Permit!,1
-71iF rl
Plumbing Permit ApplicatEI Y E®
Building Fixtures FEB 2 2022 FOR OF 1.R 1: I XI. O\1.1
City of Tigard Received
g OF I-IGARD Date/By: � ..is Permit No.: MST2021-00374
13125 SW Hall Blvd.,Tigard,OR 9�/ Plan Review
■ Phone: 503.718.2439 Fax: 503.$,IVOING DIVISION Date/By: 62/11/02 Act, Other Permit No.:
Inspection Line 503 639.4175
I I i \I p Date Ready/By: lures See Page 2 for
Internet www.tigard-or.gov Nottfied/Method:� Supplemental
upplemental Information
lew construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" fs4ft h ATE RY,OF a ( _.. SFR(l)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( 1729s .q ft.) ✓ Page g 2
";n 0 , INFORMATION Ail `1COI"i, ; ...i , i Site utilities:
Job site address: 14478 SW 165th Ave Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
ty Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Polygon at Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
• Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.2178(ADU 2' Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
v- . , ..• - • .•' Backwater valve 12.51
'' w Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
P o I , v :,;".�'" I ; Expansion tank 12.51
Y Name:
Taylor Morrison Fixture/sewer cap 25.02
Address: 703 Broadway St.Suite 710 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660
Hose bib 25.02
Phone: 816-7805( 360) Fax ( ) Ice maker 12.51
APPLICANT3 " �'"r % 9}„ C � SO 1 Interceptor/grease trap 25.02
Business name: Alliance Plumbing, LLC Medical gas(value:$_) 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
.,, ... } r a sr + Water closet 25.02
t . sue T> _ ,Again .,
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 ao,,,,00,,,,,, -- .,-. ---- 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-Permi1App.doc 10/01/09 440-4616T(I0/02/COM/WEB)
CITY OF TIGARD MASTER PERMIT
11 a COMMUNITY DEVELOPMENT Permit#: MST2021-00374
Date Issued: 05/23l2022
T6.GAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17800
Jurisdiction: Tigard
Site address: 14478 SW 165TH AVE
Subdivision: ROSHAK RIDGE Lot: 178
Project: Polygon at Roshak Ridge, Lot 178(2 of 2)ADUs
Project Description: New attached ADU (2). NO FINAL INSP UNTIL DEFERRED SDCs PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 720 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1009 sf Garage: 398 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1729 at Value: $246,182.26 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 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
Other Fixtures: 0
Orywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<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 W/Svc or Fdr: 0
Ea add!500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O SvdFdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 801+amp-1000v: 0
1000+amp/vo1C 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 1729
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: $15,177.66
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 160 days. ATTENTION' Oregon law re ires you t follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
ac..nnt_nnln thrrn inh n g7_nn1_n an V ma"nht ' a r ,nr the,ndoc nr riirart ell actinnc to nl INn by Tallinn CM 10R7 nr 1 Ann 111 9121d •
Issued By: /j; '1 Permittee Signature: �r�pL/ ,Gl
'�6/ Call 503.639,4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the lob site at the time of each inspection.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard A U G 3 12 2' Received
Dattee B a Z/ /1/ Permit Na `� ,I
• 13125 SW Hall Blvd.,Tigard,OR 97223 e /1" M ST���t7F;137!
�� Plan Review
1 Phone: 503.718.2439 Fax: 503.598.15ITY OF TIGARD DateIBy: ill Ill(/ �F�f' OtherpefmiS:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: / / 'r RI See Page 2for
Internet: www.tigard-or.gov ^'�"^`�^^' `.- ///�� '1�' I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
{a 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.
