Permit 7
Plumbing Permit CE1VED
Building Fixtures FEB 2 2022
City of Tigard Received /7 2 t PermitNo.: MST2021-00372
No 13125 SW Hall Blvd.,Tigard,OR 97 0Y UI' I IiiARI) Date/By: (� t
Plan Review ��
Phone: 503.718.2439 Fax: 503.5 t /� r� ,�(�? Other Permit No.:
Inspection Line: 503.639.4175 iI uiNG DIVISION Date/By: Ij/
1 i c,\-h n Internet: Line:www.tigard-or.gov Date Ready/By: !tins: S See Page 2 for
g g Notified/Method:� Supplementallnformation
ew 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)
ATE , :7::':1 IJ N SFR(1)bath 312.70
VI-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other Fire sprinkler(2408sq.ft.) t/ Page 2
) :"*.iiiiiiA ON to ` r Site utilities:
Job site address: 14480 SW 165th Ave Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
h Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: [oject 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.:178(SFU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,i ¢ a Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Ex
pansion tank 12.51
Y Name:
Taylor Morrison Fixture/sewer cap 25.02
Address: 703 Broadway St.Suite 710 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660
Hose bib 25.02
Phone: 816 7805( 360) Fax ( ) Ice maker 12.51
cv,'"'„ ,},mod
�.�, NT 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
.. - s Water closet 25.02
a, a"1R ., ... .. 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
Plan review (25%of permit fee)
CCB Lic.: 184601 Plumbing Lic.no.: PB732
State surcharge(12%of permit fee)
Authorized signature:Hannah Thomas`E,,,,,,,,,, F ^°°--°-°^^-°= 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.
is\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
_IN' CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permlt#: MST2021-00372
Date Issued: 05/19/2022
T I r;A R I7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17800
Jurisdiction: Tigard
Site address: 14480 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 178
Project: Polygon at Roshak Ridge, Lot 178 Primary
Project Description: New detached dwelling with(2)attached ADUs. NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 971 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 4 Second: 1437 sf Garage: 477 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2408 sf Value: $338,897.20 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 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
Bckltw 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: 7 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2
Fum>=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 Wl Svc or Fdr: 0
Ea add'I 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 SF VB R-3 2408
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 98680 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $20,720.54
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: /C y 1 � Permittee Signature: .-r/ /'eee-75
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date. /
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
lortrIgh
i , Building Permit Application R - e J112
Residential AUG 31 2021 FOR OFFICE USE ONLY
City of Tigard Rece,en
CITY Date ay:q/io/ C Permit x ctis-rg 21-0037�—
13125 SW Hall Blvd.,Tigard,OR 97223 O F TIGARD Plan Review / '7�, ,ty� �/
Phone: 503.718.2439 Fax: 503.598.1 .)ILDING DIVISION Date/By: IC/II A-� �-P-4ik.,42nzt—W27I
I I i; It n Inspectionerne: Line: 503.639.4175 Date Ready/By: ttt t 17 /� See Page for
Internet: www.[igard-or.gov odfied/Meth ' Er
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. Q �(�
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ t/ ( �I �-1,
❑Accessory building El Multi-familyNumber of bedrooms: 5
❑Master builder ❑Other: Number of bathrooms: 14
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 ZSS J
Job site address: 14480 SW 165TH AVE New dwelling area: 2,408 square feet IN 37
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: `477 square feet 9-7
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: 7Q square feet
Cross street/directions to job site: Deck area: /'� square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Polygon at Roshak Ridge Lot no.: 178 Permit foes'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 f3,-/j4(5' 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: S6f/.1+ square feet
D PROPERTY OWNER ❑ TENANT Number of stories: 40,,,,i2t'v/"7S" ,.e•
Name:Polygon Homes WLH LLC Type of construction:A2/pi ; .5.-
Address:703 Broadway St., Ste 510 Occupancy groups: (.( / : 3
City/State/ZIP:Vancouver,WA 98660 Existing: 41/34/ +,2 : 3
Phone:(360) 946-8674 Fax:( ) New: �//
0 APPLICANT 0 CONTACT PERSON Vi9 BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer to fee schedute)
Structural plan review fee(or deposit): _5 &) / Aar
Contact name:Omar Alami Abouhafs n
FLS plan review fee(if applicable): C�. 3
Address:703 Broadway St., Ste 510 _.,.•=r
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660 -Au
Phone:(360)946-8674 Fax::( )360 693-4442 Amount received: 0� +/ /96 t —
E-mail:permitsubmittals a taylormorrison.com-OAlamiAbouhafs@taylormorison.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 lic.:207247 �1�/ t " Total fee due upon application: $201.60
Authorized signature: �h2 2 ,[y lealte .41I 6.1/L/Crr,S.� 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: 08/30/2021 *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 Applicati EC 9 t FOR OFFICE USE ONLY
' Cityof TigardCe1aCd f
1 g AUG,Q U U 31 2 U Z 1 a.da c Permit No1'y5 r 24_ O 3-7?-
13125SWHallBlvd,Tigard,OR 97223 l 0
11111
'- • __ Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 171/Ui' r1GARD Datc/By: Other Permit:
71t[lr lti7 Inspection Line 503.639.4175 BUILDING DIVISION rate Rena/B : bah- H Sec Page Z for
Internet www.tigard-or.gw Nati6cdlMethud. Supplemental Information
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
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead.and profit.
