Permit Y
Plumbing Permit Application
Building Fixtures
City of Tigard RECEIVED Received permit No
IN
Date/By: %/� ,�,hj MST2021-00428
14 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_' Phone: 503.718.2439 Fax: 503.598.I96Q� ,r qq qqgg A / Other Permit No.:
Inspection Line: 503.639.4175 TIDY 9 L�LI Date/By: %� f$ 2? �lio7
11(.i A R D Date Ready/By: Jun. H See Page 2 for
Internet: www.tigard-or.gov Notified/Method
Supplemental
Information formation� OFU �� FEE. SCHEDULE
❑N63kg,plisp DttVIStO" For special information use checklist.
evy construction
Description 1 Qty. I Ea. 1 Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑■ l-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other 1228
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION Site utilities:
j Catch basin or area drain 18.76
Job site address:16620 SW Townsville St. 7 ii 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: 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.:215-ADU Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
bF;SCRIPTION''oF wou
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Taylor Morrison
Floor drain/toor 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 ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing, LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Gavin Thomes Roof drain(commercial) 12.51
Address:146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale, OR 97060 Solar units(potable water) 62.54
Phone:( 503)577-6535 Fax::( ) Tub/shower/shower pan 12.51
E-mail: gavin@allianceplumbing.net urinal 25.02
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 Lie.:184601 Plumbing Lic.no.:PB732
�r State surcharge(12%of permit fee)
Authorized signature: 1 ,JL.._J TOTAL PERMIT FEE
Print name:Gavin Thomes Date:IJ/8/2021 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:ABuildingA Permits VPLMU-PermitApp.doc 10A)I/09 440-46I 6r(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilitte Qty. Fee(ea)mm 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-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 Inspections or Fees Qty. Fetkea} Total each additional$100.00 or fraction thereof,to
l� . •, and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-I/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater.except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
❑
Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
ElCuspidor/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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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n CITY OF TIGARD MASTER PERMIT
-.-
`'1 °' COMMUNITY DEVELOPMENT Permit#: MST2021-00428
Date Issued: 11/03/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 107AA21500
Jurisdiction: Tigard
Site address: 16620 SW TOWNSVILLE ST
Subdivision: ROSHAK RIDGE Lot: 215
Project: Polygon at Roshak Ridge,Lot 215-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
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1228 sf Value: $174,454.24 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 2 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: 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'I 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 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 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 Fire Rated Conditions
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $21,027.66
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: f j Vag DI W�e Permittee Signature: 0w AY-rU 1
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 RECEIVED r.R orrla;L1SL oNI.v
City of Tigard Received 4,
Date/By: j//h'/�i 2f�% Permit No. S Z`r
" 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 2 1 2021 Plan Review /
L. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: I,0'� 2I Other Permit ��2(- 12 3
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ' la See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION ified/Metho._ 4//� 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. '],(,�
Valuation: $ 1` 4 1 J 1.;
❑ 1-and 2-family dwelling ❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder ®Other: ADU Number of bathrooms:2
JOB SITE INFORMATION AND LOCATION Total number of floors` l 5d3
Job site address: 16620 SW TOWNSVILLE ST New dwelling area: 1228 square feet I .418
City/State/ZIP:Sherwood, OR 97140 Garage/carport area:'$65S-square feet
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: X. 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.: 215 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
DES PTION 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
?lc,* d e gee SOC Seto uvt I,I O CGt. ' l c,,, New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
ri 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 Vi9 BUILDING PERMIT FEES*
(Please referrofeeschedule)
Business name:Polygon Homes WLH LLC
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 710
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:(360) 695-7700 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
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 lie.:207247 LL Total fee due upon application: $201.60
Authorized signature: Oht ..t'Q .lQ(�'9L41Q.,�4- This permit application expires if a permit is not obtained
((// within 180 days after it has been accepted as complete.
Date: 09/17/2021 *Fee methodology set by Tri-County Building Industry
Print name:Omar Alami Abouhafs Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
'Mechanical Pet iiiit Application FOR OFFICE USE ONLY
Received
City' of Tigard kecDa1C E .
