Permit Plumbing Permit Appi•lea n l IVE®
Building Fixtures 20�Z l;OR tlrrlt I: 1 sI: ONI.1
Received /� Permit No.:
City of Tigard ,p Date/By:v ?iI !i� TE
MST2021-00410
ligiso 13125 SW Hall Blvd.,Tigard,OR 97 O'- IlGARI� Plan Review i l
a Phone: 503.718.2439 Fax: 503.5 . Date/By: 0.1 J / o''�P Other Permit No.:
I{ 1 It 1� Inspection Line: 503.639.4175 i.JILDING DIVISION Date Ready/By: i �7.� luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method, Lf- Supplemental Information
'�,,, ,,,, ''' go,Ye<yid,, `IoE1`s.< ,,,, „„ , r. FED*'!8 � ��
ew construction 0 Demolition For special information use checklist.
- Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
cA a 1) , SFR(1)bath 312.70
ID 1 and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building. ❑Multi-family
- Each additional bath/kitchen 25.02
0 Master builder
❑Other:her:
2023sq ft.)Fire sprinkler( Page 2
tea, OB RM7, � , ^A
Site utilities:
Catch basin or area drain 18.76
Job site address: 16574 SW Darwin Loop
City/State/ZIP: Drywell,leach line,or trench drain 18.76
ty Tigard,OR 97223
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: f Lot no.:204(SFU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
e \ Backwater valve 12.51
B k 1.. ..: '' ; ,;. ''''• Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Cyr . Expansion tank 12.51
Y Name:
Taylor Morrison Fixture/sewer cap 25.02
703 BroaBroadwaySt.Suite 710 Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660
Hose bib 25.02
Phone816 7805( 360) Fax ( ) Ice maker 12.51
� •C ' t��� Interceptor/grease trap 25.02
Business name: Alliance Plumbing, LLC Medical gas(value:$_) Page 2
Contact name: Gavin Thomes Primer 12.51
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 )492-3490 Fax::(503 )912-6438 Tub/shower/shower pan 12.51
E-mail: gavin@allianoeplumbing.net Urinal 25.02
i .: ,.. 14 iCONTRACTOR �,.,,, .. ,v i Water closet 25.02
• °... Water heater 37.52
Business name: Alliance Plumbing, LLC
Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP: Troutdale,OR 97060 Subtotal
Phone:(503 )492-3490 Fax:( 503)912-6438 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: Hannah Thomas:=== �..n.-, TOTAL PERMIT FEE
z�za
Hannah Thomas P' 1/27/2022 This permit application expires if a permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Bui1ding\Permits\PLMU-PermiiApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
„III
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00410
Date Issued: 01/11/2022
T[G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 107AA20400
Jurisdiction: Tigard
Site address: 16574 SW DARWIN LOOP
Subdivision: ROSHAK RIDGE Lot: 204
Project: Polygon at Roshak Ridge, Lot 204-Primary
Project Description: New primary dwelling with (1)attached ADU. NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 82 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1941 sf Garage: 456 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2023 sf Value: $293,700.62 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: Storm Sewer 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2023
Owner: Contractor:
TAYLOR MORRISON NORTHWEST LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Fire Rated Conditions
PHONE: 360-946-8674 PHONE: 360-695-7700
FAX:
Total Fees: $22,861.85
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: 1-4(7. 1 VO.4'l'De'wee' Permittee Signature: Ot't'A�i,o-vt,
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.
i
1 _ Building Permit Application ..
