Permit CITY OF TIGARD MASTER PERMIT
'"l e 'rr COMMUNITY DEVELOPMENT Permit#: MST2021-00332
Date Issued: 03/31/2022
T(GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA20000
Jurisdiction: Tigard
Site address: 16561 SW BOTANY BAY LN
Subdivision: ROSHAK RIDGE Lot: 200
Project: Polygon at Roshak Ridge, Lot 200
Project Description: New detached dwelling. NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 1523 sf Basement. 0 sf Left: 3 Parking Spaces: 0
Height: 29 Bathrooms: 3 Second: 1896 sf Garage: 688 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3421 sf Value'. $481,994.82 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 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
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add?500 sf: 7 201-400 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 V8 R-3 3421
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 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $39,385.99
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
qc9-nnl-nnin thrn„nh nap ecd_nn1-0n0n vnu mm,nhtnin a rnm,of tha ndac nr dirart n„aeenne to nu INC h,.Tallinn gill 9'19 lOR7 nr 1 Ann-Az/91d4
HaU.y Vaw De,Wege, Qv„Ap-pti,c-cutiavt,
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the iob site at the time of each inspection.
Building Permit Application 104fraCt9 "--N iO(2
Residential 11 bUJ L § t L FOR OFFICE USE ONLY
Received
City of Tigard n 2021 DateBy: �/H Z/ Permit No.f jc r�-�u_0033�
li • 13125 SW Hall Blvd.,Tigard,OR 97223" �' Plan ReviewQ ^'� �'] n�.,,,.�' D �/,, ,.1
' C Phone: 503.718.2439 Fax: 503.598.19 -1'. Date/By: J 2. d/ other
Jt(,i/2..20z/_OO.g Ise
t,0 Inspection Line: 503.639.4175 61 I U r j.taAR D Date Ready/By: / Jtsw+ ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION a.otified/Metho•.f/ 44 I la Supplemental Information
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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. WI
4® 1-and 2-family dwelling ElCommerciaFindustrial Valuation: $ I / 1l"-'
0 Accessory building El Multi-familyNumber of bedrooms: 4 '
❑Master builder ❑Other: Number of bathrooms 3
JOB SITE INFORMATION AND LOCATION Total number of floors:2 9 ID
lob site address: 16561 SW BOTANY BAY LN New dwelling area: 3,421 square feet 1 $9 f$
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: C88 square feet )52,3
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.: 200 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.
New Construction/Type: SFU/Elevation plan: 222700E. Valuation: $
Projected start: March 2022 Existing building area: square feet
7 Deferrals:deferral of payment of transportation&park SDCs to 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 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360) 946-8674 Fax:( ) New:
El APPLICANT ❑ CONTACT PERSONS BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer Wfee schedule)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 510
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Phone:(360)946-8674 Fax::( )360 693-4442 Amount received:
E-mail:permitsubmittals@taylormorrison.com-OAlamiAbouhafs@taylormorrison.com 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.
Permit Fee(includes plan review $180.00
City/State/Z1P:Vancouver, WA 98660 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: Oh2Q.2.4 ,ry l7B 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
Print name:Omar Alami Abouhafs Date: 07/27/2021
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
•
Mechanical Permit ApplicIVED FOR OFFICE USE ONLY
City of Tigard °"� "" Received
Prone" ST2du-0033Z
9 13125 SW Hall Blvd.,Tigard,OR 97223 1 I U 1 t) ?sj/1 Plan Review ".- Other PermitFhone. 503.7182439 Fax: 503.598.196 V Datelliy:
Inspection Line: 503.639.4175
i I it h It 1 i , , Date Read/B Juan
interne[: www.tigard-or.gov CITY '- �'aa'�D Notified/Method: SSa pkmental Information
'1.!'LDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE'—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alterationheplacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUD'MENF/SYSTE_MS FEES*
® 1-and 2-family dwelling ❑Commercial/industria1 ❑Accessory building For special injormoeion use checklist
I J Multi-family D Master builder ❑Other. Description _ Qty. Ea I Total
JOB SITE INFORMATION AND LOCATION Realign/cooling:
Air conditioning I' 46.75
Job site address: 16561 SW Botany Bay LN Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 1 Furnace 100,000f BTU(ducts/vents) 54.91
Suite/bldg.apt.no.: Project name: Polygon at Roshak Ridge Heat pump 61.06
Duct work 23.32.
