Permit m
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.
711 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
l t E:i) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: CLAN I N THoMES MAR 2 3 2022
COMPANY: D<<-UANC- auMBI NC,
GITY OF TIGARD
PHONE: (So3) 577-4953S BUILDING DIVISIONNBY. ict
EMAIL: &psAI'NO AI-LIA N c£Pt-um BIn16• Nei'
RE: 14y to SW A'STH- ,6.'6. MS-rZo2t— OO195
(Site Address) (Permit Number)
RoS+t f IN/NOV/WE LOT rib (SFu)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 2— Revisions: FICLE SPR►,3 .L-ER—
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: BASSM£N? DAMS 'Qfsn EVE b , Rao r RI N6 N.vW DEs160
FOR O41fiCE USE ONLY
Routed to Permit Technician: Date: 4'/i t `a- Initials: A C. (s-7
Fees Due: ❑ Yes No✓Fee Description: Amount Due: .-
$ U
Special
Instructions:
Reprint Permit(per PE): ❑Yes ►' o ❑ Done
Applicant Notified: Ve.4--- Date: ---19 .2.2 Initials:
Plumbing Permit Application
Building Fixtures RECEIVED I OIZ ()IA 1( I l si.. 0NI
City of Tigard Received
`� a Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 MAR 2 2022 Date/By: is_
OS)`ate` A 66
_, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 :/•-./e/-.9a A(� Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARV Date/By:
I!GAR l) Date Ready/By tuns ® See Page 2 for
Internet www.tigard-or.gov 1LPWG D V1SIO, , Notified/Method. Supplemental Information
TYPE OF .,' 114sF FEE* sof twat,
❑■ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑Q 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath kitchen 25.02
❑Master builder 0 Other: 4t
Fire sprinkler(� sq.ft.) Page 2
JOS SITE INFORMATION'AND LOCATION Site utilities:
Job site address: 141110 sW i b ST ONE
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.: l Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: t't(O Fixture or item:
Tax map/parcel no.: (sFJ) Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
'-`f MULTIPURPOSE FIRE SPRINKLER SYSTEM (""" Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROP1RtY-:O 'ER" j Cl 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
0 APPLICANTCONTACT 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
CONritACTOR'.
Water heater 37.52
Business name:Alliance Plumbing, LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( 503)492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
State surcharge(12%of permit fee)
Authorized signature: F ,,Z__. ,'
TOTAL PERMIT FEE
Print name:Gavin Thomes Date:3.22.2022 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.\Building\Permits\PLMU-Permit App.doc I0/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
She Ut lilies. Qty. Fee(ea) 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 Valuation• ,
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
Other ntee o s or Fees Q' . Fie(ea) 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*. Ian Re'vi , oellOIIIMInstallations
Quantity by Fixture'Isype Plan review is required for any of the following.
alb. ' E... Replaee/ Please check all that apply.
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.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ 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 Pkagram
❑ 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:
l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
CITY OF TIGARD MASTER PERMIT
' II.1. COMMUNITY DEVELOPMENT permit#: MST2021-00195
TtGART7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 WWII Date Issued: 12/01/2021
Parcel: 2S107AA17600
Jurisdiction: Tigard
Site address: 14410 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 176
Project: Polygon at Roshak Ridge, Lot 176-Primary dwelling & (2)attached ADUs
Project Description: New primary dwelling with(2)attached ADUs. NO FINAL INSPECTION UNTIL SDC FEES ARE
PAID. 5/1622: REPRINT to add fire sprinklers.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 987 sf Basement: 614 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 4 Second: 1440 sf Garage: 459 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3041 sf Value: $394,570.56 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 7 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
Bcktlw 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: 8 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 1
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 5 201-400 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 3041
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: $32,038.54
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 r uires you to ollow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
ac9_nni_nn1n thrni inh f1GR 9_nni on .mmr nhfei r f the r„lac nr rlircrt ni mcfinnc to(11 INC hs,,.Ilinn cn3 979 10R7 nr 1 Ann 7'39 97dd
Issued By: w nn Permittee Signature: 1 e 404,/°.// -1.j
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 d
r f ' d- ' /_,I
Building Fixtures RECEIVE
Cityof Tigard Received
g qq9 Date/By: Permit No.: MST2021-00195
11111 • 13125 SW Hall Blvd.,Tigard,OR 97223 NOV�� LQGB y //,,, (//1
O.
