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Permit (179)
CITY OF TIGARD MASTER PERMIT 1, ', COMMUNITY DEVELOPMENT ' ri S Permit#: MST2019-00034 i f Date Issued: 04/25/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �� �,,.+�'} a� Parcel: 2S 107AA12600 Jurisdiction: Tigard Site address: 14122 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 126 Project: Polygon at Roshak Ridge, Lot 126 Project Description: New SFA. 9/3/2019: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 240 sf Left: 0 Parking Spaces: 0 Height: 35 Bathrooms: 3 Second: 560 sf Garage: 294 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1362 sf Value: $178,823.70 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 Drains: 0 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: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Fire sprinkler system 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: 3 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 1362 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 703 SRQAD Y-ST-STE-644 eU�.._C,610 _ —_1-- F-sn-CaFi 175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 1 Hour Fire Rated Soffits PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,084.99 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: , �'� ' ,C?& Permittee Signature: a , \ 1 r?` ‘`Ai;\6-. 1 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application AvL-- 'n(,s‘ Building FixturesRECEIVE I FOR OFFICE USE ONLY City of Tigard 1JJ Received a �� Date/By. d i rrmit No.: MST2019-00034 ✓ II 9 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 1 3 2019 Plan Review ` Phone: 503.718.2439 Fax: 503.598.1960 TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date/By: 5.27//5 /.1 G(,> Juris ennitNo.: Internet. www.tigard or.gov Date Ready/By: loris: 0 See Page 2 for BUILDING DIVISION Notified/Method: Supplemental Information - "` TYPE"OF WOE FEEO' SC F1VLE'°„' `„r.,.: ®New construction ❑Demolition For special information use checklist Description Qty. Ea. Total 0 Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF"CON RUCTION SFR(1)bath 312.70 ® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler Jj?99Sq.ft.)/3 6,2 Page 2 JOB SITE FORMNitON.AND LOCATION' ..• Site utilities: Job site address:14122 SW Gold Coast Terrace 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 name:Roshak at River Terrace 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:Roshak at River Terrace(Townhomes) 1 Lot no.: 126 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 ,, • • Backwater valve IIERCRIPTION OF WORD ` 12 51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 C4 P*©PE TY OWN, 12.51 >< . '. ,.,,.�. � "". =,�] TEP�1Af�l`T ' ', Expansion tank Name:Polygon NW 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 a APPEICA ' . 0 eoNlAcT PERSON Interceptor/grease trap 25.02 Business name: Polygon NW Medical gas(value:$ ) Page 2 Contact name:Jennifer Lopez Primer 12.51 Roof drain(commercial) 12.51 Address:703 Broadway St.Suite 510 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 _- --3- -- - - - P'dic"j` - w_ - Ti-- i :r s ower•-per ------ s- 12.51 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 OITRATOR 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 CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: "-7/ ) TOTAL PERMIT FEE Print name:Gavin Thomes Date:8.07.2019 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 10/01/09 440-46161(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site tilit>tes , Q F (a) Total r $,+in. ,,t, Footag `Permit Feet Footing drain-151 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.693,601 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' 37.52 ' aluation:, tverliffit'dee. 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 Feea) Tont each additional$100.00 or fraction thereof,to OerInsi ections11'Fees and 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. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) Subtotal: Other Fixtures: 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 Replacel Fixture Type for I- an evict or P l l<i I1CI ld dlll Work Performed' Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath -Tub/Shower y. -Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ 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 Z Any multipurpose fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3» Submit 2 sets of plans with any of the above. 4„ Car Wash Drain Isoretr a or.,Riser J)iagt'aa11 .;. Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lay -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 Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the https://allianceplumbing-my.sharepoint.com/personal/gavin_alliancepluml2ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc CITY OF TIGARD MASTER PERMIT 1111 8. COMMUNITY DEVELOPMENT Permit#: MST2019-00034 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2019 �f '� `O 9 Parcel: 2S107AA12600 Jurisdiction: Tigard Site address: 14122 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 126 Project: Polygon at Roshak Ridge, Lot 126 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 240 sf Left: 0 Parking Spaces: 0 Height: 35 Bathrooms: 3 Second: 560 sf Garage: 294 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1362 of Value: $178,823.70 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 Drains: 0 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: 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: 3 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 1362 Owner: Contractor: POLYGON WLH LLC 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 2 1 Hour Fire Rated Soffits PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $24,851.62 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 0' 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. r Issued By: / L1�- - Permittee Signature: !��(/t (974/°e._&'1"--77e/V7 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. . V • Building Permit Application1 �� Residential . „ 4-- 4`. ,A FOR OFFICE USE ONLY Received (� e(� �p�� - City of Tigard w7 t 1 k�iq Permit No.l \I�T 1 1'l�lJ�: L FEB 0 ¢ 2 0 i Date/By: " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598 Y i s Date/By: Other Permit 21C.. Inspection Line: 503.639.4175 l`� t � ' e T 1 G A R D p BUILDING Date ReadyBy: oris: � See Page 2 for Internet: www.tigard-or.gov d d!�r{ 4,a�g� Notified/Method: �� Supplemental Information fL ` of y'6oA - TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction ❑Demolition Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION" work indicated on this application. ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ , ` S�j ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 I(e5 C(/ Job site address: 1411�.2--, �/ Ci01� ��OC �Lo//1y7 �/ New dwelling area: square feet (40 City/State/ZIP: �V ` 0 q--) 9--?-11 V 1 V� Garage/carport area: If square feet 5(02, . Suite/bldg./apt.no.: 0 Project name:Polygon at Roshak Ridge Covered porch area: square feet 340 Cross street/directions to job site: Deck area: '7a„, square feet Other structurre� square feet REQUIRED ATA:'COMMERCIAL-USE.CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: 17. n Permit fees*are based on the value of the work performed. Tax map/parcel no.: '"C Indicate the value(rounded to the nearest dollar)of all �� equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet Ei PROPERTY OWNER 0 TENANT Number of stories: Name:Polygon WLH LLC Type of construction: ..§ Address:703 Broadway Street Ste 510 Occupancy groups: City/State/ZIP:Vancouver,WA 98660 • Existing: Phone:(360)695-7700 Fax:(360)693-4442 New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMTT:FEES* Business name:Polygon WLH LLC {Please referrofee schedule) Structural plan review fee(or deposit): Contact name:Amanda Gavin 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)695-7700 Fax::(360)693-4442 Amount received: E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist. City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00 and administrative fees): Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 Authorized signaturrn This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda Gavin Date: ii9-2V/491 *Fee methodology set by Tri-County Building Industry l Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVE;I PermitNo.: 'I 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 APR Date/By: Other Permit: Inspection Line: 503.639.4175i,1p? 1:Ia Date Ready/By: Jura: H See Page 2 for Internet: www.tigard-or.govCITY PUf�t°t ! otified/Method: Supplemental Information OFWILDING DIVISION TYPE OF WO • COMMERCIAL FEE* SCHEDULE-"USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY-OF.CONSTRUCTION, RESIDENTIAL ENTIAIs EQLTiPMENT d SYSTE113S FEES* 0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist ®Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE,INFORMATION AND LOCATION Heating/cooling: T` Air conditioning 46.75 Job site address: 1,41-2.-2_ • t,kD �btb C I\.5-r `��� Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Roshak Ridge 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 23.32 Subdivision:Roshak Ridge Lot no.: t 260 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 • ® PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name:Polygon WLH,LLC Range hood/other kitchen Address:703 Broadway St.,Ste.510 equipment 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 E APPLICANT. ❑ CONTACT PERSON Other: 23.32 Business name:Polygon WLH,LLC Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Tonja Morris Furnace,etc. Address:703 Broadway St.,Ste 510 Gas heat pump Wall/suspended/unit heater City/State/ZIP:Vancouver,WA 98660 Water heater Phone:(360)695-7700 Fax::(360)693-4442 Fireplace Range E-mail:permitsubmittals®polygonhomes.