Permit rr CITY OF TIGARD MASTER PERMIT
` It COMMUNITY DEVELOPMENT Permit#: MST2021-00371
Date Issued: 05/23/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17700
Jurisdiction: Tigard
Site address: 14454 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 177
Project: Polygon at Roshak Ridge, Lot 177(2 of 2)ADUs
Project Description: New attached ADU(2). NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 3 Bedrooms: 5 First: 1092 sf Basement: 33 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1138 sf Garage: 526 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors
Total: 2263 sf Value: $324,270.62 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 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
Bckfw Prevntr: 0
Footing Drain: 0 Ice Maker. 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 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/Feedera Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 WI Svc or Fdr: 0
Ea addt 500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v 0
1000+amp/volt: 0
ELECTRICAL•RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC. N Security Alarm: N Vaccuum System. N Garage Opener: N All Y
Other: N Other Description:
Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ADU VB R-3 2263
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 Fire Rated Conditions
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $20,730.27
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
acn_nM-onlrl lhrnunh nab g59-nn1Jingn VA,,mau nhlain a ennu of+ha ndae nr,lirart nuoefinne In rll inlet hit Tallinn FM 909 10R7 nr'I Ann'4'19 9144
Issued By: No{Lg VaA-DP,W€qte, Permittee Signature: O Ap-p- ca-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 lob site at the time of each inspection.
Building Permit Application
Residential 'ECEI VED FOR OFFICE USE ONLY
Received
City of Tigard AUG 3 20 y 7 /0 Z j 4) PermitNefy577 ZI- Cv 37/
Daze B
13125 S W Hall Blvd.,Tigard,OR 97223 2 Plan Review
• 3 Other Permit:
Phone: 503.718.2439 Fax: 503.598. �(OF DateBy: I
TIt;",AR ate Ready/By>t� / See Page 2 for
T I G n K D Inspection Line: 503.639.4175 I3 VI D / , g
Internet: www.tigard-or.gov LDING DIVISION [,"otifiedrmethod: 17 t Supplemental Information
TYPE OF WORK (/REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. I
❑ I-and 2-family dwelling ElCormnercial/industrial Valuation: $ 32,i I d /p� 1Z
ElAccessory building El Multi-familyNumber of bedrooms: 5
❑Master builder El Other: ADU 2 Number of bathrooms:L 3
JOB SITE INFORMATION AND LOCATION Total number of floors:3 --7$9
Job site address: 14454 SW 165TH AVE New dwelling area: 2,263 square feet t,t3a
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: 526 square feet i ei9 Z
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet 33
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 177 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: Triplex-ADUSjunit 3 out of 3) Valuation: $
,. Deferrals:YES-deferral of TSDC fees and park SDCs until occupancy. Existing building area: square feet
Projected start: 2022 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:
® APPLICANT 0 CONTACT PERSON U9 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 510
City/State/ZIP:Vancouver,WA 98660 Total fees due upon application:
Amount received:
Phone:(360)946-8674 Fax::( )360 693-4442
E-mail: permitsubmittais@taylormorrison.com-OAlamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
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 tic.:207247 ��// � �1[ - - Total fee due upon application: $201.60
Authorized signature: �NYGCLL . 6-11ZG.cY C1BL4,LGtpr� This permit application expires if a permit is not obtained
r(, within 180 days after it has been accepted as complete.
*Fee methodologyset byTri-County Building Industry
Print name:Omar Alami Abouhafs Date: 08/30/2021
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
j� Received
Cityof Tigard �'' E� 1 Permit N
13ISW Hall Blvd.,Tigard,OR-9TZ23� V E® Receivy: 1 jt,'�je QQ 37/
I " Pico Review
' 1 Phone: 503.711.2439 Paz: 503.59 1ppu�,, Other Permit:
rrt; 3 1 20�1 DateReady/By:
ti 1 ri A E t7 Inspection Line: 503.639.4175 v ttAo Date Read/B : rwa:
Internet: www.ti and-or. ov y y Supplemental See Pent for
$ $ CITY'C Y Notified/Method: Information
., �: TIC:,ARD
TYPE OF WORE' COMMERCLAL FEE• SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
►�� New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
®l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
j Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
_.. Air conditioning I 46.75
lob site address: 14454 SW 165th AVE Furnace 100.000 BTU(ductrhems) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ductslvems) 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 auy of above 23.32
Oth
Subdivision: Polygon at Roshak Ridge , Lot no.: 177 _ � 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas Ereplace/insert 33.39
Flue vent for water heater or gas
New construction-Type ADU 2 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace./insert 23.32
Chintney/liner/tluelveat 23.32
tij
PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT- 0 CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
514.15 for first four;S4.03 for each additional
Contact name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas beat pump
Watllsuspende&uuit beater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:pertnitsubmittals t@taylOrMOrriSOfl.COm Barbecue
,r CONTRACTOR .....__ Clothes dryer(gas)
Business name:Pro Heating&Cooling Other
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/M.:Hillsboro,OR Minimum permit fee(390.00)
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 within 180
'"
- ��t ►I days after It hat been accepted as complete.
