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
Ill
Transmittal Letter
r , ,;1.it r n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: ITO 1 4tw"*A 5 E7Z"— DATE RECEIVED:�/
DEPT: BUILDIN IVISION RECEIVED ED
JUPd 2 2 ?Pr,
(:5h4s CITY OF TIGARd
COMPANY: < t{ �1 ON BUILDING DIVISION
Si3
4!�(, �PHONE: ) 1� �j By:
EMAIL: %10413i-c>1 WIAt310'ivtier\ CPAA �� ✓
t�� Q V�1'v ke �Sc�?A (90 IA
vole;
RE: t �"L Number)
(SiteAddress) (Permit
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
l Copies: I Description: I Copies: I Description:
Additional set(s)of plans.
Revisions: CaaCit s Y t—C�ti ea'0
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:
FOR OFFICE USE ONLY
RoUteto Permit Technician: Date: 6- ,13- z_\ Initials: 11
-- Amount Due:
Fees Due.
Yes ❑No Fee Descri tion: $
s > r ploi rti.i /
$ .
$
$ .
Special
Instructions:
Reprint Permit(per PE): ❑Yes No []Done
Applicant Notified:Al,,e Date: 7,1i,g/2} Initials:
I:\Building\Forms\TransmittalLetter-Rev sions_ 311d.doc
Plumbing Permit Application / 1 -g
Building Fixtures FOR OFFICE Fst: ()NIA
City of Tigard 'eceived
g Date/By: ��/��r �- PennitNo. MST2021-00191
III ta 13125 SW Hall Blvd.,Tigard,OR 97223 NOVr t gnryq Plan Review
_ Phone: 503.718.2439 Fax: 503.598.I%t) i 7 GULN Date/By: / /13f9/ 464, Other Permit No.:
T I(;A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARL Notified/Method: Supplemental Information
TYPE OF WORK BUILfINfi''n{vIsION FEE* SCHEDULE
0 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 C'ONstior'HON SFR(l)bath 312.70
❑■ I-and 2-family dwelling SFR(2)bath 437.78
y g ❑Commercial/industrial
❑AccessorybuildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(2408 sq.ft.) Page 2
JOB SITE INFURMATION wt s ` , t Site utilities:
Job site address:14398 SW 165th Ave.
Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97224 ( / , ( ,:fii Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
l Suite/bldg./apt.no.: I Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
ICross 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: [t no.:175-SFU Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF'WORK
Backwater valve 12.51
.. Clothes washer 25.02
'I MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
-
Ejectors/sump 25.02
®;PROPERTY,OWNER I 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
1 Phone:(360 ) 695-7700 Fax:( ) Ice maker 12.51
1 0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliance Plumbing, LLC
Medical gas(value:$ ) Page 2
Primer12.51
Contact name.Gavin Thomes Roof drain(commercial) 12.51
i Address:146 W Historic Columbia River Hwy sink/basin/lavatory 25.02
City/State/ZIP:Troutdale, OR 97060 Solar units(potable water) 62.54
Phone:( 503)577-6535 Fax::( ) Tub/shower/shower pan 12.51
E-mail: gavin@allianceplumbing.net Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Alliance Plumbing, LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( 503)492-3490 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
State surcharge(12%of permit fee)
Authorized signature: V TOTAL PERMIT FEE
Print name:Gavin Thomes Date I I/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.
iA Building VPermitsVPLMU-PermitApp.doc I0/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee tea) _ 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: 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
• each additional$100.00 or fraction thereof,to
Other bons Feee feat Total and including$10,000.00.
Inspection of existing plumbing or for $10790}•4)04p V5,000.00 $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) .u,:_ 4 and including$25,000.00.
