Permit CITY OF TIGARD MASTER PERMIT
.q COMMUNITY DEVELOPMENT Permit*: MST2021-00369
Date Issued: 05/23/2022
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S107AA17700
Jurisdiction: Tigard
Site address: 14450 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 177
Project: Polygon at Roshak Ridge, Lot 177 Primary dwelling&(2)ADUs
Project Description: New detached dwelling with(2)attached ADUs. NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Reeuired
Stones: 3 Bedrooms. 5 First. 1091 sf Basement: 33 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms. 3 Second: 1184 sf Garage: 507 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2308 sf Value: $329,198.04 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 0
Drywall-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
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2
Furn>=10OK: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add?500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener. N All
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 2308
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: $24,301.75
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
Q50.nn1-nntn lhrnunh r1CR Q59-nMl10Qn Vn,i maw nhtain a rnnw of tha mine nr Airart nusatinne In rll IN(`hw ratlinn c(n 9't9 10119 nr 1 Ann CZ9 944A
1-1OU,9 Vaa.w De-Wege, Ow Ar-p-U.C.0-4-i-o-m.‘
Issued By: Permittee Signature:
Call 503.639.417E 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 WI. / 7 3- 6131 2
Residential BUG 31 2021 FOR OFFICE USE ONLY
Cityof Tigard DatRece/By:
7 fa Permit Nen5—r zo zraa �9
g BD Date BY: ✓ �®
• 13125 SW Hall Blvd.,Tigard,OR 97212k TY OF TIGA Plan Revie ane Pe�i u1J+1 ZO Zi►'L2�o`1l�D
Phone: 503.718.2439' Fax: 503.598.i '1LDING DIVISION Date/BY: it //z-)02.1
Ak `i
c ,-�. Inspectionterne: Line: 503-or.go175 CCC333UUU Date Rea d2.11_ 1 M S See Page 2 for
Internet: www.tigardor.gov otifwd/Method' -s 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.
Valuation: $ 3a9 414
® I.and 2-family dwelling ElCommercial/industrial
, l 1 �.
Number of bedrooms: 5
❑Accessory building 0 Multi-family
❑Master builder ❑Other: Number of bathrooms: ,
JOB SITE INFORMATION AND LOCATION Total number of floors:3 2-8 tS
Job site address: 14450 SW 165TH AVE New dwelling area: 2,308 square feet \\$1y1
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 507 square feet , )911
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet 33
Cross street/directions to job site: Deck area: 71 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/ New Construction/Type: Triplex-SFU(unit 1 out of 3) Valuation: $
V Deferrals:YES-deferral of TSDC fees and park SDCs until occupancy. Existing building area: square feet
Projected start: 2022 New building area: ie)2 o square feet
® PROPERTY OWNER 0 TENANT Number of stories: "T07 4E-6/2 017-5 !
Name:Polygon Homes WLH LLC Type of construction:/I/2/M pit y c
Address:703 Broadway St.,Ste 510 Occupancy groups: 41444 / Y
City/State/ZIP:Vancouver,WA 98660 Existing: .1r-t* .2- -5-
Phone:(360) 946-8674 Fax:( ) New: If
® APPLICANT ElCONTACT PERSON U9 BUILDING PERMIT FEES*
(Please refer ro fee schedule)
Business name:Polygon Homes WLH LLC ��
Structural plan review fee(or deposit): s
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable): 5 y s
Address:703 Broadway St., Ste 510
Total fees due upon application: ',;j Ar�
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:(360)946-8674 Fax::( )360 693-4442
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:permitsubmittals@taylormorrison.com-OAIamiAbouhafs'vtaylormorrison.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver, WA 98660 Permit Fee(includes
a r t plant review e $180.00
Phone:( )360 695-7700 Fax:( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lie.:207247 �J// ! /- /- Total fee due upon application: $201.60
Authorized signature: (�{YGILL �cY i(..oti 4f�6L4/ This permit application expires if a permit is not obtained
(f within 180 days after it has been accepted as complete.
*Fee methodology set by Tn-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)
1
Mechanical Permit Applicatio `FOR OFFICE USE ONLY `^'� 4`'"'
City of Tigard '�ECElVE �� Permit o/15T74ZI--0D3b9
'l 13125 SW Hall Blvd.,Tigard,OR 97223 —
AUG
Phone: 503.718.2439 Fax: 503S 3 ' Fine Revfew98.t96D 1 Oateff3y Other Permit•.