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 A,! Other Permit No.:
Inspection Line: 503.639.4175 Date/By: /W/1 /2j its.W
((t;q R(� CITY 1 OF TIGARL Date Ready/By. loos: ® See Page 2 for
Internet: www tigard-or.gov otified/Method Supplemental Information
UILDING DIVIS1()4
TYPE',OF WORK FEE* SCHEDULE
❑■ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY.OF CONSTRUCTION ' ' SFR(l)bath 312.70
■ 1-and 2-familydwellingSFR(2)bath 437.78
❑ ❑Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(3041 sq.ft.) Page 2
JOB SITE INFORM ATIO .. 1 .. Site utilities:
'
�7 Catch basin or area drain 18.76
Job site address:14410 SW 165th Ave. 1' ''
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.: 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
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:176-SFU Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
IDESCRW ION OF,Wow Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PRE Y OyNER 1 ' 0 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 iit, 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
Businessname:Alliance Plumbing, LLC Water piping/DWV 56.29
Address.146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( 503)492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
State surcharge(12%of permit fee)
Authorized signature: �� 7 TOTAL PERMIT FEE
0/2021 This permit application expires if a permit is not obtained within 180 days
Print name:Gavin Thomes Date:l(/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:V Budding V Permits VPLMU-PermiiApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities --Fee � 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-I st 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
Tull each additional$100.00 or fraction thereof,to
Other� R ' rem 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 S25,001.00 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 RQvi y ft r;Plumbing Installat ons
Quantity by Fixture Tye 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 El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ElMedical 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
❑ 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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
IN
CITY OF TIGARD MASTER PERMIT
COMMUNITY' DEVELOPMENT Permit#: MST2021-00195
T I L A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2021
Parcel: 2S 107AA17600
Jurisdiction: Tigard
Site address: 14410 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 176
Project: Polygon at Roshak Ridge, Lot 176- Primary dwelling & (2)attached ADUs
Project Description: New primary dwelling with (2)attached ADUs. NO FINAL INSPECTION UNTIL SDC FEES ARE
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 5 First: 987 sf Basement: 614
sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 5 Second: 1440 sf Garage: 459 sf Front: 12
Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 3041 sf Value: $394,570.56 Rear: 15
PLUMBING
Sinks: 1 Water Closets 5 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 7 Dishwashers 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: Storm Sewer 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 0
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: 8 Clothes Dryers: 1
r.
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!500 sf: 5 201-400 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 3041
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: $25,940.58
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
oc9-nni nnin thrn,inh nAR Qri9-nnl-nnQn Vro,mw nht2in n rnnv of the ndee nr rl irert niieefinnc fn ni IAIr by Tallinn crM 039 1027 nr 1 Ron 419,ndd
Issued B Ho�,ly Va4A,De.Wege. Op,,AY: Permittee Signature:
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.
