/ZIP:Sherwood, OR 97140 Garage/carport area:15%46149 square feet S Z
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area:4 square feet
Cross street/directions to job site: Deck area:
ttr(20 square feet
Otln attie6 ( IV) square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge Lot no.: 215 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
DESCRIPTIOg OF WORK work indicated on this application.
SFU:New home construction Elevation:221100B/221000B Duplex Valuation: $
Type:Duplex_Projected Start:November 2021 Existing building area: square feet
13Ie01SC CteleA. 90C `eC un rQ 6-CCvpanc,3 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 ❑ 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 710
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:(360) 695-7700 Fax::( ) 1
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
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 lic.:207247 Total fee due upon application: $201.60
Authorized signature: 0111.412,ty e ,41t1 46/9L� 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.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
M •City of Tigard R eivcd `�
b Permit No.
��� ,1 DatclBy:
a _ 13125 SW hall Blvd.,Tigard,OR 9722 ECEIVED /
t Phone: 503.718.2439 Fax: 503.598.196U Dal Review Other Permit:
Inspection Line: 503.639.4175 2 a Dale By.
T I Zih 1;17 S EP 1 202.1 Date Readynly. huts 0 See Page 2 for
Internet: xmw.tigard-or.gov Notititdllvlethod
Supplemental Information
CITY OF TIGARD ---
TYPE OF wcIBUILDING DIVISION CON MERCIAL FEE* SCHEDULE USE CHECKLIST
— Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
IN 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
( j Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning f 46.75
Job site address: 16618 SW TOWNSVILLE ST Furnace 100.000 BTLi(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000*BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
—___ hydronic) 23,32
Unit heaters(fuel-type,not electric),
_ in-watt,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Polygon at Roshak Ridge Lot no.: 215 Other. --- 23.32
--a— Other fuel appliances:
Tax map/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
Loa 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_37 -
----- _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 rooms) 23.32
Phone:(360)695-7700 Fax:( ) 1 Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
S14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St,Ste 510 Gas heat pump
- Wall/suspendedluoit heater
City/State/ZIP:Vancouver,WA 98660 __ Water beater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittalsEttaylormorrisorl.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
NfECILAJ''ICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00)
Platt review(25%n of permit fee)
Phone:(360)270-1590 Fax.( ) — State surcharge(12%of permit fee)
CCB he.:209001 TOTAL.PERMIT FEE
[' This permit application expires if a permit is not obtained within 180
Q; 1)u days after it has been accepted as complete.
Authorized signature: v w t� 't�s �I t� • Fee methodology set by Tri-Caunry Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r MeniltiirorAPrrmir,1MFC Nnrmn Ann a,1n1 I¢tie, a.n 441+r,,,mli,r1h nrrt:u,
Electrical Permit ApplicatillECEIVED
City of Tigard Received
Dan/By Perm" i,)5[20 - - 7
N 4 13125 SW Hall Blvd.,Tigard,OR 97223 Q F p 2 1 20p, pian gesnew _ _ ,_„
' II Phone: 503.718.2439 Fax 503.598 I960"- • Dam/By Mond Permit e.
Inspection Line 503.639.4175 Ready 13atAy tom fa Set Page 2 for
CITY OF TIGARD Notified/Method.
Internet: www.tigard-orgov sappiessentai hdarroation
TyrE oF AiD1 NG DIVISION
' PLAN-BEVIE'W. . •-..- •
El New construction 1:]Addition/alteration/replacement Please chock all that apply(submit a sets of plain whir=chocked)
0 Snore et feeder 400 amps to more 0 Building owl three stones
0 Demolition 0 other:
where the omitoble fault current 0 Maness and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 130 volts or 0 Floating buildings
El 1-and 2-family dwelling 0 CommerciaVindustrial 0 Accessory building kiss to ground,or exceed:14,000 0 Conomerciel-use agncidtural
amps Its all cIba ustallatican buildings
0 Multi-family 0 Master builder 0 Other: 0 Fire pomp 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 kracriracy•Prem Iarta averagely derived
new of system.
Job#: Job site address:1661 8 SW TOWNSVILLE ST motor held 10017P Or morn GI-A-,-E-,-1-2",-1-3",
City/State/ZIP: Tigard,OR 97140 0 six or more residential units occupancy.
0 Nealth-cate facilitws 0 Roarational vetucte parks.
Suite/bldg./apt,#: [Prame Polygon at Rosbak Ridge 0 toricitoui siestas. 0 Supply volmge for more than
0 Service or 6.,,i,600:amps a-more 600 volt.no...al
Cross street/directions to job site:
FEE SCHEDULE '! ! ' •
Dostriptioa I On, 1 Path 1 ToOt I •
New residuals'single-or multl-farally dwelling unit.
