Permit Plumbing Permit Applica ,, I v ED
Building Fixtures FEB 2 2022 i of OLi►( I.. I si. ()NIA
City of Tigard Received Z ..e Permit No.: MST2021-00373
Ill '0 Date By.
13125 SW Hall Blvd.,Tigard,OR' + OF TIGARD
3 `2`22.lt
i /Plan Review l
Phone: 503.718.2439 Fax: 50, .f 188 NG DIVISION Date/By: *lb P 4 Other Permit No.:
Inspection Line 503 639 4175 `
1 i( h 1 D Date Ready/By: /� f Juns H See Page 2 for www.tigard-or.gov Notified/Method Supplemental Information rmaho
. riii ` a I iid k 014 Y ' * ; e
r +aREB
lew construction ❑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)
o- '€ iltit g4t0' WiNsT also SFR(I)bath 312.70
-and 2-famil y dwellin SFR(2)bath 437.78
g ❑Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other Fire sprinkler ft.) ,/ 2
P 9g
Z
€ '1,ON r�'`� - as Site utilities:
Job site address: 14476 SW 165th Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:1178(ADU 1 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
�?t €M 3 ,)® ,V,t°. Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
2
m 1 Expansion tank 12.515
. ....ate .ems, ,. ,.,. r..,✓.,aMa...,... � .. .�„tz.
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
ANTii ', tJ , 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
i `',1'' e dt'{z € k f f t+,, 1NF,, w•ai 3,,.€ € r € Water closet 25.02
m .P i.. s,, 0,. -,�,,, .•, rh..' ,,n1 . .. 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 Lic.: 184601 Plumbing Lic.no.: PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: Hannah Thomas "...:4".:z.g �,„
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 1PLMiJ-PermitApa.doc 10/01/09 440-4616T(10/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
IIId COMMUNITY DEVELOPMENT Permit#: MST2021-00373
Date Issued: 05/19/2022
T f G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 107AA 17800
Jurisdiction: Tigard
Site address: 14476 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 178
Project: Polygon at Roshak Ridge, Lot 178(1 of 2)ADUs
Project Description: New attached ADU (1). NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 672 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 953 sf Garage: 287 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1625 sf Value: $226,909.86 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heal Pump: N Hoods: 1 Other Units: 0
Furn<1o0K: 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 Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ADU VB R-3 1625
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: $14,812.02
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 equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc _.nn1_nnin thrni in,-'AR O74c-nn0n nil mo„nhte' an nn
, thn n!lac nr rllrnrr nmine}inne to ni INC h.,raulnn Sol 9 1057 nr'I nnn 1199�991A4
Issued By: I__ --Z-C G g/� Permittee Signature: c ��r'/✓ �k1?'47
V✓ Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the iob site at the time of each inspection.
Building Permit Application
Residential RECEIVE I FOR OFFICE USE ONLY
City of Tigard Received
Pla w F (♦� Zj Permit Nell r 20 z)-0a373
Illg • 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 3 1 2021 Plan Rev Review (J(`
7 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: I t) �( r ' Other Permit:
11GA k I) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: �' J ® See Page2for
Internet: www.tigard-or.gov BUILDING DIVISION! No `�thod: �,` /�,� � Supplemental luformatiou
di
TYPE OF WORK REQUIRED DATA:I:I-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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.��ff�l n� (�f(o
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ !/�Ve( 6t09
.