LOT /76
Building Permit Application RECEI !/ '3-S/I 1l2
Residential ED FOR OFFICE VSL ONLY
City of Tigard MAY 11 2021 ate,d A h01
Date y: 5 Iv` Permit No:n ISIV:521_ pl�
• 1312hon S Hall vd Tigard 223 PlanDate I 13 Z I Alit- '"`��''�-,N ria-00129-
III
� Phone: 03 18 243 Fax: 03 81 60 CITY OF`l�lGARD Date ther Permit.t�JK�
y:
TIGARD nspection Line: 0363 41 BUILDING !) 'JISSION Date eady y: y uns El See Page 2for
ntemet: www tigard or gov No'' d Method: �') /r,df Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit ees are based on the value o the work per ormed
ndicate the value(rounded to the nearest dollar)o all
❑Addition alteration replacement ❑ ther: e uipment materials labor overhead and the pro it or the
CATEGORY OF CONSTRUCTION work indicated on this application S�
® 1 and 2 amily dwelling 0 ommercial industrial aluation: $ - aZq�'L"�Q t —
❑Accessory building El Multi amily Number of bedrooms: 5 7 1 J
❑Master builder ❑ ther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:3 356
ob site address: 14410 SW 165TH AVE New dwelling area: 3,041 S uare eet 6 C f l/O
ity State P:Sherwood, OR 97140 arage carport area: 459 s uare eet ei
tal
Suite bldg apt no: Project name:Polygon at Roshak Ridge overed porch area: s uare eet V I,l Li
ross street directions to job site: Deck area: s uare eet
ther structure area: s uare eet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge 1 Lot no: 176 Permit ees are based on the value o the work per ormed
Tax map parcel no: ndicate the value(rounded to the nearest dollar)o all
e uipment materials labor overhead and the pro it or the
DESCRIPTION OF WORK work indicated on this application
New home construction_Type: Triplex(SFU) aluation: $
Elevation plan: MH DL Daylight Triplex(A)222003A / Existing building area: s uare eet
Projected Start: September 2021 CS 4��r. /// New building area: s uare eet
0 PROPERTY OWNER ❑ TENAh Number o stories:
Name:Polygon Homes WLH LLC Type o construction:
Address:703 Broadway St., Ste 510 ccupancy groups:
ity State P:Vancouver,WA 98660 Existing:
Phone:(360 946 8674 Fax:( )360 693-4442 New:
® APPLICANT ❑ CONTACT PERSON Vi9 BUILDING PERMIT FEES*
(Please refer to fee schedule)
usiness name:Polygon Homes WLH LLC Structural plan review ee(or deposit):
ontact name:Omar Alami Abouhafs
FLS plan review ee(i applicable):
Address:703 Broadway St., Ste 510
Total ees due upon application:
ity State P:Vancouver,WA 98660
Amount received:
Phone:( )360 695-7700 Fax: :( )360 693-4442
E mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
ommercial and residential prescriptive installation o
CONTRACTOR roo top mounted Photo oltaic Solar Panel System
usiness name:Polygon Homes WLH LLC Submit two(2)sets o roo plan with connection details
and ire department access along with the 2010 Oregon
Address:703 Broadway St., Ste 510 Solar Installation Specialty Code checklist
ity State P:Vancouver, WA 98660 Permit Fee(includes plan review 180 00
and administrative ees):
Phone:( )360 695-7700 Fax:( )360 693-4442
State surcharge(12 o permit ee): 21 60
lic:207247 Total ee due upon application: 201 60
Authori ed signature: 7hi4h Warn":,eq A9GdsnG6. This permit application expires if a permit is not obtained
f1 within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 04/29/2021 *Fee methodology set by Tri ounty uilding ndustry
Service oard
: uilding Permits UP ESPermitApp doc 02 24 2011 440 4613T(l 1 02 M E )
Mechanical Permit �Lpplicatip� �^.Fr ' ., FOR OFFICE USE ONLY
City of Tigard Received +�
IIII11 13125 SW Hall Blvd. Tigard,OR 97223 4 Date/By_ SA ti 2.1 Permit No Vie t20A-C1O(q�
Phone: 503.718.2439 Fax: 503.598.1960 fli1A( 1- " I- 2� Plan Review `Jf.`^ t
Date/By: Other Permit:A IY"202.1-60 (21-
7 i{i A 1�1? Inspection Line: 503.639.4175 Date Rcad,B luris ` '
Internet: anew tigard-or.gov CITY lG1�RD Notit edRvlathud See Page 2 for
BUILDING DIVISION Supplemental Information
TYPE OF WORK BUILDING
COMMERCIAL FEE* SCHEDULE - USE CHECKZIST
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*
® 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 Heatinrlcoolin„:
Air conditioning ( 46.75
Job site address: 14410 SW 165TH AVE Furnace 100.000 BTU(ducts/vents) 46.75 i
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 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-
New construction:Triplex(Single amily unit)
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
�_____-._-_--_-- —�__ Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney Other:
23.32
G PROPERTY OWNER 23.32
- -- • TENANT Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.39 I
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
® APPLICA.NT 0 CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
514.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address 703 Broadway St.,Ste 510 Gas heat pump
WalL/suspended/unit heater
City/State/ZIP: Vancouver,WA 98660 Water heater _
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permitsubmittalstaylormorriSOn.CO111 Barbecue
iNk CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES'
Address: NW'Alociek Dr,Ste.1I04
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
t This permit application expires if a permit is not obtained within 180
&
t days after it has been accepted as complete.
