Permit (106) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2017-00467
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/10/2018
T f i.;t h.I) 9 Parcel: 2S106DA01700
Jurisdiction: Tigard
Site address: 13225 SW 169TH AVE
Subdivision: RIVER TERRACE EAST Lot: 17
Project: River Terrace East, Lot 17
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 97 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 31 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 8 Smoke
Dwelling Units: 1 Third: 562 sf Right: 0
Detectors: Yes
Total: 1221 sf Value: $163,089.69 Rear: 5
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
0
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1
Other Fixtures: 0
Drywell-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: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SFA VB R-3 1221
Owner: Contractor:
WILLIAM LYON HOMES INC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $23,856.99
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
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: Lt. I4/ /, Permittee Signature: �c
Call 503.639.4176 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.
LoT /7
Building Permit Application
• Residentialr�w FOR OFFICE USE ONLY
City of Tigard RDate/By: I
eceived y #2 747 -Permit No/4,57),0/7--604/6,7
71 "I 13125 SW Hall Blvd.,Tigard,OR 9 Aa 2 2 2017 PDateBy:1anReview j 3 j
Other Permit. (��/�37
I Phone: 503.718.2439 Fax: 503.598.1960
TIC A R D Inspection Line: 503.639.4175 Cl TY t. 3" D Date Ready/By: //,.... xi.„ 7uris: H See Page 2 for
Internet: www.tigard-or.gov BUpi DE3,.w ci :s!;,:;.1 Notified/Method: Supplemental Information
.,i.. _.. "s`e'as # A Y m�: igile A/i— 3.,i. .,
,„.....,,,..4 „i„..,4„4.,.....„,..4, Jiw y..rig,• ...`e.r k,---.a�,.», ,ti: ,A 7.:. �wi
0 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
_,.7
€ 4 ' 4 $ : � � ' e 5 workindicated on this application.li , s' 6m 5 4
,
Valuation:
1-and 2-family dwelling 0 Commercial/industrial $,a3. �n
❑Accessory building [ Multi-family Number of bedrooms: Z 1‘,2) 0;N. 7❑Master builder ❑Other: Number of bathrooms: NI3
a ,...-Jr.+ 60
,,,r,.:
r '� ; ,' ;.;=,4F.; Total number of floors.
Job site address: / 3225 SJ (W 61.tin ioN c New dwelling area: I I'LI square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 4,<.)-74
square feetcia
Suite/bldg./apt.no.: Project name:River Terrace East Covered porch area: ,� square feet E Gas
Cross street/directions to job site: Deck area: -�� square feet 9 1
Pig
cic -.V iV
Other structure area: 7 square feet
r. ll "1 l. 7® ! lea :€ 1 I
Subdivision:River Terrace East Lot no.:/7 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
work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
' 1 6 ^ m 6 sl '.1,, ' %� I M = Number of stories:
Name:ADVL Land Holdings,LLC Type of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/State/ZIP:Scottsdale,AZ 85258 Existing:
Phone:(602)694-4031 Fax:( ) New:
L''''''';r ._ i .tea` k - °Y 4®6 s IfiCA z.,�. i a l ' '�, `:vr�(,,,
Business name:Polygon WLH,LLC •• " . ,
Structural plan review fee(or deposit):
Contact name:Nichole Thorpe
FLS plan review fee(if applicable):
Address: 703 Banat 0,3.4Si. Su .''D
0
1 Total fees due upon application:
City/State/ZIP:Vancouver WA 9866
Amount received:
Phone:(360)695-7700 Fax::( ) a
E-mail:Nichole Thorpe •; ,
- '; " x < L
._ 'MOW '
Commercial and residential prescriptive installation of
` M
_ , :. .� ,„ , p ___,a. ,m.„“ _—, � ,.„.
roof-top mounted Photovoltaic Solar Panel System.
