Land Use Permit Application

City of Tigard
Land Use Permit Application
File #
PRE-APP. HELD BY:
Other Case #
Date
By
Receipt #
Fee
Date Complete
TYPE OF PERMIT YOU ARE APPLYING FOR
Adjustment/Variance (II)
Historic Overlay (II or III)
Comprehensive Plan Amendment (IV)
Home Occupation (II)
Conditional Use (III)
Minor Land Partition (II)
Development Code Amendment (IV)
Downtown Design Review (II, III)
X Planned Development (III)
X Sensitive Lands Review (II or III)
Site Development Review (II)
X Subdivision (II or III)
Zone Change (III)
Zone Change Annexation (IV)
X Temporary Use Permit
Model Homes/Sales Office
NOTE: FOR REQUIRED SUBMITTAL ELEMENTS, PLEASE REFER TO YOUR PRE-APPLICATION CONFERENCE NOTES
LOCATION WHERE PROPOSED ACTIVITY WILL OCCUR (Address if available)
The northeast corner of SW Roy Rogers Road and SW Bull Mountain Road
TAX MAPS & TAX LOT NOS.
Tax Lots 100-106 on Map 2S107
TOTAL SITE SIZE
ZONING CLASSIFICATION
37.84 AC
R-4.5, R-7, R-12 (River Terrace Planning District)
APPLICANT*
Polygon Northwest Company
MAILING ADDRESS/CITY/STATE/ZIP
109 E 13th Street, Vancouver, WA 98660
PHONE NO.
FAX NO.
360-693-4442
PRIMARY CONTACT PERSON
PHONE NO.
Stacy Connery (applicant's representative)
503-941-9484
E-MAIL
[email protected]
PROPERTY OWNER/DEED HOLDER (Attach list if more than one)
see attached list
MAILING ADDRESS/CITY/STATE/ZIP
PHONE NO.
FAX NO.
*When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owners must sign this application in the space provided on the back of this form
or submit a written authorization with this application.
PROPOSAL SUMMARY (Please be specific)
Polygon at Roshak Ridge: 244-unit single-family residential planned development, conceptual and detailed
development plan review, subdivision preliminary plat, urban forestry plan review, sensitive lands review, and
temporary use permit for model homes/sales office.
City of Tigard
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13125 SW Hall Blvd., Tigard, OR 97223 | 503-718-2421 | www.tigard-or.gov | Page 1 of 2
Polygon at Roshak Ridge Property Owner List
Tax Lot 100 (aka Parcel 7)
Mary Ann Newell Trust, Mary Ann Newell & Jeffry M. Newell Trustees
Jeffry M. Newell Trust, Mary Ann Newell & Jeffry M. Newell Trustees
16658 SW Jordan Way
Tigard, OR 97224
Tax Lot 101 (aka Parcel 1)
Kevin A. Roshak
16515 SW Bull Mountain Road
Tigard, OR 97224
Tax Lot 102 (aka Parcel 2)
Michael A. Roshak
15960 SW Roshak Road
Tigard, OR 97223
Tax Lot 103 (aka Parcel 3)
Mark & Claire Roshak
7515 SW 189th
Aloha, OR 97007
Tax Lot 104 (aka Parcel 4)
Roshak Family II, LLC
14205 SW High Tor
Tigard, OR 97224
Tax Lot 105 (aka Parcel 5)
Victor A. Roshak
16035 SW Roshak Road
Tigard, OR 97224
Tax Lot 106 (aka Parcel 6)
Roshak Joint Trust, Dennis & Susan Roshak, Trustees
14205 High Tor
Tigard, OR 97224