Authorized signature. v wa I\+ . Fee methodology set by Tri'County Building Industry Service Board
Print name:Elia Duran Date: 1 0/30/20
r\a.,,i,,,,,,w,,„.,,m N.rn,i,Aw,Aim 1IAn,
Electrical Permit Application
RECEIVED______________________________
City of Tigard MAY 11 20,i Received A t r- e- A /
' Dlesal.Y- iN•t ..) / 19-/2 I 06n2i4 0- Ntr'20Z-0 CA Cl r
,1114....- 13125 SW Hail Blvd.,Tigard,OR 97223 o, Plan Review
' Phone: 503.718.2A39 Pax: soa.s981960CITY OF TI GAR.) Dotesy, RobtedPennit it:sostitat-cop-4,
Inspection Line: 503.639.4175 3 LADING DIVISION Ready Datifity Sok I 0 Set Pap 2 for
hrtemet: vtrActigard-or.gov Notified/Method: Sappleseeinal lieformitlien
New construction 0 Addition/alteration/replacement Nesse diedc all that apply(submiti sets ofpkos wfirome cbseked):
0 service or feeder 400 amps or more nlitaildiag OM three stories.
0 Demolition 0 Other:
where**available fault eurrent filiferims' and boatyards
',i'it:''''.;`,._:- . "- ; • .C414900014,1•;,00111171#40rr,, , , ,.,rfayiri-t,,, ,t1 ex.dt mow amps at 150 volts or CIPloirting buildings
IKI 1-and 2-family dwelling 0 Commerciarmdustrial 0 Accessory building km tei paisid,or exceeds 14.000 CI Gornmercialnee agricultural
amps for A other installations, beadier.
0 muhi-family 0 Master btulder 0 Other: Ofire pomp CI lanallation 01150 ICVA ar
%.fr:..494:41.4.;*400**4114S1.**loOt* 01,1: ' ' -7'1.-' .13Eacr8"""rn e keen separately derived
. U Adder:km of new mum load of system.
Job#: Job site address:14410 SW 165th Ave 10011P or mops. a"A,"E",-1-2-,-1-3-,
City/State/JP: Tigard,OR 97140 a Six at more resideatial U . occupancy_
Dik.lih.....facilities. 0 Recrestionel vehicle parks.
Suite/bldg./apt.8: Project name: Polygon at Roshak Ridge 0/f1ard0ns location 0 Supply volume for more than
0 Seance sir feeder 600 amps or mem. 600 yobs nossinal.
Cross street/direct:Mr' ts to job site MCSIVICittiOITZWC-; s.1
.-0t,. Seth rtad r•
New residemdal single-or lindti-lually dwelling unit.
subdivision:Polygon at Roshalc Ridge Lot#: 176 Modes attached garage.
T 1,000 sq.lt.or keg 168.54 4
ax map/parcel#:
Es.adtri SOO sq.a or portion 33.92 1
'f:ii.7314,V"tie-141.1.CAl.'. '' .-- - *COMO...M4170.4.4..,tai.t . i.ii.4....-;:",a'r;; Linked=orgy,residsotiel
75.00 2
(svith above sq.0.)
New construction.Type SFU
, LimtMd energy,multi•family
75.00 2
nosidentiel(with above sq.ft.) . .
r . . .
0 See Pate 2
-itgaewabkor larva
feeders lastallattosiqdbrallos,and/or relocation
Name: PolygonHomes WLH LLC 200 naps or loss 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to 400 amps 133.56 2
401 imps to 600 amps 200.34 2
City/State/Z1P: Vancouver,WA 98660
601 amps to 1,000 auirt 301.04 2
Phone:(360 )9445 3674 Fax ( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installition,altetution,andior
Email: 0AlamiAbauhafs@iaylormosrison.com-PermitSubtnittals@taylotmotrisomoom rejocrigun
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 , 1
intended for sale,lease,reit,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08, 2
Owner signature: _ Date: 401 amps to 599 amps 168.54 2
Arnicorr ::1.4.,n,,,.:,y,.,ist,,,roodirr,rutsoN . , Branch tiros&-new,alteratioi,or extension,per panel ,
A.Pee far branch circuits with
Business name: Polygon Homes WLH LLC above service or fender fee.