Perrnit No.HST 2o2(_00
t 3125 SW Ball Blvd.,Tigard,OR 4722
Plan Reviewcalf
f Phone: 503.718 2439 Fax: 503.598.19RECEIVED
DatelBy: Other Permit:
71t'rAli17 Inspection Line: .503.639.4175 p 2 1 j Date Ready,By: hens H See Page 2 for
Internet: w,.vw.tigard-or.gov E f ZO L Notified Method Supplemental Information
{��CITY OF TIGARD
TYPE OF W-rS.I!!DING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECK—LIST
Mechanical permit fees*are based on the value of the work
E)New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION 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 Qty. Ea. Total
JOB SITE LNFORhLATION AND LOCATION -- Heating/cooling:
Job site address: 16620 SW TOWNSVILLE ST Air conditioning 1 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000i 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 I 23.32 _
Residential boiler(radiator or I
hydronic) J 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.: 215 Other: 23.32
____... 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
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
TT� Chimney/liner/flue/vent 23.32
El PROPERTY OWNER Other: 23.32
❑ TENANT
' --•- Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510
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 ipinA:
Business name:Polygon VlT H,LLC S14.15 for first four:S4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
---- — Wall/suspended/unit heater _--
City/State/ZIP:Vancouver,WA 98660 Water heater ___ _
Phone:(360)695-7700 1 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals(taylOrmOfrlSOfl.com Barbecue
_,-____ CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other. ___T______—
- MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal _
City/State/ZIP:Hillsboro,OR Minimum permit fee(590.00)
W Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12°i,of permit fee)
CCB he.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
e a l)c r r „ days after it has been accepted as complete.
Authorized signature: (�C le th tit t�f t� ' Fee methodology set by Tri-Counry Building lndusrry Service Board
Print name:Elia Duran Date: 10/30/20
r•tA„a,rrne+Prrrni,ctatFr P,,,,,,,Cnn 11411111 At, AAA 441'rr,,„n,eN ,min:co,
RECEIVED
Electrical Permit Application SEP 2 1 2021 yofgaRecavedP1201L, '131Sw hall Blvd.,Tigard,OR9722 ITY OF TIGARD P►>tnReviMe
s Phone. 503.718.2439 Fax 503 598 's Related Permit n
Inspection Line 503.639.4175 as III LDING DIVISION Readynatdny fu;s &i See Page 2 for
"'F.D Internet: www.ugard-or.gov NottScNMethod. Supplemental Information
TYPE OF WORK PLAN REVIEW'
IN New construction ❑Addition/alteration/replacement Plea cheer all that apply(submit 2,sets of plans wfitems checked)
0 Demolition Other: Set txc Orfeeder 400 amps a more 0 Building over three stones.
where the:avoilabk fault current ❑Marinas and Neared"
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildrn4p.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building les.to ground,or exceeds 14,000 0 Comrmemial-esc agricultural
❑Multi-family ❑Master builder ADU Mt all other ntstauanws buildingsnst
®Other: ❑Fire pump []Installation of 150 KVA a
JOB SITE INFORMATION AND LOCATION 0 hmvg cry system larger separately derived
Job#: Job site address:16620 SW TOWNSVILLE ST ❑Addition arnrw•motor load at srstem-
100irP or mane. 0"A",-k","1-2"."1-3",
City/State/ZIP: Tigard,OR 97140 0 SIX of MOM residcntaal units fey
0 Health-care facilities 0 Recreational svhtck parks..
Suite/bldgJapt/1: Project name: Polygon at Roshak Ridge 011azardous Madams 0 Supply voltage for more than
0 Service or tec+ke coo amps or more 600 volts nominal
Cross street/directions to job site: FF.F:SCHEDULE
lleasricfioa I pL i r8eh_l total i •
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 215 tadades attached garage.
1,000 sq.it or lass 168 54 4
Tax map/parcel#: _ Fa.add'I 500 aq.tt or portion 33 92 1
DESCRIPTION OF WORK _ Limited energy,residential 75.00 2
New construction.Type SFU (with above sq.ft)
Limited energy,mule-family 75.00 2
residential(with above sq.R.)