,i I Cih t: i Inspection Line: 503.639.4175 Date Ready/By: runs
for
Internet www.tigard-or.gov CITY OF TIGAHD Notified/Method: El See Page
Supplementall tn(Snformatioo
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:5
CATEGORY_OF CONSTRUCTION RESEIDENnAL Etgonta.NT/SYSTEMS FEES*
IS I-and 2-family dwelling ❑Commercial/mdustrial ❑Accessory building For special information use clrcc.tlisc
I J Multi-family ❑Master builder 0 Other. Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 14450 SW 165TH AVE Furnace 100.000 BTU(d c&veau) 46.75
City/State/ET:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldgfapt no.: Project name: Polygon at Roshak Ridge Heat pump ,, 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hat water system 23.32
Residential boiler(radiator or
hydroaic) 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.: 177 Other-
23.32
Otither fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
-New construction-Type SFU fireplace Flue t for water heater or gas 23.32
Loa Haber(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chinmey/liner/ftue/vent 23.32
Other: 23.32
® PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 equipment 33.39
, Clothes dryer exhaust 33.39
City/State/ET Vancouver,WA 98660 Single-duct exhaust(bathrooms,
compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Artic/crawlspacefans 23.32
I:3 APPLICANT: ❑ CONTACT PERSON Other: 23.32 '..
Business name:Polygon WLH:,LLC _ Fuel piping:
514.15 for first four,S4.03 for each additional
comer name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
WawsuspendeMmit beater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmit:talsCtaylormorrison.com
Barbecue
ilk CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other
1 acoANICALPEamir FEES*
Address: N%%'Alociek Dr,Ste.1104
Subtotal
Ctry/State/ZIP:Hillsboro,OR Minimum permit fee($90.00)
Phone:(360)270-1590 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lit.:209001 TOTAL PERMIT FEE
! This permit application expires if a permit Is not obtained within 180
A: , a ^ days after it has been accepted as complete.
Authorized signature: C•GW ll'JJJW✓tMl. ' Fee methodology set by TriCounty Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r,a,sA:xu\pmm,c s,Wr Puma*rfn(WI it A.,, 4n11.141 tr r r r re,ma•Nur.,
' `Electrical Permit Applicatip Er. p FOR OFFICE USE ONLY
City of Tigard • t-4.." -l V L.L. Received pry a,: f/
13125 SW Hall Blvd,T' p Date/By i�1?-r��'�3I,9
. Tigard,OR 97223 1 1 i 2 •' plan Review
Ili a- . Phone: 503.718.2439 Fax: 503.598.1960 - " ! oateiay Related Permit d:
..itch+.'1) I anion Line: 503.639.4171 —. Ready naeeBy luny: � 6 See Page 2 for
Internet: www.liglr'd-or.gov Notified/Method. Supplemental reformation
TYPE OF WORK PLAN`REYLEW "
®New construction ❑Addition/alteration/replacement Please check as that apply(saran;sets of pleas w/itemv checked):
0 Demolition ❑Other: 0 snot.or feeder 400 amps or mum ❑Budding over three stones.
where the available fault curmat ❑Marinas and boatyante.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 woks or ❑Floating huiidmas
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to pound,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other amps fen all otherinstallations buldm .
_ ❑Pine pump. 0 lnsW lanpr of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
Job it: Job site address:14450 SW 165TH AVE ❑ *oofoevmoto antral slates.
I00/IPOITP or more ❑"A"",�","I-2",`7-3;
City/State/ZIP: Tigard,OR 97140 0 Six a more residential nails occupancy
❑Ilcaltlecare facilities. ❑aervmomal setmcle parks.
Suite/bldgJapt#: Project name: Polygon at Roshak Ridge ❑llaavdora locations 0 Supply wine Immure than
0 Service or feeder 600 amps or more 600 volts nominal
Cross street/directions to job site: nit SCLEDUI E
Descrmama I Q47. I rarh l 'rah,/ i .
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 177 Includes attached garage.