Inspections outside of normal business 90.00/hr ,$25,001.00 to$50,000 0 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) - each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 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
0 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./Retrig.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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/20I1 2
'PI CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2021-00191
T I G A R[) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2021
Parcel: 2S 107AA17500
Jurisdiction: Tigard
Site address: 14398 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 175
Project: Polygon at Roshak Ridge, Lot 175-Primary& (2)ADUs
Project Description: New primary dwelling with (2)attached ADUs. NO FINAL INSPECTION UNTIL SDC FEES HAVE
BEEN PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First 971 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25.5 Bathrooms: 4 Second: 1437 sf Garage: 477 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2408 sf Value: $317,922.78 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
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: 4 201-400 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 2408
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
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $23,436.61
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-nnl nnl n fhrni inh cia 17 oc9-nnl nnon Vni i ma,,nhroin m rnnv of fhe ri iliac nr riirorf ni loctinnc rn(ll IAIC by Tallinn cnZ 949 10R7 nr 1 Ann'249 9'1AA
Issued By: Hoa..LJ VOA '17e'Wege Permittee Signature: Oln,A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
LL'T l 75-
Building Permit Application w sk !z1
Residential RECEIVED FOR OFFICE USE ONLY
Iii City of Tigard MAY e l 2021 Received_ ,y (,'2 i
13125 SW Hall Tigard, Date/By: �[ Permit No.: �� M��
_ gPlan Review 'I I n I n S,,`�n^�`-col Zo
Phone: WHal503.718.2439Blvd., Fax: 5 OR 97223 r. DateR !/ r1d Other Permit: VU W 1�ri'I'T 4t ��jv:��f.l..� y'
T I G A R D Inspection Line: 503.639.4175 p DIVISION Date Ready/By: t 0 See Page 2 for
Internet: www.tigard-or.gov �� � otified Method: 3 � r,/, G Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
i ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. 146
I$1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 3111 .)..P..,
❑Accessory building El Multi-familyNumber of bedrooms: 5
I ❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: 4.14 O r. r J
Job site address: 14398 SW 165th Ave. New dwelling area: • 7: f square feet I(4�-7
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 4 77 square feet k'71
Suite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 175 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: P YI� Indicate the value(rounded to the nearest dollar)of all
frVl t% '" equipment,materials,labor,overhead,and the profit for the
DESCRIPTION O ORK work indicated on this application.
SF aNew home construction: Triplex standard ( SFU, ADU I, ADU2) Valuation: $
Elevation: 221200AR/221300AR921400AR Existing building area: square feet
Projected Start: September 2021�t"J ., /' Syks )I New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:703 Broadway St., Ste 710 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)946 8674 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON Vi9 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 a%taylormorrison.com,OAIamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 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: $201.60
Authorized signature: Qb 2422,.cy 6.41LG//GBLG/.CL,La- This permit application expires if a permit is not obtained
�� within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 05/04/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit AQplic IuE FOR OFFICE USE ONLY
Cityof Tigard �� Received I
g Date/By: Pr S/11/?iI PemldNo.: ?021"00lgi
i .. i! 13125 SW Ha1lBlvd.,Tigard,OR 972 nv� 2021
F4 • 61 Plan Review
Phone: 503.718.2439 Fax: 5p3>9$.l J Date/By: Other Permit: Ciee,�Q.2.02.\-t�t'u.J
TiGAltl7 Inspection Line: $03.639.4175 CITY OFTIGARD DateReady/Ily: turfs ElSee+Page 2for
Internet: tvww.tigard-or.govNotified/Method:
Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECkZIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY,OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
T' 1-and 2-family dwelling a Commercial/industrial 0 Accessory building For special information use checklist
Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 14398 SW 165th Ave. Furnace 100.000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000*BTU(duets/yews) 54.91 _
Suite/bldg./apt.no.: 7 Project name: Polygon at Roshak Ridge Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
® Residential boiler(radiator or
(Ironic) 23.32
Unit heaters(fuel-type,not electric),
�._ in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23_32
Subdivision: Polygon at Roshak Ridge Lot no.: 175 Other 23.32
------ Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
— Flue vent for water heater or gas
New home construction- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fi.replace/iinsert 23.32
Chimney/liner/flue/vent 23.32
r$ PROPERTY OWNEROther. 23.32
a TENANT
-- Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste,510 equipment 33.39
_____ Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
-_.. toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
CO APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping: _
S14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
_______
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Ranee
E-mail:permitsubmittals@taylOrmOrriSOn.COm Barbecue
CONTRACTOR Clothes dryer(Ras)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Z t, t days after it has been accepted as complete.
