Permit FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: GM IN 1-4OM?3 ECEIVE
D
COMPANY: Md�.IANC.E. PL RMIA Nb BAR 31022
I OF I-IGARL)
PHONE: (603) 51'1-1053s ;WILDING DIVISION By.
EMAIL: ( A4INe`ILLIANLEPLUM13tN(o.OET
RE: 1 4400 UN) 1ld5TN AVE. 1AS-r2.02,1— OO19b
(Site Address) (Permit Number)
ROSI4-A / INNOVATE LOT 11140 (A.Dv I)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 2- Revisions: 1%RE 5 PRI NKt .R.
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: $AS‘meol ERTt4S REmeNtED, itE4vlRirlto p4 Dfs'Ih I
FOR OFFICE USE ONLY
Routed to Permit Technician: ate: / j - 21 � Initials: A
Fees Due: ❑ Yes EZ..No Fee Description: Amount
$ U
Special
Instructions:
Reprint Permit(per PE): ❑ Yes 21am ❑ Done
Applicant Notified: ate: . /2 Initials: ` /A.-
RECEIVED
Plumbing Permit Application
MAR23 '
Building Fixtures t;iTY OF TI,
tr;)
Citylli.11,1=1=1111M
of Tigard BI JILDING l.i eceived
ill ll Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �1`. / �
C Phone: 503.718.2439 Fax 503.598.1960 Plan Review Ig_
Date/By: .2 a 67 Other Permit No.:
1 I G A R t) Inspection Line: 503 639 4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
SEE* SCHEDULE
❑■ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)_
CATEGORY +OF CONSTRUCTION SFR(I)bath 312.70
ElI-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(21C(sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: (440(0 sw 1 io ST11 Am E 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.: J 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.: I rl kit Fixture or item:
Tax map/parcel no.: (ADV O Backflow preventer 31.27
T)E CRP or.w 1 Backwater valve 12.51
�' •
Clothes washer 25.02
"-'j MULTIPURPOSE FIRE SPRINKLER SYSTEM 4(--" Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PRO1'FR'tTY': NEft , I ❑TENANT ` Expansion tank 12.51
Name:Taylor Morrison Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway Street Suite 710 Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660 Hose bib 25.02
Phone:(360 ) 695-7700 Fax:( ) Ice maker 12.51
❑ APPLICANT, • fjg covrAct 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
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
CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: �` TOTAL PERMIT FEE
Print name:Gavin Thomes Date:3.22.2022 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
LABuildingAPermitsVPLMU-PermiiApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Pp
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qry. Bee t Taal 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 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
fraction thereof,-Fie(ea) TAW
each additional$100 00 oro to
`Other�,.,. t +elarlia O � '' 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
❑ 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
❑Stall New exterior plumbing site utilities for any complex structure
Car Wash: -Eachas defined in OAR918-780-0040.
-Driveto
CICuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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"
3 Isometric or Riser Diagram
4„ -❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related
-Bradley
-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
ITY
TI
COMMUNOITFY DE VEOPDMENT ,` MASTER PERMIT
4 Permit#: MST2021-00196
r Date Issued: 12/01/2021
TIG,yRD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 !�
Parcel: 2S107AA17600
Jurisdiction: Tigard
Site address: 14406 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 176
Project: Polygon at Roshak Ridge, Lot 176 (1 of 2)ADUs
Project Description: New attached ADU. NO FINAL INSPECITON UNTIL SDC FEES ARE PAID.5/16/22: REPRINT to
add fire sprinklers.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 703 sf Basement: 503 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 3 Second: 945 sf Garage: 241 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 st Right: 3 Detectors:
Total: 2151 sf Value: $275,051.76 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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
Bckllw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 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 addl 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
N Garage Opener: N Allstem:
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: 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 2151
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 Fire Rated Conditions
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
3 Geo Tech Report Required
Prior To Pour
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $25,338.96
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: Ore n law requir s you to follow t e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
QF7-nn1-nnl n thrn,inh rlAR QF7- -nn0f1 nil v nhtain a AM/ ha rnlae nr ti irart nuaetinnc to rli INC:Mr Tallinn FM 917 10547 G nr 1 Ann 3'37 71dd
���e,0/77
Issued By: Permittee Signature: l�
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 lob site at the time of each Inspection.