Value:S
CATEGORY_OF CONSTRUCTION RE D)EMTAL EQUIPMENT/SYSTEMS FEES*
IC. 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building - For special information use checklist
I i Multi-family ❑Master builder 0 Other. Description Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Keating/cooling:
Air conditioning 1 46.75
Job site address: 14480 SW 165TH AVE Furnace 100.000 BTU(duets/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000f BTU(ductslvetas) 54.91
Suitelbldg./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
bydronic) 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.: 178 Othe 23.32
Other fuel appliances:
Tax map/parcel no.: Water beater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
- Flue vent for water heater or gas
New construction-Type SFU fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood frreplace/msert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other23.32
- Environmental exhaust and ventilation:
Name:Polygon Will,LLC Range hood/other kitchen
Address:703 Broadway St,Ste.510 equipment3333.399
Clothes drryer exhaust 33.39
City/StateiZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
CO APPLICANT 0 CONTACT PERSON Other 23.32
Business name:Polygon WLH,LLC - Fuel piping:
814.15 for first four;$4.03 for each additional
Contact name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas beat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
E-mail:permitsubmittalsedaylOrmOrriSOtl.COM Range
Barbecue
ellit CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating StCooling Other
MECHANICAL PERMIT FRFS*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/Z.P: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 ISO
i�""} days after it has been accepted as complete.
Authorized signature: ^ � a Fee methodologyset byTri-Coup Building
ry Industry Service hoard
Print name:Elia Duran Date: 10/30/20
rnL,ikli,e\PrnnirhUfF-Anna,Ann WI 11 Mr nun aa,-.r+r.mmm�,m+cn:
•
Electrical Permit Aaplication EC
/� -1
City ojTigard Received
l r1omNBy Fenno r V Vr)3 7 r lig 4' 13125 SW Hall Blvd.,Tigard,OR 97223 1 U G 31 L1q
8 Phan: 503.7182439 Fax: 503-598.1960 �j an w Related Permit it:
;,t:n Inspection Line: 503.639 4175 Y C Tl(-,Ali D g-"yy nateBy - /uri:
Ql See senlage 2Inr
Internet: R'WW.11gard-Of.gOV '1(^ -�,! /rnin�1 N�c�c� Ssppiameolal Information
TYPE OF WORK PLAN REVIEW
IN New construction D Addition/alteration/replacement Please cheek all that apply(submit 2 sets of plans wiiorma checkcd)-
01)emOlitlon ❑Oilier: ❑Service or feeder 400 amps re molt D Building over three stones.