1,000 aq ft.or ass 168.54 4
Tax map/parcel#: Ea.add'd 500
sq.(k or portion 33.92 1
DESCRIPTION OF WORK Limited miergy,residential
(with above sq.ft.) 75.00 2
New construction.Type SFU Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
OW
NER Energy 0 Sec Page 2
D TENANT Services or feeders iustallatloa,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps re leas 100.70 2
_Address: 703 Broadway St,Ste 710 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/LIP: Vancouver,WA 98660 601 amps to 1,000 amps 301.04 z
Phone:( 360 )946 8674 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders inalallatlun,alteration,and/or
Email: OAlamiAbmthhafs@laylormorrisoncom-PermitSubmittals@taylormorrison.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 _ 125.08 2
Owner signature: Hate: 401 amps to 599 amps 168 S4 2
0 APPI.ICANr 1 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes MA LLC above service or feeder fee, 7.42
tomContact name: Omar Aland Abouhafa branch circuit
B.Fee for branch circuits wirkota
Address: 703 Broadway St.,Ste 710 service irfut«fee,flint
branch circuitcuR 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Florae 360 )946 8674Miseellaaeons(service or feeder not included)
t Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:OAlamiAbouhafs@laylotmarrison.con-PermitSubmittals@taylormolrison.com le«nonco only 67.84 z"
CONTRA('IOR A. Pump arur.gadoa circa 67.84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Signal circuits)or limited-energy
Addrom 105 DresdenSt ❑ See Page 2 2
panel,alteration,car cxtcosion
City/State/ZIP: Astoria OR 97103 _Each additional inspection over allowable In any of the above
Additional inspcetion(I hr Mtn) 66 25/hr
Phone:(503 3818 0563 Fax,( ) Investigation(I hr min) 90.00/hr
Email:David@waliacewires.com Industrial plant(1 hr min) 78.18/hr
—
CCB Lit::224868 Inspecttrma for which no fee,s 90.00f hr
Electrical Li ' C 1441 Su v. l.j .: 6363S specifically find(K br min)
I'' ELECTRICAL PERi1fn.FEES :-
Suprv.Electrician signature,required: �J..'-"-'i Subtotal
I
Print name: s Hate: t /G' I ,^❑Plan Review Required(25%of permit fee):
( I State surcharge 02%of permit fee)
Authorized signature TOTAL PERMIT FEE
This Permit appleatloa expires V a permit is not obtained within 180
Print name: swD t t a/ i w,trr. Date: zit if l days after it has beau accepted as complete.
�Y��'r'*+ .v� 4// r + Number of twes:lroas allows per permit.
1:muiidlaahrbmi&flC_PntoitApp_17$EAE.dmc Rev06'17Ro15 4 0-4515T(t l/11SCOMNYFB
Plumbing Permit Applicatiop_ i j_
Building Fixtures ECE! !/ E FOR OFFICE USE ONLN
. City of Tigard
BUG I�, : DaRecteiswWy: P ma Nom ST2o2t-co 3`
a 13125 SW Hall Blvd.,Tigard,OR 97223 III 2.
Plan Review
Phone: 503.71.8.2439 Fax: 503398 9 pa�/B Other Permit No.:
Inspection Line: 503.639.4175 MY 0=. T IGARD y.
rtC3''�D Intern c www.ti rd-or. ov BUILDING DIVISION DaleRady/By: runs: ®SeePage2for
ga g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
E New 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)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
Xl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Acooesory building 43-Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( ,sq.ft.) Page 2
1 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14450 SW 165TH AVE Catch basin or area drain 18.76
drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or ur wh
Footing drab(no.linear ft.: 1 Page 2
Suitebldg./apt.no.: Project name:iiasb.LafiipPolygon 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 It:_) Page 2
Storm sewer(no.linear ft:_) Page 2
Subdivision: Polygon atRoshakRidge I Lotno.: 177 Watereeorie linear ft.: ) Page2
_ Fixture
re or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New construction-Type SFU Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
E PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixwrr/sewereap 25.02
Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
.14 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Omar Alami Abouhafs
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sinkitesin 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:permitsubulittals@polygonhomes.com potygoohomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water pip ng(DW V 56.29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:184372 Plumbing Lic.no.:pb634
(1 e� �-- State surcharge(12%of permit fee)
es Authorizsignature: 1V71t^f�....... TOTAL PERMIT FEE
Print name:Steve Fowler Date: 10/30/20 This permit application expires if a permit I,not obtained within 180 days
after It has been accepted as complete.