Plumbing Permit Application /l ‘
Building Fixtures �ECE'V ED
Received /J MST2021 00196
City of Tigard Date/By: , /44 /.,yam Permit No.:
ill lig 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1."
w
■ Phone: 503.718.2439 Fax: 503.598.19612%OV 9 ZOZ1 y l�/J/;y �G� Other Permit No.:
Date/By:
Line 503.639 4175 Date Ready/By' Juns ® See Page 2 for
1 1�`�} 1) Internet www ligard-or.gov A Notlfied/Method Su lemental Information
siTY OF TIGARI FEE* aCIEIEDUIE
TYPE OF WU12K�*^��y,��J�iLj�''l�ING DvS� '
En New construction ❑DSmofition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION. SFR(1)bath 312.70
❑! 1-and 2-family dwelling IIICommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(2151 sq.ft.) Page 2
JOB SITE INIFORMATI I® ® t t" • " 1 . " Site utilities:
,,. -.., ,.;1.1 Catch basin or area drain 18.76
Job site address:14406 SW 165th Ave.
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97224 / / i'4si Footing drain(no linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: P•lyg•n 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.:176-ADU 1 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESORPTION OF WORK
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
IR PROPERTY OWNFR ❑ 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
City/State/ZIP: Vancouver,WA 98660 Hose bib 25.02
Phone:(360 ) 695-7700 Fax:( ) Ice maker 12.51
❑ 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
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
CCB Lie.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: /max 71..._J TOTAL PERMIT FEE
Print name:Gavin Thomes Date:ll/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:A Budding VPermitsVPLMU-PermitApp.doe 10/01/09 440-4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Pee:
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
valuation: Permit
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
()flier specti ns�,r Fees ' g } atat 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 I r;Plua bi>ti tallations
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
-Jacuzzi/Whirlpool engineer.
ElCar Wash. Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR9 I 8-780-0040.
Cuspidor/Water Aspirator IDMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El 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: -Lay/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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
l II ~ Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 •503.718.2439 •www.tigard-or.tov
TO: Agnes Lindor DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Omar Alami Abouhafs
OCT 13an
COMPANY: Taylor Morrison
al FY OF TIGARD(I nn
PHONE: (360)946 8674 +HLDING ONISION'y:
EMAIL: OAIamiAbouhafs@taylormorrison.com
RE: 14410/14406/14408 SW 165th Ave MST2021.93t95/...00196/...06493
(Site Address) (Permit Number)
Polygon at Roshak Ridge lot 176
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. 3 Revisions: site plan+Details
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: Additional documents were provided with the site plan to resolve the waterline issue in the driveway.
FOROF CE USE ONLY
Routed to Permit Technicia . D . ‘k ty z1 Initials:
Fees Due: ❑Yes Fee Descr do - Amount Due:
�/ $
NI_o
Specialt Instructions:
Reprint Permit(per PE): ❑ Yes / No ❑ DoneApplicant Notified:7--- ----Date: ((12 `r)2/
L ( Initials: j
a+xawar: ra.tra.aarataav>axea f . uNfxNuuYuruaNasuaeiar +uu Yrx.aaYaY.taaauxtawi:tYt.i xte iHaNUHlaui3i4YWYY}Hfr{YMANIYatLaY:lNYlailsYiUiWUiitMtiiWYYltY.srAas .. . .. eraa 4vtvaa:tN aYYaueia Ye.etlt;vtefii l.Artult4 iirY x aaFut4tY5uNNia.-
y CITY OF TIGARD MASTER PERMIT
I. COMMUNITY DEVELOPMENT Permit#: MST2021-00196
Date Issued: 12/01/2021
T I GA R.D 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17600
Jurisdiction: Tigard
Site address: 14406 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 176
Project: Polygon at Roshak Ridge, Lot 176(1 of 2)ADUs
Project Description: New attached ADU. NO FINAL INSPECITON UNTIL SDC FEES ARE PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First 703 sf Basement: 503 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 4 Second: 945 sf Garage: 241 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2151 sf Value: $275,051.76 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 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: 5 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 ADU VB R-3 2151
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 Fire Rated Conditions
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
3 Geo Tech Report Required
Prior To Pour
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $19,286,01
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
ac9-nn1-nnl n fhrn,inh CAP oF9-M1-Man Vnn mot,nhfnin n nnnxi of fhc n!lac nr riironf ni.efinnc fn rN Ifklr by nallinn cnz 9'39'1�00,R�7' .a�n rr 1,,Ann'Iv)9'2dd
Issued By: Hotly Vaw D��nlege Permittee Signature: Ow AYIwt�
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 iob site at the time of each inspection.