❑ 1-and 2-family dwelling ClCommerciaUindustrial Valuation: $ L Y i i$2 Ile
0 Accessory building 0 Multi-family Number of bedrooms: 3
h batrooms:�5��
❑Master builder ®Other: ADU 2 Number of �^� 3
JOB SITE INFORMATION AND LOCATION Total number of floors:2 Z t a7��y,,q
Job site address: 14478 SW 165TH AVE New dwelling area: 1,729 square feet `
City/state/ziP:Sherwood,OR 97140 Garage/carport area: 398 square feet --,aO
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 Lot no.: 178 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
--';�"A /� equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK' 1 work indicated on this application.
ew Construction/Type: Triplex-ADU (unit 3 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 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 ElCONTACT PERSON 09 BUILDING PERMIT FEES*
(Please refer w 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*
a
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 lie.:207247 n�/ Total fee due upon application: $201.60
Authorized signature: O112.42 .ry l:C n422.4 . .40'ti?/a� 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)
ECE!VED tki
Mechanical Permit Applica FOR oe�rcE USE,ONLY
- City of Tigard Received
U�7 <! �. L Z DatetBY ' Permit Na.: 3 J,
" I3I25 SW Hall Blvd.,Tigard,OR 97223 MS�Ze�� Lid s 7 '
' Plan Rwiew
,,, 111 • Phone: 503.718.2439 Fax: 503598.I9 Date/BY: OchcrPermir.
Inspection Line: 503.639.4175 CITY OF EL;:ARD
ritif.r.l; Internet: www.ti and-or. ov BUILDING DIVISION DateReadyBy. lak- 0 See Page 2tor
8 $ Notifie -
d Me lwd: Supplemental Information
TYPE OF WORK COMMERCIAL FEE° St.t16DULE- 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 RESIDENTIAL EQUIPMENT/SYSTEMS FEES°
IS 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use cheek&,.
I j Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total _
JOB SITE INFORMATION AND LOCATION Hestinp,/cooling:
Air conditioning f 46.75 Job site address: 14478 SW 165th AVE _Furnace 100,000 BT(Rducuslvcats) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 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
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 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater
23.32
DESCRIPTION OF WORK Gas fireplacelmsert 33.39
Flue vent for water heater or gas
New construction-Type ADU 2 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/hued 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
' Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
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 rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attiekrawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH,LLC S14.15 far first four,54.03 for each additional
Contact name: Omar Alami Abouhafs Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas beat pump
Wall/suspendediunit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Ranee
E-mail:permitsubmittals(dtayIOrmOlTISOff.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
[' This permit application expires if a permit is not obtained within 180
GA' 1)64.4.19.n. days after It has been accepted as complete.
Authorized signature: C.LLti ` Fee methodology—__..._....................._._ sm b Y Tri County Building Industry Service Board
III
Print name:Elia Duran Date: 10/30/20
r\nnil+n.\PmnnaMar P..mi tint,mill Ix An.
Electrical Permit Application •-i t - 1 y E FOR OFFICE USE ONLY
City f Tigard Received _ ... n,
•J rDate/By rrnntt h L. l0V S
1133,125 Sw liTO Blvd.,Tigard,OR 97223 A U G 3 1. Reviewlan P 15 7 lfr J
I 0 Phone: 503.718,2439 Fax: 503.5981960 lyatc,7jy- Related PUMA it:
I1.GARD
Inspection Line: 503.6394175 .ITY OF TIGAHiL Readyllatday /uric $Ste Peat 2far
Internet: www.6giad-or.gov i ".. .,;ram rill. Notifed/Moho& Supplemental Information
TYPE OF WORK PLAN'REVf)sA'
®New construction ❑Addition/alteration/replacement Please check all that.apply(submit g sets orphan wrtemsdecked):
El Demolition ID Other: ❑stn..or feeler 400 amps ra more 1]8uddiog over three stones.
where the:readable fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
,.4 1-and 2-family dwelling ❑Commercial/industrial lets to wand,or exceeds14.000 ❑f on metci.-e a agricultural
❑Aox:esssory bul7ding
ID Multi-familyID Master builder ❑Other ❑P amps for all otherinstallations Millibarpomp. 0 tessellation of 150 KVA or
JOB SITE INFORMATION AND LOCATION °Emergency system. tamer separately derived
anewJob#: Job site address:14478 SW 165th AVE ❑A0t`na 1941IP orm more ator toad af eystan.
ore.
City/State/GIP: Tigard,OR 97140 ❑six Of man residential nits occupmsoy
❑licaltbtarc facilities. ❑Rocrcaeonal vehicle parks.