Cross street/directions to job site: Hydronic hot water system 23.32 ,
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Polygon at Roshak Ridge Lot no.: 200 Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water beater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
—
New construction,type:Single-Family Units Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Cbiumey/linet/fluefvent 23.32
El PROPERTY OWNER 0 TENANT Other. 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT. 0 CONTACT PERSON Other. 23.32
Business name:Polygon WLH,LLC Fuel piping:
S14.15 for Gra four,S4.03 for each additional
Contact name:Tonj a Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump -
W all/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittalsCataylOrm0rflSOf1.COM Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Coaling Other.
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/L1Y:Hillsboro,OR Minimum permit fee(590.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCH lic.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained widths IRO
(.1- days after it has been accepted as complete.
Authorized signature: ^'I �U--'t to n' • Fee methodology set by Tn-Counry Building Industry Service Board
....................
Print name:Ella Duran Date: 10/30/20
,•,An:limelp,,Oth.nN 0.,mi,P.n.Mnt i a AM aen a[,-.r'II 015,vn0..1 rtuc°I
Electrical Permit Application FOR OFFICE USE n`1 ti
City of Tigard may`' p"'"a.11ST7-fv t -oo 3 v
li 13125 SW Hall Blvd.,Tigard,OR 97223
g Phone: 503.718.2439 Fax: 503.598.1960 tt�se-- Relined Permit a:
'it R lhl�
inspection Line 503.6394175 Ready Ontoilly kris 0 See Page 2 for
Internet: www.tigard-or.gov NotifcdJMothod. Supplemental Information
•
TYPE OF WORK PLAN REVIEW
®New construction El Additiadalteratioulrtplacement Please check all that apply(sellout lusts of plans wirtems checked): 1
0 Snvicc err feeder 400 amps or more 0 Budding ova n three stoes.
❑Demolition El Other.
where the available fault camera Q Ma[]ma4 and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO was or ❑Honing buildings
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to gonad,or exceeds 14.000 0 Commercial-use agricultural
❑Multi-family El Master builder El Other: amps fen all oilier installations buddmirs
❑Fire pump. 0 Installation of 130 KVA or
JOB SITE INFORMATION ANT/LOCATION Q Emergency system larger separately derived
Job*: Job site address:16561 SW Botany Bay LN ❑00TIPaof
more motorload of 'A
City/State/ZIP: Tigard,OR 97140 0 six or mom residential units occupancy
❑Healthcare&cilium 0 Rcacatmaai vetuok parks.
Suite/bldgiapL#: Project name: Polygon at Roshak Ridge 0 Ilarardms locations Q supply vol ergs for m«e than
❑Servicc or feeder 600 amps or more 600 iota sosuaal.
Cross street/directions to job site: FEE S01EEitLE '
.
nrsaripaoa I Qua I Each 1 Total I •
New residential single.or multi-faintly dwelling unit
Subdivision:Polygon at Roshak Ridge Lot*: 200 Includes attached garage.