, lo'Cr r2L
Building Permit Application
Residential RECEr Pr'' FOR OFFICE USE ONLY
City of Tigard MAY 1 1 2021 Received �. 2Maw
a—bd 4(f
,IDate/By: PermitNo.: Gv `'�t7
r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 2 q
Phone: 503.718.2439 Fax: 503.598.1960 CI OF TIGARD Date/By: '� Z� Other Permit: 1^
T I CARD Inspection Line: 503.639.4175 UIL�I i DIMS 1 ti l Date Ready By: Eris: See Page 2 for
Internet: www.tigard-or.gov �¢ tified/Method: /�/ c e Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. �f
Valuation: $ 215ei of! l!
❑❑ I-and 2-family dwelling Commercial/industrial 1
ElAccessory building El Multi-familyNumber of bedrooms: 3
❑Master builder ®Other: ADU 1 Number of bathrooms:o2'u if
JOB SITE INFORMATION AND LOCATION Total number of floors: 3 iS9 D-
Job site address: 14406 SW 165th Ave. New dwelling area: 2,151 square feet 49 tic
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 241 square feet 7o3
Suite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Covered porch area: 'p( square feet 5b.3
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 Lot no.: 176 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 home construction_Type: Triplex(Accessory Dwelling Unit 1) Valuation: $
Elevation plan: MH DL Triplex(A) 221803A Existing building area: square feet
Projected Start: September 2021 51 67s ✓J -(yz..,/ 7 New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:703 Broadway St., Ste 710 Occupancy groups:
City/State/ZIP:Vancouver, WA 98660 Existing:
Phone'(360)946 8674 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON 9 BUILDING PERMIT FEES*
(Please refer to fee schedule)
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) 946 8674 Fax::( )
E-mail: PermitSubmittals taylormorrison.com, AlamiAbouha s taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 710 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 Total fee due upon application: $201.60
Authorized signature: £2m4 4.1 6CL4/tG 4(T9G4/;LL�L� 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: 04/29/2021 *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
. City of rl igard s h„ . . , Received �jr— �^
Date/By, l, 2 t N Permit No Nisi--�t- (��
" 13125 SW Hall Blvd.,Tigard,OR 97223 Y 3 1 1 lJ��c �.�t t
1 MAY Ft Plan Review
Phone: 503.7 t A_2439 Fax: 503.598.1960 Date/By: Other Permit: QtOZ opt TitiAltl7 Inspection Line: 503,639.4175 DateRead B : Jurist_ Z�
Internet: www.ttgard-or.gov CITY OF T IGAi y Y0 See Page 2 for
NotiScdfvlethod: SupplementalInformation
BUILDING [IVlSfC:. _
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
- Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alterationlreplacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist
Multi-family ❑ Master builder ADU 1 Description _ Qty. Ea. Total _
®Other:
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 14406 SW 165th Ave. Furnace 100,000 BTU(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 waters stein 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.: 176 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
Accessory Dwelling Unit 1 fireplace 23.32
Log lighter(gas) 23.32 ,
- Wood/pellet stove 33,39
Wood fireplace/insert 23.32
Chimney/liner/Oue/vent 23.32
e PROPERTY OWNER 0 TENANT Other: 23.32 --
- Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510
- — — equipment 33.39
Clothes dryer exhaust 33.39
4
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
C. APPLICANT 0 CONTACT PERSON Other: 23.32 __
Business came:Polygon WLH,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
—' Walllsuspended/unit heater
City/State/ZIP: Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: (360)693-4442 Fireplace
Ranee
E-mail:permitsubmittalsttayi0M1OffiSOn.Cora
Barbecue
iVI CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address. NW Alociek Dr,Ste.1104
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00)~
Plan review(25%u of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
'�a lei n n vl days after it has been accepted as complete.
Authorized signature: w't�M * Fee methodology set by Tri-County Building industry Service Board
Print name:Elia Duran Date: 1 0/30/20
I.1RItilriirse1Prrontt ckhotrr Y.+mu 4nn rant 11,In. a.vi,.,rr r ranrrne rmrt:n
Electrical Permit Application RECEIVEDt a,,r I I t 11 I I ., (;\I
MAY 11 2021
City o Tigard o>;9r t 5 i? 21 laamitp- M ' 4 —co •
IN CITY OF TI AidD Plan RM ew
Phone: 503.7182439 Fax: 503.598. 1II DI G nlVR slOI', Rehired Nunn 4:514122)Z1-doe 23-
1- Inspection Lane: 503.639.4175 gay > :
Internet: www.tigard-ar.gov Nam;
- _ � k,A '7 k U.,1. ei i
®New construction 3�' , �„�.�C=�t i�irs�. ;.� �-;; ",,.� 'y� � �� �� .' r!` ar;3��i,
[0Addition/alterationheplacement rlamc cheek:uein amity(submit hats op w! a :
❑1)tl[lolitian El Other: CIService or fa over der 400 amps or more 1]Building or Afars wanes.