where the available fault marmot 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating huitdmg,
® t-and 2-family dwelling 0 Commercial/industrial ❑Accessory building kaa to ground,or exceeds 14,000 O Carman al-usc agricultural
0 Multi-family ❑Master builder ❑Other amps for as ether installations buildings.
F1fC Tamp. ❑tmrallatton of 150 KVA or
Jon STFE INFORMATION AND LOCATION ❑FmerBancy system larger separately derived
lob it: Joh site address:14480 SW 165TH AVE 0 Addition of WSW motor load af sYstmx
10071P w more. ❑"A"_E.."1 Z","I-3"
City/State/ZIP: Tigard,OR 97140 0 six or more residential onus 0e051221cy
Suitelbld ! t # latiralth-raxc facilities. ❑Recreational.chick parks.
g aP : Project name: Polygon at Rosbak Ridge 17ttaardeus location, ❑Supply voltage fee some than
0 Service or fccdm 600 amps or more 64)0 volts nominal_
Cross street/directions to job site: FEE SCHEDULE --
!Description 1 0tr. I Each I 'rural I •
New residential single•or aoullFfamily dwelling unit
Subdivision.Polygon at Roahak Ridge Lot#: 178 Includes attached garage.
Tax num/parcel#: 1,000 sq.ftor less 168 54 4
En.add'!500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
New construction.Type SFU (with above sq.ft.) 75.00 2
Limited effigy,multi-family 7S.00 2
_ residential(with above sq.ft.)
® PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Paste 2
Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or leas 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to 400 amps 133.56 2
City/State/Z1P: Vancouver,WA 98660 401 amps 1e600 amps 200.34 2
601 amps to 1,000 amps 30104 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps or volts $51.26 2
F.mail: OAIamiAbouhafs@taylormorrison.com-PermitSubmittal a lofmorrison.com Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
lease,for sale, rent,or exchange,according to ORS 447,449,670,and 701. 201 amps en400 amps —ll+ 125 os 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits new,alteration,or extension,per panel
0 APPLICANT 1 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: Polygon Homes MR LLC above service or feeder fee,
each branch circuit 7.42 _
Contact name: Omar Alami Abouhafa B,Fee for branch circuits without
Address: 703 Broadway St.,Ste 710 service or cadet fee,rase 56.1 R 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 - 2
Pratte: 360 946 8674 Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular 67.84 2
Email:0AlamiAbouhafs@taylormorrison.com-PemtilSubmittals nttaylormorrison.coin d"ciiir'g,bet„iae aorvor tad«
ltaormmt wily 67.84 2
CONTRACTOR Pomp or irrigation circle 67.84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
Address: 165 Dresden St Siboa-1 nircud(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Astoria OR 97103 — Each additional inspection over allowable to any of the above
Additional inspection(I hr min) 66 25/hr
Phone:(503 388 0563 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:David O(wallaccwires.com Industrial plant(l hr min) 78.15/hr
Inspection.,for which no tee is
CCB Lie.:224868 Electrical Li •CI 441 St rv.1." .• 6363S specifically listed OS Br min) 90 QO/hr
Electrician ELECTRICAL:PERMIT.FEES
Suprv. signature,required: ,/— Subtotal:
Print name: ,_- 4.6, Date: q I/Z 1st t ❑Plan Review Required(25%of permit fee):
t State surcharge(12%of pennit fee)
Authorized signature � TOTAL PERMIT!:i:1i:
1 Thu permit application expires It a permit is not obtained within no1a Print name: I rL Date: (j days after It boa bard accepted as complete C c• L4,raFu.>�'' ` �L r..__. I • Number of inspections allowed
tlHuiGhr;WanilslEIR Pasant*/all.GRE.dcc Ices 06772015 4 Isttt V8520M11VFB spati Per(serail.
` ' Plumbing Permit Applic IVE�_..
Building Fixtures FOR OFFICE USE ONLY
r
City of Tigard J i .� 1 Zi)7.1 Date py peril No./�•rz. i l-C!13'Z 2.--
1111 •r 13125 SW Hall Blvd.,Tigard,OR 97 y W6d -
TIGARD Plan Review
a' Phone: 503.7182439 Fax. 503.59i. Date/By: Other Permit No.:
TIGARD Inspection Line: so3.639.at7s ;_..J LDING DIVISION Date ReadylBy: runs: ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: 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(1)bath 312.70
SFR(2)bath 437.78
Xl-and 2-family dwelling ❑commercial/industrial
SFR(3)bath 500.32
❑Accessory building Multi-family
Each additional bathadtchen 25.02
❑Master builder ❑Off': Fire sprinkler( sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14480 SW 165TH AVE Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ( Project name:fl_LtirAia)EaPolygon 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.:_J Page 2
Subdivision: Polygon at Roshak Ridge f Lot no.: 178 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 SFU
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,1.LC Fixturdsewercap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:S_) Page 2
Primer 12.51
Contact name: Omar Alami Abouhafs
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals®polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:C&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
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: }ly alk 1 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[bard.