❑Accessory building 0 Multi-family Number of bedrooms: 3
❑Master builder In Other: ADU I Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:2 VI I -
Job site address: 14476 SW 165TH AVE New dwelling area: 1,625 square feet 4:153
City/State/ZIP:Sherwood, OR 97140 Garage/carport area: 287 square feet 121)„
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.: 178 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-ADU 1 (unit 2 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: square feet
® PROPERTY OWNER ❑ 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 U9 BUILDING PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please r¢fer roles schedule)
Structural plan review fee(or deposit):
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 510
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Phone:(360)946-8674 Fax::( )360 693-4442 Amount mete ved:
E-mail: permitsubmittalsntaylormorrison.com-OAIamiAbouhafs@taylormorrison.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St,Ste 510 Solar Installation Specialty Code checklist.
city/state/zip:Vancouver, WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( )360 695-7700 Fax:
( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lit.:207247 �1 /!! Total fee due upon application: $201.60
Authorized signature: OGlZC�l. ,r y ,r y ry6 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:1Building\PermitsiBUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit ApplicatiREC IVEI FOR OFFICE USE ONLY
City of Tigard Received
WI, 91 7n"�, Date/By: Pennr1No•
13125 S W Hall Blvd.,Tigard,OR 97223 ST Z ,3
1 j Plan Review
Phone: 503.718.2439 Fax: 503.598.196Q1T Dai6By, Other Permit:
1 I i i A r,l i Inspection Line: SD3.639.4175 l� Date Ready/By: Jura H See Page 2 for
Internet: wwwtigard-or_gov BUILDING nIV!Cl•
_.. ��jV Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE' SCHEDULE— USE CHECKLIST
Mechanical permit fees*arc based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY_OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
►T. 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
I j Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION ANT) LOCATION Heating/cooling:
Air conditioning ( 46.75
Job site address: 14476 SW 165th AVE Furnace 100.000 BTU(ducWveats) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,0001-BTU(ducts/vents) 54.91
Suite/bldg.apt.no.: Project name: Polygon at Roshak Ridge Heat p 61.06
Duct work 23.32
Cross street/directions to job site: Hydrooic 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 7g Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater
23.32
DESCRIPTION OF WORK Gas firepiace/insert 33.39
— Flue vent for water heater or gas
New construction-Type ADU 1 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
EI PROPERTY OWNER 0 'TENANT Other 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
Address:703 Broadway St.,Ste.510 a p1 ent 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
S14.15 for first four;54.03 for each additional
Contact name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
City/State/ZIP:Vancouver,WA 98660 Wall/suspended/unit limit beater
Water heats
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittaisCatayIOrmorrison.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(590,00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:209001 TOTAL PERMIT FEE
Il\� n r, This permit application expires If a permit is not obtained within 180
Authorized signature: �� 'Jt�s-'t'ut•'rt' days after it has been accepted as complete.
• Fee methodology set by Tri-County Building industry Service Board
Print name:Elia Duran Date: 10/30/20
TARniliiinalPmmvOsofFi e.nne Am,WI 11 Mr
Electrical Permit Application RECEIVE r FOR OFFICE USE ONLY
City of Tigardeceived
I 13125 SW Ball Blvd.,Tigard,OR 97223 AUGA U G 3 l 1 lea Review Prrmtt" r7 S'r20 zl -063'7.3
a. Phone: 503718.2439 Fair 503.598.1960 Pan RelatedPetmit#:
Inspection Line: 503.6394175 CITY Gr Tin.ARL' Reedy
T1CiAFD 1 iII f-:'�I(` fZls/If'1�^>>.keuficd/ dBy laic � SVPIl Pa5e2for
Internet wWW,llgerd-0[,gOV P ' Nuvficdadmhod: Supplemental Information
i TYPE OF WORK PLAN REV[F.w
®New construction ❑Addition/alteration/replacement Please cheek all that apply(submit 2.sets of plans w/itmua checked):
El Demolition ❑Other: ❑Sxvice or feeder 400 amps or mom fl Budding over three stones,
where the available fault current ❑Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 rolls et ❑Eloaung buildings
® t-and 2-family dwelling 0 Commercial/industrial ❑Accessory building rem w ground,or exceeds 14.000 0 Commercial-toe agricultural
❑Multi-family ❑Master builder amps for au other installations buildings.