where the available fsvk cwreat C Mariam soid boatyards
,•' gteorde 10,00o wept at l so was Of Mimeos buildings
❑1-and 2-family dwelling 0 Com i nercial mdustrial 0 Accessory building less so lam or Nomads 14.000 ❑Commeroial.,.e agricahmat
❑Multi few ley 0 Master builder ®Other. ADU 1 amps for d1 other installations, beadier.
..- ,Y.. a.fi R,re
1awD �laoaof tsaR:vA a
• Job#: Job site address: 14406 SW 165th Ave • 1 cf
City/State/ZIP: Tigard,OR 97140 ❑Sue or more reaideatial traits.00HP or mom ❑ "I-2","13;
CI Health-e a facilities ❑Rural vehicle parks-
Sllite/bIdgiapt. Project name: Polygon at Roshak Ridge L7xamaem!maims. D supply voltage for more than
Crass street/directions to job site: El service or fader 600 amps or mar 6a10 valor nominal-
oasr:4re 1 off, I Serb 1 Teed f,.
New residential single-or irons-faa:Ry dwelRig unit.
Subdivision:Polygon at Roshak Ridge Lot#: 176 l adedes attached garage-
1,000 eq,ft.erlms 168.54_ 4
t,;. '�! r Ba.add'I 5(0 eq.S.munition 33.92 1
,; : t ,,
New construction. Type: ADU 1 (viola csq.lt) 7s.00 2
Limited
residential(wish bw R) 75.00 2 energy,multi- mily
n -CI
Rena wabh!iRaerzq D Ste Page 2
- - °liEn +a►#;' . . I -!�y.I INNOTT w Services orfeedRJi iestalladomodistalioll,sIMIk'rdocitloa
Name: Polygon homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to 400 amps 133.56 2.
City/State/ZIP: Vancouver,WA 98660 401 i id 600 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps rx volts 552.26 2_
Email: DAlemiAbtarhaf aylormcnrison.com PermilSubmittals(taylormarrlson.arm Temporary services erioxdeaa laetan.d0a,attention,and/or
Owner installation:This installation is being made on property that I own which is not 200 amps Of less 59.36 I
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature:
— Date. 401 amps to394 amps 168.54 2
APPLICANT J. p pzorrA cr'PE1tsl3N "'ma. t ireeils_sew,alterstiatg a d°14 Per Peed
Pee tar braaoh Ito trtDr
Business name: Polygon Homes WLH LLC above service or feeder tee,
each breach circuit 7.42 2
Contact name Omar ALrai Abouhafr B.Fee for branch circuits without
Address: 703 Broadway St,Ste 710service or Erecter fee,Eras 56.18 2
branch circuit
City/State/2 P:Vancouver,WA 98660 Each add'l bumph circuit 7.42 2
Phone:(360 )946 8b74 Fax:: Miscellaneous(service or feeder oat included)
( ) path manufactured a modular 67.84 2
dwemR °nnacr only
67.84 2
Email:OAlamiAboabals@taylormOrrison.com-Pe mitSUbmitlals(�tayylormorrison.corrt ec 'Oa• nl antra Eerier
CONTRACTOR y
Pomp or irrigation circle 67.84 2
Business name: Wallace Electric Sign or airline lighting 67.84 2
Address: 105 Dresden St Signal tea)or lsnuted cncrgy p age 2 2
panel,alteration,or cod Asian. LI We
City/SlattlLlP: Astoria,OR 97103 Each additional inspection over allowable In any of the above
Additional iospoctioa(1 hr min) ' 66.25/br
Phone:(503 3)8 0563 Fax:( ) Investigation(1 Iv min) 90.00/hr
Email: David@wallacewires.com Industrial plant
(I hr in) 78.18/hr
Inspections for which no fee is
CCB Lie.:224868 �ecbrical Li C1441 Su ,• 6363S IY listedO4 hr min) 90.00/hr
Suprv.Electrician signature,required: ,,w .,�-� '- t r;°''. ..•
Prim Hanle: �""� Subtotal:DAKI1Q t, , Date_ 13 Plan Review Required(25%of permit foe):
State sntxltasge(12%of permit fee):
Authorizedjitwo, TOTAL PERMIT FEE:
Print name: per appaeatin expires Ka pencil is net obtab *thi
s'ia ia0
)434
iD til4.41 Date. 4(/„zKd., n( a days ataer 1r bps be accepted as enmpiete.