1,000 sq.It or lees 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.R.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
New construction.Type SFU (with above r 8)
Limited energy,multi-family 75.00 2
_ residential(with above sq.ft)
®-PROPERfk OWNER Renewable Energy ❑ See Page 2
❑ 'IF. ANT Services or feeders Inatafla lion,alteration,and/or reloealloa
Name: Polygon Homes WLH LLC 200 amps or leas 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to 400 amps 113.56 2
401 amps to 600 amps 301.04 2
City/State/ZIP: Vancouver,WA 98660
rS01 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax ( ) Over 1,000 a or volts 552.26 2 W
amps
Temporary services or feeders installation,alteration,and/or
F.mait: OAIamiAbouhafs@taylormorrison.com•PermitSubmittals®taylormorrison.com relocation
Owner installation:'ibis installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps in 400 amps 125 08 2
Owner signature: Date: 401 amps to 599 amps 168 54 2
0 APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extenSion.pr panel
A.Fee for Mauch circuits with
Business name: Polygon Homes WLH LLC above service or feeder Gat,
each branch circuit 7.42 -
Contad name: Omar Alami Aboubafs B.Fee for branch circuits without
service or feeder fee,first
Address: 703 Broadway St,Ste 710 branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each adrl'I branch circuit 7.42 2
360 946 8674Miscellaneous(service or feeder not included)
Phone:
( ) Fax::( ) Each manufactured or modular
dwelling.service araYor feeder 67.84 z
Rmait:OPJamiAbouhafs@taylormorrison.com-PeonitSubmittals@taylormorrison.eom oMttt only z
CONTRACTOR Pump or in gatioa circle 67.84 2
Business name: Wallace Electric sign or outline lighting 67.84 2
Address: 105 Dresden St Signal arettet(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension
City/State/Z P: Astoria OR 97103 Each additional inspection over allowable in any of the above
Each
inspection(1 hr min) 6625/hr
Phone:(503 388 0563 I'm;( ) luvestigatmoo(I hr min) 90.00/hr
Email: DavidJwallaccwires.cam Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:224868 Electrical Lif,:,C1441 S rv-I: 6363S specifically listed(%hr min)
Suprv.Electrician signature,required Y/F� ELECTRICAL PERMLT oFEES
/ '� Subtotal
Prim name:t7. t)(+ao .t'•Y Date_ U/`/!z I ❑Plan Review Required(25%of permit fcc) - -
� [ State surcharge(12%of permit fee):
Authorized stature TOTALTALPERMIT FEE:
Tkis permit appiicslien expires if a permit is not obtained within 180
Print name: �tr 4a tA ��,0�r Date: zi p J7 t days after it has been attepted as campkle<
r'marls �Sr T ` • Number of inspcdroas allowed per permit.
Ellaifdn%Wemda'ddC_PmrutApp_a&ERE.dce Rev 0617/2015 1501 h05C0MlWEB
Plumbing Permit Applicatio
Building Fixtures 1 tLj L.i .V FOR OFFICE USE ONLY
City of Tigard q f DateiBya Permit No.: C-T-2A 7,i-0033 .2-
III 2 .* 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.7182439 Fax 503 598 . Other Permit No.
?Tri s r._ ..i Dete/By:
116.A
Inspection Line: 503.639.4175 ,:; l N 1 Date Ready/By: Nos: ® See Page 2 for
• Internet: www.li rd-or. ov �� ..- '.
8a g Notified/Method: Supplemental information
-
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description I Qty. I La. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building Multi-family
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: 16561 SW Botany Bay LN Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft: 1 Page 2
Suite/bldgJapt.no.: I Project name:Aoi-MAiirPolygon 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 R:_) Page 2
Water service(no.linear ft:_) Page 2
Subdivision::Polygon at Roshak Ridge Lot no.: 200 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction,type:Single-Family Units
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
121 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
' Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptorlgrease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Toeja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water _
.DWV I in 56.29
PP g
Address:P.O.Box 92 Other 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: 572.50
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25°k of permit fee)
q��� State surcharge(12%of permit fee)
Authorized signature: 'tiErA y"` 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.
"Fete methodology set by Tn-County Building Industry Service Board.
I.\&midairPermits1PLMU-PermitApp.doc I0/01N9 440-4616T(I0W02LOIWWEB)
Plan# 'L22_76d5
Floors ' ' Large 2- 1
Bed rooms t^ Small 78
we 3
LAV
Tub 3 Basement
Vent 5 1st Floor 152 3
Water Heater I 2nd Floor e $
AC 1(<p 3rd Floor
School �[ [[ R-3Total 342-I
Garage le$$
rr ^ � , � f Total ti l 0ci
1.. `, �{66c), #for Elec ` 7
d
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City of Tigard
