Permit ED
Plumbing Permit Applicatio
Building Fixtures FEB 2 2022 Foli oFli( l': I si.. 0.l.1
Received
City of Tigard �;��Y OF Y IG�1 �J Permit No.: MST2021 00408
• 13125 SW Hall Blvd.,Tigard,OR_'7 Date/By: �'2'ZZ TEE,
� i ! ING DIVISION Plan Review
'1 Phone: 503.718.2439 Fax: 503.: uu��ww®I V�A DIVISION to Date/By: ,2/i;/ eeie.67 Other Permit No.:
I t h i Inspection Line: 503 639 4175 Date Ready/By s See Page 2 for
Internet www.tigard-or.gov Notified/Method /J��kris ®Supplemental Information
„ ...��', << � w�� ..:ems... A��;�...��t �"za�_� �a��r �.,,t�t�tl8 ��Forspecis� e.- , ', ;`
few construction Demolition al 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)
:' .'. �" ORY OF` cON ioN - .,; SFR(1)bath 312 70
...Al-and 2-family dwelling 0 Commercial/industrial SFR(2)bath
SFR(3)bath 500 32
❑Accessory building...' 0 Multi-family
Each additional bath/kitchen 25 1
❑Master builder - 0 Other: 1228
Fire sprinkler( sq.ft.) t� Page 2
i t', 4 JO ,, A TION .'• . I t Site utilities:
Job site address: 16728 SW Darwin Loop 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.: 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: Lot no.:1188(ADU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,,,'Ti'- r ."
'' iN �� .., ac water valve
B 1 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r ., ..x rO.,.,,,�_.r T,I ,.A ,�NANT Expansion tank 12.51
Taylor Morrison Fixture/sewer cap 25.02
Name: Y
Address: 703 Broadway St.Suite 710 Floor drain/floor sink/hub 25.02
-
Garbage disposal 25.02
City/State/Z1P: Vancouver,WA 98660
Hose bib 25.02
816 7805
Phone:( 360) Fax ( ) Ice maker 12.51
M s 4
i� 4i (. � 1 • <, iii Interceptor/grease trap 25.02
Business name: Alliance Plumbing, LLC Medical gas(value:$ ) Page 2
Contact name: Gavin Thomas 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
� ,t Water closet
�a �, 1aT ►cR a 4 l r 37.52
z
�ti._. .. _.a.., 'i Water heater 37.52
Business name: Alliance Plumbing,LLC
Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP: Troutdale, OR 97060 Subtotal
Phone:(503 )492-3490 Fax:( 503)912-6438 Minimum permit fee: $72.50
CCB Lie.: 184601 Plumbing Lic.no.: PB732 Plan review (25%of permit fee)
D.d�� �� I State surcharge(12%of permit fee)
Authorized signature: Hannah Thomas:=» a" .. TOTAL PERMIT FEE
Print name: Hannah Thomas Date: 1/27/2022 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PernuiApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00408
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2022
Parcel: 2S 107AA18800
Jurisdiction: Tigard
Site address: 16728 SW DARWIN LOOP
Subdivision: ROSHAK RIDGE Lot: 188
Project: Polygon at Roshak Ridge, Lot 188 ADU
Project Description: New attached ADU. NO FINAL UNTIL DEFERRED SDC FEES ARE PAID&WATER METER HAS
BEEN UPSIZED.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1228 sf Basement: 0 sf Left: 3 Parking Spaces. 0
Height 26 Bathrooms: 2 Second: 0 sf Garage: 275 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 1228 sf Value: $174,454.24 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 2 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: 2 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
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 3 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1
Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves, 0 Gas Outlets: 2
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 2 201-400 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 ADU VB R-3 1228
Owner: Contractor:
TAYLOR MORRISON NORTHWEST LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 One Hour Fire Rated Eaves
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX
Total Fees: $17,510.65
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: Fla'( / V61-4"-'De,Wege, Permittee Signature: Ow A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the lob site at the time of each inspection.
1
Building Permit Application RECEIVESResidential �' t FOR OFFICE USE ONLY
City of Tigard EP 0 $I.Q�� Received n t,
or (r Date/By: 9 Gj' Z 1 Nf Permit No.: MSFW�'I-007�%
111 r 13125 SW Hall Blvd.,Tigard,OR 97223 �/ Plan Review I '
C Phone: 503.718.2439 Fax: 503.598.1960 CITY i ®� `y Date/By: Other Permit: SwQ•10Z( W(.Sc
T I GA R D Inspection Line: 503.639.4175 BUILDING NMDate Ready/By: Jur s: 0See Page 2 for
Internet: www.tigard-or.gov Notified/Met Supplemental Information
7- 'K
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. t -C(
0 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ li i („
❑Accessory building El Multi-familyNumber of bedrooms: 3 /
❑Master builder ®Other: ADU Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors ( Icb-
Job site address: 16728 SW DARWIN LOOP New dwelling area: /1,228, square feet 1' ,
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: a-juare feet
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge I Lot no.: 188 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 /1 T/t t work indicated on this application.
New Construction/Type: Duplex(unit 2 out of 2) 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 ❑ CONTACT PERSON QS) BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Polygon Homes WLH LLC
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 Photo Voltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St, Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver, WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( )360 695-7700 Fax:
( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247 � �/ Total fee due upon application: $201.60
Authorized signature: ON.Laib,(Q//JJ� 1ZG,fy 640'1. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 09/07/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Receives(i1
Date/By; (�t/�'u �� Permit No: (�Y//1 �f�y�
't 13125 SW Hall Blvd.,Tigard,OR 97223 J �+
f r Plan Review Other Pamir C�p/ 1��G
Phone: 503.718.2439 Fax: 503.598.1960 DateBy; J
Y 1 t'rh 1;17 Inspection Lint: 503.639.4175 Date Ready/F3y SV
him
Internet: www.tigard-or.gov H See Page 2 for
Notified/Method Supplemental Information
_
1 TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USECHECi{I.IST
r Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacementperformed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION
Value:S
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
I a Multi-family ❑Master builder
❑Other: Description
Qty. Ea. T--Total_
JOB SITE INFORMATION AND LOCATION Heating/cooling:
�— — Air conditioning ( 46.75
Job site address: 16728 SW DARWIN LOOP
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIT':Tigard,OR 97224 Furnace 100,000i BTU(ducts/veats) 54.91
Suite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric);
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Polygon at Roshak Ridge Lot no.: 1 g$, Other: 23.32
_
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33,39
Flue vent for water heater or gas
~New construction-Type ADU 1 fireplace 23.32
Log tighter(gas) j 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.31
0 PROPERTY OWNER J ❑ TENANT Other. 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hoed/other kitchen
__.. u 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:
Contact name: Omar Alami Abouhafs 514.15 for first four;S4.03 for each additional
Furnace,etc.
Address:703 Broadway St.,Ste 510 v Gas beat pump
— Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water beater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permitsubmittals(taylormorrison.com Barbecue
r# CONTRACTOR Clothes dryer(gas)
. Business name:Pro Heating&Cooling Other.
MECHANICAL PERMIT FEES*
Address: Nei'Alociek Dr,Ste.1104
Subtotal
City/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 lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
1. � ,- 1':::Q days after it has been accepted as complete.
Authorized signature: ' Fee methodology set by Tel-County Building industry Service Board
Print name:Elia Duran Date: 10/30/20
r lRniI,i, ,WPrrm,,,iM r Prrmil An..Mill Ant- n.•, ., irr r,.ew er-n...of n:o
Electrical Permit Application l t)R OFFICE:FSE:ONLY
City of Tigard Receiy+cd CI
a 13125 SW Hall Blvd., 17aulfiy permit 4 0 101A_WA I �
.,Tigard,OR 97223 Plan Review
74
llatcTiy ]�'Phone. 503.718.2439 Fax 503.598I960 RelatedPermitt'.�—Di�ZrD�
U R U Inspection Line' 503 639 4175 Ready Date Ry runs. la See Page 2 for
Internet: www,pgard-or,gov Notthedt lethod- Supplemental Inforraation
1
TYPE OF WORK PLAN REVIEW
El New construction ❑Addition/alteration/replacement Please check 4J1 that apply(submit/sets of plans wiitcros checked)
❑Demolition0 Other: Sa%ice or feeder 400 amps al more El Building over three statics
where the available fault current 0 Marinas and tx,atyard.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating huddings
Q I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building lass to gonad,or exceeds 14,000 0 Commercial-use agricultural
amps fur all other installations burlilinvs.
❑Multi-family ❑Master builder []Other: a Fire pomp
0 Installation of 150 KVA or
JOB SITE INFORMA1OON AND LOCATION ❑Emergency system larger separately droved
Job#: Job site address:16728 SW DARWIN LOOP ❑Addition of new motor tend af system_
IooflPormore.
City/State/ZIPI Tigard,OR 97140 ❑Six of more residentlal utt[ts occupancy
0 Heatth-eare facilities. 0 Reereanonal vehicle parks.
Suite/bldg.apt.1/: Project name: Polygon at Roshak Ridge 0 Hazardous locations 0 Supply voltage los'more than
❑Service or feede,600 amps or more 600 volts nominal
Cross street/directions to job site:
FEE SCIIEDt1L E
Uarrtimaa l Qtx 1 Each I Total I .
New residential single•or multi-family dwelling unit,
Subdivision:Polygon at Roshak Ridge Lot#: 188 Includes attached garage.
Tax map/parcel#: 1,0oosy ft.or less 168 54 4
Fa.add'I 500 sq tl.or portion 33 92 1
DESCIUrTION OF WORK Limited c,c uy,rcsitteutaa[
r 7s 00
New construction_Type ADU 1 (with abuve sq.ft) 7.
Limited cii❑gy,multi-family 75 00
residential(with above sq.ti)
Oil PROPERTY" U1i1I R Renewable Energy 0 See Page 2 _
❑ TENA)v I Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less too-70
Address: 703 Broadway St.,Ste 710 :rl)[amps to 400 amps 133.56
401 amps to 600 amps 200 34 2
City/State/ZIP: Vancouver,WA 98660 6tll amps to 1,000 amps 301 04_ 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: OA.lamiAbouhafs@tsylat-morrison.com-PetmitSubmittal o'ormomson_com Temporary services or faders installation,alteration,andlur
��t }l relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59-36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps m 400 amps 125 08 2
Owner signature: Date 401 amps to 599 amps 168 54 7.
0 APPLICANT' _I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A Fee for branch circuits wah
Business name: Polygon Homes Wl.l-t LLC above service or fecrh-r fee,
each branch circuit 7 42 _
Contact name: Omar Alami Abouhafs B Fee for branch circuits without"
Address: 703 Broadway St.,Ste 710 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Vancouver,WA 98660 Each add'/branch circuit 7 42 2
Phone: 360 946$674 Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67 84
Email:OAlamiAbouhafsitjtaylo mourrison_corn-PcrmitSubmittals(iptaylorrnorrison.com
�_ Reconnect only 67 84 2
CONTRAC1 OR Pump or soigation circle 67 84 2
Business name: Wallace Electric Sign or outline lighting 67 84 2
At1dRs: 105 Dresden St - Signal circutt(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Astoria,OR 97103 Each additional inspection over allowable in any of the above
Additional inspection(1 lir min) 66 25/hr
I Phone:(503 3T18 0563 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: David@wallacewires.com industrial plant(1 hr min) 78 t sr hr
cal laic.:224868 Inspections for which nu fee is _
Electrical Li • C 1441 Su v. I; .: 6363S specifically listed(h hr min) 90 01)/hr
Suprv.Electrician signature,required: ELECTTtICAI, PERMITcal FEES
_. ,,w �.�— Subtotal '
Print name:' .p Date: �r /z , a Plan Review Required(25%of permit fee):
-
f /.� State surcharge(12%of permit fee)
/ 5..,
Authorized signature TC)7'AL PERMIT FI E
This it a
Print name: /
perm ppticalioa expires If a permit is not obtained within tall
N ( Date: /I 11, t days after It has been accepted as complete.
b r ° Number of inspections allowed per permit.
1:tBwlafingTermits`LLc_PcrmrtApp_FZR Malec Rev 0617,r1015 4 d/j t;-1615r(i 405KOMAITr
4 . ,
Plumbing Permit Application
,Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard Received ti �20Iv1 N�' I. M9 ,01:‘'4ot
g Permit Na.:
it 13125 SW Hall Blvd.,Tigard,OR 97223 Datv`By:
'PIg Plan Review r
Phone: 503.7t82439 Fax: 503.598,1960 Date/By: Other Permit No.: S1,JI,I,o?�vriZS
TIGARD Inspection Line: 503.639.4175 Date Ready/By: tors: El See Page 2 for
Internet: www.tigard-or.gov Notifcd/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special in orntation use checklist.
-- - - Description ��b'. Ea. 'Total
❑Addition/alteration/replacement 0 Other. New I-2-family dwellings(includes 100 ft.for each utilityconnection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 I
I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath - 437.78 _
t ~ - - SFR(3)bath
El Accessory building Multi-family 500.32
Each additional bath kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
~Job site address: 16728 SW DARWIN LOOP Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apL no.: Project name:aisoksioliiirigiePolygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
I Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Polygon at Roshak Ridge Lot no.: 18$ 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 ADU 1
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap _ 25.02
Address:703 Broadway St.,Ste 510 Floor drain/floor sinkthub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 I
Phone:(360)695-7700 Fax:( ) lee 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 Sink/basin/lavatory 25.02 l
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:permitsubmittalspolygonhomes.com Urinal 25.02 --
CONTRACTOR Water closet 25.02
Water heater 37.52
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)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
Plan review (25%of permit fee)
CCB Lic.:184372 Plumbing Lic.no.:pb634
State surcharge(12%of permit fee)
Authorized signature: ~`" TOTAL PERMIT FEE
Print name:Steve Fowler Date: 10/30/20 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:+Buitdmg+Pcrcnits't'LMti-PermihApp.doe 1 OtOIr09 440-4616T(10+02+COMM1Ea)
City of Tigard
° Deferral Until Occupancy Request
TIGARD Washington County Transportation Development Tax (TDT),Transportation and Parks System
Development Charges (SDCs)
This form is to be signed and submitted prior building permit issuance or, if no building permit is required, then
upon land use approval(TMC 3.24, as amended by Ordinance No. 21-09).
Date: 11/3/2021 Site Address: 16728 SW Darwin Loop
Project Polygon at Roshak Ridge Land Use Case or MST2021-00408
Name: Building Permit#:
Tax Lot Total Parks
# 2S107AA18800 Amount*: $5,839.00
Lot 188
TDT Total TSDC
Amount: N/A Amount*: $2,134.00
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $1,909.00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$4,727.00 for Parks-Improvement,$ 1,112.00 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$ 0 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT, TSDC, and Parks SDCs, as provided above,
until occupancy.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option, I understand that any deferred TDT,TSDC, and Parks SDCs must be paid prior to final
inspection or issuance of an occupancy permit.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be accepted both the Property Owner and the Developer must sign this request.
Property Owner: Orxa.,41,a0to 4eoz Date: 11/4/21
Developer: Om v,Waha46eu Date: 11/4/21
Permit Coordinator: I/ '4 Date: 11/3/2021
City of Tigard
diPIII " COMMUNITY DEVELOPMENT DEPARTMENT
■
z l c A u D Building Permit Review — Residential
f
Building Permit #: PA Sie ail -OD(40g,
Site Address: 16728 SW Darwin Loop
Project Name: Polygon at Roshak Ridge Lot #: 188
Planning Review
Proposal: New attached ADU
0 Verify address/suite#active in Accela. CI In River Terrace: Cl No Q Yes,River Terrace Review Addendum
Site Plan Elements: Jrosion Control
I: copies of site plan on 8-1/2"x 11"or 11 x 17"paper ..itetained trees with drip line and tree protection measures
0 e rawn to scale(standard architect or engineer scale) Footprint of new structure(including decks)and FFE
CI orth arrow 'LlJtility locations&easements(required for new and additions)
Dbite address,project or subdivision name and lot number ,Sidewalk/driveway approach
111•pplicant information(name and phone number) ,_Location of wells/septic systems
0 ot dimensions and building setback dimensions •Street tree size,type and location
I.quare footage of buildings to be demolished •Street names
I 'xisting structures on site °:orner elevations(2'contours if more than 4'differential
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
CIClean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑Yes,applicant was notified ❑o No Received: ❑Yes ❑ No
❑s Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑Yes,applicant was notified No Received: Yes A No
❑o SDC Exemption for ADU applied for: LJ Yes CI No Received: Yes No
0 Public Facilities Improvement(PFI) Permit:
Required: ❑Yes,applicant was notified ❑o No Applied For: ❑Yes ❑ No,stop intake
CI Land Use Case#: ADU2021-00005 CI Zoning: R-7
ElRequired Setbacks: Front: 8/12 Rear: 10 Side: 3 Street Side: NSA Garage: 20
❑o Building Height: Max. Height: N/A Actual Height: 26
CILandsca.e Area: 20 % 0 Lot Coverage Max: 80
Entrance 13 Set back no more than 8'from street-facing wall ❑o Parallel to street or offset 45 degrees or less
Windows Q Minimum 12%of area of all street-facing facades
Garage 0 Garage door is behind widest street-facing wall ❑Yes ❑r 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 2°d floor.
❑r Gara e door width is II 12'or less El50%or less of facade ° 60%or less and includes 7 of following:
Covered porch 0 Recessed entrance 0 Wall offset ' 1'Roof cave Fire shingles Lap Siding
Accent siding ❑ Roof itch ❑° Gable,hi ,or gambrel roof ❑ Dormer
Window trim Roof offset
Window recess Window projection ❑r Balcony
❑ Visual Clearance El Urban Forest Plan
❑ Sensitive Lands: ❑ Yes L"J No Type:
ElConditions met prior to issuance of building permit
Notes:
❑ Approved By Planning: 4 , Date:zwiar 91 4 3/z/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\BuildineFonns\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: / 7 J i
Site Plans: # 3
Building Plans: # __
Building Permit#: 11 Enter buildinge #above.
Workflow Routing: Planning Engineering ermit Coordinator wilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Engine ring: (1) copy of permit application, (1) site plan, (1) building plan and
' nal plan review routing form.
Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician: �:m Date: �'` /
Engineering Review
Slope at building pad: 3 LO
ErConditions "Met"prior to issuance of building permit
IFasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility: rn
Assess Water Quality Fee in-lieu: El [Yes 'No
Assess Water Quantity Fee in-lieu: ❑ Yes E No
LIDA Facility on lot: ❑ Yes 'No
EFinal Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: . /'// /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
fg 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 7ErDoes not aejly
SDC Fees Entered: Wash Co Trans Dev Tax: Yes LJ N/A
Tigard Trans SDC: 2-Yes ❑ N/A
Parks SDC: . Yes ❑ N/A
LIDA ❑ Yes N/A
to Issue Permit
)21"OK
Approved by Permit Coordinator: Date:
I:\Building\Fonns\BldgPermitRvw_RES_122419.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T><c A RD River Terrace Building Permit Review Addendum
Building Permit #: mSruzi-co log
Site Address: 16728 SW Darwin Loop
Project Name: Polygon at Roshak Ridge Lot #: 188
(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 0 No (Per MMD2020-00044)
iculation: a minimum of 1 element per each street-facing facade that has 30-60 ft.of frontage.An additio
ele -nt required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch :.. 5 ft. deep ft.deep min.2ft.,5 ft.wide min.2 ft.,6ft.wide Gable. .oomer
❑ 0 ❑ 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:
❑Parallel to street, , gle no more than 45° from street,
❑Max. 8 ft. setback from longes trees- facing wall
or open onto por
Entrance opens to a porch: 0 Yes 1 o
IfLes,all the following apply: ❑25 sq.ft. in.
One street facing entry 0 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 façades:
❑Covered porch min. 5 ft.wide x 5 ft.deep I Recessed entry area min. 5 ft.wide x 2 ft.deep
❑Wall offset min. 16 inches ei I ormer min. 4 ft.wide
❑Roof eave min. 12 inch projection 0 R•• offset min.of 2 ft.
❑Roof shingles either tile or wood 0 Gable, •ip or gambrel roof design
❑Roof pitch oriented south min. 500 sq. . ❑Horizont.. ap siding min.3-7 inches wide
❑Accent siding min.40%of street fa .e ❑Window trim • ' .2 '/2"wide by 5/8"deep
❑Window recess min.3 inches for , street facing ❑Bay window min. ft.wide by 2 ft.deep
0 Balcony min. 5 ft.wide x 3 ft. .eep with inside access ❑Attached garage is 3 'o or less of street facade
5. Garages and Carports: 'ay face the front or side lot line on a corner lot.
Setbacks:
No closer to front o .ide lot line,than longest street-facing wall. ❑Yes 0 No. If No (Check o - :
❑May extend u. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro .orch.
O 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 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: 1/I 1/I 401
IABuilding\Forns\BIdgPermitRvw_RES_RT_I214I7.docx 111