Authorized Signature: ____ n Fee methodology set by Tn-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
rinnsi inn\Arm;it,tuunr V,.rmd Ann virlt is A...
Electrical Permit Applicatio E F I V I t 1 k(e l l I t I I S I n\I \
IpiCity of Tigard Re"
", Pit# CDtgl
13125 SW Hall Blvd.,Tigard, �Y �, "5 (� Z1 M�2o Z�OR 97223 ` flan Review
Phone. 503.718.2439 Fax: 503.5981960, 1 . Related Permit 4: C,,0QlljZ'-(151 20
Inspection Lim 503.639.a175 Y F f iUAF�E� b lurk _/--
t i GA R n i I i .,; i .., 0 See Page 2 far
Internet: www.tigard-or.gov t(l�f N��
Supplemental Information
TYPE Of WORK
PP New construction PLAN REVIEW'❑Addition/alteration/replacement Please check all that apply(submit 2 sets of Mans whims checked)
❑Sat Same or feeder 400 amps to more ❑Building over three stones
❑Demolition 0 Other:
where the available fault currant 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION excocdt 10,000 amps at 150 volts or ❑Floating buildings
!:1 1-and 2-family dwelling ❑Commerciabinclustrial ❑Accessory building bean to ground,Of exceeds 14.000 0 commercial-user agneuIuual
❑Multi-family ❑Master builder ❑Other amps
fix all other Installations buildings.
❑Fire pump ❑Instillation of 150 KVA or
JOB SIFE INFORMATION AND LOCATION 0 Emergency system larger separately derived
Job#: Job site address: 14398 SW 165th Ave 0 Addition of new motor hoed of system.
10011P or more. 0"A","E","1-2","1-3",
City/State/ZIP: Tigard,OR 97140 0 Six or more residential units occupancy
❑Health-ewe facilities.. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Polygon at Roshak Ridge ❑ilaaardous locations 0 Supply voltage for more than
Cross street/directions to job site:
❑Service or!-cedes 600 amps or more 600 volts nominal-
— FF.F, SCHEDULE
niistriptiso I O r. I rate 1 Total I •
New residential single-or midtl-fainUy dwelling unit.
Subdivision:Polygon at Roshak Ridge ( Lot#: 175 Iodides attached garage.
Tax map/parcel#: 1,000 sq.ft,or less 168 54 4
— DESCRIPTION OF WORK add'1500 ft°r 'On 33 92 1
Li
New construction.Type SFU above sgi�sicieutial
75.00 2
.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
1 PROPERTY OWNER El TENANT Renewable Energy 0 Page 2
Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway Si,Ste 710 ---...— 201 amps to 400 amps 133.56 2
City/State/Z.IP: Vancouver,WA 98660 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301 04 2
Phone:( 360 )946 8674 Fax:( ) Over 1,000 snips or volts 552.26 2
Email: OAlanliAbotlh Temporary services or faders installation,alteration,and/or
afs@tsylarmorrison.com-Pen itSubmittals( jtaytormonrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps i I 125,08 1 2
Owner signature: Date: 401 amps to 599 amps 168-54 2
Branch -new,alteration,or extension, r panel
❑ APPLICANT f El CONTACT PERSON
A.Pee for branch circuits wall
Business name: Polygon Homes WI.1-1 LLC above service or feeder fee,
each branch circuit 7 42 -
Contact name: Omar Alamo Abouhafi: B.Fee for branch circuits without
Address: 703 Broadway St,Ste 710 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Vancouver,WA 98660 Each sdd'i branch circuit 7.42 2
MiseelliuseoPhone:(360 )946 8674 Fax::( ) manufacturedEach oa(servicemodular not included)
2
Email:OAlamiAbouhafs@taylormotrison.con-PermItSubmittals@taylormorrison,cixrt divel1iA$ ice
and/or feeder 67 84 2
CONTRACTOR RGCO1riOG1 O°h 67 84 2
Pump or irrigation circle 67,84 2
Business name: Wallace Electric Sian cc outline lighting 67.84 2
Address: 105 Dresden St signal circuit(s)or Invited-energy ❑ See Page 2 2
panel,alteration,a extension.