71 ■ COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c RD Building Permit Review — Residential
Building Permit #: N 5 r2-6 24 ^003 3
Site Address: KO 5(49 ( SIN BuirAmi PA.y Lh
Project Name: Polygon at Roshak Ridge Lot#: top
Planning Review
Proposal: New Neese- dce C c r,1a-(r1 w ,
I
J Verify address/suite#active in Accela. ® In River`rerrace: ❑ No ® Yes,River Terrace Review Addendum
See comment below
Site Plan Elements: leErosion Control
*13 copies of site plan on 8-1/2"x 11"or 11 x 17"paper YffiRetained trees with drip line and tree protection measures
®Drawn to scale(standard architect or engineer scale) k7Footprint of new structure(including decks)and FFE
]North arrow XJUtility locations&easements(required for new and additions)
(Site address,project or subdivision name and lot number ®Sidewalk/driveway approach
®a�,Applicant information(name and phone number) @Location of wells/septic systems
C lLot dimensions and building setback dimensions ®Street tree size,type and location
'Square footage of buildings to be demolished ®Street names
rIalExisting structures on site ®Corner elevations(2'contours if more than 4'differential)
®Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EWA❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a stone water quality facility shown? ❑Yes❑No
J Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified E No Received: 0 Yes ❑ No
® Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified li] No Rerpived: 0 Yes 0 No
b SDC Exemption for ADU applied for: ❑ Yes 0 No Received: 0 Yes ❑ No
n Public Facilities Improvement(PFI) Permit
Required: ❑ Yes,applicant was notified i7 No Applied For. ❑ Yes 0 No,stop intake
® Land Use Case#: SUB2015-00004 5 zoning R-7
J Required Setbacks: Front: 8 Rear: 10 Side: 3 Street Side: 8 Garage:AL__
® Building Height Max.Height: WA Actual Height: 29
Cl Landscape Area: 20 % El Lot Coverage Max: 80
Entrance p Set back no more than 8'from street-facing wall n Parallel to street or offset 45 degrees or less
Windows M Minimum 12%of area of all street-facing facades F: 16%/S: 12%
Garage ® Garage doot is behind widest street-facing wall lil Yes 0 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 garage on 22.1 floor.
In Garage door width is ❑ 12'or less fl 50%or less of facade ❑ 60%or less and includes 7 of following
El Covered porch 0 Recessed entrance ❑ Wall offset 0 1'Roof eave ❑ Roof offset
El Fire shingles 0 Lap Siding 0 Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
D Accent siding 0 Window trim ❑ Window recess ❑ Window projection 0 Balcony
® Visual Clearance E Urban Forestry Plan
I1 Sensitive Lands: ❑ Yes Cl No Type:
® Conditions met prior to issuance of building permit
Notes: NMAD2020-0004 -Design standa-ds in 18.290 p only.
® Approved By Planning: �►t ✓�td�(� Date: 8/16/2021
Revisions (after Building Submittal only)' U Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
I:luidding\FonnstBldgPennitRvw_RES 122419.docx
Building Permit Submittal
Original Submittal Date: 8-/I6/Z/
Site Plans: # 3
Building Plans: # 3
Building Permit#: 0"Enter building permit#above.
Workflow Routing: 0 Planning ❑ Engineering 0 Permit Coordinator .,.-E Building
Workflow Sign-off: Ei 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
original plan review routing form.
0 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ..�1� d2,,ki-/Q,- Date: i7/Cp/2-/
Engineering Review
411 Slope at building pad: 3/1
onditions"Met"prior to issuance of building permit
[( F,asements (encroachments)per engineering conditions of approval and plat
PS/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes //No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot ❑ Yes 0 No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
CP/Approved by Engineering: Date: y!et/Z/
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
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant
Revision Notice 2: Date Sent to Applicant:
2 SDC Exemption: 0 Received eg Does not apply
'SDC Fees Entered: Wash Co Trans Dev Tax: g Yes ❑ N/A �
Tigard Trans SDC: 'Yes +❑ N/A ,DC5 Gi-e-fre ' `~"
Parks SDC: A Yes ❑ N/A
LIDA ❑ Yes „A N/A
y
jZi. OK to Issue Permit ���'"
Approved by Permit Coordinator: ___PT Date: 8/19/2021
1:1Bui ld ing\Fonns1Bl dgPermitRvw_RE S_122419.docx
City of Tigard
. Parks SDC Charge (Parks)
TIGAR Notification of Fee and Payment Options
Please sign and return prior to building permit issuance.
This advises you that the total Parks SDC charge for this project is as shown below and outlines the payment
options that may be available to you. This total includes Parks SDC-Improvement,Parks SDC-Reimbursement,
and either Parks-Neighborhood or Parks-Neighborhood River Terrace charges as relevant. This form is to be
signed and submitted prior to issuance of a building permit.
