Permit Oregon Residential Specialty t.lt:y Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
M
Roh �(QC�,v , am the general contractor or the owner-builder
at the following address: �1 @�Site Address: 164 Q 7 S , e0ThL- ()AV LI"
City: 6AN2
Permit m5r2Q211 ` 004112
Subdivision/Lot#: River�a r ROC /4 Tefrf Cc
cT f(
and/or
Map and Tax Lot#:
To conform with the 2008 Oregon Residential Specialty Code(ORSC), Section R318.2 and
OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture-sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: Date: f I -- Ia 22
G era!Contractor or Owner-Builder
L\BnildingTonn\LIES-MoisfireSensitiveWood.dor, 09/n/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Th50,0 41 O U y 12 — Jurisdiction: rf 6 A R D
Site Address: 16aQ9 w (3QrANy !Ay -N
Subdivision/Lot#:
Terrace
and/or
Map and Tax Lot#:
By my signature below, I certify that a minimum of fifty(50)percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)1
Signature: ` Date: II "' 12 - 2,2.
er/General Contractor/Authorized Agent
Print Name: Rah 1 L e4
t ORSC Section N1107.2.High-efficiency interior lighting systems. A minimum of filly(50)percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent,or a lighting source that
has a muumuu efficacy of 40 lumens per input watt. Screw-in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent,or a minimum efficacy of 40 lumens per
input watt.
1:1BuildingWFans\ItPS-t-lighl:fficiencyLighting.doc 07/0)/08
tf ..
Form 640S 2017
Completion Certification—Site Inspection p`"
New Homes Program—Single Family E ,,, Trust
of Oregon
To be completed by Verifier
CLEAResult is a Program Management Contractor far Energy Trust of Oregon,Inc.
Payment Information
Incentive Payee Company Name: 'Taylor Morrison Its this payment redirected?: I No
Builder or Company. Taylor Morrison Redirect to Name:
Verifier Payee Company Name: Performance Insulation end Energy Redirect Payee Com
Affordable Housing No
Solar Ready Builder Incentive- No Solar ReadyVerifier Inc No
Site Information
Development: RT4EIIN 'Lot 1198 Ass ID. 'REM/Rale®ID.
Address: 16909 SW Botany Beyin me _•....a_.
Street Line 2 Vu1!1-Family INo City. Tigard Slate: OR Zip: 97224
Total conditioned area(sq.ft.): 2.142 House Volume: I 18,989 Housing Type: Duplex
Number of Stories: 12 Number of Bedrooms: 4 Foundation Type: Other/More Than One(add comment)
Electric Provider: Portland General Electric Gas Provider. NW Natural Gas
Solar installed None Solar Installer Name/Company.
Blue shaded fields are required for EPS sheet
Verification Type Actual Model Equipment Details a Notes
Slab Perimeter Insulation R- Slab Under Insulation R-
Insualion Framed Floor R- 30 Secondary Framed Floor R-
Above Grade Wall Insulation R- 23 Below Grade Wall Insulation R-
Flat Ceiling Insulation R- 49 Vaulted Ceiling Insulation R-
Wlndows Windows U- SHGC.I Total window area.
Cooling Air Conditioning SEER: Models: MI14XC15036-230
Primary Heating System Details AFUE: 95 Brand Lennox
Type: Gas Furnace HSPF: Models: ML196UH045XE36
Primary Heat Heating Fuel: Gas SEER:
Source Comment: COP:
Location: Ante Outdoor Unit(for heat pumps)
ECM: No Models'. I
AHRI Certificate:4805339 f of Systems 11
Gallons: 165 Brand: BradfordWhite
Water Heater Type Heat Pump EF: 13.4 Model f', RE250T6
Water Healing Fuel Electric Location. 'Garage or ope AHRI Certificate:9952297
Ducts
sand Duct Location 'Unconditioned %ducts inside: ? , .y",Duct Leakage(CFM)r 50Pa. '191
Test
Infiltration Air Changes per Hour(ACH)fIti 50Pa: 4.7 I
Ventilation Ventilation Type HRV/ERV Model:
Supply Side-Air Cycler Airflow measured or why untestable? I Roof Termination
Appliances •
-. . . ..,. ,,. .,.