City/State/ZIP: Astoria OR 97103 Each additional inspection over allowable in any of the above
Additumal inspection(1 hr min) 66 25/hr
Phone;(503 3)8 0563 I Fax:( ) Investigation(I hr nvn) 90.00/hr
Email: David@wallaccwires.com Industrial plant(1 hr min) 78.18/hr
COI tic,:224868 Inspections for which no fee is
• Electrical Li•- C 1441 Su .I; .• 6363S specifically listed Os hr min) 90 001 hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
_art.......„... Subtotal-
Print name:Dlitto; ce, Date: 1� �t —0Plan Review Required(25%of permit fee)
i f!„jr// State surcharge(12%of permit fee)•
,t4 joe,014e
Authorized signatureTO AL PERMIT FEE:
Print
name: �t�]p. �( This permit application expires it a permit is not obtained within 180
+i-",�„ .f e . Date: 7 /4//L.t.... days after It ban been accepted as complete,
tt/ ( ' Number of inspections allowed
t:lnuitfino'Permii.ttt r•a..,,.we,...n ii car•__o_.,u„......., i per permit.
Plumbing Permit ApplicationtuE
D
Building Fixtures MAY
!/} FOR OFFICE USE ONLY
1City3125 of Tigard P�'!'A'i' 0 2021 Received t , c `1/St Permit va ly tsois2A pi 0j
't 13125 SW Hall Blvd.,Tigard,OR 972 DatmBy: `�)` ` !i
Phone 503.718.2439 Fax: 503.598.M1Y OF TIGARD pa gy 1eµ Other Permit No.: .U"a -e5C,Vrif,
Inspection Line: 503.639,4175 B1JU D Nr flip/i lOJ1J Date Ready/By: rem 4
TIGARD Y y: i a See Page 2 for
. Internet: www.ttgard-or.gov Notificdilethnd: 1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Z New construction 0 Demolition For syecial information use checklist.
Description Qty. I Ea. 1 Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312,70
I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building •Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(__sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14398 SW 165th Ave Catch basin or area drain I 18.76
City/State/ZIP:Tigard,OR 97224 Dtywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suitc/bldg./apt.no.: Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18,76
Rain drain connector 18:76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot nc 175 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER J 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC
Fixturetsewer 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 Interceptorigrease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof dram(commercial) 12.51
Address:703 Broadway St.,Ste 510 _ Sink/basin/lavataty 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)6934442 Tub/shower/shower pan 12.51
E-mail PermitSubmittals@taylormorrison.com,OAlamiAbouhafs u,taylormorrison.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water pi m DWl 56.29
PF _
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
V
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
CCB Lic.: 184372 Plumbing Lie.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: _ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Steve Fowler Date: 0/30/20 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
t:+Building,PvmitePi.MMtr-PennoApp-dec 10/O1r09 440-4616T(10+02/C0(.41WEB)
i
City of Tigard
111 COMMUNITY DEVELOPMENT DEPARTMENT
s
T i G A�D Building Permit Review — Residential
Building Permit #: lOSTdi0ak-GO tq 1
Site Address: 14398 SW 165th Ave
Project Name: Polygon at Roshak Ridge Lot #: 175
Planning Review VeV t-I E./Y EOSt1'�F:k 1 limptf,V *.U.� ,
Proposal: New detached dwelling
ElVerify address/suite# active in Accela. ❑° In River Terrace: ❑ No ❑° Yes,River Terrace Review Addendum
Site Plan Elements: ,erosion Control
Oi copies of site plan on 8-1/2"x 11"or 11 x 17"paper Retained trees with drip line and tree protection measures
Ol9 rawn to scale (standard architect or engineer scale) Footprint of new structure(including decks)and FFE
111 orth arrow 'LJtility locations&easements(required for new and additions)
Fite address,project or subdivision name and lot number ''idewalk/driveway approach
0 Npplicant information(name and phone number) 0� -ocation of wells/septic systems
ot dimensions and building setback dimensions 1�treet tree size,type and location