Authorized signature: ^' ' """"' • Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r-1Thra,I*tPmmirAMF: P..mn♦m.nab Il A... AAA a<r+r,I I at,vvls•n eo,
ElectricalS PeCity of rmit A�pplicatt0 " r ' _ FOR OFFICE USE ONLY
yy
�-. - ... s, �.."N� ,11 Received
i}aoe/By Paon:it t. OD 77/
_. _.._ J
Tigard,OR 97223 Dee/flyllea w Related Permit N.
ligil'" Phone: 503.718.2139 Fax: 503.598.1960 Data9y
1--) Inspection Line: 503.639.4175 Ready DatMAT tuns: VI See Pose 2 for
Literati: www.tigard-or.gov Noti6cd/Mcthod. Supplemental Information
TYPE OF WORK PLAN REVIEW' '
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 1 acts of plans wlitems checked).
❑Demolition ❑Other: ❑Savicc or feeder Mho amps a more aBuilding over s,three stone
where Me available fault correct ❑Matins mat tuneyardx
CATEGORY OF CONSTRUCTION exceeds]g000 amps at 150 wets or ❑Florian buildings
® t-and 2-family dwelling ❑Commercial/industrial ❑Accessory building )as,to mound,or exceeds 14.000 commeec d-use erg cultural
0 Multi-family El Master builder 0 Other a pimp
other Installations l to ate
❑Fire pare. 0 Installation of 150 KVA or
JOB srrE INFORMATION AND LOCATION I7 hmergeney system larger septrately derived
AddJob#: Jab site address: SW 165th AVE ❑10O17011P m moree.onofo mmrload of sy��.
❑•'A","E-,•'1-2""L-3"
City/State/ZIP: Tigard,OR 97140 ❑six et more residential meta occupancy
❑Health-care facilities 0 Rceicatoxal vehicle parks.
Suhe/bldgfapt.#: Project name: Polygon at Roshak Ridge ❑Hazardous locations ❑Supply voltage for mere than
0 Service or feeder bop amps or more. 600 volts normal.
Cross street/directions to job site: FEE SCHEDULE -
O meriptioa I (Kr. I grata l roe I '
Ncw residential siaglc-or multi-family dwelling unit.
•
Subdivision:Polygon at Roshak Ridge Lot#: 177 Includes attached garage.
Tax map/parcel#: 1,000sq.R or less 168 54 4
Ea.add'l 500 sq.ft.or potion 33.92 1
DE5cRIYI'ION OF WORK Limited energy,msideutial
75.00 2
New construction.Type ADU 2 (with above sq.R)
Limited energy.muhi-family 75 00 2
residential(with above sq.ft)
Renewable Energy 0 See Page 2
®pROPERTI OWNER ❑ TENANT Services or feeders insfailation,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70 2
Address: 703 Broadway Si.Ste 710 201 amps to 400 amps 133.56 2
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:( ) Ova 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: OAlamiAbouhafs@taykamorrison.com-PermitSubmittalsl taylo rmorrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange according to ORS 447,449,670,and 701. 201 amps to 400 amps 123 08 2
Owner signature: _. Date: 401 amps to 599 amps 168 54 2
❑APPLICANT I ❑ CONTACT PERSON circuits—new,alteration or extension,per email
A.Fee for branch circuits with
Business name: Polygon Homes WLH LLC above service or feeder fee, 7_42 2
each branch coma
Contact name: Olnar Alamo Abouhaf5 B.Foe for branch circuits mamma
Address: 703 Broadway St.,Ste 710 bean h circuit
a or feederfoe,fast
branch 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add't branch circuit 7.42 2
Phone 360 946 8674Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular 67.84 2
Email:OAlam cct,onlyiAbouhafs@laylolmorrison.com-PennitSubmittals@tay[nrmorriso com d" h'a'a,,iy and/or feeder —
Rxona 67.84 2
CONTRACTOR _ Pump or.rtigation circle 67.84 2
Business name: Wallace Electric Sign or outline lighting 67 81 2
Address: 105 Dresden St Signalli eirmot(s)or mited-eoagy 0 set Page 2 2
panel,alterations or extension.