Suite/bldgJapt.#: Project name: Polygon at Roshak Ridge ❑1Lvardots locations 0 Supply voltage for more then
0 Service or fender 600 amps or mom 609 volts noamal
Gloss street/directions to job site: FEE SCHEDULE '
nesertaasa 1 9sr. I eats I Tot. I
New residential single•or multi-family dwelling unit.
Subdivision:Polygon at Roshalc Ridge Lot#: 178 Includes attached garage.
Tax map/parcel#:
1,1100 xq.It or less 168 54 4
Ea.add'I 500 sq.IL or portion 33.92 I
DESCRIPTION OF WORK Limited enemy,residential
(with above ft.)
75.90 2
New constnIction-Type ADU 2 Limited energy multi Gently
resideal(with above sq.ft.) 75.00 2
nti
Renewable Energy ❑ See Page 2
NI PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes WLHLLC 200 amps or less 100.70 2
Address: 703 Broadway St.,Ste 710 201 amps to 400 amps 13336 2
401 amps le fi00 amps 200.34 2
City/State/ZIP: Vancouver,WA 98660 601 amps to 1,000amps 301.04 2
Phone:(360 )946 8674 Fax( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,'Herndon,and/or
Entail: OAIamiAbouhafs([taylormorrisoncom-PermitSubmittals@tayloemorrison.com relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT ,�J 0 CONTACT PERSON Branch circuits—new alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes WLFI LLC above&ervice or(coder foe,
each branch canna 7.42 '
Contact name: Omar Alain(Abouhafs D.Fee for branch circuits without
Address: 70313roadway St,Ste 710 service or feeder fee,first roadway 56.18 2
ranch circuit
City/State/2tP:Vancouver,WA 98660 Each add'.branch cveuit 7.42 2
360 )946 8674Miseellaoeous(service or feeder bet included)
Phone
( Fax::( ) Each manufactured or modular 67 84 2
Entail:OAiamiAbouhafs@taylormorrison.com-PermitSubmittals@taylormorrison con dwelling,service and ay fo del
Recumncc[rmly 67.84 2
CONTRACTOR Pump or miTation circle 67.84 2
Business name: Wallace Electric Sign or outline lighting 67.84 2
r
Address: 105 Dresden St Sigui circutt(a)or duelled-energy 0 See Page 2 2
panel,alteration,or extension.
CityfStat JZIP: Astoria OR 97103 Each additional inspection over allowable is any of the above
Adcbtemal inspection(I kv min) 66 25/hr
Phone:(503 3418 0563 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: David@wallacewires.com
haosn;alplant(lbrmin) 78,18/hr
lnspecnoos for which no fee is gp Op/hr
CCI3 Lie.:224868 Electrical Li�r—•1C1441 ( Su v I. .• 63635 specifically listed('A hr min)
(/�/`--�_ ELECTRICAL PEikMIT tal-
Suprv.Electrician signature,required: f�N`�A' Subtoral
Print name:pit av _.. Date: 1�L l�1 -❑Phut Review Required(25%of permit foe):
( / State surcharge(12%of permit fee).
Authorized signature `�� TOTAL PERMIT FEE;
nth permit appaeatina expires if a permit is nut oblaiaed within r80
Print nattlC: yO „S Date: (f p- / r days,naru ban been accepted as complete.
�3t ( ...—. i Number of mope rmas allowed per permit.
1.41wlde sand/aLC cnartApp_an r1t1..dre 1tev0607fmo A W1615f(i IlOWOM4YE12
Plumbing Permit Application e ,
• Building Fixtures RECEI �/ E I FOR OFFICE USE ONLY
City of Tigard Received
' r ` );`,',1 Permit No.
U G 31 , ,. ply: TZo ry _h 3 itic
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review vI
a Phone: 503.718.2439 Fax: 503.598.}�t y Other Permit No.:
Inspection Line: 503.639.4175 l,� Y G' �` "'dc`+�rU� Dat Ready/By: turfs; PI Sec Page 2 for
TIGAP.O Internet: www.tigard-or.gov F'' DIN( :'VISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist.