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:Pro Heating&Cooling Other. MECHANICAL PERMIT FltltS* Address: NW Alociek Dr,Ste.1104 Subtotal City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00) 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 �Q; n btom'�r'✓U•f t�„ days after it has been accepted as complete. Authorized signature: "✓'�' * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) • RECEIVED Electrical Permit Apphcati (, FOR OFFICE USE ONLY City of Tigard APR 12 2019 Received Permit OP 'li 13125 SW Hall Blvd.,Tigard,OR 9,847 ,,. Date/13 9 Phone: 503.718.2439 Fax: 503.S�8r 6® �� i� � � Pla"Review ! ' {p��-± p�i�d �r{ 8 DateB Related Permit#: Inspection Line: 503.639.4175 F3UILD1NG DIVISION ReadyDateBy: Luria: H See Page 2 for .Lir-iJ.ILU Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF;WORK', PLAN REVIEW ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 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 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: 2 Z SW GOLD 4 t)R`sr lie 0 Addition of new motor load of system. �� ]OOHP or more. ❑"A","E","I-2","I-3", City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than ❑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 New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot##: 126, Includes attached-garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.fi.) 75.00 2 Renewable Energy ❑ See Page 2 2. PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name:Polygon WLH,LLC 200 amps or less 100.70 2 Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 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)695-7700 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service or feeder fee, 7 42 2 h Contact name:Jolene Smith for branch branchcircuit n B.FeeFee ranch circuits without Address: 703 Broadway St,Ste.510 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:permitsnbmittals@polygonhomes.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Portland Electric Sign or outline lighting 67.84 2 Address: 1915E 5th St.,Ste D Signal circuit(s)or limited-energy a❑ See Page 2 2 panel,alteration,or extension. g 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:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:pawl@portlandelectric.biz l /9 Industrial plant(1 hr min) 78.18/hr C'/� Inspections for which no fee is CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.:—.43112S specifically listed(V22hr min) 90.001 hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Qx � Subtotal: Print name: Alex Shalya Date: 04/08/2019 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: }� -Ini„a- . 4. . TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: MISHCHUK,SERC Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. 4 Plumbing Permit Applicati ���dr Building Fixtures FOR OFFICE USE ONLY II City of Tigard APR 9 2019 Received - Date/By: Permit No.: q 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.5901 0V OF TIGAHD DIVISION PP lan ate/Byiew :RevOther Permit No.: T I G A R D Inspection Line: 503.639.4175 BUILDING Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist Description Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ®Multi-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: / .j ZZ S� C�04,3) ei) -r 'II es... Catch basin or area drain 18.76 �.W 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.: 1 Project name: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:Roshak Ridge 1 Lot no.: t'L(p Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 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 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Tonja Morris 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 Urinal 25.02 E-mail:permitsubmittals@polygonhomes.com Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:G&13 Plumbing&Sons Inc Water piping/DWV 56.29 Address:P.O.Box 92 Other: 25.02 City/State/ZIP:St.Paul,OR 97137 Subtotal Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.:184372 Plumbing Lic.no.:pb634 0 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Steve Fowler Date:04/08/2019 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 1616T(10/02/COM/WEB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT III ` C Building Permit Review — Residential g .. : .BuildingPermit #: Site Address: /4/ S� Cid d 000127/--- 0 ` 7? Project Name: �o/ , ,n SOS e1 7- Lot #: ,I / '_ /� (Ne'`t g=subdivision name;Addition or Alteration st name of owner) Planning Review Proposal: ')F FE site address/suite#exists and active in permits m. la River Terrace Neighborhood: 0 No V Yes,See River Terrace Review Addendum Attached Site 'Ian Elements: it . ee(3)copies of site plan I1.