Business name: pomp, imLN '1 i Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 03 bciW S T�L {� (t) Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247
Total fee due upon application: $201.60
Authorized signature: -/ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Nichole Thorpe Date:06/16/2017 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application , - . 017 FOR OFFICE USE ONLY
City of TigardReceived
' '1 i ''' ' " : '' Date/By: Permit No/17_5732 7
IN
' 13125 SW Hall Blvd.,Tigard,OR 97223:. • •• ••,, * Plan Review
Phone: 503.718.2439 Fax 503.598.1960 Date/By: Other Permit
Inspection Line: 503.639.4175 .,
TIGARD Date Ready/By: Anis: El See Page 2 for
.
Internet www.tigard-or.gov Notified/Method: Supplemental Information
4w-toWiiiigiATilit,".'11,MIKAfi“. .' Vit.-fr.:11NR—.
A....w,41:437:1.1.c.n4Arf,5:43k.B. .kiltu.-..ri:4.— —.4.,,,,.:k.—:•.,';`... iciit-W0-c..i. -ki=cr..q.A74.;:3!..k. 4,!reA2.,:, '
Mechanical permit fees*are based on the value of the work
El New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition El Other: mechanical materials,equipment labor,overhead,and profit
Value:$
..-*.Ficiraa".71:;44- 404137P4.:41;./06:.7. :":.f t',"4.'"..,§fi.WW100:1MT,V4 ••k•74-•---'igitic-s-•-•-----------• ,---••--,..= ,-:kse.,;
'' '''.- -•''°''''' tt'i•
___, 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
qM111.ti-family 0 Master builder 0 Other: Description Qty. Ea. Total
`4-044?:AVX-Pifjr:3-14KCft#:;*70744.4704,:tftl'Ib.•72.ka-gfiliftlitari.. Wrt-i.:.
Heating/cooling
' Air conditioning 1 46.75 46.75
Job site address: (371s-- ,, ,„Grti., p„,,,,., Furnace 100,000 BTU(ducts/vents) 1 46.75 ...
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ductstveuts) , 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:River Terrace East
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
,in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 1 23.32
Other:
Subdivision:River Terrace East . Lot no.: /7 23.32
Other fuel appliances:
Tax map/parcel no.: 4 •
Water heater • 2332
-:•-`,11ritkilkfigLi•-itt•e45n-14iii-kiiiino—f.t•bi•iiirtifie-•;,2:114;'W.:V.1_,---1.:3'•;1,-g f,'4';-FM Gas fireplace/inset:t 1 33.39
Flue Vent for water heater or gas
fireplace 2332
_ .
Lull lighter(gas) 2332
Wood/pellet stove 33.39
• Wood fireplace/insert 2332
Chimney/liner/flue/vent 23.32
'•T:1:07i'rg-'1Aitiiitoritilliiki&Mittr4..:N1 p••';`.0•;...,7•.•,:j!,:=A.....I EctitkAws•-,g,„!5i?hc,.,-0,;?; Other: 2332
•-•-r•-•:••••••" — • -•-•-• --'"•''"...- '---•,''''''''"'• "--:''-'5.•;-''''''''- ' ' •••• `''''''re!:''''' ' Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
equipment i 33.39
Address:7600 E Doubletree Ranch Road Clothes dryer exhaust t 3339
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms, Tj,
toilet compartments,utility rooms) -1 2332
Phone:(602)694-4031 Fax:( ) •Attic/crawlspace fans _ 23.32
;•.1.7-i4i;N•4131.:f*iif.e.4.**F;,:;1141:1',; '-e'i:::4?;4 ;12:e9'*01.*: C4:44i0 i Olen 2332
piping:
Business name:William Lyon Homes,Inc. Fuel
$14.15 for first four;$4.03 for each additional
,
Contact name:W I CA/b .e..,--Iii,ofve, Furnace,etc. 1
Address:1716 MO,A),A)01 *t. SVuutt, Si O Gas heat pump
Wall/suspendedhmit heat=
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax:(360)693-4442 Fireplace 1
Range 1
E-mail:Ikkk ej kt,... :TA, 1. , 4,-,omes . (Ayr Barbecue
f''--;?'izi•Q2..},-...s •••14.4%,•1;;+;•447."7.: a'''' p \
--,.. ..q.:::f .... 2.:AV'':43:':--,k:.2. Clothes dryer(gas)
Business name:pn vtc\-voc arra Qbokivyl
''4'.*::th I':iTra:17—MiriClieriNIC--kilititlikr titRgiii-tXtr•:•-71 :••••••:Y".