1:'iaufldingranh tsl)W_PenutApp EI.R FRE,doc Rev 06/17/2013 ar CM r ,.�■,1111, limber of inspections allowed per permit.
Plumbing Permit Application.. p°�
Building Fixtures �°
FOR OFFICE USE ONLY
City of Tigard ��IAY 1 20�1 Received n Permit�7o
NI 13125 SW Hall Blvd.,Tigard,OR 9?22 DatelEty 5/13- 2( N� nc-c,2�, C7il19-C�
Plan Review
Phone: 503.718.2439 Fax: 503.598.t96IY OF TIGARD Other Permit Na: (-�(
DatetIIy: Z
Ins ection Line: 503.639.4175 ``'' �y --
TIGARD P C3��1 0 n�V�S¢{�h Date ReadyBy: lurks El See Page 2 for
Internet: www.tigard-or.gnv Notificd`Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
— . Description I Qty. I Ea. I 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
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building -Multi-family Each additional bath kitchen 25.02
❑Master builder Dit Other: ADU 1 1
Fire sprinkler(_ L
sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14406 SW 165th Ave Catch basin or area drain 18.76
Dry yell,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
Subdivision: Lot nc 176 Water service(no.linear ft.:_) Page 2
Fixture or item:
Tax map/parcel no.: Bac Blow preventer 31.27
DESCRIPTION OF WORK Backwater 12.51
Clothes washer 25,02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
l PROPERTY OWNER 0 TENANT Expansion tank 12.51
Nance: Polygon WLH,LLC Fixturc'sewercap 25.02
Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub _ 25.02
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 Interceptorigrease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Paget
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 —.
Sink/basint1avatory III 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
Email: Urinal — 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water piping'DVW 56.29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
CCB Lie.: 184372 -�-7-�� Plumbing Lie.no.:pb634
Plan review (25%of permit fee)
�:tia lr State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
L Print name:Steve Fowler Date: 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 sal by Tri•County Building Industry Service Board
t flsiida +Permits'PLhtti-PermitApp.doe 10,01,09 440-4616T(10+02,COMf WEB)
City of Tigard
:74 " COMMUNITY DEVELOPMENT DEPARTMENT
r c A R'D Building Permit Review — Residential
,.-
Building Permit #: N1ST'2c12.1.(Di q(i
Site Address: 14406 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 176
Planning Review eat 1. QF�N196bWS 4W)Th R.6Su_ ( 12 IS
Proposal: New attached ADU (ADU 1)
0 Verify address/suite#active in Accela. 0 In River Terrace: ❑ No 0 Yes,River Terrace Review Addendum
Site Plan Elements: erosion Control
12: copies of site plan on 8-1/2"x 11"or 11 x 17"paper .etained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) footprint of new structure(including decks)and FFE
12 orth arrow .Jtility locations&easements(required for new and additions)
Fite address,project or subdivision name and lot number r sidewalk/driveway approach
D pplicant information(name and phone number) Nip ,ocation of wells/septic systems
12 ot dimensions and building setback dimensions street tree size,type and location
Ii quare footage of buildings to be demolished '-treet names
NIP II xisting structures on site ororner elevations(2'contours if more than 4'differential_�
Iot 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
0 Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑No Received: 0 Yes ❑ No
0 Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified 0 No Received: Yes ❑No
❑ SDC Exemption for ADU applied for: ❑Yes ❑ No Received: Yes ❑No
CI Public Facilities Improvement (PFI) Permit:
Required: 0 Yes,applicant was notified ❑ No Applied For: 0 Yes ❑ No,stop intake
0 Land Use Case#: ADU2020-00024 0 Zoning: R-4.5
0 Required Setbacks: Front: 12 Rear: 15 Side: 3 Street Side: NSA Garage: 3
0 Building Height: Max. Height: 30 Actual Height: 25.5
`P Landsca e Area: N/A % `p Lot Coverage Max: N/A 0/0
Entrance ° Set back no more than 8'from street-facing wall 0 Parallel to street or offset 45 degrees or less
Windows Minimum 12%of area of all street-facing facades
Garage e door is behind widest street-facing wall ❑Yes , e o the following is met:
Doo nds no more than 5'from wall and there is re porch extending beyond garage.
i Door extends no an 5'from wall ere is a 12 sq ft.window above garage on 2*'d floor.