CRY/Slate/ZIP: Astoria OR 97103 Each additldaal inspection over x0owable in any of the above
Additional inspection(1 ter min) 66 25/hr
Phone:(503 308 0563 ( Fax:( ) Investigation(I ter min) 90.00/ter
Email: David@wallacewires.com Industrial plait(I ter min) 78.18/ter
—
Inspections for which no fee is 90.001 ter
CCB Lie.:224868 Electrical Li
rf• C1441 Su rv.1: .• 6363S specifically listed(156r min)
Suprv.Electrician signature,required y/ ' ELEClBICnL PEFS>Sub tsl'
Print name:DA,0 ad a C Date: /L itz t ❑Plan Review Required(25%of permit fec):
`•'Y• l fd F State surcharge(12%of permit fee):
—
Authorized signature TOTAL PERMIT FEE;
Ibis permit application expires if a permit is not obtained within 180
Print nerve: '7,. _ c, �+-yrY.r Date: c7 4 / .t days alter it has been accepted as complete.
n �� I/ • Number ofinsyectums allowed per permit
Lt5aildtogfamtSaC-PanitApp aR EREdue Sc,0617/2813 151111RSt0MlWEB
Plumbing Permit ApplicatiOl1RECGCF1VE '
Building Fixtures FOR OFFICE USE ONLY
City of Tigard .UG 31 20t tt°"e1Oed Perm
1111 a 13125 SW Hall Blvd.,Tigard,OR 97223 Pla r�IS ( �t 0 3 7/
a . Plannley: tNo.Review
Phone: 503.7182439 Fax: 503.598.I4 TY OF TIGARD DateBy: Other Permit No.:
TIGARD inspection
line: 503.639.4175 BUILDING DIVISION Date Ready/By: /uri,: 61 See Page for
Internet: www.tigard-or.gOv Notifed/Medmd: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special Information 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(I)bath 312.70
gtI-and 2-family dwelling ❑CommerciaVindustrial SFR(2)bath 437.78
❑Accessory building �M lti-famil SFR(3)bath 500.32
u y
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14454 SW 165th AVE Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suitelbldg./apt.no.: I Project name:rselewi rnii.Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Polygon at Roshak Ridge 1 Lot no.: 177 Fixture or item:
Tax map/parcel no.: Bacldlow pieventer - 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction-Type ADU 2
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/suntp 25.02 '..