Address: .),,Q\ 5.kilk(,Ill Subtotal
City/State/ZIP: - ( fl) )(-1, en kt61 brminumi permit fee($90.00)
Plan review(25%of permit fee)
Phone:5t,-.6)4143. siAl, Pam( 15) poi, .... cij-1 s.-
State surcharge(12%of pemait fee)
CCB lic.:loci DOI TOTAL PERMIT FEE _
This permit application expires If a permit h not obtained within 180
days after it has been accepted as complete.
Authorized signature: (144/eyeigr.-10--- * Fee methodology set by Tri-County BuildMg Industry Service Board
Print name:M/4?die...7h OIL- Date:
• c ' c 1
Electrical Permit Ap /plication '''' ' FOR OFFICE-USE ONLY
City of Tigard ,, ,, i ,. - 11"eived t0:/4757—?e/7— e 97
III 13125 SW Hall Blvd.,Tigard,OR 97723 Phm Retiew
Phone: 503.718.2439 Fax: 503.598.1960 Dte,63. ReleedPeratit g:
..r.,,,, InspectionLine: 503.639.4175. Reedy DatelBy: Turk
0 See Page 2 ihr
1 1"I'IW Internee.wwW:tigard-otgC1 Noted/Method: Supplemental Information
El New construction 0 Addition/alterationfreplacement Huse check ell that apply(submit 2 sets of plans write=checked):
0 Service or feeder 400 amps or mons 0 Building over three stades.
0 Demolition 0 Other: •
where the available fault current C3 Urdu;and boatyards.
.....d.10,000 amps at 150 volts or 0 Floating buildings.
d..-and 2-family dwelling 0 Commercialliticitistrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agrioultural
amps for all other installations. . bnllclings.•
1XMulti-family -- 0 Master builder 0 Other: ['Fire pump. 0 installation of 150 KVA.or
r - .-1 -' .- 0 EtpergewY cYstem• larger separates,derived
0 Addition ofnew motor load of system.
Job# Job site addre.7 S--W • 10,012 or more. 0"A","3","I-r,n-r,
0 Six or more residential units. occapanoy.
City/State/Z1P:Tigard,OR 97224
0 Heanireate facilities. 0 Recreational vehicle parks.
Suite/bldg./apt#: I Project name:giVeive-TeAArvale ,„ °Hazardous locations. 0 Supply voltage for mom than
0 Service or feeder 600 amps or room 600 volts nominal.
Cross street/directions to job site: ,,LX-,--_,77,V:'1Agal2V-4.gs-ttA iMilF.,-',A.-'-'1,1 ,‘IiT:1•' :
Description -Qtr. I Ent iota!
New residential single-or multi-family dwelling unit.
Subdivision: r..2 , • .ii i , A I Lots i 77 Includes attached garage.