7.42 2
cart branch circuit
Contact name: Omar Aland Abonhafs
B.Fee for branch circuits without
service or feeder fee,first
Address: 703 Broadway St,Ste 710 branch circuit 56.18 2
City/Stale/ZIP:Vancouver,WA 98660 Each addl branch circuit 7,42 '
2
Miscellaneous(seri/lee or-feeder not included)
Phone:(360 )946 8674 Fax::( ) Each manufactured or modular
67.84 2
dwelling,service ancd=
' Entail:0AlatniAbouhafs@taylormorriscacom-PCIIIIIISUNTlinalF011YiCITMOITiS011.Corn Vor foo
0.,onty '
67.84 2
.- -.' - ". -• --C,ON'IrNACTON ' - Pump or origami=circle 67.84 2
Business name: Wallace Electric Sip or outline lighting 67.84 2
Spat cireuit(s)or limited-eacrgy ..., -
Address: 105 Dresden St
panel,alterahon,or extension. LJ MC raEc 2 2
City/StatefLW: Astoria,OR 97103 Each addln inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr ,
Phone:(503 3)8 0563 Fax:( ) Investigation(1 la min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr Email: Davidgwallaccwires.com -
Inspections for which no fee is
00/hr
CCB Lic.:224868 El .---errical Li • C1441 j S .1: 90.
.* 6363S specifically listod(Si hr rnin)
Suprv.Electrician signature,required: ade.-/ Subtotal: _ ..
Print name:Milo iD 5 c,f, Date: 1:1 Plan Review Requited(25%of pemiit fee): 1
)Authorized signature 7
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
This permit application expires if*permit is set ebtaitied width'180
Print WW2: 211440 IA iiatt.twite Date: rift Ai days after it Sias bees accepted as complete.
• Number of impactions allowed per permit.
Plumbing Permit ApplicatiotRECEI\ED
Building Fixtures a.a,V 11 2021 FOR OFFICE USE ONLY
City'of Tigard Rcccived Permit No.:
•
tt 13125 SW Hall Blvd.,Tigard,OR 97223CIl Y OF T IGARD Date'By: 5111-�Zp2t or tyt- 1A2i-c o cts-
N Plan Review �,�(��)Phone: 503.718.2439 Fax: 503.598; (_dII�IIvI�w"DIVISION• Other Permit No.: <�r"12' i 1Z�-
DatelBy: i
T[GARD Inspection Line: 503.639.4175 Date Ready/By; fors: 0 Sec Page 2 for
Internet: www.tigard-ocgov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New constriction ❑Demolition For special information use checklist.
Description I Qty. I Ea. J 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 ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory %�-Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14410 SW 165TH AVE Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18J6
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:fmokokoRiriL..Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
•
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Polygon at Roshak Ridge Lot no.: 176 Fixture or item: _
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New Single Family Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
_
El PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon WLH,EEC Fixture'sewer cap 25.02
Floor drain/floor sink(hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660
Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Paget
Contact name:Tonja Morris Primer 12.51
--- Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 � _ Solar units(potable water) 62.54 I
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:C&B Plumbing&Sons Inc Water P1n 'iP I'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
Authorized signature:
' C --�3L�tJ' State surcharge(12%of permit fee)
_ TOTAL PERMIT FEE
Print name:Steve Fowler Date:
10/30/20 This permit application expires if a permit is not obtained within INdays
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board,
I:SBuiidin&`•Percnits`PLMU-PecwitApp-doe I0/Si05 440.4616T(10'02/COM'WEB)
•
t
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
■
1 A h I) Building Permit Review — Residential
Building Permit #: MC,1-9..0'j.l - pQ i %
Site Address: 14410 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 176
Planning Review vftv. 1 ASEbSt% 1411) QE'( VIFirceMS
Proposal: New detached dwelling
❑o Verify address/suite# active in Accela. ❑o In River Terrace: ❑ No ❑.• Yes, River Terrace Review Addendum
Site Plan Elements: rosion Control
11 copies of site plan on 8-1/2"x 11"or 11 x 17"paper detained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) Footprint of new structure (including decks)and FFE