® PROPERTY OWNER , 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap _ 25.D2
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S ) Page 2
Contact name:
Omar Alami Abouhafs Primer 12.51
Roof drain(commercial) 12.51
Address:703 Broadway St,Ste 510 SinkJbasi /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:permltsubmittais®polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 3752
Business name:G&B Plumbing&Sons Inc Water piping/DWV 56.29
Address:P.O.Box 92 Other. 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)S68-1417 Fax:(971)727-8170 Minimum permit fee: 572.50
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
< State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler Date: 10/30/20 Thu 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 1Buildine ormirslPLMU-Pamiuspp.dac IWObO9 440-4616T(11M/COMrR'F.E)
rr \r
Plumbing Permit Applica �CE� Y E
Building Fixtures FEB 2 ZQZZ FOR OFFICI'. I. ONLY
City of Tigard Received rj 12. 2 - MST2021-00371
t . �f�' OF TIGARG DateBy: Lr permit No.:
II -el 13125 SW Hall Blvd.,Tigard,OR 9712� plea Review
Phone: 503.718.2439 Fax: so3•5 L ING DIVISION Date/By: ,?�j/f?r�� OtherPemtil No.:
Inspection Line[ 503 639 4175 Date Read B lures ® See Page 2 for
TIGAKU Ie o 2f7/ g
Internet www.tl Bard 9r gov 'Jofified/Ne[ho /`u Supplemental Information
TYPE Of WORK _ -.. `/ FEE* SCHEDULE
New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION 1ii7 (,I1 SFR(I)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family I
Each additional bath/kitchen 25.02
O Master builder ❑Other: Fire sprinkler(226dsq.ft.) V Page 2 '
JOE SITE 'INFORMATION AND LOCA'(XU) I ` d Site utilities:
Job site address: 14454 SW 165th Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
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 50.03
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.:_I Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.2177(ADU 2, Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
I, Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWN , . ",� �H ) -' 1 Expansion tank 12.51
Name: Taylor Morrison Fixture/sewer cap 25.02
Address: 703 Broadway St.Suite 710 Floor drain Floor sink/hub 25.02
Vancouver,WA 98660 Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( 360)816-7805 Fax:( ) Ice maker 12.51
1 d q„w a 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@allianceplumbing.net Urinal 25.02
17 - - Water closet 25.02
Water heater 37.52
Alliance Plumbing,name: 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 Lie.: 184601 - - Plumbing Lic.no.: PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
�._,�E_..,7.,-------'
Authorized signature:HannahThomas ' o,,, „.m" TOTAL PERMIT FEE
Hannah Thomas Date: 1(27/2022 This permit application expires if a permit is not obtained within ISO days
Print name: it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Bailding1 Permits\PLMU-PermisApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
.
e ' City of Tigard
p
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
P
Building Permit #: ,1 S 7-Zo 7- 1 — 00 3 7/
Site Address: 14454 SW 165th Avenue
Project Name: Polygon at Roshak Ridge Lot #: 177
Planning Review
Proposal: New attached ADU (2)
❑r Verify address/suite# active in Accela. El In River Terrace: ❑ No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: LiErosion Control
12; copies of site plan on 8-1/2"x 11"or 11 x 17"paper , ,,Jtetained trees with drip line and tree protection measures
O•rawn to scale (standard architect or engineer scale) Footprint of new structure(including decks)and FFh
ril orth arrow :,:„.Jtility locations&easements (required for new and additions)
D.ite address,project or subdivision name and lot number jidewalk/driveway approach
Q pplicant information(name and phone number) plc",Location of wells/septic systems
0 of dimensions and building setback dimensions jtreet tree size,type and location
i`11 tI.quare footage of buildings to be demolished street names
V* II xisting structures on site ,° omer elevations(2'contours if more than 4'differential
II .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es o
r
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° 'o
❑' Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified O No Received: ❑Yes ❑o No
0 Water Meter Fixture Unit Worksheet-Additions,Remodels and ADUs
Required: El Yes,applicant was notified ❑ No Received: Yes ❑ No
❑o SDC Exemption for ADU applied for: ❑ Yes ❑r No Received: Yes ❑r No
❑r Public Facilities Improvement(PF1) Permit:
Required: ❑Yes,applicant was notified El No Applied For: El Yes ❑ No,stop intake
❑r Land Use Case#: ADU2020-00025 ❑r Zoning: R-4.5
ElRequired Setbacks: Front: 8 Rear: 15 Side: 3 Street Side: N/A Garage: 3
ElBuilding Height Max. Height: 30 Actual Height: 25
0 Landsca e Area: 20 % El Lot Coverage Max: 80
Entrance ' Set back no more than 8' from street-facing wall ❑r Parallel to street or offset 45 degrees or less
Windows ' Minimum 12%of area of all street-facing facades
Garage door is behind widest street-facing wall ❑Yes ❑ No,one of the following is met:
Door exten re than 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than all and there is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is 12'or less 50°°o f facade - 60%or less and includes 7 of following:
Covered porch Recessed entrance ❑Wall offse 1'Roof eave Roof offset
Fire shingles Lap Siding ❑Roof itch ❑ Gable,hi ,o rel roof Dormer
_ Accent siding Window trim U Window recess U Window projec' ❑ Balcony
❑r Visual Clearance ❑o Urban Foresta.Plan
❑r Sensitive Lands: El YesL.I No Type:
❑r Conditions met prior to issuance of building permit
Notes: —
0 Approved By Planning: Nam— 1 Date: 9/9/21
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\Bl dgPermitRvw_RE S_122419.docx
Building Permit Submittal • t
Original Submittal Date: c2/3wi
Site Plans: # 3
Building Plans: # 3
Building Permit#: en"nEnter buildin ermit# above. `
Workflow Routing: L�Planning engineering Ly--Permit Coordinator wilding
Workflow Sign-off: Et-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
riginal plan review routing form.
sp Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: K7- (0,4jy,e- �R.�_ Date: /<< ."