1;111alldioglPermirs\PLMU.PeanitApp dec I0.11101 44OA616T00,02,COM,WEB)
' / e ow-)
Plan # /M 14 25 Tr,o A jary\kry S- U
Floors a Large r'Y �y
WC roBedoms S Small (� 4-:. rk— Ra-A 4
`
LAV Co
Tub 3 Basement
Vent / 1st Floor 9`7 1
Water Heater I 2nd Floor I - ,' 7
AC )/� 3rd Floor
Schooleevi
R-3 Total a go$
��A Garage ��]-7
N� s t� Total a c`t,E�jS
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,
- City of Tigard
lig a COMMUNITY DEVELOPMENT DEPARTMENT
c Building Permit Review — Residential
TIGARD
Building Permit #: tiS TZo Z I -O o 3 7.7—
Site Address: f gili0 SCA) ((pg. AVE.
Project Name: a)1:1400K) Al— 'f 4415,k P-(OC.E Lot #: /71
Planning Review
Prop sal: A.10,3 `Q(2.1MA(2-Y WeuuNt-
Verify address/suite#active in Accela. PyIn River Terrace: ❑ No Yes,River Terrace Review Addendum
Site lan Elements: lJE °s ion Control
3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper ILR wined trees with drip line and tree protection measures
wn to scale(standard architect or engineer scale) t tprint of new structure(including decks) and FFE
E rth arrow 17 Pity locations&easements(required for new and additions)
LSJS4te address,project or subdivision name and lot number Sidewalk/driveway approach
KApplicant information(name and phone number) [ cation of wells/septic systems
Lot dimensions and building setback dimensions IZ' treet tree size,type and location
❑S uare footage of buildings to be demolished Street names
10 iaExisting structures on site kr6omer elevations(2'contours if more than 4'differe a1)
ElLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? tJ' es ElNo
im ervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? EYes C o
zrypClean Water Services—Service Provider Letter (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified 2"-No Received: ❑ Y es ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
quired: Yes,applicant was notified ❑ No Received: Yes ❑ No
C Exemption for ADU applied for: ❑ Yes L/JNo Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
/ F
Required: ❑ Yes,applicant was notified erNo Applied For: p❑ Yes El No,stop intake
ILf sand Use Case#: SUB2OIS--Oco0t{ Zoning: y'S
Z equired Setbacks: Front: 1-I, a Rear: Side: 3 Street Side: Garage: 3
YJ uilding Height: Max. Height: Actual Height: 2Ca
VJ Landscapee Area: la 0/0 ZLot Coverage Max: NA
Entrance 12rlet back no more than 8'from street-facing wall ❑ 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 ❑ e of d e o owing is met:
tends no more than 5'from wall and there • porch extending beyond garage.
0 Door extends n than 5'fro n there is a 12 sq ft.window above garage on 2°d floor.
❑ Garage door width is e 0%or less of facade ❑ 60%or less and includes 7 of following:
❑ Coy rc ❑ Recessed entrance ❑ Wall o se 1'Roof eave ❑ Roof offset
Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or 1 roof ❑ Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection alcony
0"--Visual Clearance /2Urban Forestry Plan
sittve Lands: ❑ Yes Type:
Conditions met prior to issuance of building permit
Not /
Approved By Planning: /1/`'-- Date: 'il Z i
Revisions (after Building Submittal ly) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
I:\Building\Fonns\B1dgPermitRvw_RES_122419.docx
____---A
Building Permit Submittal
Original Submittal Date: .P/3//2/
Site Plans: # ,j
Building Plans: # 3
Building Permit#: [ ''Enter building permit#above.