11,
Residential RECEI FOR OFFICEUSE ONLY 77ss (( (�/
Date/By: 7(.2.1// 9 �Jf(N 2,(
t O (
City of Tigard Permit No.:
IIIa 13125 SW Hall Blvd.,Tigard,OR 97223 r� eview
'1. Phone: 503.718.2439 Fax: 503.598.1960 S E P 1 7 y, (,o (q 24 Other Permit:40V jai.0 el 0 to
I'I G A R D Inspection Line: 503.639.4175 Date Ready/By: / H See Page 2 for
Internet: www.tigard-or.gov CITY OF TI ,,, D/Method: 4,10.(x.003, J , Supplemental Information
PLANNING/ENGINFFRIMCYP'c7
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. 24
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ �� /
❑Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder El Other: ADU Number of bathrooms:2
JOB SITE INFORMATION AND LOCATION Total number of floors:1 `c0 '3
Job site address: 16576 SW DARWIN LOOP New dwelling area: 1228 square feet LD.0'1(a,
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 26.5y p 7cquare feet
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 Lot no.: 204 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: /t/1V1 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
SFU:New home construction Elevation:221100B/221000B Duplex Valuation: $
Type:Duplex_Projected Start:November 2021 Existing building area: square feet
- ,q}„c 4 f .crx ittn Oti New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:703 Broadway St., Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360 946 8674 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON o9 BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
Address:703 Broadway St., Ste 710 FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Phone:(360) 695-7700 Fax::( ) Amount received:
I PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver, WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( )360 695-7700 Fax:( )360 693-4442
State surcharge(12%of permit fee): $21.60
CCB lic.:207247 /" / Total fee due upon application: $201.60
Authorized signature: 0 YLQ,/L 4 un, 461,1.4 This permit application expires if a permit is not obtained
r/ " within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 09/17/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application RE F.OR OFFICE USE ONLY
City of Tigard !_1 t! F�. :.;� Y Permit No,; //� �-^�� _ [�
" 13125 SW Hall Blvd.,Tigard,OR 97223 i �"��I G�/�� �-!II
Phone: 503.718.2439 Fax: 503.598.1960 (j L: a la L,, Other Permit'
TiciAltl) Inspection Line: 503.639.4175 PP a "("� „„'}}++ I rs
Internet: www.tigard-or.gov CITY OF IC7'�". RetiNethud; S See Pent fnr
SupplementalInformation
TYPE OF WORK ING/ENGINEERI[�_COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
76Iechanieal permit fees*arc based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONS'FRUCTTON RESIDENTIAL EQUIPMENT I SYSTEMS FEES* •
D 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building _ For special information use checklist
I j Multi-family ❑Master builder 0 Other: ADD Description Qty. Ea.T Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning ( 46.75
Job site address: 16576 SW DARWIN LOOP
Furnace 100.000 BTU(ductevents) 46.75
City/State/ZIP.Tigard,OR 97224 -Furnace 100,000i BTU(ducts/vents 54.91 _
HeSuite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Duct wopurk 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.: 204 _' Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
- Flue vent for water heater or gas
New construction,new Single Family fireplace 23.32
Log lighter(gas) 23.32
- Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER ElTENANT Other 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.34
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:( ) Atticicrawlspace fans 23.32
_
® APPLICANT � ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping: Y-
S14.15 for first four;S4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St-,Ste 510 Gas heat pump
- Wall/suspended/unit heater
I1 City/State/ZIP:Vancouver,WA 98660
Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals¢taylormorrison.com Barbecue
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(S90.00)
Phone:(360)270-1590 Fax:( ) Plan review(25%of permit fee)
— State surcharge(12%of permit fee)
CCB iic.:209001 TOTAL PERMIT FEE I
This permit application expires if a permit is not obtained within 180
pl' days after it has been accepted as complete.
Authorized Signature: �" a �u Q ' Fee methodology set by Tn-County Building Industry Service Board
IPrint name:Ella Duran Date: 10/30/20
1 r/OnJAma\Prr,,,,/5t5C P.rmie Ann Rail I:dew nn��.r'rt,,.mn„��,rni+eu•
N
f 4
{
RECEIVED
Electrical Permit Application SEP 1 7 1(,l;Of 1:1( 1 l.'SI O.1
City of Tigard 13125 SW Ha Blvd.,Tigard,OR 97 223
IN
Phone: 503.71$.2439 Fax 5035981960 CITY OF TI I ; !1
NING/EN ' •'`
Dually' Pentad a lit!t?AO —00 q I
Related Permit aAA)v",i--oat a
h:li Inspection Lirle 503 639 4175 Ready l3ate'lly tun, ®See Farm 2 for
lnteinel: www,ttgard-or.gov Notified/Method. g
applameehl Lroreatiw
TYPE OF WORK PLAN'REVIEW
IN New construction ❑Addition/alteration/replacement Please check a0 that apply(sahmit lads ofplans w/itons chocked)
❑Demolition ❑Other; 0 Sa%xe or kerier 400 amp°or more 0Building osier three stones
where de mailable ilable fault current 0 Manna,and boatyard
CATEGORY OF CONSTRUCTION exceeds 10,000 limps at 150 volts or 0 Floating buildings
❑ 1-and 2-family dwelling 0 Commerciadustrial 0 Accessory building 1ess to� ,or exceeds la,ewa 0 commercial-use agricultural
❑Multi-family ❑Master builder s El ❑Other: ADU for all oils ttvstan'mans Makings.