1.000 sq.ft or less 1 168.54 4
Tax map/parcel#:
Be.addl 500 sq.ft.or pottinn I 332. 1
It'-':•;'''=.::'-'---- --Z- is .f_i-Llt:tiq tP.7719,70-&-gitgaY' . _-.,A7:;--;--34-i- FA Limited energy,residential
00
- (with.above sq.ft) 75. 2
Limited energy,multi-farruly
75.00 2
residential(with above sq.ft)
Services or feeders installationalteration,and/or relocation
ame:ADVL Land Holdings,LLC • 200 amps or less 100.70 2
,
ublR201 amps to 400 amps 133.56 2
Address:7600 E Doetree •anch Road
401 amps to 600 amps 20134 2
City/State/Z1P:Scottsdale,A.Z 85258
601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over 1,000 amps or volts 55226 2
Temporary services or feeders Installation,alteration,and/or
Email:
relocation
OintwenndeitlltiJLAohni =gcomrdaidng Rt4a4t9I,o6w70n,wcl7a0is1,not 2ms or 0amps 59.36 I
125.08 2
Owner signatue: Date: 401 amps to 599 amps 16854 2
Bran chforribranrcuichts-.nen alteration,or"tension'per panel
Business name:William Lyon Homes,Inc. above service or feeder fee,
7.42 2
uft
CMtallnme: Ithchole,111 0!lit B.Poe for branch cinmitrwithout
service or feeder fee,
Address: 103 4NrOrkolkocui St StkL, D branch circuit first . 56.18 2
City/StairiZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 ' ' ' I Fax::(360)693-4442 Each manufactured or modular
R
67.84 2
dwelling,service andfor feeder TnRill;A i 6.1 _AstA, 0 ,i ,4_. Ac.i Ask Roommect anly 57.84 2
Pump or inigation circle 67.84 2
Business name:Garner Electric Washington,LW • Sign.or outline lighting 67.84 2
Signal cuctut(s)or limited-energy
Address:1.4 cp v al‘kAA i'. .v.e...,k\l‘1,311 . "UP pane,alteration,or odension. 13 See Page 2 2
Each additional inspection over allowable in arty of the above
City/State/Zfas:'p,At icut,4 pit vyys,_ cie3 I
Additional inspection(I hr rein) 6625/hr
Phone:(253)320-1657 I Fax:( ) Investigation(1 bruin) 90.00/hr
_
Industrial plant(3 hr min) ' 78.18/hr
Frosn•bdaniels@gweusa.com
Inspections forwhichno fes is
CCB Lic.: C1158 Electrical Lie.: 208174 Suprv.Lk.: 4496S . .4. • listed(th la min) 90.00/1a-I_
Supry•Electrician signature,required'.' .:Aor.A . Ai • .. — '"' , • Subtotal:
Print name: ToalP Albert •• ' Date: 4/26/2016 0 Plan Review Required(25%of pelt fee):
-
-"' — Stat surcharge(12%of permit fee):
..
N. . . . ---- - TOTAL PERMIT FEE:
.:4
This permit application expires ifs permits not obtained within LSO
Print name: Bill Daniels Date: 4/26/2016 days after it has been accepted as complete.
P.t
* Number ofmspeotions allowed per prrauit
;!;141•IBandingIT'ambal.0 Pern*Ano EL12 ffitlititle Rev D6/17/2015 441146117117/05/1"7114707012
Plumbing Permit Application . -' ,
Building Fixtures
City of Tigard ;, ,.. Recelved Pstmit wo:/f SJR/7"CyG`lV47
'f+• 13125 SW Hail Blvd.,Tigard,OR 97223
Phone: 503.7152439 Fax 503.598.1960Plan Review
tXl>aPernhit =
T I c A n Inspection Line: 543.639.4175 Date Readying; ;min »See rage 2 for
Internet: www.tigard-or.gov ltotified/Madmd: Supplemental Information
!T,ff�*:?1;. ...q"iti;:_ .-frig' tl'? ?+:...t?T:5.:.t.•:!]. .. :x,.:.:.�>t _;:.i -• k•,g..4.'v/� ti• �,�a,y , '
s'�.z -"�.�. .,.•.. - •�..+,.!'�*t�F.7f��� .ri:. .. .. r ..._�•_. ...... _'+i y� = V -.. ».§3`.Z,�'�;_.1�VLdS,-•
^®New construction 0 Demolition x Fars ret inlorrnatloa'use chec#tst
Deccrial
❑Addition/siterationf lacenlent 0 Otherp Qty. ! Ea i Tet
roPNew 1-2-family dwellings(includes 144 ft,.fon'each utility connection)
• ;-• - -; 't A`l O LYiYSR Ci ,.: ,.-,;"'a•;4.:'-3-'4:'
- 4-.;:f'. = SFR I bads 312.74
..• d , :` si :• :ik
1-and 2-family d%Velling0 Comtnercialrmdustrial SFR(2)bath • - 437.78 "4. -
❑Accessory building IKMulti-familySFR{3}bark" 4 50032 ;
Each additional both/kitchen 25.02
❑Master builder 0 Ocher: Fire sprinkler-1 sq.ft.), Page 2
-", - :k,:4 Jt$1tteD�¢Al rOlif ffida 101tg = Site utilities:
Job site address: t/37 , SUsJ I t A ofth k(� Catch basin or area drain • 18.76
t Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: fZiV&Teri re_.E4 Manufactured home utilities 50.03 .