® PROPERTY OWNERRenewable Energy J Sri Page 2
Q TENANT Services or feeders Installation,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to oral amps 133.56 2
401 amps to 600 amps 200 34 2
City/State/ZIP: Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or faders installation,alteration,and/or
Email: OA1amiAbouhafs@taylonnorrison.com-PermitSubmittalstjtaylormorrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 snips 123 Os 2
Owner signature: Date: 401 amps to 599 amps 168 54 2
Q APPLICANT+iT I a CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A Fee for branch circuits with
Business name: Polygon homes Wi.H LLC above service or feeder fee,
7.42 2
Contact name: Omar Atrial Abouhafa cacti branch circuit
D Fee for branch circuits withnat
service or feeder fee,first Address: 703 Broadway St.,Ste 710 branch circuit 56.18 2
City/State/ZIP: Vancouver,WA 98660 Each add'l branch circuit 7.42 1 2
Phone: 360 94b 8674 Miscellaneous(service or feeder not included)( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:0A1amiAbouhats@taytormorrison.com-PermitSubmittals@taytnrmonison-corn Recnnneat only 67 84 2
CONTRACTOR Pump or irrigation circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67 84 .2
Address: 105 Dresden St Signal creutt(s)or tin iiedcnergy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Astoria OR 97103 Each additional inspection over allowable in any of the above
... _ Additional inspection(i In ram) 66 25/hr -
Phone:(503 308 0563 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:Davitl@wallaccwires.com Industrial plant(1 hr min) 78 18/hr
Inspections for which no fee is
CCB I.ic.:224868 Electrical Li •CI 441 Su .I' .• 6363S specifically listed(AAA hr min) hr
,J
ELECTRICAL. PERMIT FEES
'^
Suprv.Electrician signature,required: it 64 _` Subtotal-
Print name:Dho 4w yf Date: it/�A( Plum Review Required(25%of permit fee):
`� (f State surcharge(12%of pit fee)
Authorized si�xtttre TOTAL PERMIT FI,E.
�.,, This permit application expires if a permit Is not obtained within the
Print name: 1p_„ t a A s d itr _LL-_ _ i)ate: days after 1I has been accepted as complete.
`-'r�v`a liViok f—st i.- ' Number of inspections allowed per permit.
1.a wldngTerauts'dl.C..PmntAppp F18 ORE doc Rer 0617f2015 4 'r446IST(i I/0YlC0M4WFB
Plumbing Permit Application
Building Fixtures RECEIVE . FOR OFFICE USE ONLY
City of TigardImpi
Received '�17 t��1 7(}
Permit No.; L(Ju V !tea
w 13I25 SW Hall Blvd.,Tigard,OR 97223 S E P 2 1 7.0?1 Data/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit
Date/By;
TIGARD Inspection Line: 503.639.4175 CITY�OF TIGkt sia Date Ready By; lutist I See Pare 2 for 4
Internet: www.tigard-or.gov BUILDING DIVISIC.II Notified/Method. _ Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition
For special information use checklist.
Description 1 Qty. 1 Ea. J Total
❑Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft,for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
fi-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 41-Multi-family
Each additional batluk itchen 25.02
❑Master builder ❑Othtx: ADU Fire sprinkler( sq.h.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16620 SW TOWNSVILLE ST 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:.Yiicieak lii g 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 Lot no.: 215 Fixture or item:
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
-
(l PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/wb 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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:5_) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof dram(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 I2.51
E-mail:permitsubmittals@polygonhomes.eom Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water Pin tP g/DWV 56,29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 w _ ti 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
=xi State surcharge(12%of permit fee)
Authorized signature: 1:1"' ". , TOTAL PERMIT FEE
Print name:Steve Fowler a Dale: O�3OIZO 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
l:tBuilding+PennitslPLMU-PermitApp_doc 10101/09 440-4616T(10/02/COM1WEFtl
_.
City of Tigard
N . " COMMUNITY DEVELOPMENT DEPARTMENT
T n u D Building Permit Review — Residential
Building Permit #: ST2O2 (-OO1(29
Site Address: 16620 W Townsville St.
Project Name: Polygon at Roshak Ridge Lot #: 215
Planning Review
Proposal: New attached ADU
CIVerify address/suite#active in Accela. 0 In River Terrace: ❑ No 0 Yes,River Terrace Review Addendum
Site Plan Elements: ,rosion Control
CI copies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures
0 0 rawn to scale(standard architect or engineer scale) Footprint of new structure(including decks)and FFE
0 orth arrow ,Utility locations&easements(required for new and additions)
I.ite address,project or subdivision name and lot number ,Sidewalk/driveway approach
0'pplicant information(name and phone number) _.f.ocation of wells/septic systems
11 of dimensions and building setback dimensions .:;,Street tree size,type and location
II.quare footage of buildings to be demolished ,street names
existing structures on site ''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
CIClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified a No Received: ❑Yes ❑r No
CIWater Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified I No Received: Yes No
CI SDC Exemption for ADU applied for: _1 Yes ❑° No Received: A Yes H
No
QPublic Facilities Improvement(PFI) Permit:
Required: ❑Yes,applicant was notified ❑o No Applied For: ❑Yes ❑ No,stop intake
CI Land Use Case#: ADU2021-00011 El Zoning: R-7
0 Required Setbacks: Front: 8/12 Rear: 10 Side: 3 Street Side: N/A Garage: 20
CI Building Height: Max.Height: N/A Actual Height: 24
0 Landsca.e Area: 20 % CI Lot Coverage Max: 80
Entrance 111 Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows Q Minimum 12%of area of all street-facing facades
Garage I Gaffe door is behind widest street-facing wall ❑Yes Q 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 2nd floor.