*Fee methodology set by Tri,County Building Industry Service Board
t:lautdingWermits'a'IAN-PrnnitApp.doe 10/010 a 40-4616r(IIWJCOMiWEB)
Plumbing Permit Application r'
Building Fixtures 71" � v�®
City of Tigard FEB 2 2022 Received n'2 n e 7� MST2021-00369
Date/By: P r Pemut No.:
IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ] / `,
■ Phone 503.718.2439 Fax: so3,Sy�11�6(>)FTIGARD Date/By: /iiJ. ,L}�(rj Other Permit No,:
Inspection Line: 503 639.4175 ,.,i,,,,As f rr al nin,t.• Date Rea / I inns RI See Pee 2 for
I IGARp dye' / nr S
Internet uww tigaramr gov No[iSed/Method7/7 Supplemental Information
TYPE OF WORK ),i r:/ 4 . ,
E
ate For special information use checklist.
New construction ❑ Demolition
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
a T l.t;
CATEGORY' OF'CONSTRCICTtON ) SFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
D Accessory buildingSFR(3)bath 500.32
0 Multi-family Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler(2308sq.ft.) Page 2
.e tr i( ),!i:oirmir7nr7rfrioN AND LOCA t ra , I(,1 i r .) i site utilities:
Job site address: 14450 SW 165th Ave Catch basin or area drain 18.76 -
Ci City/State/ZIP: Drywell,leach line,or trench drain 18.76
ty Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
-- - - Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no linear ft.: Page 2
Water service(no.linear ft.:_ Page 2
Subdivision: I Lot no.:177(SFU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
, Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
it, ' R 0 TENANT - 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
Garbage disposal 25.02
City/State/ZIp: Vancouver,WA 98660 Hose bib 25 02
Phone:( 360) 816-7805 Fax:( ) Ice maker 12.51
=,m
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
L-mail' gavin@allianceplumbing.net Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name: Alliance Plumbing, LLC
Water piping/D W V 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)
Authorized signature:Hannah Thomas/=.._---
TOTAL PERMIT FEE
Print name: Hannah Thomas Date: 1/27/2022 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i 1 Budding\Permits\PLMU-PermitApp.doc IaN1/00 440-4616T(10/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
■
TlcnuD Building Permit Review — Residential
Building Permit #: 1'1 STZn 24 - 00 3( 9
Site Address: 14450 SW 165th Avenue
Project Name: Polygon at Roshak Ridge Lot #: 177
Planning Review
Proposal: New single detached house
ElVerify address/suite #active in Accela. El In River Terrace: ❑ No ElYes, River Ten-ace Review Addendum
Site Plan Elements: -rosion Control
�1 copies of site plan on 8-1/2"x 11" or 11 x 17"paper FA �tetained trees with drip line and tree protection measures
12 Drawn to scale(standard architect or engineer scale) footprint of new structure(including decks)and FFE
CI orth arrow :„:Ttility locations&easements (required for new and additions)
Mite address,project or subdivision name and lot number °Sidewalk/driveway approach
pplicant information(name and phone number) NR ,ocation of wells/septic systems
0 •t dimensions and building setback dimensions ,',Street tree size,type and location
0II.quare footage of buildings to be demolished ,street names
II-.xisting structures on site °Corner elevations (2'contours if more than 4'differential
CI of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? •' es o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es o
ElClean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: El Yes,applicant was notified ❑r No Received: ❑Yes El No
❑. Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: El Yes,applicant was notified No Received: El Yes No
QSDC Exemption for ADU applied for: Yes El No Received: ❑ Yes No
El Public Facilities Improvement (PFI) Permit:
Required: El Yes,applicant was notified El No Applied For: ❑ Yes El No,stop intake
El Land Use Case#: SUB2015-00004 ElZoning: R-4.5
❑r Required Setbacks: Front: 8 Rear: 15 Side: 3 Street Side: N/A Garage: 3
El Building Height Max.Height: 30 Actual Height: 2#
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 r is behind widest street-facing wall El Yes ❑No,one of the following is met:
❑ Door extends no an 5'from wall and there is a covered porch extending beyond garage.
Door extends no more than 5' ro nd there is a 12 sq ft.window above garage on 2°d floor.