Workflow Routing: -g-"Planning [engineering 0 Permit Coordinator c❑-Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: .2-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original 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: d()44-0' Date: 'T'//D/2-7e
Eta ineering Review
Lc7 Slope at building pad: /e 2,
f Conditions "Met"prior to issuance of building permit
U' Easements (encroachments)per engineering conditions of approval and plat
Later Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes yrivo
Assess Water Quantity Fee in-lieu: ❑ YesVo
'LIDA Facility on lot: ❑ Yes [1:4- l0
Iti Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:
VApproved by Engineering: Date: `A6CT2
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received Does not apply
7 SDC Fees Entered: Wash Co Trans Dev Tax: f/' Yes 0 N/A
Tigard Trans SDC: ;2' Yes 0 N/A
Parks SDC: Z Yes 0 N/A
LIDA ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 91 (t.Q 2D2(
l:\Building\Forms\BldgPermitRv w_RES_122419.docx
City of Tigard
MI ° COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
a
Building Permit #:
Site Address: 1400 S6J llOs AVE.
Project Name: Polygon at Roshak Ridge Lot #: (�Q
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.I.):
Is the project subject to the plan district design standards? ❑Yes El No (Per M M D2020-00044)
;dilation: a minimum of 1 element per each street-facing façade 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 I. 5 ft. deep ft.deep min.2ft.,5 ft.wide min.2 ft.,6ft.wide Gable. .ormer
❑ 0 0 0
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 - ance must meet both of the following standards:
❑Max. 8 ft. setback from longes trees- facing wall ❑Parallel to street, . gle no more than 45° from street,
or open onto por
Entrance opens to a porch: 0 Yes 1 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. ❑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 II Recessed entry area min.5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches g l ormer min.4 ft.wide
❑Roof cave 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. . ❑Horizont.. ap 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 -.I 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 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 - :
O May extend u. o 5 ft.if there is a covered front porch and garage does not extend beyond the fro : porch.
❑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 t age that faces the street with a min.area of 12 sq.ft.
Width• heck one)
O -foot-wide garage door 0 40%max.of street façade
50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: Date: Z
I:1Ruilding\Forms\BldgPo,tkvw RES RT 121417.docx
City of Tigard
" 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: 11/3/2021 Site Address: 14480 SW 165TH Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00372
Name: Building Permit#:
Tax Lot 2S107AA17800 Total Parks
#: Lot 178 Amount*: $5,839.00
TDT Total TSDC $2,134.00
Amount: N/A Amount*:
*The total TSDC amount shown above is the sum of$ 0 for TSDC-Improvement,$ 225.00 for TSDC-
Reimbursement,and $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.
1'DT 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: Oh -.A1�m , 6,5y2.1taeld. Date: 11/4/21
Developer: Ohtn i.e 46eu a- Date: 11/4/21
Permit Coordinator: Xti ` `" Date: 11/3/2021
Water Meter Fixture Unit Worksheet For New BuildingsCEIVED
Please complete the following information: AUG 31 2021
Contractor Name: Polygon Home, WLH LLC Y OF TIGARD
•�._,LDING DIVISION
Billing Address: Street/Suite#: 703 Broadway St, STE 710
City: Vancouver State: WA Zip: 98660
Phone Number: 360 946 8674 Email: OAlamiAbouhafs@taylormorrison.com
New Meter Address: 14480 SW 165th Ave(SFU)- 14476 SW 165th Ave(ADU 1)- 14478 SW 165th Ave(ADU 2)
Subdivision Name: Polygon at Roshak Ridge Lot#: 178
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, 1st one 1 1 x 2.5 = 2.5
Hose bib, each add'l 1 2 2 5 x 1 = 5
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: 88.5
Fixture Unit Points:
1 to 30=5/8" 37.5 to 89= 1"
30.5 to 37=3/4"
Meter Size: 1" Meter Cost: $ 24,886.00
*************************************************************************************
FOR OFFICE USE ONLY
Fixture Units Points verified with
Building(Master) Permit or Plumbing ❑ Yes ❑ No ❑ Other:
Meter#: Sale Date:
Receipt#: Meter Cost:
Employee Name:
I:/Building/Forms/WaterMeters_010121 New.dOCx Page 2