--" Description 1 Qty. 1 Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
(�I-and 2-family dwelling ❑Catnmercial/industrial SFR(2)bath 437.78
1Accessory buildingSFR(3)bath. 500.32
❑" �MLLiti-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14478 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:JillaaitW.Qrrlgapolygon 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.: 1 Page 2
Subdivision: Polygon at Roshak Ridge Lot no.: 178 Fixture or item:
Tax map/parcel no.: Back lowpreventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New construction-Type ADU 2 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ 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
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:'Omar Alami Abouhafs
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 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@polygonhonies.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water gD PP u in WV 56.29
Address:P.O.Box 92 Other 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:184372 Plumbing Lic.no.:pb634
State surcharge(12%of permit fee)
Authorized signature: _ ___ TOTAL PERMIT FEE
Print name:Steve Fowler Date: 0/30/20 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Trl-County Building Industry Service Board.
1:VBaiiimslPami[s1P1.Mt.l-PetmitApp.doe lG'01A9 440-4616TO 0'02rCOMM1YEBy
Spre-ry P ° 4-c2
Plan# 'LS '17-4(:4_,c A--
Floors Z. Large r 1 z
Bed rooms 3 Small �f
We 3
LAV 5 1 1-J l..U441)3 ' �l
Tub 2 Basement
Vent 1st Floor 7
Water Heater I 2nd Floor 1 Pbc'(
AC II 3rd Floor
Schooll 1 ,seal R-3 Total
Garage - cg
No Total Z to -7
#for Elec 3
Z sA- bt
City of Tigard
711 • COMMUNITY DEVELOPMENT DEPARTMENT
c Building Permit Review — Residential
TIGARD
Building Permit #: J"i 5 r i 7- ►— O03 711
Site Address: J 4y 3 g S W 140.51t- NC
Project Name: PD(,Wy-) i4r izo tMAK- 12(P( € Lot #: (:%
Planning Review
Pro
sal: Nat) / pcll`O AQU (z)
1CJ Verify address/suite#active in Accela. .a.In River Terrace: D No es,River Terrace Review Addendum 1
Site lan Elements: ['rosion 44copies of site plan on 8-1/2"x 11"or 11 x 17"paper tained trees with drip line and tree protection measures
Drawn to scale(standard architect or engineer scale) ,F otprint of new structure(including decks) and FEE
orth arrow ?J Utility locations&easements(required for new and additions)
ite address,project or subdivision name and lot number Sidewalk/driveway approach
I )pplicant information(name and phone number) 1 1I cation of wells/septic systems
Lot dimensions and building setback dimensions "K reet tree size,type and location
❑Square footage of buildings to be demolished 41 SStreet names
Oh ❑Existing structures on site La Corner elevations(2'contours if more than 4'differential)
ELot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [es ❑N
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes C No
can Water Services—Service Provider Letteot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified I[J No Received: ❑ Yes E No
Water Meter F ture Unit Worksheet—Additions,Remodels and ADUs
,equired: Yes,applicant was notified ❑ No �� Received: Yes ❑ No
�C Exemption for ADU applied for: ❑ Yes IQ No Received: ❑ Yes ❑ No
IQ Public Facilities Improvement (PH) Permit:
Re aired: ❑ Yes,applicant was notified M [ No Applied For: ❑ Yes 0 No,stop intake
d Use Case#: ��U� ����8 P r-oning: R q- s—
'�equired Setbacks: Front: $ Rear: I r Side: 'T Street Side: Garage: 3
D ding ,.
Height: Max. Height: 30 Actual Height: Z�
Landscape A it.
% Lot Coverage Max: 1-1A %
Entrance Set back no more than 8'from street-facing wall ElParallel to street or offset 45 degrees or less
I�Windows --
Minimum 12%of area of all street-facing facades
G ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
xtends no more than 5'from wall and there is a covered porch extending beyond garage.
❑ Door extends n an 5'from wall and there is a 12 sq ft.window above garage on 2°d floor.