- AA �I'quare footage of buildings to be demolished ��treet names
ccN�t` II xisting structures on site °,_corner elevations (2'contours if more than 4'differential
Vot 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: El Yes,applicant was notified ❑o No Received: ❑Yes a No
❑r Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified ElNo Received: 11 Yes ❑No
❑ SDC Exemption for ADU applied for: ❑Yes ❑ No Received: El Yes ❑No
ElPublic Facilities Improvement (PFI) Permit:
Required: ❑o Yes,applicant was notified ❑No Applied For: El Yes ❑No,stop intake
ElLand Use Case#: SUB2015-00004 ElZoning: R-4.5
0 Required Setbacks: Front:-I? Rear: 10 Side: 3 Street Side: NSA Garage: 3
❑r Building Height: Max. Height: 30 Actual Height: 25.5
0 Landscape Area: 20 % ElLot Coverage Max: 80
Entrance '' Set back no more than 8'from street-facing wall ❑r Parallel to street or offset 45 degrees or less
Windows ' Minimum 12%of area of all street-facing facades
Garage 1 Gara e door is behind widest street-facing wall Q Yes El No,one of the following is met:
Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than 5'from wall and there is a 12 sq ft.window above gataag_on 2nd t7-yer--.-'
I fi Garage oor ' ' r less El50%or les 0%or less and includes 7 of following:
Covered porch — Rec ance 1'Roof eave Roof offset
,... Fire — Lap Siding ❑ Roof itch Gable,r4o, 1 roof Dormer
_Accent siding Window trim Window recess U Window projection y
❑o Visual Clearance ❑ Urban Forestry Plan
❑o Sensitive Lands: ❑ Yes LI No Type:
ElConditions met prior to issuance of buildin permit
Notes:
0 Approved By Planning: Date:
Revisions (after Building Submittal only) Re ewer D to
Revision 1: Approved ❑ Not Approved 0 VI
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw RES_122419.docx
Building Permit Submittal
Original Submittal Date: 6/(0/2.)
Site Plans: # '3
Building Plans: # 3
Building Permit#: Er Enter building ermit# above. �/
Workflow Routing: a Planning Engineering Ld Permit Coordinator 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
E(�riginal plan review routing form.
' . a. - . .` " .. Building: original permit application, site plans,building plans,engineer and
beam calculatio s nd trust details,if applicable,etc.
Notes:
By Permit Technician: Date: S'/I /2/
En ineering Review
liff Slope at building pad: �)
1 Conditions "Met"prior to issuance of building permit
l asements (encroachments) per engineering conditions of approval and plat
2 Water Quality/Quantity Facility: t�-770����
Assess Water Quality Fee in-lieu: ❑ Yes O' o
Assess Water Quantity Fee in-lieu: ❑ Yes o
LIDA Facility on lot: ❑ Yes [J No
i rF al Plat Recorded:
ILif NOT Approved by Engineering: Date: 3 /I 2
Notes: K/27Aer" d rrte"� lire ":"L/Gt, "
Approved by Engineers g: bate: 2.477 �y/per/
Revisions (after Bpclin Submittal only) ..e...„---ReNie.kver Date
Revision 1: Approved ❑ Not Approved tef yP�74/'
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
gConditions"Met"prior to issuance of building permit
gApproved,NOT Released: see, curnw ►+ r,,,1a0,,c._ Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
ZSDC Exemption: ❑ Received Does not a-4 ly
all SDC Fees Entered: Wash Co Trans Dev Tax: Yes N/A
Tigard Trans SDC: ,i•Yes ❑ N/A
Parks SDC: Yes N/A
LIDA ❑ Yes N/A
,r OK to Issue Permit
Approved by Permit Coordinator: 14 Date: 10I 21)I202.E
I:1Building\Forms\B1dgPermitRvw RES_122419.docx
City of Tigard
11111 COMMUNITY DEVELOPMENT DEPARTMENT
11 G R o River Terrace Building Permit Review Addendum
Building Permit #: 2021-O01R1
Site Address: 1 y3q?' 'Z(ti) L(0S-th Vt
Project Name: Polygon at Roshak Ridge Lot #: !�-
(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 ❑o No (Per MMD2020-00044)
Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additio
ele •nt required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch ;�. 5 ft. deep Balcony w/ access 2 Window Projection Vertical Wall Offset a Gable. .ormer
ft. deep min. 2ft.,5 ft.wide min. 2 ft.,6ft.wide
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:
❑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 I o
If es,all the following apply: ❑25'sq.ft.