Refrigerator kWMyr Model:
ENERGY STAR Diswasher kWh/y, Model: GDF510PSR
Percent High Efficacy Interior Lighting(%) 100% Thermostat
Showerhead 1.5 GPH I Showerwend 1.5 GPH I Showerhead 1.6 GPH I Ihowerhead 1.75 GPH I
Nobs: - •
Plumbing Permit Applicati E " E
Building Fixtures FEB 2 2022 Foiz ()Hitt: i si.: Oyl.l
City of Tigard Received n MST2021-00412
I f Y OF fIGARb Date/By. 24Z i�?j r� PemtitNo.:
• 13125 SW Hall Blvd.,Tigard,OR 97; A' A Plan Review
_ Phone: 503.718.2439 Fax: 503.5 SL fINC !n/IVISIOIv Date/By: e2/f i 7 D A6 Other Permit No..
I 1(;4 R 1) rl✓Inspection Line: 503.639.4175 Date Ready/By: 2 /��� ='� Jura ET See Page 2 for
Internet: www.tigard-or.gov Notified/Metho Supplemental Information
w ' ;,ONA OF WORK SEE*.SCHEDULEx r
Iew construction ❑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)
xF tt�O1i 7 ` SFR(1)bath 312 70
1 and 2-family dwelling ❑Commercial/industrial SFR(2)bath
32
ID Accessory buildingSFR(3)bath l t
-. ❑Multi-family
Each additional bath/kitchen 25 t
❑Master builder ❑Other: Fire sprinkler(2U13
r �>TI, ..-. —'ION --, Site utilities:
sq.ft.)
Job site address: 16609 SW Botany Bay Ln. Catch basin or area drain
Drywell,leach line,or trench drain
City/State/ZIP: 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 t
Cross street/directions to job site: Manholes
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 no.:198(SFU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' Backwater valve 12.51
MULTIPURPOSE FIRE SPRINKLER SYSTEM Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r " 1 ,; vim, :v Expansion tank 12.51
Y Name:
Taylor Morrison Fixture/sewer cap 25.02
Address: 703 Broadway St.Suite 710 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660
Hose bib 25.02
Phone:( 360) 816-7805 Fax:( ) Ice maker 12.51
i41 r,� j ��•t t °t .- Interceptor/grease trap 25.02
Business name: Alliance Piumbing,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@allianceplumbing.net Urinal 25.02
R I z u 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
CCB Lic.: 184601 Plumbing Lic.no.: PB732
Plan review (25%of permit fee)
Digay„�,, ,,,„Mwr u State surcharge(12%of permit fee)
Authorized signature: Hannah Thomas, „:tea.&�.r a'„,�,.M,,wr
��, WOO' TOTAL PERMIT FEE
o,.<.20::..1
Print name: Hannah Thomas Date: 1/27/2022 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.
l:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
rrearur uuupEa :wr:eurru;.:suu.s;:nurrn++te ru...ems :urruuuu,uv✓d .
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00412
Date Issued: 02/09/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA19800
Jurisdiction: Tigard
Site address: 16609 SW BOTANY BAY LN
Subdivision: ROSHAK RIDGE Lot: 198
Project: Polygon at Roshak Ridge, Lot 198 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: 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: 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
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 One Hour Fire Rated Eaves
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
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
Q59_M1_nMn thrniinh(NAP Q59-nni-nnon V, m.0 nht in rnnw of the r i nr r6rort niiacfi ne fn(lI!AI(` 1QR7 nr I Ann 119 Y14.4
Issued By: Ffo�ty Va v1 D�Wegl Permittee Signature: Ow 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.