Cross street/directions to job site: Manholes 18.76 ;
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:,__) Page 2
Storm sewer(no.linear az_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: �'j,eAr "'r ce__ es.i--• Lot no.:/1 _ ` Rixture•or item:
Tax map/pareel no.: Backflow per " l 31.27
..54;"4-: 14.43,',;:'!14.,:',1:: "iciaiTPTiOfiF4 -WURit" : ..: , Backwater valve 12.51
aothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-47 [Q}j ;•azµ -;I i. l f >',::' h• Expansion tank 12.51 ,
Name:ADVL Land Holdings;LW Fixture/sewer cap 25,02
Floor drain/floor sink/hub 25.02 '
Address:7600 E Doubletree Ranch Road Garbage disposal 25.42
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
rime:(602)694-4031 Fax:( ) Ice maker 12.51 ,
-•4''17,..:1:314..17: .^ i .. • .F•'.T ,47- ii,*�• f Interceptor/grease trap F 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2 .
Primer 12.51
Contact name;A [G�h 1de..Tf 1
Address:103 Q,roocwol'5A--5,,uL k.. sko Roof drain t� 25.42
. Sink/basin/lavatory
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 ' Fax::(360)693-4442 Tub/showcr/shewerpan . 121E
E-mail i . 14 ► 1• . - Urinal 25.42
,l .: _ .q .. y.-.7„1,-,--,%
t-.�y�_ :.=4:: " l• Ps.e 9 Ci'? water closet , 25.42
:-.-•:•u: ":ra ,�';':'..- 'r•,.^,,-4't1 N.�;'3.54}`�'"-•Yr.+t-.� - 1 +. '
. . Water-heater 37.52
Business name:AlliancePlumbing•LLC Water.piping/DW3/ fi 9 56.29
Address:146 W Historic Cohumbia River Hwy Other !f 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)913-6438 Minimum permit fee: 872.50
CCB Lie.:184601 ! numbing Lie.no.:28732
Plan review (25%ofpennit fee)
I State surcharge(12%of permit fee)
Authorized signature: 1 i/, TOTAL PERMIT FEE
Print name:Robert Dlshman Date:5/2312016 This permit-applicationmOres lta-permit is rat obtained sritbin ISO days
atter Ube been accepted asreesplete.
*Fie methedoingy set-by Tri-County Building Indus Service Board
t.WuilifimglRennin1Pl4.S1-ThermitAppdoe IoimAw 440-4616T(u04aCONIIWF8)
• ,,, City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
:II III
T I G A R D Building Permit Review — Residential
1
Building Permit #: , ,/,^o 2'f 7
Site Address: . ) /Z2 94A A/-L
Project Name: Over —re ^ice ?-('--i– Lot #: J
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review 7 p /�
Proposal: p v S'/ ie__ __g/b____ ,04c/L (2.e l,fdtl L _
Werify site address/suite#exists and active in permit stem.