112 orth arrow ,,Jtility locations&easements(required for new and additions)
Fite address,project or subdivision name and lot number v sidewalk/driveway approach
111pplicant information(name and phone number) 0 ocation of wells/septic systems
ot dimensions and building setback dimensions Street tree size,type and location
Avp �1 Square footage of buildings to be demolished I,treet names
,`"1� 11 xisting structures on site °,'orner elevations(2'contours if more than 4'differential
1 ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? "es o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° o
QClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑r No Received: ❑o Yes ❑No
❑e Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ❑ No Received: ❑o Yes ❑ No
❑ SDC Exemption for ADU applied for: ❑Yes ❑ No Received: ❑Yes ❑ No
❑o Public Facilities Improvement(PFI)Permit:
Required: ❑r Yes,applicant was notified ❑ No Applied For: ❑o Yes ❑ No,stop intake
❑.• Land Use Case#: SUB2015-00004 ❑ Zoning: R-4.5
❑r Required Setbacks: Front: 12 Rear: 15 Side: 3 Street Side: NSA Garage: 3
Building Height:Landscape Area: NM Max. Height: 30 Actual Height: 25.5
% Lot Coverage Max: N/A 0/0
Entrance v Set back no more than 8'from street-facing wall ❑r Pa allel to street or offset 45 degrees or less
Windows v Minimum 12%of area of all street-facing facades
Garage a or is behind widest street-facing wall Yes ❑ No,one of the following is met:
Door exten s re than 5' from wall and there is a covered porc beyond garage.
Door extends no more than all and there i sq ft.window above garage on 2nd floor.
0 p' ❑ Gara e door width is 12'or less o facade 60%or less and includes 7 of following:
Covered porch e entrance ❑Wall offset ' oof cave ❑ Roof offset
❑Fi es Lap Siding Roof itch ❑ Gable,Ao,or gam oof Dormer
Accent siding Window trim U Window recess U Window projection alcony
Visual Clearance ❑• Urban Forestry Plan
RIA
Sensitive Lands: ❑ Yes LI No Type:
CIConditions met prior to issuance of building permit
Notes:
0 Approved By Planning: > Date: .L/1 7/21
Revisions (after Building Submittal on y) eviewer Date
Revision 1: ,Approved ❑ Not Approved tot(1-.I`20 2
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
r
t
Building Permit Submittal
Original Submittal Date: S/ii ASite Plans: # ,
Building Plans: # 3
Building Permit#: Enter building t# above.
Workflow Routing: Planning Engineering Permit Coordinator kl 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
Uoriginal plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: /� Date: S /7- Zi
Engineering Review
M Slope at building pad: 37
d
0/Conditions"Met"prior to issuance of building permit
pEasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility: �22�
Assess Water Quality Fee in-lieu: ❑ Yes I'No
Assess Water Quantity Fee in-lieu: ❑ Yes r 1•
LIDA Facility on lot: ❑ Yes L No
l'F al Plat Recorded: --- —
(/J NOT Approved by Engineering: Date: 77,/2�
Notes: /`7l ve 4 iP - 1- e.4Ae 1. C riV Q./'C1
r,
�,�
d Approved by Engineering: Date: `lj__<-- 2J
Revisions (after Budding Submittal only) Reviewer Date
Revision 1: I'Approved ❑ Not Approved /Y��..._7Z/
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
Approved,NOT Released: see cpftf,i.,.,.fa kok,c — /fit. 61241264 Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
2,12'SDC Exemption: ❑ Received El/Does not a ly n,,r-_
SDC Fees Entered: Wash Co Trans Dev Tax: 'Yes U N/A SC>! 1'C`S �
Tigard Trans SDC: ,-Yes ❑ N/A
Parks SDC: 2-Yes ❑ N/A
LIDA ❑ Yes a N/A
OOK to Issue Permit
Approved by Permit Coordinator: Date: VC)I2(0`2-‘3Z1
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
s
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
III
T 1 C;A RD River Terrace Building Permit Review Addendum
Building Permit #: Mc c o2 -Ob 1°LS-
Site Address: 14410 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? ❑Yes 0 No (Per MMD2020-00044) '
Articulation: a minimum of 1 element per each street-facing façade 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. dee Balcony w/ access 2 Window Projection Vertical Wall Offset a
P ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gable. .oomer
I ❑ ❑ 0 El
2. Eyes on the str• : a minimum of 12%of each street facing facade must include windows . entrance doors.
Percentage Shown:
3. Entrances:At least one e ance must meet both of the following standards:
❑Parallel to street, . gle no more than 45° from street,
El Max. 8 ft. setback from longer trees- facing wall
or open onto por
Entrance opens to a porch: ❑Yes 111 o
IfUes,all the following apply: ❑25 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 I Recessed entry area min. 5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches ormer min.4 ft.wide
❑Roof eave min. 12 inch projection DR., offset min. of 2 ft.
❑Roof shingles either tile or wood 0 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 0 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 '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 .ide lot line,than longest street-facing wall. ❑Yes ❑No. If No (Check o - :
❑May extend u. 0 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
0 May extent p to 5 ft.where the garage is part of a two-story building and there is a window at the se . d story
above the t..age that faces the street with a min. area of 12 sq.ft.
Width. heck one)
❑ -foot-wide garage door ❑40%max. of street façade
I 50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: 44 -} Date: S-- A 9/2(
I:\Building\Forms\BldgPennitRvw_RES_RT_121417.docx
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
Ilq
_ U Transmittal Letter
T I G A R C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Agnes Lindor DATE RECEI
DEPT: BUILDING DIVISION RECEIVED
FROM: Omar Alami Abouhafs ocT 1 3 Ell
COMPANY:Taylor Morrison CITY OF 1(Umi-
PHONE: (360)946 8674 3UIL0IW( (1n/ISKBy:
EMAIL: OAIamiAbouhafs@taylormorrison.com
RE: 14410/14406/14408 SW 165th Ave MST2021-00195/... ...
(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.
FOR OFFICV USE ONLY
Routed to Permit Technici D . 1 l 119 -Zvi Initials:
Fees Due: ❑Yes [✓ o Fee Description: Amount Due:
C//\_.) 0 N $
$
Special
Instructions: //
Reprint Permit(per PE): ❑Yes o /� ❑ Done
Applicant Notified: �te: (0---1-- L-/ Initials:
Water Meter Fixture Unit Worksheet For New Buildings
i' ,^''.( 1 A 2 021
Please complete the following information:
Ci I t..lr- lUtl iri0
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:
New Meter Address: 14410 SW 165th Ave(SFU)- 14406 SW 165th Ave(ADU 1)- 14408 SW 165th Ave(ADU 2)
Subdivision Name: Polygon at Roshak Ridge Lot#: 176
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 ADU1 ADU2 Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer I 1 1 3 x 4 = (2
Dishwasher I ( t '3 x 1.5 = 4
Hose bib, 1st one 1 t 1 3 x 2.5 = 7.
Hose bib, each add'! t .4 x 1 =
Kitchen sink 1 I 1 3 x 1.5 = 4(5
Laundry sink x 1.5 =
Lavatory -1-- S j _ x 1 = /6j
Water closet, 1.6 GPF it ) g x 2.5 = 26
Bathtub/whirlpool x 4 =
Shower stall o2 1 1 (_ x 2 = q
Bath/shower combo 9_ k I if x 4 = 4
Total Fixture Unit Points: S 9
Fixture Unit Points:
ito30=5/8" 37.5to89= 1"
30.5 to 37 =3/4"
Meter Size: 1" Meter Cost: $ .24, 0 p A G. 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
al Deferral Until Occupancy Request
TI GAR 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: 14410 SW 165th Ave
Project Polygon at Roshak Ridge Land Use Case or MST2021-00195
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: Dhco.a.Wa-yiao.R6ewAtise- Date: 10/26/21
Developer: Om.44,.R kultb. eeadii Date: 10/26/21
Permit Coordinator: Date: 10/26/2021