r'''' 1.1)r idm
Building Permit Application
RECEI` �--91 12.E
Residential FOR OFFICE USE()NIA o
City
f Tigard SEP 1 7 2 ivedBy: 9 e A 5( Permit No. `�1
��� Z('00"rz
(
, II13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
- 24 Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TI!` �9y: 11 3
Other Permit:g e/'ge 2 for u-10Q*6
f t c,A 1.,,,[1 Inspection Line. 503.639.4175 PLANNING/ENG wada�7! Je S soup See Page 2 for
Internet: www.tigard-or.gov W piemental Information
0
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. _ 1='Jj
® 1-and 2-family dwelling ElCommercial/industrial Valuation: $ 3, 7°6
ElAccessory building 0 Multi-family Number of bedrooms: 4
❑Master builder 0 Other: Number of bathrooms 3
JOB SITE INFORMATION AND LOCATION Total number of floors:2 3341'
Job site address: 16609 SW BOTANY BAY LN New dwelling area: 2,023 square feet
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: y qfp square feet
Suite/bldg./apt.no.: Project name:Poi n at Roshak Ridge Covered porch area: 40 square feet( f f
Cross street/directions to job site: Deck area: I square feet g'z
Othiy tt t its I jb square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 198 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 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:221100AR/221000AR Duplex Valuation: $
ype:Duplex_Projected Start:February 2022 Existing building area: square feet
Deferrals:Please defer payment of transportation&park SDCs until occupancy. 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 ElCONTACT PERSON 0t9 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
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 710
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:(360) 695-7700 Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic 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: (. MCuZ.41 460 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: 09/20/2021 *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 R OFFICE USE ONLY .CEI . , FQ
.. . . .. . ,
City of Tigard Received
pw Datc/By. Penult No. itig-zoz,_0
... " 13125 SW Hall Blvd.,Tigard,OR 97223
SEP 1 7 2Cr24.Re,..,,,,; -
— Phone: 503.718.2439 Fax: 503.598.1960 Other Perinit.5v/R:4,0 a(—001,5 Cao
, oalemy.
1)1CiAltf)
Inspection Line: 503.639.4175 CITY OF TIGAM Radey/By Jwis E Sec Page 2 for
Internet. www.tigard-or got ,, ,,,,
Supplerriental lofortnariou
PLANNING/ENGINEERING
TYPE OF WOItIsl COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
' Mechanical permit fees*are based on the value of the work
ig New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other:
CATEGORY OF CONSTRUCTION i mechanical materials.equipment,labor,overhead.and profit_
Value:S
RESIDENTIAL EQUEPMENT/SYSTEMS FEES*
Eg I-and 2-family dwelling Ej Cominercial'industrial 0 Accessory building. For special informarion use checklisL
Multi-family 0 Master builder [j]Other: Description Qty. Ea I Total
n./
JOB SITE EN _Heati cooling:
:FORMATION AND LOCATION _
Air conditioning 1 46.73
Job site address: 16609 SW BOTANY BAY LN
Furnace 100.000 BTU(ducts to Nen..., 46.75
City/State/ZIP.Tigard,OR 97224 Furnace 100.000 t BTU(duets/vents) 1 54.91
Heal pump 61.06
Suiteibldg./api no.: Project name: Polygon at Roshak Ridge --------4
Duct work 23_32 1
_. ._
Cross street/directions to job site: 1 H vdromc hot water system 23.32
---
Residential boiler(radiator or
hydronic) 1 23.32
Unit heaters(fuel-type,not electric).
in-wall,in-duct,suspended.etc. 46.75
Flue'vent for any of above 23.32
Other: 23.32
Subdivision: Polygon at Roshak Ridge Lot no.: 198
Other fuel appliances:
Tax map/parcel no.; Water heater 23_32
____.
DESCRIPTION OF WORK Gas fireplace/insert ' 33.39 __I
Flue vent for water heater or gas
New construction,new Single Family fireplace 23.32 ____
Log lighter(gas) 23.32
NI:load/pellet stove 33.39
Wood fireplace/insert
23.32
Chtmricyliner/Cueivent .