�i
Engineering Review
Er Slope at building pad: /4
IConditions "Met"prior to issuance of building permit
Kr
Et Easements (encroachments)per engineering conditions of approval and plat
N7 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot ❑ Yes No
�y
u Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
gApproved by Engineering: Date: f4..S1
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 aly
SDC Fees Entered: Wash Co Trans Dev Tax: �/J Yesi N/A
Tigard Trans SDC: g Yes ❑ N/A
Parks SDC: EYes 0 N/A
,( LIDA ❑ Yes N/A
yJ OK to Issue Permit
/Approved by Permit Coordinator: P\ Date: q I I(P 12_0z 1
I:\Building1Fonns1BldgPermitRvw_RES_I22419.docx
r
City of Tigard
31„„ ° COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 199 51A) I( S
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 (18.640.07O.L):
Is the project subject to the plan district design standards? ❑Yes ❑° No (Per MMD2020-00044)
Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft.of frontage.An additio
ele -nt required for lots with over 60 ft.of street frontage shall be provided every 30 ft.
Porch •. 5 ft. deep Balcony w/ access 2 Window Projection Vertical Wall Offset a Gable. .ormer
ft.deep min.2ft.,5 ft.wide min. 2 ft.,6ft.wide
❑ ❑ 0 ❑
2.Eyes on the str- • :a minimum of 12%of each street facing facade must include windows . entrance doors.
Percentage Shown:
3.Entrances:At least one e •ance must meet both of the following standards:
❑Max. 8 ft. setback from longes .eet- facing wall El Parallel to street, . gle no more than 45 from street,
or open onto poi
Entrance opens to a porch: ❑Yes o
IfUes,all the following apply: El25 sq.ft. in.
One street facing entry ❑12 f ax.roof above floor of porch
❑5 ft. depth min. ❑30/o min.porch roof coverage
4. Detailed Design:All buildings shall include a min.o v of the following elements on all street-facing facades:
ElCovered 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 g •ormer min.4 ft.wide
ElRoof cave 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.. .p siding min. 3-7 inches wide
❑Accent siding min.40%of street fa •e ❑Window trim • ' . 2 1/"wide by 5/8"deep
❑Window recess min. 3 inches for , street facing El Bay window min. ft.wide by 2 ft.deep
❑Balcony min. 5 ft.wide x 3 ft. eep with inside access ❑Attached garage is '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 ..rch.
❑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 r 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: °J /9/21
I\Bu[lding\Fo, ABIdgPcu itRtw_RES_RT_121417.docx
City of Tigard
N = Deferral Until Occupancy Request
T[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: 9/16/2021 Site Address: 14454 SW 165TH Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00371
Name: Building Permit#:
Tax Lot Total Parks
2S 107AA 17700 5,839.00
#: Lot 177 Amount*:
TDT Total TSDC $225.00
A Amount: N/A mount*:
*The total TSDC amount shown above is the sum of$ 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: Off+-4 4 /lee d- Date: 09/16/21
Developer: Oj'.a4- Date: 09/16/21
Permit Coordinator: ( ✓ „" ` Date: 9/16/2021
Plan# '(Aki -tV irt'�J,.t.,* 041( D `-�
Floors 3 Large
Bed rooms 5Small n i . C�53 g o Q V\
WC 3LAV K/�
Tu 3 FF.(-tz- R4-e J et) �J t "R
b Basement 33
Vent 5 1st Floor 109 ).-
Water Heater ' 2nd Floor 1 `3$ / 111 (S
AC 13rd FloorINj uSchool I; R-3Total 22•�a3
III Vi`,-t_Q (--12-- Garage 5.24.e
ry V.�^- 2- Total ). 7Ca1
�- � '/ #forElec /� 1