U One street facing entry ❑12 f ax. roof above floor of porch
❑5 ft. depth min. 030/o min. porch roof coverage
4. Detailed Design:All buildings shall include a min. o iv- of the following elements on all street-facing façades:
ElCovered porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
0 Wall offset min. 16 inches ormer min. 4 ft.wide
0 Roof eave min. 12 inch projection ❑R• 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 de ❑Window trim • ' . 2 '/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 'o or less of street façade
5. Garages and Carports: 'I 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.
❑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 :.rage 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 façade with 7 detailed design elements
Notes:
Approved By Planning: Date: 5/I l Z 1
I:\Bui(ding\Forms\BIdgPevnitRvw_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
111 _ Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
TO: Agnes Lindor DATE RECEIVED:
DEPT: BUILDING DIVISION
FROM: Omar Alami Abouhafs RECEIVED
COMPANY: Taylor Morrison OCT 13 all
PHONE: (360)946 8674 CITY OF TIGAPL1: ,
BUILDING DIVISION
EMAIL: OAIamiAbouhafs@taylormorrison.com
RE: 14398/14400/14402 SW 165th Ave MST2021-00191/.-99492/...UUi tJ
(Site Address) (Permit Number)
Polygon at Roshak Ridge, lots 175
(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/VICE USE ONLY
Routed to Permit Technic' : I. 24 Initials:
Fees Due: ❑ V Yes [ No Fee Descrion: Amount Due:
$ 7r2c/
Iv) b P - ----1,--
Special
Instructions:
Reprint Permit(per PE): ❑Yes / No ❑ Done V11 ._
Applicant Notified: Z. Date: /l l 1 Initials:
RECEIVED
Water Meter Fixture Unit Worksheet For New Buildings, 21)21
Y �
Please complete the following information: CITY Cr +u, riu
P!V!S!ON
Contractor Name: Polygon Home, WLH LLC
Billing Address: Street/Suite#: 703 Broadway St, STE 710
City: Vancouver State: WA Zip: 98660
Phone Number: 360 946 8674 Email: OAlamiAbouhafs@taylormorrison.com
New Meter Address: SFU: 14398 SW 165th Ave/ADU 1: 14400 SW 165th Ave/ADU 2: 14402 SW 165th Ave
Subdivision Name: Polygon at Roshak Ridge Lot#: 175
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 ADU 2 Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer 1 1 1 3 x 4 = 12
Dishwasher 1 1 1 3 x 1.5 = 4.5
Hose bib, l st one 1 1 1 3 x 2.5 = 7.5
Hose bib, each add'! 1 1 1 3 x 1 = 3
Kitchen sink 1 1 1 3 x 1.5 = 4.5
Laundry sink x 1.5 =
Lavatory 6 4 5 15 x 1 = 15
Water closet, 1.6 GPF 3 2 2 7 x 2.5 = 15
Bathtub/whirlpool x 4 =
Shower stall 1 1 1 3 x 2 = 6
Bath/shower combo 2 1 1 4 x 4 = 16
Total Fixture Unit Points: 83.5
Fixture Unit Points:
1 to 30= 5/8" 37.5 to 89= 1"
30.5 to 37=3/4"
Meter Size: Meter Cost: $ 24,886.00
*************************************************************************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building(Master)Permit or Plumbing ❑ Yes ❑ No ❑ Other:
Meter#: Sale Date:
Receipt#: Meter Cost:
Employee Name:
I:/Building/Forms/WaterMeters_010121_New.dOCX Page 2
City of Tigard
IIIDeferral Until Occupancy Request
TIGARD Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
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: 14398 SW 165th Ave
Project Polygon at Roshak Ridge Land Use Case or MST2021-00191
Name: Building Permit#:
Tax Lot Total Parks
# 2S107AA17500 Amount*: $5,652
Lot 175
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 fmal
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: Ohta4,.A ',A6a� Date: 10/26/21
Developer: Oi a4,41a te:x e&ula • Date: 10/26/21
Permit Coordinator: ATM oetitilrb Date: 10/26/2021