❑ Garage door width is 12' 50%or less of facade ❑ 60%or less and includes 7 of following:
Covered Recessed entrance offset 1'Roof cave ❑ Roof offset
ire shingles Lap Siding Roof itch or gambrel roof Dormer
Accent siding Window trim U Window recess Win o • tion ❑ Balcony
l itk Visual Clearance 0 Urban Fores Plan
Sensitive Lands: ❑ Yes No Type:
0 Conditions met prior to issuance of building permit
Notes:
El Approved By Planning: / .. Date: .� 13/21
Revisions (after�Buuilding Submittal on y) Revi wer ate
Revision 1: ,a Approved ❑ Not Approved 14
P 1 202,1
Revision 2: ❑ Approved CINot Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
.. s
Building Permit Submittal
Original Submittal Date: c/i Zo?,l
Site Plans: #
Building Plans: # _
Building Permit#: nter building ermit#above.
Workflow Routing: diPlanning Engineering Permit Coordinator [24uilding
Workflow Sign-off: 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
ginal plan review routing form.
5 Building: original permit'application,site plans,building plans,engineer and
beam calculatio s and trust details,if applicable,etc.
Notes:
By Permit Technician: Xl/14-
-- Date: 3/7 A
Engi eering Review
Slope at building pad: 3 I
Conditions"Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
(u Water Quality/Quantity Facility:
V 17}�
Assess Water Quality Fee in-lieu: CIYes Er No
Assess Water Quantity Fee in-lieu: ❑ Yes INo
LIDA Facility on lot: ❑ Yes liKo
5Mal Plat Recorded:
U NOT Approved by Engineering: Date: ..g'-' 1/'v
Notes: ,e2/4E..7 t / ler,i e.k. .
IIKApproved by Engineering: Date: ld/2s-z/
Revisions (after Bui mg Submittal only) eviewer Date
Revision 1: Approved ❑ Not Approved /oq�s/z/
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
,Conditions "Met"prior to issuance of building permit
Approved,NOT Released: see ,rt4 a --P s/74204 Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
2 SDC Exemption: CI Received Received , Does not a-41y
2te.SDC Fees Entered: Wash Co Trans Dev Tax: g Yes J N/A
Tigard Trans SDC: 2(Yes ❑ N/A See, . _ 4 D
Parks SDC: Yes CI N/A P
LIDA I Yes 2-N/A
,Er-OK to Issue Permit
Approved by Permit Coordinator: Date: 10 tag iv i't
I:\Building\Fomts\BldgPennitRvw_RES_122419.docx
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G n xn River Terrace Building Permit Review Addendum
Building Permit #: mo--2r - 00(C
Site Address: 14406 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 176
(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? El Yes 0No (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 ft. deep min. 2ft., 5 ft.wide min. 2 ft.,Eft.wide Gable. .ormer
■ 0 0 0 0
2. Eyes on the str• : a minimum of 12%of each street facing facade must include windows • entrance doors.
Percentage Shown:
3. Entrances:At least one e ance must meet both of the following standards:
ElMax. 8 ft. setback from longer trees-facing wall El Parallel to street, • gle no more than 45° from street,
or open onto por
Entrance opens to a porch: ❑Yes ■ o
IfLes,all the following apply: El25 sq.ft. 'n.
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 ■ Dormer min. 4 ft.wide
❑Roof eave min. 12 inch projection ❑Re., offset min.of 2 ft.
❑Roof shingles either tile or wood ❑Gable, •'p 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 1/2"wide by 5/8"deep
❑Window recess min. 3 inches for .i 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 El 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: ,s--A 7 /2
1:1Building\Forms\BldgPermiRvw_RES_RT_121417.docx
City of Tigard
Deferral Until Occupancy Request
T l GA R D Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
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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: 10/26/2021 Site Address: 14406 SW 165th Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00196
Name: Building Permit#:
Tax Lot Total Parks
2S107AA17600
#: Lot 176 Amount*: $5,652
TDT Total TSDC
Amount: N/A Amount*: $211
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$211 for TSDC-
Reimbursement,and$ 0 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$4,576 for Parks-Improvement,$1,076 for Parks-
Reimbursement,and either$ 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: Dfii 't-4 unu-.46ai4 Date: 10/26/21
Developer: Dlx�u.egga,ha.cQ6eliita Date: 10/26/21
Permit Coordinator: AIWA oelfrani Date: 10/26/2021