City of Tigard
Date: 8/19/2027 Site Address: 16561 SW Botany Bay Lane
Project Polygon at Roshak Ridge - Land Use Case
Name: Lot 200 or Permit #: MST2021-00332
Tax Total Parks
2S107AA20000 $10,903
Lot#: SDC Amount*:
*The total Parks SDC amount shown above is the sum of$ 6,278 for Parks-Improvement,$1.739 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$2.886 for Parks-Neighborhood River Terrace.
This constitutes my request to use the Parks SDC payment option or combination of options I have selected below.
[This selection can be changed up to the time a building permit is issued.] I realise that SDC charges are due and payable at the
time a building permit is issued unless those charges are Deferred or are financed through Installment Payments.
❑ Cash, Check,or Credit Card,payment due at building permit issuance.
Deferral until Occupancy,payment due before issuance of an occupancy permit.
Payment of the Parks SDC may be deferred until issuance of the occupancy permit. In requesting this option,I
understand that any deferred Parks SDC must be paid prior to issuance of a Certificate of Occupancy. For a deferral
request to be accepted both the Property Owner and the Developer must sign this request.
❑ Credit Voucher (for developer-built required public improvements, subject to approval, completion,and acceptance of
creditable improvements.)
PLEASE NOTE: Parks SDC Credits must be redeemed at the time Parks SDC Payment is due, either at the time
the building permit is issued or, if payment is deferred,prior to issuance of an occupancy permit. If you expect to claim
Parks SDC Credits be sure the improvements, any creditable payments,and your Request for Credits is complete either
before your building permit is to be issued or,if payment is deferred,before you request an occupancy permit. No
refund of Parks SDC Payments will be made if Credits are submitted more than 30 days after issuance of the relevant
building or occupancy permit.
El "Bancroft" or Installment Payments (separate application required.)
Om em 4 lean.4..46e Onra�,APami..A6eul
PROPERTY OWNER DEVELOPER
DATE: 08/19/2021 DATE: 08/19/2021
I:\Community Development\Permit Coordinator\SDC Forms\Payment Option Forms
City of Tigard
III : •
q Transportation System Development Charge (SDC)
TIGARD Notification of Fee and Payment Options
This advises you that the total TSDC for this project is as shown below and outlines the payment options that may be
available to you. This total includes charges for TSDC-Improvement,TSDC-Reimbursement, and TSDC-River
Terrace,if relevant.
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).
City of Tigard
Date: Site Address:
8/19/2021 16561 SW Botany Bay Lane
Project Polygon at Roshak Ridge - Land Use Case or
Name: Lot 200 Building Permit#: MST2021-00332
Tax Total TSDC
2S107AA20000 $10,348
Lot#: Amount*:
*The total TSDC amount shown above is the sum of$6,690 for TSDC-Improvement, $386 for
TSDC-Reimbursement, plus $ 3,272 for TSDC-River Terrace,if relevant.
This constitutes my request to use the TSDC payment option or combination of options I have selected below. [This
selection can be changed up to the time a buildingpermit is issued] I realize that TSDC charges are due and payable at the time
a building permit is issued unless those charges are Deferred or are financed through Installment Payments.
❑ Cash, Check, or Credit Card,payment due at building permit issuance.
IX Deferral until Occupancy,payment due before issuance of an occupancy permit.
Payment of the TSDC may be deferred until issuance of the occupancy permit. In requesting this option, I understand
that any deferred TSDC must be paid prior to issuance of a Certificate of Occupancy or final inspection. For a deferral
request to be accepted both the Property Owner and the Developer must sign this request.
El Credit Voucher for developer-built required public improvements, subject to approval, completion,and
acceptance of creditable improvements.)
NOTE: TSDC Credits must be redeemed at the time TSDC Payment is due,either at the time the building permit
is issued or,if payment is deferred,prior to issuance of an occupancy permit. If you expect to claim TSDC Credits be
sure the improvements, any creditable payments,and your Request for Credits is complete either before your building
permit is to be issued or,if payment is deferred,before you request an occupancy permit. No refund of TSDC Payments
will be made if Credits are submitted more than 30 days after issuance of the relevant building or occupancy permit.
❑ "Bancroft" or Installment Payments (separate application required.)
Os Ads 46e Opt 4 .R6e
PROPERTY OWNER DEVELOPER
DATE: 08/19/2021 DATE: 08/19/2021
l:\Community Development\Permit Coordinator\SDC Forms\TSDC Combination Payment Option Form 112718 AMS