Foe prang. ❑Installation M 150 KVA or
JOB srl'E INFORMATION AND LOCATION ❑Emergency system larger separately derived
Job it: Job site address:16576 SW DARWIN LOOP ❑Aad,cr°o of new m°'°`kind of system
10011P w more. ❑"A", E."14"."1-3",
City/State/LiP: Tigard,OR 97140 ❑sax o niece residential rums occupancy
❑health-care[belittles ❑tie minanal vehicle parks_
1 SuitelbidgJapt,II: Project name: Polygon at Roshak Ridge ❑hazardous locations 0 Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nnmraal.
Cross street/dinections to job Site: FEE.SCHEDULE
uatrriptim 1 4tr, 1 Lark 1 natal 1 •
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot II: 204 Includes attached garage.
Tax map/parcel it: 1,000 tit ft or less 16a 54 4
Ea add'l 500 sq ft,or portion 33.92 1
DF.C+CRWI'ION OF WORK Limited energy,residential
(with above fL 75.OD 2
New construction.Type SFU )
Limited energy,muhi"famlly 75.00 2
residential(with above sq.it.)
MI PROPERTY OWNLit [� TENAI\i. Renewable Energy ❑See Page 2
Services or feeders installattou,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway 5t Ste 710 201 antes to 400 amps 133.56 2
401 amps to 600 amps 200 34 2
City/State/ZIP: Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax:( ) over L000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: OAIamiAbouhafs@taylommorrison.com-PermitSubmittals@taylarmorrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps bn400 amps 125.08 2
Owner signature:`_ - _. .._. Date: 401 amps to 599 amps 168.54 2
0
APPLICANT ❑ CONTACT PERSON Branch circuits-new alteration,or extension,Rer panel
A.Fee for branch circuits with
Business name: Polygon Homes Wi.H LLC above service or feeder foe, 7.42 2
cacti brands circuit _
Contact name: Omar Alami Abonbafi A Fee for branch circuits without
Address: 703 Broadway St,Ste 710 bunch circuitor feeder fee,first
brranch56.18 2
City/State/ZIP: Vancouver,WA 98660 Eaoh arki'I branch circuit 7.42 ( 2
Phone: 360 )946 8b74Miscellaneous(service or feeder not included)
( Fax::( ) Each manufactured or modular 67 84
dweEmail:OAlamiAbouhafs@taylormomson.corn-PermitSubmittals(astaylormorrson-com i Reon lli°e'scr nnc r only
l and/or rends
Reom 67 84 2
CONTRACTOR Pump or Irrigation circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67.84
Signal errcutt(s)or limited-energy
Adrlrmis: 105 Dresden St pared,atteratron,or extension,. ❑ See Page 2 2
C' /State/IIP: Each additional inspection over allowable in any of the above
rty Astoria OR 97103 _ Additional inspection(1 hr men) 66 25/hr
Phone:(503 3►$0563 lax:( ) Investigation(1 hr men) 90.001 hr
Email: Uavid@wallaeewires.com Industrial plain(1 hr min) 76 181 hr
Inspections for which no fee is
CCB laic.:224868 Electrical Li'.C1441 S -I' .' 6363S specifically listed(SS hr min)
Suprv.Electrician signature,retirlired: ELECI'ItICAL PERMIT FEES
Subtotal•
Print name;D pnLE, Date: y /4' t _0 Plan Review Required(25%of pemut fee):
t( State surcharge(12%of permit fee).
Authorized signature T(f I'AL PERMIT FT E
This permit application expires it a permit is eel obtained within 180
Print name: �u�u Date: days alter n ken been eetepted as complete.
----....__.-- • Number of npspections allowed per permit.
l.vauld ogtperm;lru:i c_Perrait F1.a EJ1X.doc Rev 06'17na15 _ T I05/C0MtWP
Plu:mbin';- Permit Application Building Fixtures RECEIV FOR OFFICE USE ONLY
EriCity of Tigard Received (�r
�' Date/By. Permit No.: �Sr?,d Z �G 1
.t 13125 SW Hall Blvd.,Tigard,OR 97223 S E P 1 7 202 plan Review
II Phone: 503.7182439 Fax: 503.59$.1960 Other Permit No.:AN w J - oU(d
Inspection Line: 503.639.4175 Date/By.
TIGARD P CITY OF TIGA�1 ate Ready/By: )wis: El See Page 2 for
Internet: www.tigard or.gnv PLANNING/ENGIN-, C.
vtethod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
►1 New construction ❑Demolition For special i, ornrarion use checklist.
Description I Qty. I Ea. I Total
❑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
SO-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building V-Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Othtx: ADU Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16576 SW DARWIN LOOP Catch basin or area drain *18.76
City/State/Z]P:Tigard,OR 97224 Dryweli,leach line,or trench drain 18.76
- -- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: :dial{ 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.:i) Page 2
Subdivision: Polygon at Roshak Ridge Lot no.: 204 Fixture or item:
I Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction SFU
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,EEC Fixturelsewercap 25.02
Floor drain/floor sink/hub 25.02
I Address:703 Broadway St.,Ste 510
- - Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon Vs LH,LLC Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatoly 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonbomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
-
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water P 1P g m `DWV 56.29
Address:P.O.Box 92 _ Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8I70 Minimum permit fee: S72.50
Plan review (25%of permit fee)
CCB Lie.: 184372 Plumbing Lic.no.:pb634
Q, _ State surcharge(12%of permit fee)
Authorized signature: �W'� TOTAL PERMIT FEE
Print name:Steve Fowler Date: O/3O/ZO This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by'l et-County Building Industry Service Board.
C:lauildmg\Pennds\PLMU-PermitApp.dw 10+01114 440-46167110+02/COM+WER}
City of Tigard
et
.71 COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED
TIGARD Building Permit Review — Residential SEP 1 7 2021
g Permit #: /"Vd� -- 1 1 CI fY OF TItaAHU
Building V� I PLANNING/ENGINEERING
Site Address: I 6 57-6 Suv P Loop
Project Name: PO (Zr) kc az R4 Lot #: Zey
Planning Review 0
Proposal: IQeLd cf,ffaChtit AD )
Verify address/suite#active in Accela. P3In River Terrace: ❑ No IWYes, River Terrace Review Addendum
Site Plan Elements: PErosion Control
P3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper ($Retained trees with drip line and tree protection measures
[ )rawn to scale(standard architect or engineer scale) [Footprint of new structure(including decks)and FEE,
Xt\Torth arrow OUtility locations&easements(required for new and additions)
PSite address,project or subdivision name and lot number WSidewalk/driveway approach
Applicant information(name and phone number)
Lot dimensions and building setback dimensions 4Street tree size,type and location
g.Sgt*sxe_footag,of buildings to he demolished PStreet names
11S..,ctYltCh7rPc nil c;+P •Corner elevations(2'contours if more than 4'differential)
I01Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Wes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes IEbTo
Clean Water Services—Service Provide - of p a .-d prior to 9/10/1995):
Required: OFTE,applicant was noti r ed T° Received: 'es ❑ No
Water Meter Fixture Unit Worksheet— - .. tions,Remodels and ADUs
Required: e Yes,applicant was notified ❑ No Received: eigP Yes ❑ No
SDC Exemption for ADU applied for: Ai Yes ❑ No Received: XP Yes ❑ No
I Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified or No Applied F • ❑ Yes ❑ No,stop intake
a Land Use Case#: 19—PU 21iO0-0 1 0 1 �Zoning:I
vi Required Setbacks: Front: 12. Rear: 0 Side: 3 Street Side: g ` Garage: �Q
Building Height: Max. Height: /V Actual Height: 2S
Ei Landscape Area: % Lot Coverage Max:eco
Entrance 11 Set back no more than 8'from street-facing wall WParallel to street or offset 45 degrees or less
Windows 8 Minimum 12%of area of all street-facing facades
Garage Garage door is behind widest street-facing wall ❑ Yes No,one of the following is met:
ER Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
Garage door width is ❑ 12'or less ❑ 50%or less of facade AP 60%or less and includes 7 of following:
j Covered porch g Recessed entrance ❑ Wall offset r 1'Roof eave A Roof offset
❑ Fire shingles ❑ Lap Siding M Roof pitch 0 Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ,® Balcony
Ig Visual Clearance Urban Forestry Plan
EP Sensitive Lands: ❑ Yes '?' No Type:
Or Conditions met prior to issuance of building permit
Notes:
5-1 Approved By Planning: Date: 41Z37/____ _2.4
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 4 f 1 a
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building permit#above.
Workflow Routing: Planning X7 Engineering Permit Coordinator , Building
Workflow Sign-off: g Sign-off for Planning(include notes from planning review)
Route Application Documents: 7 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original 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: L/ Date: G 2
En!ineering Review
'z Slope at building pad: Jets
Conditions "Met"prior to issuance of building permit
L Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes I"No
Assess Water Quantity Fee in-lieu: ❑ Yes CNo
LIDA Facility on lot: ❑ Yes Id' No
//Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Vf Approved by Engineering: Date: 21
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received (� Does not apply (__,�_
SDC Fees Entered: Wash Co Trans Dev Tax: [� Yes ❑ N/ASee ���T '
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: / Yes ❑ N/A Mr mS
LIDA ❑ Yes 71 N/A
l OK to Issue Permit
Approved by Permit Coordinator: Date: I DI5 1202.1
I:\Building\Fonns\B1dgPennitRvw_RES_122419.docx
RECEIVED
City of Tigard S E P i 2
■ COMMUNITY DEVELOPMENT DEPARTMENT CITY OF TIGARD
■ PLANNING/ENGINEERING
T 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #: /1/1/51-2-0 Z(— 004 t
Site Address: 106 (5(J) krwi frt. Lee p
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 CINo (Per MMD2020-00044)
iculation: 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.,6ft.wide Gable. .oomer
❑ ❑ ❑ ❑
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:
0 Parallel to street, . gle no more than 45° from street,
❑Max. 8 ft. setback from longes trees- facing wall
or open onto poi
Entrance opens to a porch: ❑Yes 1 0
If es,all the following apply: ❑25 sq.ft. in.
1One 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 façades:
❑Covered porch min. 5 ft.wide x 5 ft.deep I Recessed entry area min. 5 ft.wide x 2 ft.deep
❑Wall offset min. 16 inches g w ormer min. 4 ft.wide
❑Roof eave min. 12 inch projection ❑R.- offset min.of 2 ft.
❑Roof shingles either tile or wood ❑Gable, .ip or gambrel roof design
❑Roof pitch oriented south min. 500 sq. . ❑Horizont., ap siding min.3-7 inches wide
❑Accent siding min.40%of street fa .e ❑Window trim • ' .2 1/2"wide by 5/8"deep
❑Window recess min.3 inches for street facing ❑Bay window min. ft.wide by 2 ft.deep
❑Balcony min. 5 ft.wide x 3 ft. eep with inside access ❑Attached garage is 3 '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. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
❑May 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 s, 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: ab/7i3/2d Z1
I: ` GG
City of Tigard
Deferral Until Occupancy Request
T I G A R D 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: 11/3/2021 Site Address: 16576 SW DARWIN LOOP
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00411
Name: Building Permit#:
Tax Lot Total Parks
2S107AA20400 $5,839.00
#: Lot 204 Amount*:
TDT Total TSDC
Amount: N/A Amount*: $2,134.00
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $1,909.00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$4,727.00 for Parks-Improvement,$ 1,112.00 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$ 0 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT,TSDC, and Parks SDCs, as provided above,
until occupancy.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option, I understand that any deferred TDT,TSDC, and Parks SDCs must be paid prior to final
inspection or issuance of an occupancy permit.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be accepted both the Property Owner and the Developer must sign this request.
Property Owner: DM44- 4kart':. eedtezd.t. Date: 11/3/2021
Developer: Ohta4..Aiamb'.A6ou Date: 11/3/2021
Permit Coordinator: Date: 11/3/2021