❑o Gara e door width is 112'or less ❑ 50%or less of facade r 60%or less and includes 7 of following:
Covered porch 13 Recessed entrance ❑r Wall offset ° 1'Roof cave Roof offset
Fire shingles 0 Lap Siding ❑ Roof itch CI Gable,hi ,or gambrel roof Dormer
Accent siding Window trim Window recess Window projection ❑ Balcony
ClVisual Clearance ❑o Urban Foresta,Plan
ElSensitive Lands: ❑ Yes L"I No Type:
ElConditions met prior to issuance of building pe it
Notes:
0 Approved By Planning: / Date: 9/' ?//
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
I:\Building\Fonns\BldgPermitRvw_RES_122419.docx
•
Building Permit Submittal p
Original Submittal Date: l (/zO21/
Site Plans: #
Building Plans: #
Building Permit#: Enter buildin ermit#above.
Workflow Routing: " Planning Engineering 1ermit Coordinator ErBuilding
Workflow Sign-off: Er ign-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.
ErBuilding: original permit ,.;lication,site plans,building plans,engineer and
beam calculations and •etails,if applicable,etc.
Notes: /
/ ��/`��
By Permit Technician: ,�%ilm'' Date:
Engineering Review
Er Slope at building pad: ,i)
ErConditions "Met"prior to issuance of building permit
�El Easements (encroachments) per engineering conditions of approval and plat
[ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes V} 10
Assess Water Quantity Fee in-lieu: ❑ Yes buy'/No
�/ LIDA Facility on lot: ❑ Yes I No
E Final Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 9'/._3C./ /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
1
,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 i N/A _
l
Tigard Trans SDC: Yes CI N/A N/A -t-DryY
Parks SDC: Yes ❑ N/A
LIDA ❑ Yes 7ErN/A
g OK to Issue Permit
Approved by Permit Coordinator: 16rr
& Date: (D(SOU
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 ct n D River Terrace Building Permit Review Addendum
Building Permit #: HSI-IOW-60 4Z'
Site Address: 16620 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.L):
Is the project subject to the plan district design standards? ❑Yes Q 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.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch •.. 5 ft. deep Gable. .ormer
ft. deep min.2ft., 5 ft.wide min.2 ft.,6ft.wide
• ❑ ❑ ❑ ❑
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 longer trees- facing wall
or open onto por
Entrance opens to a porch: ❑Yes hi o
If yes,all the following apply: ❑25 sq.ft. in.
One street facing entry ❑12 f ax. roof above floor of porch
❑5 ft. depth min. ❑3►/o min.porch roof coverage
4. Detailed Design: All buildings shall include a min. o v- of the following elements on all street-facing facades:
❑Covered porch min. 5 ft.wide x 5 ft.deep Recessed entry area min. 5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches wormer 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
ElRoof pitch oriented south min. 500 sq. . ❑Horizont.. ap siding min. 3-7 inches wide
❑Accent siding min.40%of street fa .e ❑Window trim , in.2 1/2"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 ❑Attached garage is 3 0 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 .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.
ElMay 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 .. 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
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: Date: 9/23/21
:\Building\Forms lBldgPe mitRvw_RES_RT_I2I417.docx
City of Tigard
111 " Deferral Until Occupancy Request
T I G A R D Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
4 aY#iM4)104RXSM.av 1 .... 1~107KAWAff 8 }X AMMO irO'nh,"r7044*-Lx 0006MOb F.. 9i Yr4OMPI: # V11004004-k'F#XSACd.-:
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: 16620 SW TOWNSVILLE ST
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00428
Name: Building Permit#:
Tax Lot Total Parks
2S107AA21500 $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: 17m4A-.A game:.A6ea Date: 10/05/21
Developer: D 4kafra 46euU a Date: 10/05/21
Permit Coordinator: oetiKeirb Date: 10/4/2021