❑ Garage door width is ❑ 12'or less ° r less of facade ❑ 60%or less and includes 7 of following
❑ Covered porch ❑ Recessed entrance ❑ W o ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable, p, rel roof ❑ Dormer
❑ Accent siding Window trim ❑ Window recess ❑ Window projecao Balcony
yisual Clearance ring Urban Forestry Plan
sitive Lands: ❑ Yes 1�No Type:
Conditions met prior to issuance of building permit
Notes:,,
clAPproved By Planning: Date: 9/5/Z(
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
1:\Building\Forms\BldgPermitRvw_RES_1224 I 9.docx
Building Permit Submittal
Original Submittal Date: k/3/2/
Site Plans: #
Building Plans: #
Building Permit#: n�ter building permit# above.
Workflow Routing: [-Planning ❑`E gineering 13- ermit Coordinator gY13utlding
Workflow Sign-off: [Sign-off for Planning(include notes from planning review)
Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
� ginal plan review routing form.
EJ Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: J°
By Permit Technician: d! -'�T` at-214 f -- Date: 9/0,
Engineering Review
EtKgiope at building pad: /2/191
ErZ.Conditions "Met"prior to issuance of building permit
Easements (encroachments)per engineering conditions of approval and plat
If'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes &No
Assess Water Quantity Fee in-lieu: ❑ Yes No
VFinal
Facility on lot: CI Yes [5'No
�a Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: p//�2/
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Permit Coordinator Review
JZY 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:
gr SDC Exemption: ❑ Received .7 Does not apply
IJ SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: "Yes ❑ N/A
LIDA 0 Yes 12(N/A
! J OK to Issue Permit
Approved by Permit Coordinator: Date: I l(Q (2{j vr
t:\Building\Forms\BldgPermitRvw_RES_1224 19.docx
f
City of Tigard
11, . . COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: 14L1 5t,J ((OY ' Pk-V�
Project Name: Polygon at Roshak Ridge Lot #: 1"7-t
(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 ❑No (Per MMD2020-00044)
culation: a minimum of 1 element per each street-facing facade that has 30-60 ft.of frontage.An additio .
ele -nt required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch :.:ft. deep ft.d❑eep min.2ft., 50
ft.wide min.2 ft.,6❑ft.wide Gable. .or❑mer
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, . ,le no more than 45° from street,
❑Max. 8 ft. setback from longer trees- facing wall
or open onto por
Entrance opens to a porch: ❑Yes hi o
IfUes,all the following apply: El25 sq.ft. ' .
One street facing entry ❑12 f ax.roof above floor of porch
❑5 ft.depth min. ❑30 o min.porch roof coverage
4.Detailed Design:All buildings shall include a min. o v- of the following elements on all street-facing facades:
❑Covered porch min. 5 ft.wide x 5 ft. deep I Recessed entry area min.5 ft.wide x 2 ft.deep
0 Wall offset min. 16 inches ig •ormer min.4 ft.wide
0 Roof eave min. 12 inch projection ❑R. • offset min. of 2 ft.
❑Roof shingles either tile or wood ❑Gable, ..p or gambrel roof design
❑Roof pitch oriented south min. 500 sq. . ❑Horizon.. .p siding min.3-7 inches wide
Accent siding min. 40%of street fa .e El Window trim 2 1/2"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 ade lot line,than longest street-facing wall. El Yes ❑No. If No (Check o - :
❑May extend u. o 5 ft if there is a covered front porch and garage does not extend beyond the fro .otch.
0 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 y age that faces the street with a min. area of 12 sq.ft.
Width• heck one)
❑ -foot-wide garage door El 40%max.of street facade
ill 50%max.of street facade with 7 detailed design elements
Notes:
Approved By Planning: —wIV —. Date: //S/Z/
I:1Building\k oms‘BldgPennitRvw_RES_RT_121417.docx
City g of Ti and
Deferral Until Occupancy Request
T I G A}z 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: 14478 SW 165TH Ave
Project Land Use Case or
Polygon at Roshak Ridge MST2021-00374
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$1,000.00 for 1bDC-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 1'DT 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: Dyxa r,.Reu ru.Rdeu/ Date: 11/4/21
Developer: Onra.-.Rnw & Date: 11/4/21
Permit Coordinator: Nylb5 d - '- 1- Date: 11/3/2021