►t TA�e plan must be on 8-1/2"x 11"or 11 x 17"paper v Fo:sting structures on site VD awn to scale(standard architect or engineer scale) rel tont ons structure(including decks)with finished •rth arrow it •l ty locations&easements(required for new and additions) Ce address,project or subdivision name and lot number 1 Si'ewalk/driveway approach V pplicant information(name and phone number) Mb'..cation of wells/septic systems 51 • dimensions and building setback dimensions r ;a.sting trees to be retained with drip line,and tree H.t uare footage of buildings to be demolished , otection measures 1.Lot area,building coverage area,percentage of coverage and V S eet tree size,type and location )mpervious area(applicable if R-7,R-12,R-25&R-40) treet names IreProperty corner elevations(2 foot contour lines if more than >1,000 sf of im pervious area 4 foot differential) P created or replaced? [IdYes ❑ If yes,is a storm water quality facility shown? 3) Yes NJNo ,lean Water Services—Service Provider Le (l(lot platted prior to 9/10/1995): equired: 0 Yes pplicant was notified YJ No Received: Ud Public Faciliti rovement F Permit ❑ Yes ❑ No P (PFI) Required: Yes,applicant was notified 0 No Applied For: Yes 0 No,stop intake Vcriand Use Case#: -2)t8261-C= 00 01 ' ��� �.2 /S DI onning: ,2_/2 equired Setbacks: FrontRear Side 1� Street Side ` Garage r,;.. ndscape Requirement _ t /o I (2 Lot Coverage Maximum: e1 ding Height Maximum Height 14 isual Clearance plpr Actual Height 1%/SensitivelidP Lands: qd Yes 0 No iod Type F"%i(�e�l� A31, 4,71_are Urban Forestry Plan ❑ Condition "Met"prior to issuance of b gtlduig permitNotes: 'jays Mil-ti- ,bP_-e_ pr t Y-/t'S e6:2.4 cQ Approved By Planning: • ----- , 7 Date: v2 AV Revisions (after Building Submittal only) Reviewer Revision 1: 0 Approved 0 Not Approved Date Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved 1:13uilding\Forms\BldgPermitRvw_REs_061417.docx • • Building Permit Submittal . Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: 0 Enter building permit#above. Workflow Routing: 0 Planning 0 Engineering 0 Permit Coordinator 0 Building Workflow Sign-off: 0 Sign-off for Planning(include notes from planning review) Route Application Documents: 0 Engineering: (1) copy of permit application, (1)site plan, (1)building plan and original plan review routing form. 0 Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: Engineering Review 2 Slope at building pad: 4 70 ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ,D"Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes Er No Assess Water Quantity Fee in-lieu: 0 Yes Q No LIDA Facility on lot: 0 Yes la..No ,Er Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: Al T - FailLW1 14-14 '� Est.-)4,00 ii -J1Jf. ,155-4 tE.. ID Approved y Engineering:roved b E ee At j r Date: 2 , I re Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review Conditions"Met"prior to issuance of building permit ppoved,NOT Released: Date: z 2 S fi r Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant Revision Notice 2: Date Sent to Applicant ' ,.sion Notice 3: Date Sent to Applicant: �/ /, SDC Fees Entered: Wash Co Trans Dev Tax: dd es 0 N/A r Tigard Trans SDC: es 0 N/ Parks SDC: /Yes 0 /A LIDA 0 Yes N/A L�OK to Issue Permit 4/1"--- � I`P I Approved by Permit Coordinator: '� 6 Date: 1' 1:\Building\Forms\BldgPermitRvw RES 010118.docx City of Tigard N COMMUNITY DEVELOPMENT DEPARTMENT III ■ r 1 c A D River Terrace Building Permit Review Addendum Building Permit #: At 5T 28LR - 000 3 - Site Address: /41,&22 <�i0 C7-11d Covx-71- --Thrace Project Name: Ai i , cs2=1 Peel f/11Lot #: J�(c (Ne lling=subdivision name;Addition or Alteration=J��f name of owner) Planning Review of River Terrace Plan Disttri esign Standards (18.640.070.1.): Is the project subject to the plan district design standards? lJdYes ❑ 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 ft. deepBalcony w/access 2 Window Projection Vertical Wall Offset a ft. deep min. 2ft.,5 ft.wide min. 2 ft.,6ft.wide Gabled dormer ❑ ❑ ❑ ❑ fid/ 2. Eyes on the street: a minimum f12%of each street facing facade must include windows or entrance doors. Percentage Shown: 10 e D 3. trances:At least one entrance must meet both of the folio g standards: Max. 8 ft. setback from longest street- facing wall Parallel to street,angle no more than 45° from street, or open onto porch Entrance opens to a porch: ❑ Yes ❑ No If yes,all the following apply: ❑ 25 sq.ft. min. ❑ One street facing entry ❑ 12 ft.max.roof above floor of porch ❑ 5 ft. depth min. ❑ 30%min.porch roof coverage 4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades: ❑ Covered porch min. 5 ft.wide x 5 ft. deep ❑ ' -cessed entry area min. 5 ft.wide x 2 ft. deep ❑ Vali offset min. 16 inches 7 9ormer min.4 ft.wide Roof eave min. 12 inch projectionR f offset min.of 2 ft. ❑ Roof shingles either tile or wood VGable,hip or gambrel roof design ❑ Roof pitch oriented south min. 500 sq. ft. ❑ orizontal lap siding min. 3-7 inches wide ❑ Accent siding min. 40%of street facadeendow 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. tYJ 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. W : (Check one) 12-foot-wide garage door ❑ 40%max. of street facade ❑ 50%max. of street facade with 7 detailed design elements Notes: Approved By Planning: E - williiiiii, -i Date: %..rj" I:\Building\Porins\BldgPermitRvw_RES_RT_121417.docx Plumbing Permit Application Building Fixtures " FOR OFFICE USE ONLY City of Tigard 16 L;J 1 y Received 1,„, • . " 13125 SW Hall Blvd.,Tigard,OR 97223 .J Date/By:Review \lam 1 S`�- Permit No.