OE River Terrace Neighborhood: 0 No DiYes,See River Terrace Review Addendum Attached
Sit lan Elements:
Jree(3)copies of site plan laI,°: 'sting structures on site
!giS.rte plan must be on 8-1/2"x 11"or 11 x 17"paper 1Ti Footprint of new structure(including decks)with finished
yawn to scale(standard architect or engineer scale) oor elevations
Worth arrow W�tility locations&easements (required for new and additions)
VJ to address,project or subdivision name and lot number YJ Sidewalk/driveway approach
plicant information(name and phone number) 0 ation of wells/septic systems
1a of dimensions and building setback dimensions ■ �S sting trees to be retained with drip line,and tree
al:.uare footage of buildings to be demolished protection measures
TI Lot area,building coverage area,percentage of coverage and M�treet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) 'VJStreet names
Property corner elevations (2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Yes ON/
4 foot differential) If yes,is a storm water quality facility shown? ❑Y s JLU'&o
lean Water Services—Service Provider Lett r(lot platted prior to 9/10/1995): y re / 1 - -
/Required: ❑ Yes,applicant was notified 101 No Received: ❑ Yes ❑ No
LRE Public Faciliti Improvement(PFI)Permit: PFI ) ,r-6606
e uired: Applied For:
q Lld Yes,applicant was notified ❑ No pp� "4d Yes. ❑ No,stop intake
9
/Required:
Use Case#: Me 2Q/ / 90 J
vol. Zoning: •E— �•� j`�
'Required Setbacks: Front Rear \5— Side 0 Street Side ��Garage .,,..20,0 Landscape Requirement: .2 C )
0,0
Tr/Lot Coverage Maximum: d
le Building Height: Maximum Height A Actual Height
05Tisual Clearance
tiSt1.ensitive Lands: ❑ Yes 'No Type
YA Urban Forestry Plan
❑ Conditio "M "prior to issuanfe of b ding permit
Notes: ���'C//1ht 5 ,c' �' 1C�� 721f/ P/�i�t e� /,S'S7L(.)1'C'� -
Approved By Planning: -- _IIIIIDate:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: , /77
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning Engineering p.-Permit Coordinator Building
Workflow Sign-off: ? Sign-off for tanning(include notes from planning review)
Route Application Documents: Ai 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:
ByPermit Technician: / _ ` t Date: l/%
108111190410,
Enn ineering Review
[ Slope at building pad: o
ErConditions "Met"prior to issuance of building permit
E EE/asements (encroachments)per engineering conditions of approval and plat
L3 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes EcNo `
Assess Water Quantity Fee in-lieu: ❑ Yes CJ No
LIDA Facility on lot: ❑ Yes El No
❑ NOT Approved by Engineering: (Date:
Notes: �b, 1c ) 5 \L ,�: Awl- 'PSI tea. 4, g i, t N 1,ns ��,,P-te..d.
Approved by Engineering: t t,41-1rr,(1--_ Date: /z- i J r'i
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
El 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:
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: !—Yes ❑ N/A
Tigard Trans SDC: !-Yes ❑ N/A
Parks SDC: ro es ❑ N/A
LIDA ❑ Yes /A
OK to Issue Permit
Approved by Permit Coordinator: Date: 1
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Jyrt
• City of Tigard
11/411
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD River Terrace Building Permit Review Addendum
Building Permit #:
Site Address: a l'30 2 c— .,c)(0 /(j9. 4 /5 t
Project Name: / !-/v — �-ed7oC � Lot #: i+
(New
—
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dist*t Design Standards (18.660.070.L):
Is the project subject to the plan district design standards? or Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 dee Balcony w/access 2 Window Projection Vertical Wall Offset a
p ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
❑ ❑ ❑ ❑
2. Eyes on the street: a minimu of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: /�c/o
j3
. ntrances:At least one entrance must meet both of the foll g standards:
Max. 8 ft. setback from ion t street- facing wall Parallel to street,angle no more than 45° from street,
or op n onto porch
Entrance opens to a porch: Yes ❑ No
Is,all the following apply:
121
5 sq.ft. min.
ne street facing entry 2 ft.max. roof above floor of porch
5 ft. depth min. 30%min.porch roof coverage
4. etailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades:
1 Covered porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep
❑ % all offset min. 16 inches ❑ P ormer min. 4 ft.wide
f Roof eave min. 12 inch projectionoof offset min. of 2 ft.