❑Other. ❑Fire pomp. 0 Installation of 150 KVA or
JOB SITE INFORMATION ANTI LOCATION 0 Emergency system_ larger separately derived
Job it: lob site address:14476 SW 165th AVE ❑Addtionofxw motor load nf synm
1001113 or more. ❑"A",`k","1-2","1-3";
City/State/ZiP: Tigard,OR 97140 0 six a room residential units occupamy
_ ❑health-can facilities. ❑Rnaeabond vehicle parrs.
Suite/bldg/apt.#: Project name: Polygon at Roshak Ridge ❑uMardous locate-ma 0 Supply volutge fur more than
❑Service or feeder 600:reps or more. 600"ohs nominal.
Cross streetdirections to job site: _ FEE 9CEIF.D(TI,E
Deirrlption I Otv. 1 Each I Tatar 1 •
New residential single.or multi-family dwelling atilt.
subdivision:Polygon at Roshak Ridge Lot#: 178 Includes attethed garage.
Fax map/parcel#: 1,000 sy.ft.arless I68.54 4
Ea.add'l 500 eq.R.or portion 33.92 _ 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.it.) 75.00 2
New construction.Type ADU 1 Limited energy,multi-family 75.00 2
residential(with above sq.tt)
Renewable Energy 0 Sec Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installatloaialtcretion,and/or relocation
Name: Polygon Homes WLH LLC 200 amps or less 100.70_ 2
Address: 703 Broadway St,Ste 710 201 amps to 400 amps 133.5E 2
401 amps to 600 amps 200.34 2
City/State/ZIP- Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360 )946 8674 Fax:( ) Over 1,000 amps or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Email: OAIamiAbouhafs@taylormorrison.com-PermitSubmittals( taylormorrison.com relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 I
intended far sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125,08 2
Owner signature: __ Date: 401 amps to 599 amps 168.54 2
El APPIJCANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
Business name: Polygon Homes WI.H LLC — A.aboveFbo for branchorc fondtser
with
service fmrlcr Tee, 742
each branch atrouit -
Contact name: Omar Alarm Abouhafs B.Fee for branch circuits wilhart
Address: 703 Broadway St,Ste 710 serviceor
branch circuit feeder fee,first 56.18 2
City/State/ZiP:Vancouver,WA 98660 Each add'l branch circuit 742 2
Phone: 360 )946 8674Miscellaneous(service or feeder not included)
( Fax::( ) Each manufactured or modular 67.84 2
Email:OAlamiAbouhafs@taylormatison.com-PenntlSubmittals(c�taylm l onlymorrison.com dwelling.�^ly c and/orcode`
Rmonrra 67.84 2
CONTiL►Cfolt Pump or irrigation circle 67.114 2
Business name: Wallace Elect is Sign or outline lighting 67.114 2
^
Address: 105 Dresden 5 Signal cucuegs)or limited-energy 0 See Page 2 2
panel,alteration,or extension
0 City/State/ZIP: Astoria OR 97103 Each additional inspection over allowable in any of the above
_ Additional inspection(I hr min) 66 25/hr
Phone:(501 3118 0563 Fax:( ) Investigation(I brain) 90.00/hr
Email:David@wallaccwires.com
om Industrial plant(1Lr min) 78.18/hr
cm 224868pections for which no tee is
Electrical Li•ClCI441 Su .I: .• 6363S specifically hated('A hr min) soon hr
C
Strprv.Electrician signature,required a.,.......----a.,.......----fT/] ELECTRICAL.PERMIT:FEES
�- Subtotal
Print name: a _ Date: /2 r4 /�i 0 Plan Review Required(25%of penult fcc):
i it
f State surcharge(i2%of permit fee).