ElGarage door width is 12'or less ❑ 50%or ess de — 60%or less and includes 7 of following:
Covered porch Recessed entrance El Wall offset eave Roof offset
Fire shingles Lap Siding 0 Roof itch ❑ Gable,hi ,or gambre ❑Dormer
- Accent siding Window trim UWmdow recess li Window projection cpIIy
ElVisual Clearance Q Urban Forestry Plan
ElSensitive Lands: ❑ Yes LI No Type:
0 Conditions met prior to issuance of building permit
Notes:
0 Approved By Planning: A -------
Date: 9i9i21
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
I:\B uilding\Forms\BI dgPermitRvw_RES_122419.docx
r /
Building Permit Submittal
Original Submittal Date: k/3//21
Site Plans: # 3
Building Plans: # T _3___
Building Permit#: Enter buildinermit# above. � A �
Workflow Routing: Planning me-Engineering Kermit Coordinator t�tsuilding
Workflow Sign-off: E 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
al plan review routing form.
1. Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes: /
By Permit Technician: q\��2 )c(�i 24,1_4�l.�4,— Date: ,AV:2--/
En ineering Review
� SlSlope at building pad: /d/®
ID/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 111'"No
Assess Water Quantity Fee in-lieu: 0 Yes LUIo
LIDA Facility on lot: ❑ Yes 0 No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering:
Er
Date: .9'1 _S 2//
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 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 a-ply
SDC Fees Entered: Wash Co Trans Dev Tax: Yes I N/A
Tigard Trans SDC: Z'Yes 0 N/A
Parks SDC: 'Yes ❑ N/A
LIDA ❑ Yes VN/A
0 OK to Issue Permit
Approved by Permit Coordinator: Date: glue 12.02.1
I_\Building\Forms\BI dgPermitRvw_RES_122419.docx
•
City of Tigard
1111 ° COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
vaiteal
Building Permit #:
Site Address: 4 4 SD S en) toil— AVc'
Project Name: Polygon at Roshak Ridge Lot #: f f r
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? ❑Yes ElNo (Per MMD2020-00044)
.culation: a minimum of 1 element per each street-facing facade that has 30-60 ft.of frontage.An additio
ele nt required for lots with over 60 ft.of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch ;.; ft. deep ft.deep min.2ft.,5❑ft.wide min.2 ft.,6ft.wide Gable. .ormer
2.Eyes on the str :a minimum of 12%of each street facing façade must include windows entrance doors.
Percentage Shown:
3.Entrances:At least one e ante must meet both of the following standards:
0 Parallel to street, . :le no more than 45° from street,
❑Max.8 ft. setback from longes treet- facing wall
or open onto por
Entrance opens to a porch: ❑Yes 1 o
Ives,all the following apply: ❑25 sq.ft in.
UOne street facing entry ❑12 f ax.roof above floor of porch
❑5 ft.depth min. ❑3./o min.porch roof coverage
4. Detailed Design:All buildings shall include a min.o v of the following elements on all street-facing facades:
❑Covered porch min.5 ft.wide x 5 ft.deep I Recessed entry area min. 5 ft wide x 2 ft.deep
❑Wall offset min. 16 inches E I ormer min.4 ft.wide
❑Roof eave min. 12 inch projection ❑R., offset min.of 2 ft.
❑Roof shingles either tile or wood ❑Gable, ..p or gambrel roof design
❑Roof pitch oriented south min. 500 sq. . ❑Horizon.. ap siding min.3-7 inches wide
❑Accent siding min.40%of street fa .e ❑Window trim • ' .2 1/2"wide by 5/8"deep
❑Window recess min.3 inches for street facing ❑Bay window min. ft.wide by 2 ft.deep
❑Balcony min. 5 ft.wide x 3 ft. eep with inside access ❑Attached garage is 'o or less of street façade
5. Garages and Carports: ' ay face the front or side lot line on a cornet lot.
Setbacks:
No closer to front o .ide lot line,than longest street-facing wall. ❑Yes 0 No. If No (Check o :
0 May extend u. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
❑May exten. p to 5 ft.where the garage is part of a two-story building and there is a window at the se , d story
above the v age that faces the street with a min. area of 12 sq.ft.