❑ Roof shingles either tile or wood [LG Gable,hip or gambrel roof design
0/Roof pitch oriented south min. 500 sq. ft. ❑ Horizontal lap siding min. 3-7 inches wide
Accent siding min.40%of street facade ❑ Window trim min.2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
No closer to front or side lot line,than longest street-facing wall. 0 Yes No. If No (Check one):
❑ ay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Wi : (Check one)
12-foot-wide garage door ❑ 40%max. of street facade
❑ 50%max. of street façade with 7 detailed design elements
Notes:
Approved By Planning: _________ IIIIIIIIIIVI.
Date: /r/c2 / .
1:\Building\Forms\B1dgPermitRvw_RES_RT_062216.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
T €:r 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Tom H. DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
NOV 14 2017
FROM: Nichole Thorpe
CITY OF'TIGARD
COMPANY: Polygon Northwest BUILDING DI Isi 1 ,
PHONE: 360-989-40204
B '4: ir
RE: 13243,13237,132 -41011W219 SW 169TH /ZS%,2Co/7-Q 2 6 7
(Site Address) (Permit Number)
River Terrace East bet ztr— 4-O7 / 7
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
0 Additional set(s) of plans. 3 Revisions: Bulletin, Plan Sets
0 Cross section(s) and details. 0 Wall bracing and/or lateral analysis.
0 Floor/roof framing. 0 Basement and retaining walls.
0 Beam calculations. 0 Engineer's calculations.
0 Other(explain):
REMARKS: Please pay fees owed ' Trust Account.
Adding 3rd Bathroom Option �✓'`X
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: J - 3 -- ) g Initials: +3'
Fees Due: ❑ Yes ❑No Fee Description: Amount Due:
nr P1av, Ccvq® `�
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ( -41 No one 7 �
Applicant Notified: Date: Initials: d '
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13225 SW 169TH AVE, BEAVERTON, OR, 97007 July 25, 2018 at 2:22:03 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00467
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Protection Ballard at gas line not installed.
Install fire sprinkler scussion cover and light upper level front bedroom.
Install missing tension brackets and nuts on back deck.
No ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13225 SW 169TH AVE, BEAVERTON, OR, 97007 July 18, 2018 at 10:36:53 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00467
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 70 psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13225 SW 169TH AVE, BEAVERTON, OR, 97007 July 25, 2018 at 2:15:51 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00467
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
Provide protection Ballard for gas line in front of garage, will check at building final.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13225 SW 169TH AVE, BEAVERTON, OR, 97007 July 23, 2018 at 10:19:07 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00467
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
No A/C installed.
Note: range not installed at this time
Violation Summary:
Inspector Contractor
Plumbing Permit Applicati ECFI
vED
Building Fixtures �, FOR OFFICE USE ONLY
City of Tigard
3F
yr Received
13125 SW Hall Blvd.,Tigard,OR 97223�� ® 2018 Date/By: ,J��1Permit No/�f` j,?_dc29,
Phone: 503.718.2439 Fax: 503.59�*8'�.19�60) Plan Review
CITY l 11 �ylr,TIG e Rn Date/By: a/�0/i*v Ll Oilier Permit No.:
TI G A R D Inspection Line: 503.639.4175 [j OF 1 (y[� D Date Read /B
Internet: www.tigard-or.gov Y Y mns See Page 2 for
r Nottfied/Method Supplemental Information
TYPE �F. LDING I IViSION S.
FEE* SCHEDULE ',
®New construction ❑ Demolition For special information use checklist.