Authorized signature TOTAL PERMIT RE:
}� _ This permit application expires ifa permit is not obtained within tall
Print ,{]/ae n.n r 4,r 4 a w. i)atC if ` e 1 days aner 11 has been accepted es complete_
- -•r' ►`V--1/l/trs .T 7 47�z " Number of inspections allowed per permit.
is18n1dinjhrmiu&7.c_PerwitApp_Elg ERF..dcc Roe 061112013 d il.4615T(1 h5i/COWWE2
Plumbing Permit Applicatio ECFIVE
Building Fixtures FOR OFFICE USE ONLY
A Cityof Tigard A U G I Received �y� -s�f,� - g Pcrmrt No. KJ'vJ '003/ l
n 13125 SW Hall Blvd.,Tigard,OR 97223 Da1eBy: S r
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 TY OF I IGARD DarNBy Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 BUILDING DIVISION
Dale Ready/By: Saris: RI See Page 2 for
Internet: www.tigard-or-gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
Description I Qty. I Fa. I Total
0 Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building Multi-family SFR(3)bath 500.32
Each additional batMkitchen 25.02
❑Master builder 0 Other. Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14476 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.: I Project nameaiaai.irfiigePolygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Polygon at Roshak Ridge i Lot no.: 178 Fixture or item:
Tax map/parcel no.: Back low presenter 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 1 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
Cr APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) 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
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:permitsubmittalscpolygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sous 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: $72.50
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler Dale: 10/30/20 Thin permit application expires If a permit is not obtained within 180 days
after It has been accepted as complete.
'Fee methodology set by To-County Building Industry Service Board.
I:IBuidisTemits1PLMU-PemitApp.dor 10/0IN9 440-4616r(iaasiCOMAVEB)
✓Servcn -4-__ Ulm
Plan # ` t
I'h� 25 t p -4c
Floors 'Z Large Q�.} I� u
Bed rooms B Small ' \ �.Jl
WC 3 ,/r�r.L ,i-J a �- ,
LAV
Tub Basement
Vent y 1st Floor Cos?a
Water Heater I 2nd Floor 0153
AC VF ,f 3 3rd Floor
School �-rtt �'�R R-3 Total �.k?Z.5
. ( e� ' ��- Garage 7i
I C�. 1 Total 19 i
Z .5 av(4-
#for Elec
2 . 1405A- b; 1nS
I ,
City of Tigard
e COMMUNITY DEVELOPMENT DEPARTMENT
C
T 1 c A R D Building Permit Review — Residential
Building Permit #: f j 5 T 2-0 'Z l— 0 0 3 73
Site Address: /yy'}(e Sw ,/(os ` pie_
Project Name: tCY(cot1/4J Af fa11?3C g(96E Lot #: /38
Planning Review
Proposal: NW) A"1TF'C-tkeID ADO ( l)
❑ Verify address/suite#active in Accela. ❑ In River Terrace: ❑ No ❑ Yes,River Terrace Review Addendum
Si".Plan Elements: C7Erosion Control
Lr3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper C etained trees with drip line and tree protection measures
[�Drawn to scale(standard architect or engineer scale) l�Footprint of new structure(including decks)and FFE
L/Jorth arrow Ell Utility locations&easements (required for new and additions)
g:Site address,project or subdivision name and lot number dewalk/driveway approach
plicant information(name and phone number) [IlLocation of wells/septic systems
IJLot dimensions and building setback dimensions YJS reet tree size,type and location
Square footage of buildings to be demolished I�/1/Street names
Nr Existing structures on site 7 orner elevations (2'contours if more than 4'differential)
Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? al Yes ❑INN9"
_ impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes L7No
Ip Clean Water Services—Service Provider Letter of platted prior to 9/10/1995):
_quired: ❑ Yes,applicant was notified YJ No Received: ❑ Yes ❑ No
IV Water Meter F ture Unit Worksheet—Additions,Remodels and ADUs
equired: 7 Yes,applicant was notified 0 No Received: [e---Yes ❑ No
YJ SDC Exemption for ADU applied for: ❑ Yes IQ No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: p❑ Yes ❑ No,stop intake
4I�and Use Case #: AO V 2d00-000 17 'oning. T� q '
Fr equired Setbacks: Front: _ 8 Rear: IS Side: Street Side: Garage: 3
��/ ding Height: Max. Height: �� Actual Height: 2&O
Landscape Area: /�A' % ,, Lot Coverage Max: AJA
Entrance Id SAet 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 ❑ No,one of the folio - et:
❑ Door ore than 5'from wall and there is a covered porch e eyond garage.
❑ Door extends no more than and there is .window above garage on 2°1 floor.
❑ Garage door width is ❑ 12'or less o or ess e ❑ 60%or less and includes 7 of following.
❑ Covered porch ssed entrance ❑ Wall offset ve ❑ Roof offset
g es ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel ro Dormer
❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ a ,-
y,„isual Clearance 2Jxban Forestry Plan
rr
Sensitive Lands: � 12"-No Type:
"Conditions met prior to issuance of building permit
Not l/ _
r Approved By Planning: fi — Date: 9/972 f
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
I:\Building\Forms\Bl dgPermitRv w_RES_122419.do cx
V
Building Permit Submittal
Original Submittal Date: /MA/
Site Plans: #
Building Plans: #
Building Permit#: 'E.-Inter building permit# above.
Workflow Routing: '1 lanning engineering rmit Coordinator L iIIilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: ... Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
90;ginarplan 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: /)ti"r_14A----, Date: 9/la/
Engineering Review ,
LVJ Slope at building pad: /119
[ 'Conditions "Met"prior to issuance of building permit
rer Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes [VNo
Assess Water Quantity Fee in-lieu: 0 Yes CVNo
LIDA Facility on lot: 0 Yes ArNo
VFinal Plat Recorded:
El NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: P
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received 7 Does not apply
Z(SDC Fees Entered: Wash Co Trans Dev Tax: /le Yes 0 N/A
Tigard Trans SDC: ,� Yes ❑ N/A
Parks SDC: .6 Yes 0 N/A
LIDA ❑ Yes /171 N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: c l I IQ, ZO2
I:\Building\Forms\BldgPennitRvw_RES_122419.docx
City of Tigard
111 COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: (I-(t 1-(a SW /10-514- AVE-
Project Name: Polygon at Roshak Ridge Lot #: /31
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.07O.1):
Is the project subject to the plan district design standards? ❑Yes QNo (Per MMD2020-00044)
Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft.of frontage.An additio .
ele •nt required for lots with over 60 ft.of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch :.: ft. deep ft.d❑eep min.2ft.,50
ft.wide min.2 ft.,6❑ft.wide Gable. .ormer
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 .ante must meet both of the following standards:
❑Parallel to street, . gle 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 II o
IfUes,all the following apply: ❑25 sq.ft. in.
One street facing entry ❑12 ax.roof above floor of porch
❑5 ft.depth min. ❑3►/o mitt.porch roof coverage
4.Detailed Design:All buildings shall include a min.o of the following elements on all street-facing facades:
❑Covered porch mitt. 5 ft.wide x 5 ft.deep I Recessed entry area min. 5 ft.wide x 2 ft. deep
❑Wall offset min. 16 inches 1 1 ormer min.4 ft.wide
❑Roof cave nun. 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 '/z"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. .rep 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 coaster lot.
Setbacks:
No closer to front o .rde lot line,than longest street-facing wall. ❑Yes ❑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.
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 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 facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: t s Date: 9 J9/Z(
I:OuildingWomuadgPcrmiIRvw_RES_RT 121417.docx
City of Tigard
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: 11/3/2021 Site Address: 14476 SW 165TH Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00373
Name: Building Permit#:
Tax Lot 2S107AA17800 Total Parks
#: Lot 178 Amount*: $5,839.00
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: Ohi44,4 xe.,A6o Date: 11/4/21
Developer: 0 -Wean,:4 6cuilt.a641, Date: 11/4/21
Permit Coordinator: P.Tto oem '" '" Date: 11/3/2021