Subdivision:Polygon at Roshalt Ridge Lot#: 215 Ineledes attached garage.
Tax map/parcel#: 1,000 so.ft or less 168 54 4
Ea.add'l 500 aci.ft,or portion 33.92 I
ovicturrioN OF WORK Limited energy,residential
75.00 2
(with above act.11.)
New corsstruction.Type SFU
• , ,
Limited energy,multi-family
2
residential(with above sq.fr) 75.00
12 PROPERTY OWNER 0 TTNANT ,Renewable Energy 0 See Page 2
-
Services or feeden installatior alteration,and/or relocation
Name: Polygon Homes WLH LI,C 200 amps or kits 100.70 I ,2..
s Address: 703 Broadway St,Ste 710 201 amps to 400 amp 133.56 2
401 amps to 600 atups 200 34 2
City/State/ZIP: Vancouver,WA 98660
601 amps to 1,000 amps
, 301.04 2
Phone:(360 )946 8674 Fax ( ) Ova 1,000 amps or volts 552.26 2
----- Temporary services or feeders installation,alteration,and/or
Etna 0AlamiAbouhafs@taylonnorrison.com-PermitSubmittals@taylotlnorrison.coni relocation
Owner installation:This installation is being made on property that I 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 to 400 amps 123.08 2
Owner signature: Date: 401*nips to 599 amps 168.54 2
0 APPLICAPilT I - 0 CONTACT PERSON Branch et/cults-newatiteratiori,or extension,per panel
- A.Fee for branch tumults with
Business name: Polygon Homes WI.H LI,C above service or feeder fee,
7.42 -,
each branch circuit
Contact name: Omar Alami Abonhafs
B.Fee for branch circuits wrthow
service or feeder fee,first
Address: 703 Broadway St.,Ste 710
branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each tuid'I branch circuit 7.42 i 2
Miscellaneous(service or feeder not included)
Phone:(360 )946 8674 Fax::( ) Each manufactured or modular
67 84 2
Email:OAlamiAbouhafs@taylormorrison.com-PermitSubmittals@ dwelling,semi«and/or feedertaylormorrison.com , Oniy
67
CONTRACTOR
Pump or irrigation circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Signal eircutt(s)or limitaionergy
Address: 105 Dresden St
panel,alteration,or extension. 0 see Page 2 2
Each City/State/ZIP: Astoria,OR 97103 additional Inspection over allowable in any of the above
Additional inspection(1 ht min) 66 25/br
Phone:(501 308 0563 Fax:( ) Investigation(1 hr min) 90.00/tar
Email:David#wallaccvvires.com — Industrial plain(1 In mud 78 1 8/hr
Inspections for winch no fee is
9
CC13 Lie.:224868 Electrical Li • C1441 Su .I' .• 6363S specifically hstod 05 tir min) 0 00/hr
ELECTRICAL PERMIT YU'S
Suprv.Electrician signature,required:
-Subtotal'
Print name; Date: i(/‘A f -0 Plan Review Required(25%of permit fee):_444,17(
- State surcharge(12%of permit fee)
Authorized signature
TOTAL PERMIT TEE:
This permit application expires if•permit is sal obtained within ISO
Print name:beti4
,42___IAltiC1-•OF•1•‘-• Date: /./.4 A.4 days airier 11 has been accepted as complete-
' Number of intucalum allowed per permit
1.1tuildingtermaidd&PartalApp EUt.ERE.doc Rev 0617r2015 4(0-4615T(11/05COWV/Ell
' , ''.1Iumbing, Permit Application
Buikkling Fixtures RECEIVE' FOR OFFICE USE ONLY
} IrCity of Tigard 9 Received �t�TZ�
} Lr, / Permit No.
13125 SW Hall Blvd.,Tigard.OR 97223 SEP 2 1 2021 Date/By' i�Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit tvo.•
TIGARD Inspection Line: 503.639.4175 CITY OF TIGAHL) Date Ready'By: tw s: B See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition Fec 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(I)bath _ 312.70
-Xt-and 2-family dwelling 0 Comrnercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑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: 16618 SW TOWNSVILLE ST Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suiteibldg./apt.no.: Project name:_" ""irij1 olygon 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 l Lot no.: 215 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction SFU
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sutnp 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture sewer cap 25.02
Floor drain/lloor 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:( ) lee maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor.'grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Page 2
Primer 12,51 i
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sinktiasin/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 Pip g I 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: S72.50
Plan review (25%of permit fee)
CCB Lie.:184372 Plumbing Lic.no.:pb634 State surcharge(I 2°to of permit fee)
Authorized signature: �' tJ�_it.: - TOTAL PERMIT FEE
This permit application expires if a permit is nut obtained within 180 days
Print name:Steve Fowler Date: 10/30/20
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
t:'9uildurg•.PermitstPLNIU-PemritApp.drx I0+0109 440.4616T(10+021COM4WEt4t
City of Tigard
II ~ COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 c Iz n Building Permit Review — Residential
Building Permit #: qSrJ—OOcL2q
Site Address: 16618 Townsville St.
Project Name: Polygon at Roshak Ridge Lot #: 215
Planning Review
Proposal: New single detached house
ElVerify address/suite#active in Accela. El In River Terrace: ❑ No 0 Yes,River Terrace Review Addendum
Site Plan Elements: Jrosion Control
II copies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures
0 D rawn to scale(standard architect or engineer scale) footprint of new structure(including decks)and FFE
0 orth arrow •L:Jtility locations&easements(required for new and additions)
0.ite address,project or subdivision name and lot number .Sidewalk/driveway approach
0•pplicant information(name and phone number) ,J.ocation of wells/septic systems
0.ot dimensions and building setback dimensions street tree size,type and location
D.quare footage of buildings to be demolished ,$treet names
II xisting structures on site v Corner elevations(2'contours if more than 4'differential
0 .t 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? es ° o
ElClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑° No Received: ❑Yes El No
▪ Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ❑° No Received: Yes 0 No
❑ SDC Exemption for ADU applied for: ❑Yes ❑° No Received: ❑Yes 0 No
ClPublic Facilities Improvement(PFI) Permit:
Required: ❑Yes,applicant was notified ❑° No Applied For: El Yes ❑ No,stop intake
0 Land Use Case#: SUB2015-00004 0 Zoning: R-7
0 Required Setbacks: Front: 8/12 Rear: 10 Side: 3 Street Side: N/A Garage: 20
El Building Height: Max.Height: N/A Actual Height: 24
ElLandsca.e Area: 20 °A, Q Lot Coverage Max: 80
Entrance 0 Set back no more than 8'from street-facing wall El Parallel to street or offset 45 degrees or less
Windows 0 Minimum 12"/0 of area of all street-facing facades
Garage 0 Gara e door is behind widest street-facing wall ❑Yes ID 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.
❑ Garage door width is I 12'or less ❑ 50%or less of facade ° 60%or less and includes 7 of following:
Covered porch 0 Recessed entrance El Wall offset 8 1'Roof eave ,_ Roof offset
Fire shingles 0 Lap Siding ❑ Roof itch ❑o Gable,hi ,or gambrel roof _ Dormer
_ Accent siding I Window trim U Window recess LI Window projection ❑ Balcony
ElVisual Clearance Urban ForestrxPlan
❑ Sensitive Lands: El Yes u No Type:
ElConditions met prior to issuance of building permit
Notes:
0 Approved By Planning: Date: ' 2 1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_122419.docx
Building Permit Submittal
�A.�/
Original Submittal Date: U /262
Site Plans: #
Building Plans: #
Building Permit#: )Enter building permit#above. a-
q.
Workflow Routing: 0-Planning ngineering Permit Coordinator L1 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.
L t3uilding: original p- it application,site plans,building plans,engineer and
beam calculations . : trust details,if applicable,etc.
Notes:
By Permit Technician: 1144'////,' Date: 09Ah/.
En ineering ReviewVd /
Slope at building pad: e
E1Conditions "Met"prior to issuance of building permit
Q 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 Et No
LIDA Facility on lot: ❑ Yes Er No
[Vim'Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ✓l Date: 9' ‘.S2 �7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received Does not a-� ly
SDC Fees Entered: Wash Co Trans Dev Tax: Yes N/A
Tigard Trans SDC: Yes ❑ N/A See cl:?-�e aS vrrnS
Parks SDC: gYes ❑ N/A
LIDA ❑ Yes giN/A
ZOK to Issue Permit
Approved by Permit Coordinator: PlO\(\ria
Date: l0I55 I2D2.1
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
44
i III
11111 City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
r 1 A R D River Terrace Building Permit Review Addendum
Building Permit #: qSr2O?,( -OO(I27
1
Site Address: 16618 SW Townsville St
Project Name: Polygon at Roshak Ridge Lot #: 215
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1):
Is the project subject to the plan district design standards? ❑Yes El No (Per MMD2020-00044)
Articulation: 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 Gable. .ormer
ft.deep min.2ft., 5 ft.wide min. 2 ft.,6ft.wide
I 0 0 0 0
2.Eyes on the str- -t: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,
El Max. 8 ft. setback from longes treet- facing wall
or open onto por
Entrance opens to a porch: ❑Yes M o
I�f j es,all the following apply: ❑25 sq.ft. in.
U One street facing entry 0 12 f ax. roof above floor of porch
❑5 ft. depth min. ❑30/o min. porch roof coverage
4. Detailed Design: All buildings shall include a min. o v. of the following elements on all street-facing facades:
❑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 l ormer min.4 ft.wide
❑Roof eave min. 12 inch projection ❑R•• offset min. of 2 ft.
❑Roof 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 ❑Window trim , ' .2 '/z"wide by 5/8"deep
❑Window recess min. 3 inches for street facing ❑Bay window min. ft.wide by 2 ft.deep
❑Balcony min. 5 ft.wide x 3 ft. .eep with inside access Cl Attached garage is 3 'o or less of street facade
5. Garages and Carports: 'ay face the front or side lot line on a corner lot.
Setbacks:
No closer to front o Side lot line,than longest street-facing wall. ❑Yes ❑No. If No (Check o - .
0 May extend u. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
❑May extenrn, 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 .. age that faces the street with a min. area of 12 sq.ft.
Width: heck one)
❑ -foot-wide garage door ❑40%max.of street facade
ti 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: Date: 9/23/21
I:\Building\Fo`ms\BldgPeimitRvw_RES_RT_121417.docx
Water Meter Fixture Unit Worksheet For New Buildings ECEIVED
SEP 2 1 2071
Please complete the following information: CITY OF TIGM L)
Contractor Name: Polygon Home, WLH LLC BUILDING DIVISION
Billing Address: Street/Suite#: 703 Broadway St, STE 710
City: Vancouver State: WA Zip: 98660
Phone Number: 360 946 8674 Email: OAlamiAbouhafs@taylormorrison.com
New Meter Address: SFU: 16618 SW TOWNSVILLE ST /ADU : 16620 SW TOWNSVILLE ST
Subdivision Name: Polygon at Roshak Ridge Lot#: 215
Building Permit#:
Please fill in the number of each fixture as detailed on the plans. Multiply the quantity by the point value
to arrive at the point total. Add all point totals together for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
SFU ADU Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer 1 1 2 x 4 = 8
Dishwasher 1 1 2 x 1.5 = 3
Hose bib, 1st one 1 1 2 x 2.5 = 5
Hose bib, each add'l 1 1 2 x 1 = 2
Kitchen sink 1 1 2 x 1.5 = 3
Laundry sink x 1.5 =
Lavatory 3 4 7 x 1 = 7
Water closet, 1.6 GPF 2 3 5 x 2.5 = 12.5
Bathtub/whirlpool x 4 =
Shower stall 1 1 2 x 2 = 4
Bath/shower combo 1 2 3 x 4 = 12
Total Fixture Unit Points: 56.5
Fixture Unit Points:
1to30=5/8" 37.5to89= 1"
30.5 to 37=3/4"
Meter Size: Meter Cost: $ 24,886.00
****************************************************** ******************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building (Master) Permit or Plumbing ❑Yes ❑ No ❑ Other:
Meter#: Sale Date:
Receipt#: Meter Cost:
Employee Name:
1:/Building/Forms/WaterMeters_010121_New.doCx Page 2
City of Tigard
111 Deferral Until Occupancy Request
T I G A RD Washington County Transportation Development Tax (TDT),Transportation and Parks System
' Development Charges (SDCs)
Xinroy im[A.w bi'J d TfMo�ogowtrAW3YilFNXISOMMVAW!," fAMONISMIAMOMMARMa
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: 10/4/2021 Site Address: 16618 SW TOWNSVILLE ST
Namet Land Use Case or
Polygon at Roshak Ridge Building Projec Permit#: MST2021-00427
Tax Lot Total Parks
25107AA21500 $5,839.00
#: Lot 215 Amount*:
TDT Total TSDC $225.00
Amount: N/A Amount*:
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $ 0 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: 0 +-4u:.A6eli Date: 10/05/21
Developer: Drn44LW-41 .4eea/i'a Date: 10/05/21
Permit Coordinator: AreA oeitfrtelfb Date: 10/4/2021