Width• heck one)
O -foot-wide garage door ❑40%max. of street façade
50%max.of street façade with 7 detailed design elements
Notes:
Approved By Planning: Date: e
I\Building lFonn,B1dgPcnniIRvw_RES_RT_I21417.docx
City of Tigard
1,1 q Deferral Until Occupancy Request
T I G A R D Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
This form is to be signed and submitted prior building permit issuance or, if no building permit is required, then
upon land use approval(TMC 3.24,as amended by Ordinance No. 21-09).
Date: 9/16/2021 Site Address: 14450 SW 165TH Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00369
Name: Building Permit#:
Tax Lot Total Parks
2S107AA17700 $5,839.00
#: Lot 177 Amount*:
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: Omra.4/a' ,44,, Date: 09/16/21
Developer: OhuzA.,/Mune 46eu Date: 09/16/21
Permit Coordinator: Ara
Gei" e ` Date: 9/16/2021
RECEIVED
Water Meter Fixture Unit Worksheet For New Buildings AUG 31 2021
Please complete the following information: CITY OF TIGARD
BUILDING DIVISION
Contractor Name: Polygon Home, WLH LLC
Billing Address: Street/Suite#: 703 Broadway St, STE 710
City: Vancouver State: WA Zip: 98660
Phone Number: 360 946 8674 Email:
New Meter Address: 14450 SW 165th Ave(SFU)- 14452 SW 165th Ave(ADU 1)- 14454 SW 165th Ave(ADU 2)
Subdivision Name: Polygon at Roshak Ridge Lot#: 177
Building Permit#:
Please fill in the number of each fixture as detailed on the plans. Multiply the quantity by the point value
to arrive at the point total. Add all point totals together for total fixture unit points.
Fixture Unit Quantity Point Value Point Total
SFU ADU1 ADU2 Total
Bar sink x 1 =
Bidet x 1 =
Clothes washer 1 1 1 3 x 4 = 12
Dishwasher 1 1 1 3 x 1.5 = 4.5
Hose bib, 1"one 1 1 x 2.5 = 2.5
Hose bib, each add'l 1 ,r 12 5 x 1 = 13" el
Kitchen sink 1 1 1 3 x 1.5 = 4.5
Laundry sink x 1.5 =
Lavatory 6 4 5 15 x 1 = 15
Water closet, 1.6 GPF 4 3 3 10 x 2.5 = 25
Bathtub/whirlpool x 4 =
Shower stall 2 1 1 4 x 2 = 8
Bath/shower combo 1 1 1 3 x 4 = 12
Total Fixture Unit Points: SFr.S g 7.
Fixture Unit Points:
1 to 30= 5/8" 37.5 to 89= 1" /1/0 : v '^ $116 ht zi C'.SXn+it f raystect
30.5 to 37=3/4" rtt,- ✓cateova/ Df- Q) haS- .h. b
dv 4-4 u 0 ei-4) Ai5!Au A I-003?a
Meter Size: 1" Meter Cost: $ 24,886.00
*************************************************************************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building (Master) Permit or Plumbing 0 Yes ❑ No ❑ Other:
Meter#: Sale Date:
Receipt#: Meter Cost:
Employee Name:
1:/Building/Forms/WaterMeters_010121 New.docx Page 2
e_ekr k - -r, R-ug v s-F.ej
4:6-
Pr, r`1 S -U ir � 1
Plan# i'hii- TU -Tr'p(z( (e-( ) `��nh ���� I
Floors 3 Large 3p U"�`e
Bed rooms 5.A. Small De/ ( ,
we 3 1 F r-L.- ram- -� C o , (b-r__..%
LAV 5
Tub 3 Basement 33
Vents 1st Floor 1Q9 ► `
Water Heater I 2nd Floor I i �N /4c..
L '�,� r.2 1 f rtLLAC Y 3rd Floor o1* l �j�.�� --'
School T'"& R-3 Total 2-30S 1
.� �-4.- ° Garage S 01
FI.K..\ �,(V - ,D. Total a C6 (� IS� P _CrntA` On- 1Y
1-40 b; bs
#for Elec ii
4V/1 V t c y,‘4.).) ( S a,r--e_ ►et.6 a. Lau-c-o,C , n
S-c,c.. 12 4j03 , S Gxc�- t er,n �''`� /Z y0 se./
.) 'Pm v\, c—a,t._. 1 ctc_ r mil.` C_atia f A ij-cr—reic
o c-tiL ,fir .`f
P