�S�; �,_ �1� Phone: 503.718.2439 Fax: 503.5941 Plan J TIGARD Inspection Line: 503.639.4175 r ` ., Date/By: Other Permit No.: Internet: www.tigard-or.gov ;•-"Iii!i _W . . s 1 'e t. Date Ready/By: Jugs: 0 See Page 2 for Notified/Method Supplemental Information TYPE OF WORK ti ., FEE*..SCFIED"UL) ®New construction 0 Demolition For special information use checklist Description I Qty. I Ea. + Total o Addition/alteration/replacement 0 OtherC J T i New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY"OF CONSTR[JCTION �` SFR(I)bath I I 312.70 o 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ElAccessory building ®Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE_INFORMATION AND LOCATION: g Site utilities: Job site address: 1 Us 22 e.,0 LbCONST --C.-ill?. 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.: X Project name: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 I Subdivision:Roshak Ridge Lot no.: i 2,l.p Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 6AOLIA.Ozse- 1 t)A.JJ.%2 bv•. '-K 201ek-00061-1 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 / .121 PROPERTYOWNER , . I 0 TENANT '= Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 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 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Contact name:Tonja Morris 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 otable 6234 Phone:(360)695-7700 1 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:Alliance Plumbing 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) Authorized signature: State surcharge(12%of permit fee) TOTAL PERMIT FEE This permit application expires if'a permit isnot obtained within 180 days Print name:Robert Dishman Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. L\Building\Permits\PLMU-PermitApp;doc 10/01/09 440-4616T(10/02/COM/WEB) Electrical Permit Application '' - ' FOR OFFICE USE ONLY rF City of Tigard Received � \vGT Permit#:`MSS"' VC-t_ s 'I 13125 SW Hall Blvd.,Tigard,OR 97223 '` - 4 ' ,-1,,' Plan Review Phone: 503.718.2439 Fax: 503.598.19.60 Date/B : Related Permit#: TlG`ARI Inspection Line: 503.639.4175 Ready Date/By: Juris: El See Page 2 for a, Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK w. PLAN;ItEVIEW El New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition 0 Other. 3��� stories. S, ,, ❑Service or feeder 400 amps or more0 Building over three CATEGORY_OF-CONSTRUCTION,,` --r. amps or Floating buildings. • where the available fault current 0 Marinas and boatyards. exceeds 10,000 m s at 150 volts ❑Flo lin buildin less to ground,or exceeds 14,000 Z 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi family 0 Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND'LOCATION` 0 Emergency system. larger separately derived 14'7Z S,,` a O. (� � ❑Addition of new motor load of system Job#: Job site address: w 100HP or more. ❑ °A , 'E^,"l-2; '1-3', City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. f Each f Total I * New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#: k Z10, Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea,add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (� �M ^fin (with above sq.ft.) 75.00 2 ""� {{�s� !/V —60064 (with energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 ® PROPERTY OWNER'.... 0 TENANT, Services or feeders installation,alteration,and/or relocation Name:William Lyon Homes,Inc. 200 amps or less 100.70 2 Address: 703 Broadway St Suite 510 201 amps to 400 amps 133.56 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)695-7700 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 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 CI 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, 7.42 2 each branch circuit Contact name:Nichole Thorpe B.Fee for branch circuits without Address:703 Broadway St Suite 510 service or feeder fee,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:perinitsubmittals@polygonhomes.com --6744- ---- 2 - CONTRACTOR Pump or inigation circle 67.84 2 Business name:Alameda Electric Sign or outline lighting 67.84 2 Address:3415 NE 44th Signal circuit(s)or limited-energy o See Page 2 2 panel,alteration,or extension. City/State/ZIP:Portland,OR 97213 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr • Email:solarpdx®me.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871 S specifically listed(`/s hr min) ELECTRICAL PERMIT FEES • Suprv.Electrician signature,required: Subtotal: Print name: Kile Rood/.4....' Date: 03/08/2019 0 Plan Review Required(25%of permit fee): - State surcharge(12%of permit fee): Authorized signature: --^— TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.