23.32
Other: f 23.32 I1
t3 PROPERTY OWNER a TENANT
• ----- Environmental exhaust and ventilation:
Name.:Polygon WLII,LLC Ranee bocid'other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510
___ Clothes dryer exhaust _ 3339
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 7131
Phone (360)695-7700 Fax:( ) Atticicrawls ace fans 23.32
_ ---
APPLICANT D CONTACT PERSON Other: I 23.32
Fuel piping:
Business name:Polygon WEB,LLC
S14.15 for first four;S4.03 for each additional
Contact name:Tonja Morris Furnace,etc. I I_
Gas heat pump I
Address.703 Broadway St,Ste 510
_ --- _ _ Wall/suspended/unit heater
Coy/State ZIP.Vancouver,WA 98660
Water heater ..... _
,
Phone.(360)695-7700 Fax::(360)693-4442 Fireplace
Ranee
E-mail:permitsubmit-tals(4taylOrMOITISOH.COM
Barbecue
'Dt CONTRACTOR
Clothes rhyer(5.ias)
Other: I
Business name.Pro Heating&Cooling
NIECITAN1CAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
Subtotal
Coy/State/ZIP.Hillsboro,OR Minimum permit fee(S90-00)
Plan review(254:4 of permit fee)
Phone:(360i 270-1590 I Fax:( )
State surcharge(12°,0 of permit fee)
CCB be.:209001 TOTAL PERMIT FEE
This permit application expires if 2 permit is not obtained within 181,
--ei.eCt.- huAzt,n, days after it has bees accepted as compiele.
Authorized siertanue. ' • Fee methodology set by 7 r,-C nun)Building industry Ser,te.e.Board
_ —
Print name:Elia Duran Date' 10/30/20
r kr4rtile4•nelPerrn.r014..—P..,.,,Anr flan I It An,
ii,..
RECEIVED
Electrical Permit Application S E P 1 7 2
`� City of Tigard CITY OF TI
Tigard,OR 97zz3�'LAi�INING/ENGI ""`"
1312s SW ball$1�d.,r Mae?1-60 4[_l 2_
Phone: 503.718.2439 Fax 503.598.1960 t),ednv Related Permit a t, �Q:Ze 22 -QOL
1 i;;F f) Inspection Litre 503 639 4175 Ready rarely- Anne: RI See Page 2 for
Internet: www.ligaxd-or.gov Notified/Method. Supplemental Information
TYPE OF WORK PLANi-REVIEW.
„A New construction 0 Addition/alteration/replacement mese meet all War apply(submit I sets of plans xreems checked)
❑Demolition ❑Service m feeder amps a more 400
❑Other: src sheElHarmBudding three storms
wb available fault current 0 Hermes and
storms boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Boating Moldings
Is]1-and 2-family dwelling 0 Commercialrmdustrial ❑Accessory building I.w ground,or exceeds 14.000 0 G.m,w,ciat-apse agncalwral
❑Multi-family ❑Master builder ❑Other: amps for all enha in uallrrtons building
❑Flit pump 0 Installation of 150 KVA a
JOI1 SiTE INFORMATION AND LOCATION ❑Emergency ayMem larger separately derived
Job#: .lob site address:16609 S W BOTANY BAY LN IOO1TP El Add1 om ofnew taomr tend f system
or more. ❑"A",'E',"1-2"."1-3',
City/Stater JP: Tigard,OR 97140 ❑six or more residential nits occupancy
❑health-care facilities ❑Rwramonal cantle parks.
Suite/bldg./apt#: Project name: Polygon at Roshak Ridge ❑Hazardous locations 0 Supply voltage for more dtaa
0 Service or frede 600 maps or more 600 yokettominal
Cross street/directions to job site: FEE SCHEDULE E `
_tea 1 ov, I Farr I- Total i •
New rteldestial single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot 4: 198 Includes attached garage.
Tax map/parcel#: 1,000 sq.IL or less 168 sec 4
DESCRIPTION OF WORK En.add 1500 sq.tt or portion 33.92 1
Limited energy,residential 75A0 2
New construction.Type SFU ( +above sq.R)
Limited energy,multifamily 75.00 2
residential(with above sq.ft.)
ea PROPERTY OWNER _�__J ❑ TENANT' Renewable Energy CI Set Page2
Services or feeders installation alteration,as/or relocation
Name: Polygon Homes WLH LLC 200 amps or fees 100.70 2
Address: 703 Broadway St Ste 710 201 amps to 400 amps 133.56 2
City/State/ZIP: Vancouver,WA 98660 401 asps to 600 amps 200,34 2
601 amps to 1,000 amps 301 04 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 mica or volts 552.26 2
Email- OAIa niAbouhafs®taylormonison.com-PennitSubmittals@taylormorrisoll-otmt Fro Temporaryquitkon
'ervic ea or feeders installation,alteration,and/or
Owner installation:This installation is being made on properly 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 to400 amps 125.08 2
Owner signature: Date: 401 amps to 599 snips 168 54 2
❑ APPLICAlcI' ( ❑ CONTACT PERSON Branch circuits—new,at elation,or extension,Err panel
A Fee for branch circuits with
Business name: Polygon Homes WLH LLC above service or feeder fee,
Contact name: Omar Alarm Abonhafa
.... a branch circuit 7 42 2
B Fee for branch circuits without
Address: 703 Broadway St,Ste 710 service or feeder fee,lint 36.18 2
branch circuit,
City/StatefZLP:Vancouver,WA 98660 Each add'l branch circuit 7.42 1 2
Phone: 360 946 8674 Miscellaneous(service or feeder not included)t ) Fax::( ) Each manufactured or modular
Email:OAIamiA lormomsotr seen-Permit5ubmittal dwelling,service and/or feeder
67 84 2
�taY s@taylotmonison.com cooniy 67 84 2
CONTRACTOR
RACI OR Pump or irrigation circle 67 84
2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Address: 105 Dresden St signal ettcuet(a)or limited-enemy ❑ gee Page 2 2
panel,alteration,or extrnsm°.
City/State/ZIP: Ay) OR 97103 Each addittoaal inspection over allowable in any of the above
.-. Additional inspection(1 tar min) 66 25/to
Phone:(503 308 0563 Fax:( ) Investigation(1 hrmin) 90.00/tar
Email:Davidrgwallaccwires.com Industrial plant(1 hr min) 78 18/tar
CCB 1.1C.:224868 inspections
for which no tee is
Electrical Li 'C 1441 Su .1- .. 63635 specifuadiv listed(K hr min) tar
Suprv.l lectrician signatures ELECIRICAT. PERMIT'FEES -
required:
Subtotal j
Print name:Dt u a() f,E, Date: '(f�/if p Plan Review Required(25%of permit tic)
Slate surcharge(12%of permit fee)
Authorized signature TOTAL PERMIT IT:1
.._This permit application es res if.
Print name: �l�]p,� t t i>` permit is net obtained within 1.811
.�•t-"ea 41_3rw.—.4 4.6 e: days after n has been accepted as complete
• Number of inspections allowed per perms.
1-4101,1 agy'crmits'EL:_PmoK ELR ERE doc 11ev 061711015 4 }-4615T0 I/05/COM/9.118
. ..
, , ,Plumbing Permit Application
Building Fixtures
RECEIV: 7 i,,ed FOR OFFICE USE ONLY
1
City of Tigard
SEP0F1 TlicA2OR2 1 Da eiBY Permit No /145 f Z.624.,...00y/Z,,,
•0 13125 SW Hall Blvd.,Tigard,OR 97223 111
c iiateilly
Hain Review ---t-
: Z Phone: 503.7182439 Fax: 503.598 1960 ! Other Permit No. stA)(2:7.411firo., zaf
Inspection Line: 503.639.4175
TIGARD Date RcarlyTy.
abANNING NG . ....-,s. 1 ra see Page 2 for
Internet: www,tigard-orgov CITY
/ENGINEERINotified/Meihod I Supplemental Information
TYPE OF W FEE* SCHEDULE
iz New construction 0 Demolition For special information use checklist.
Description I Qtv, i Ea, I Total
0 Additionfalterationkeplacement 0 Other: New 1-2-family dwellings(includes 100 ft,for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312 70
XI-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
Ei Accessory building 41-Multi-family '
1'
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq fi.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
h., ,_ Catch basin or area drain 18.76
JOU site address: 16609 SW BOTANY BAY LN .._.___
Drywell,leach line,or trench drain 1 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no,linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name/'''''''ApiPolygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
IRain 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.: 198 Fixture or item: .._
Backflow preventer 31.27
Tax map/parcel no.:
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25,02 1
New construction SFU
Dishwasher I 25.02
Drinking fountain 25.02
,
Ejectors/sump 1 25.02
'-- t
1 PROPERTY OWNER 0 TENANT 1 Expansion tank ' 12 51 ' 1
I Fixture'sewer cap I 25.02
Name:Polygon WLH,LLC
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal
25.02
City(StatelZlP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 I Fax:( ) Ice maker 12.51
1 I4 APPLICANT 0 CONTACT PERSON Interceptor/grease trap I 25.02
Medical gas(value S 1 Page 2
,
Business name:Polygon WIN,LLC —
Contact name:Tonja Morris Primer 12.51
Roof drain(commercial) 12.51
Address:703 Broadway St_,Ste 510
Sink/basiniavatory 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
25.02
Email:permitsubinittals@polygonhotnes.com Urinal
Water closet 25.02
CONTRACTOR •
Water heater 37 52
Business name:G&B Plumbing&Sons Inc
1 Water piping.'DWV 56 29
Address:P.O.Box 92 Other: 25 02
City/StareIZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-$170 Minimum permit fee 572.50
Plan review (25%of permit fee) I
CCB Lic.:184372 Plumbing Lic,no.:pb634 I State surcharge(12%of permit fee)
Authorized signature: .., ----- --....____.. TOTAL PERMIT FEE
1 0/30/20 1 This permit application expires if a permit is ma obtained within 180 days
Print name:Steve Fowler Date:
after it has been accepted as complete,
''u' methodology set by Tn-Count)Bulltiing Indust..7 See,ice Baard
I aoldingTertnaaLhit,-FcrmiApn dox I 0,01,09 440-4615Tk I 0,02,COMIVE131
q
City of Tigard RECEIVED
:11/
COMMUNITY DEVELOPMENT DEPARTMENT
SEP 1 72021
TIGARD Building Permit Review — Residential CITY OF TIGARD
rLJj11111daictiatimRII1e
Building Permit #: /4$-t--Z?A- 00'-t(2_
Site Address: C Ut,
Project Name: / e gam, k Y pp Lot #: kg
Planning Revie Proposal: 0 SL& e1(1'vLy
ii Verify address/suite#active in Accela. ® In River Terrace: ❑ No kg Yes, River Terrace Review Addendum
Site Plan Elements: ZErosion Control
1013 copies of site plan on 8-1/2"x 11"or 11 x 17"paper iil Retained trees with drip line and tree protection measures
®Drawn to scale(standard architect or engineer scale) ®Footprint of new structure(including decks)and FFE
Callorth arrow AUtility locations&easements(required for new and additions)
rSite address,project or subdivision name and lot number Sidewalk/driveway approach
RrApplicant information(name and phone number)
®Lot dimensions and building setback dimensions ia r Street tree size,type and location
IISguar- fs ± a oLla ildizgc to -_a -its - L- ' *!Street names
sIF "4' Omer elevations (2'contours if more than 4'differential)
yLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ❑No
LiP Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ie No Received: ❑ Yes ❑ No
CD Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: [A,Yes,applicant was notified ❑ No Received: .er Yes ❑ No
cd-fe : L Irs'—f TNo o
® Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified CT No Applied For: /�❑ Yes ❑ No,stop intake
® Land Use Case#: Su5 21� OM c4 ® Zoning: Lam'—�
JO Required Setbacks: Front: 17 Rear: I 0 t Side: 3 �' Street Side: t 2
1 Garage: e
® Building Height: "'�� Max. Height: /WA- Actual Height: Z2
® Landscape Area: '�C/ % Z1 Lot Coverage Max: ea
Entrance Set back no more than 8'from street-facing wall Parallel to street or offset 45 degrees or less
Windows 0 Minimum 12%of area of all street-facing facades
Garage p, Garage door is behind widest street-facing wall ❑ Yes Cp No,one of the following is met:
RI 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 2"a floor.
,10 Garage door width is ❑ 12'or less ❑ 50%or less of facade 1•d' 60%or less and includes 7 of following:
pi, Covered porch ❑ Recessed entrance [!ih Wall offset NO 1'Roof eave iP Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch P' Gable,hip,or gambrel roof iie Dormer
❑ Accent siding I}ir Window trim ❑ Window recess ❑ Window projection ❑ Balcony
712 Visual Clearance , Urban Forestry Plan
f Sensitive Lands: ❑ Yes )I No Type:
<7 Conditions met prior to issuance of building permit
otes:
R Approved By Planning: Date: 1(7,7.711
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPennitRvw REs 122419.docx
Building Permit Sukmittal
Original Submittal Date: 4 l u T 12i
Site Plans:
Building Plans: # 3
Building Permit#: ® Enter building permit#above.
Workflow Routing: i' Planning tin Engineering ip Permit Coordinator ?® Building
Workflow Sign-off: (' Sign-off for Planning(include notes from planning review)
Route Application Documents: e Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
e Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: keeikL 4j64AdfriA Date: Q/7/4�zJ
En neering Review
1G Slope at building pad: `vs
Conditions "Met"prior to issuance of building permit
[Easements (encroachments) per engineering conditions of approval and plat
[ 'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 2/No
Assess Water Quantity Fee in-lieu: ❑ Yes [No
LIDA Facility on lot: ❑ Yes ge No
ld/Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering:
Date: 9 29 2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El 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/A
Tigard Trans SDC: Yes ❑ N/A See \ ekiered �bYrnS
Parks SDC: jzrYes ❑ N/A
LIDA ❑ Yes / N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: IO S (2021
I:\Building\Forms\B1dgPermitRvw_RES_122419.docx
RECEIVED
City of Tigard SEP 1 72021
_ " COMMUNITY DEVELOPMENT DEPARTMENT 111
CITY OF TIGARD
T AR„D River Terrace Building Permit Review 1� NEEPoNG
Building Permit #: /"$ 'r��- O,('2i
Site Address: S W130111713�
Project Name: ,PO� ,0 2 2,( Lot #: C(
(New dweTlir�=subdivision name;Addition or Alteration=last name of owner)
G
Planning Review of River Terrace Plan District Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? ❑ Yes ❑ No M'M D ZQ z.v-oc,o(i C f
1.Art'e ulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An a..itional
elemen equired for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 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 G-sled dormer
❑ ❑ ❑ ❑ ❑
2.Eyes on the stree a minimum of 12%of each street facing facade must include windo. s or entrance doors.
Percentage Shown:
3.Entrances:At least one ent ,nce must meet both of the following standards:
❑ Parallel to street angle no more than 45° from street,
❑ Max. 8 ft. setback from longest . eet- facing wall
or open onto po
Entrance opens to a porch: ❑ Yes ❑ .
If yes,all the following apply: ❑ 25 sq.f min.
❑ One street facing entry ❑ 12 max. roof above floor of porch
❑ 5 ft. depth min. ❑ i%min.porch roof coverage
4.Detailed Design:All buildings shall include a min. of . e of the following elements on all street-facing facades:
❑ Covered porch min. 5 ft.wide x 5 ft.deep \ Recessed entry area min. 5 ft.wide x 2 ft. deep
❑ Wall offset min. 16 inches ❑ ►.rmer min. 4 ft.wide
❑ Roof eave min. 12 inch projection ❑ Roo .ffset min. of 2 ft.
❑ Roof shingles either tile or wood ❑ Gable,h'. or gambrel roof design
❑ Roof pitch oriented south min. 500 s. t. ❑ Horizontal siding min. 3-7 inches wide
❑ Accent siding min. 40%of street ade ❑ Window trim I,.2 1/2"wide by 5/8"deep
❑ Window recess min.3 inches all street facing ❑ Bay window min. 5 wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 't. deep with inside access ❑ Attached garage is 35% .r less of street facade
5. Garages and Carpo s:May face the front or side lot line on a corner lot.
Setbacks:
No closer to fr• t or side lot line,than longest street-facing wall. ❑ Yes ❑ No. If No (Check one
❑ May ex - d up to 5 ft.if there is a covered front porch and garage does not extend beyond the front .orch.
❑ Ma, extend up to 5 ft.where the garage is part of a two-story building and there is a window at the sec..d story
ab. ,e the garage that faces the street with a min. area of 12 sq.ft.
•4 • h: (Check one)
❑ 12-foot-wide garage door ❑ 40%max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: 4-ati/t_ 1/iAi/1'7/e( Date: �/Z 7i 'Z(
G
I:\Building\Forms\BldgPermitRvw_RES_RT_]2141 7.docx
City of Tigard
Deferral Until Occupancy Request
T I GA RD 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: 10/4/2021 Site Address: 16609 SW BOTANY BAY LANE
Project Polygon at Roshak Ridge Land Use Case or MST2021-00412
Name: Building Permit#:
Tax Lot Total Parks
#:
2S107AA19800 Amount*: $5,839.00
Lot 198
TDT Total TSDC $225.00
Amount: N/A Amount*:
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $ 0 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$4,727.00 for Parks-Improvement,$ 1,112.00 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$ 0 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT, TSDC, and Parks SDCs, as provided above,
until occupancy.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option, I understand that any deferred TDT,TSDC, and Parks SDCs must be paid prior to final
inspection or issuance of an occupancy permit.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be accepted both the Property Owner and the Developer must sign this request.
Property Owner: Omati.4E Jnd; Q6alil:a Date: 10/05/21
Developer: Wauna.46au/ Date: 10/05/21
Permit Coordinator: oetiKebib Date: 10/4/2021
Water Meter Fixture Unit Worksheet For New Buildings RECEIVED
Please complete the following information: SEP
CITY OF TIGARD
Contractor Name: Polygon Home, WLH LLC PIG/ENGINEERING
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: 16609 SW Botany Bay LN (SFU)/ 16611 SW Botany Bay LN(ADU)
Subdivision Name: Polygon at Roshak Ridge Lot#: 198
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
Primary ADU Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer 1 1 2 x 4 = 8
Dishwasher 1 1 2 x 1.5 = 3
Hose bib, lst one 1 1 2 x 2.5 = 5
Hose bib, each add'l 1 1 x 1 = 1
Kitchen sink 1 1 2 x 1.5 = 3
Laundry sink x 1.5 =
Lavatory 4 3 7 x 1 = 7
Water closet, 1.6 GPF 3 2 5 x 2.5 = 12.5
Bathtub/whirlpool x 4 =
Shower stall 1 1 2 x 2 = 4
Bath/shower combo 2 1 3 x 4 = 12
Total Fixture Unit Points: 55.5
Fixture Unit Points:
1 to30 =5/8" 37.5to89= 1"
30.5 to 37=3/4"
Meter Size: 1 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
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
III N Tra
nsmittal Letter
r I c,,IZ t, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: c t to so,,) Agfyri5fR DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
FROM: 9/y7icliy2 M)vm AlaCtA i NOV 2 2011
COMPANY: io96 fpitogR,N( ,. �)��e.�tk" U C (A I Y TIGARD
3UILDING
DIVISION
PHONE: 3 I Q S 14 Co g 6 -1-4 By.
EMAIL: aaiariv`aho vil P pnn 6k.• ....,
RE: / 7609/4j 6`�1 SW' g�T4 AI �� /.1`J7-,(0.91 -- OO , .
(Site A ress (Permit Number)
Pdn al- ackft R\..dpie. bqlf - 0043
( name or subdivision name and lof numbeq
ATTACHED ARE THE FOLLOWING ITEMS
Copies: 1[ Description: $rTi '' 'V1." 1 iJ7 r Cop s"'-� 3Des k , "cl
Additional set(s) of plans. ,Z, Revisions: nee/
+-TRUSS K
Cross section(s) and details. Wall bracing anor 1 teral analysis. po ,-.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain): Jf
REMARKS: ? e& /' tT� i �liist, 1'� � P.a. oui-f-- ch
) pC L}i'c ,DQ p r e44J1nerrzz►'n .
FO O FIE USE ONLY :�;,
Routed to Permit Technic' . Date: [,( j Z) Initials:
Fees Due: ❑ Yes [ f No- Fee Descrip ion: Amount Due:
......\ L,------------- $
$ ;21-,_______
• $
Special
Instructions: (/
Reprint Permit (per PE : E Yes No ill Done
Applicant Notified: te: / /7/ .k l Initials:
l:\Building\Forms\TransmittalLetter-Revisions P 1O.doc
,r.