Descriptiont
❑Addition/alteration/replacement ❑Other: Q Y Ea. Total
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 ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-familySFR(3)bath 500.32
El Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler(1,221 sq.ft.) [/ Page 2
JOB SITE INFORMATION AND.LOCAT"ION Site utilities:
Job site address: 13225 SW 169T"Ave Catch basin or area drain 18.76
City/State/ZIP: Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.:17 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF'',WORK Backwater valve 12.51
Multipurpose Fire Sprinkler System Clothes washer 25.02
Permit# /NS/Z017- 001/67 Dishwasher 25.02
Drinking fountain 25 02
Ejectors/sump 25.02
►ii PROPERTY OWNER 1 • ❑ TENANT Expansion tank 12.51
Name:Polygon Northwest Fixture/sewer cap 25.02
Address:703 Broadway St.Suite 510 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660
Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
E APPLICANT 0,CONTACT PERSON 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
ONTRACTOR • Water closet 25.02
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
C'CB Lie.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
/ .) State surcharge(12%of permit fee)
Authorized signature: l
TOTAL PERMIT FEE
Print name:Gavin Thomes Date:2/5/2018 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-PermitApp.doc 10/01/09 440-4916T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site.Utilities QtY. Fee,4ea) Total ^ Square Footage: ` Permit Fee:'
Footing drain-1St 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 3752 Valuation:atic n: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
IFee( a), Total each additional$100.00 or fraction thereof,to
Other Inspections of Feesand including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Other Fixtures: I 1
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type -
Fixture Type for Replaeel Plan Review for Plumbing Installations
Work Performed: Capped Added Relocate
Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower
-Jacuzzi/Whirlpool 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Car Wash -Each Stall
-Drive Thru engineer.
Cuspidor/Water Aspirator 0 New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ® Any multipurpose tire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
-3" Submit 2 sets of plans with any of the above.
Car Wash Drain Isometric Or Riser Diagram
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related
-Commercial-food related that meet the qualifications above.
-Industrial-food related
lee Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet
Urinal fees assessed for the sewer increase must be paid before the
https://allianceplumbing-my.sharepoint.com/personal/gavin_allianceplum12ng_net/Documents/Documents/Fire Sprinklers/RT/City of Tigard
Permit.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13225 SW 169TH AVE, BEAVERTON, OR, 97007 July 27, 2018 at 10:26:45 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00467
Inspection Type: Inspector:
299 Final inspection Jeremy Burrows
Result:
PASS - CofO
Comments:
Corrections completed
Final erosion control passed
Moisture content form received
Moisture barrier acknowledgement form received
High efficiency lighting form received
Insulation certification verified
Blower door and/or duct seal test certificate received
C of 0 left on counter.
Violation Summary:
Inspector Contractor
i)E c Fi iv E p
Electrical Permit ApplicationFOR OFFICE USE ONLY
City of Tigard MAY 7 1. 7 t3 te �na /B:f F4A Penult 3tAf fj' i/7_o eY6, 7
't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.59 41a i OlIGARIJ Date/B : Related Permit#:
Inspection Line: 503.639.4175 ReadyDate/By: rags:
TIGARD See Page 2 for
e, Internet: www.tigard-or.gov BUILDING fIvISIO Notified/Method: Supplemental Information
TYPE OF WORK 3 1\V PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
®1-and 2-family dwelling ❑Commercial/indus rial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB Snit INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:/3 2_ 2_5-,5v4 t t,"1 f'tl p � ❑Addition of new motor load of system.
11", 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt,#: n l Project name:River Terrace East ❑Hazardous locations. 0 Supply voltage for more than
`-(�
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total l *
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace East Lot#:/7 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion t 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
h f //�, 7 (with above sq.ft.)
/ 1 �� U i! Limited energy,multi-family 75.00 2
r aebr Ona A� residential(with above sq.ft.)
® tP►BJOPERTYOWNER� Renewable Energy 0 See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E Doubletree Ranch Road 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 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
® APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
7A2 2
each branch circuit
Contact name:Nichole Thorpe B.Fee for branch circuits without
sAddress:703 Broadway St Suite 510 branchce it feederitfee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:Nichole.Thorpe@polygonhomes.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Sunlight Electric Inc Sign or outline lighting 67.84 2
Address:2804 NE 65th Ave Suite D Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(971)222-5758 Fax:(360)326-9660 Investigation(1 hr min) 90.00/hr
Email:sunlight.incl@comcast.net Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 172549 Electrical L• : c230 Su .Lic.: 1793 specifically listed(%hr min) 90.00/hr
�� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required. Subtotal:Print name: Chester Garrett JhliL. 'Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 0w
1. /f TOTAL PERMIT FEE:
( ` This permit application expires if a permit is not obtained within 180
Print name: Peter Kozarez . Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building\Permits\ELC PermitApp ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB