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Permit (172) INCITY OF TIGARD MASTER PERMIT 1B as ( Permit#: MST2019-00031 COMMUNITY DEVELOPMENT -� . TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ock 1 �, Date Issued: 04/25/2019 Parcel: 2S107AA12300 Jurisdiction: Tigard Site address: 14160 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 123 Project: Polygon at Roshak Ridge, Lot 123 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) ST€319 793-11ROAOWANSTRS€T,SATE Sib _4 €t'8n Gntri 17 , a 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: \A A A Permittee Signature: CjeirL e --kCcj 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. Plumbing Permit Application 'L```IL 'n�+ Building Fixtures RECEIVED City of Tigard Received r/�j Date/By: J Permit No.: MST20I9-00031 ./'.. 41 13125 SW Hall Blvd.,Tigard,OR 97223 G 1 3 2019 Y. .71 ► Plan Review8/27// �G� Phone: 503.718.2439 Fax: 503.598.1'.1 Date/By: < Other Permit No.: TIGARD Inspection Line: 503.639.4175 CITYReady/By: JurisEl See Date : Page 2 for Internet: www.ti and-or. ov OF TIGARD g gWILDING DIVISION Notified/Method Su leme RE 's•SCIII1 < n to n ormatton ®New construction 0 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 CONSTRUCTION '-- , • SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 IIIAccessory building ElMulti-familySFR(3)bath 500.32 El Master builderEach additional bath/kitchen 25.02 El Other: Fire sprinkler 'sq.ft.) t3(,a. Page 2 JOB-=SITE'INFORMATION`NO UKATION Site utilities: Job site address: 14160 SW Gold Coast Terrace Catch basin or area drain 18.76 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.: CZ l 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) Lot no.: 123 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESSCRIPTION OF"WORK• Backwater valve 12.51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 I2."PROP .ItTY OWNER ❑ TENANT Expansion tank 12.51 Name:Polygon NW Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.Suite 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 �a Appuem Q coNf A 'r PEI2Ssoi 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 - __ .- - � _- t�nbwerTsfiower On 7 .51 r. E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 •; ONT�� Water closet 25.02 37.52 Water heater Business name:Alliance Plumbing,LLC Water piping/DW V 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 Lie.: 184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: �� 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/V'EB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities:, e 00 Tntal Square-F04 lie. ... ... ei lilt: 'ee:.`' Footing drain-1'1100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 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' 37.52n lie• Yaig#t� 1111Y re'ipt,, #e^4 .. 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 Fee Tial each additional$100.00 or fraction thereof,to t ier i 1 ill* or y, e Q 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 Fixture Type for Replacer ReVle foe uni.l ing ntallations Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath -Tub/Shower pp y. 1:1Jacuzzi/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 0 Medical gas and vacuum systems for health care facilities. Drinking Fountain ® Any multipurpose fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" Submit 2 sets of plans with any of the above. Car Wash Drain Isometaric or Riser xagr m Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic-food related -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/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 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_alliancepluml521'ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc CITY OF TIGARD MASTER PERMIT i COMMUNITY DEVELOPMENT Permit#: MST2019-00031 Date Issued: 04/25/2019 T t f A Tt O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 107AA12300 Jurisdiction: Tigard Site address: 14160 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 123 Project: Polygon at Roshak Ridge, Lot 123 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 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 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 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 Tvves 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.'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 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: <9"<'.1214174:-"W:—' ..- Permittee Signature: c V </f"/'z-/c.9- 70W 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. I a Building Permit Application V. U ---\--- \ ''.. ..").-> ResidentialI a '` FOR OFFICE USE ONLY Cityof Tigard _ Received `( g ill Permit No.ms-c-,- .1.-1 fJ l"\...n?,' a 13125 SW Hall Blvd.,Tigard,OR 9722 k Q 2,019 Date/By: Q�� /� (� p IS-61. ^�, DtanBYew�/�� 1 4. t kg-(1J�CJI " Phone: 503.718.2439 Fax: 503.5 Other Penni. Inspection 503.639.4175 � � I it.."1,�ti4) '� TIGARD p DateReadyBy: 7uris: ® SeePage2for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: ///e//9 I Supplemental Information &:77 )f1— TYPE ,(S--- - OF WORK REQUIRED DATA:1-AN])2-FAMILY DWELLING [21 New construction 0 Demolition Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement El 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 I]Commercial/industrial Valuation: $ `�] V` IDAccessory building ❑Multi-family Number of bedrooms: ` v ❑Master builder 0 Other: Number of bathrooms: '7 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 S ALJ Job site address: `t )(p0 S I/V\ ) o con sl-��1 r1/YA New dwelling area: square feet S(u City/State/ZIP: V 1Y/ 0 t? 2— 11!L Garage/carport area: square feet 5 'Z, Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: square feetD Li 0 Cross street/directions to job site: Deck area: "7 ... square feet OthJr'000lr 7 Z square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: '7,7 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ,,J Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. PA Valuation: $ `'n Existing building area: square feet New building area: square feet i....1 ® 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 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Pteaserefert°jeeschedute) 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: $201.60 Authorized si This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda Gavin Date: ,/-9,ir/'a *Fee methodology set by Tri-County Building Industry f Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanial Permit Application ! FOR OFFICE USE ONLY g RECEIVED DateBy Cityof Tigard 222 Y Permit No.: '1 13125 SW Hall Blvd.,Tigard,OR 97 23 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit: Y l i ill.I:I J Inspection Line: 503.639.4175 APR Date Ready/By: loris: g Page 2 for Internet: www.tigard-or.gov Notified/Method: fl H See PaSupplemental Information CITYOFIGAF7D TYPE CAF" RK I N G DIVISION. COMMERCIAL FEE* .SCHFDUL.E- USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION, RESIDENTIAL EQUIPMENT/SYSTEMS FEES* X1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total TOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: t,1.t(00 Cllr GocD (�t)k T 1-�� 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.: , 3 Other: 23.32 Z Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPT ON 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 0TENANT 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:( ) Attic/crawlspace fans 23.32 El 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 FEF.S* 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 �l i nL b days after it has been accepted as complete. Authorized signature: G(�G * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I.iBnildme Permits\ME.C_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Electrical Permit Applicatio'RECEIVED FOR OFFICE USE ONLY City of Tigard n Received Permit#: 1 11 13125 SW Hall Blvd.,Ti ard,OR 97223 !�� Za�J p R g Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503.598.19{ � � Date/B Inspection Line: 503.639.41751 t @ MASK.) Ready Date/By: Jurist H See Page 2 for LIt-AtIU Internet: www.tigard-or.gov 3U LD t\G Dt'V '.) Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Z New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): IDService or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current ❑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. 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 Job#: Job site address:i{� � c>C� I:L/ ez 1A er ri ID Addition of new motor load of system. � OG� �t 100HP or more. ❑•,A",•,E„ ••1-2„ ••1.3„ City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units, occupancy. 0 Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge 0 Hazardous locations. ❑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 I * New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 125 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 75.00 2 residential(with above sq.ft.) Renewable y ❑ See 2 N PROPERTY OWNER ❑ TENANT Services or Energfeeders installation,alteration,Page 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 E 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, 7A2 2 each branch circuit Contact name:Jolene Smith B.Fee for branch circuits without service or feeder fee,first Address:703 Broadway St,Ste.510 branch circuit 56.18 2 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:permitsubmittals@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 Signal circuit(s)or limited-energy Address:1915 E 5th St.,Ste D ❑ See 2 2 panel,alteration,or extension, Page 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 Industrial plant(1 lir min) 78.18/hr Email:paul@portlandelectric.biz L/9 3C`S r Inspections for which no fee is 90.00/hr CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.: 49825 specifically listed('/a hr min) n ^_ ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: t�1.C�. „ � Subtotal: Print name: Alex Shalya Date: 04/08/2019 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: , "TY _i,d LziLeA, 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. Plumbing Permit Applicati r7.ECEIVED Building Fixtures APR 9 2019 FOR OFFICE USE ONLY - City of Tigard �^+t Received II n 13125 SW Hall Blvd.,Tigard,OR 9 3TY OF tGARD Date/By:. Permit No.: Phone: 503.718.2439 Fax: 503 6�gt6 ryDIVISION Plan Review U L O N G Date/By: Other Permit No.: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: runs: 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. Ea. I 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 K1-and 2-family dwellingSFR(2)bath 437.78 0 Commercial/industrial ❑Accessory building Multi-family SFR(3)bath 500.32 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: 1L-N 5loo (&OL: ap .. --(-ice Catch basin or area drain 18.76 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: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.: ( 2.-5 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 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 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 ® 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 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:G&B 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 State surcharge(12%of permit fee) Authorized signature: 1:i: ----7'57y, 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:\Buiding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB) City of Tigard a. 4/ COMMUNITY DEVELOPMENT DEPARTMENT i G°ARD Building Permit Review — Residential Building - -......:Z..,--,. .-1,_-•_ .:�>R :.--'W-7-7.-AX,, .:.� - ,. Permit #: !'l1, .: -3. T 5T r � 6oQ 31 Site Address: 21/( 6 (2. 47 pay Project Name: �J�, i :_ 'i /I ice_ �� _ Lot #: (Newr i g=subdivision name;Addition or Alteration dof st name of owner) Planning Review Proposal: / , c")F/ ��rift'site address/suite#exists and active in ermit s . la River Terrace N ' boyhood ❑ NoP Yes,See River Terrace Review Addendum Attached Site 'Ian Elements: ►, ee(3)copies of site plan IJ t.;sting structures on site Rteplan must Je on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished awn to scale(standard architect or engineer scale) 1.or elevations .rth arrow IK .1'ty locations&easements(required for new and additions) ®Site address,project or subdivision name and lot number 15 Si.ewalk/driveway approach pplicant information(name and phone number) 54 • dimensions and buildin i 111i'..cation of wells/septic systems g setback dimensions \ll�a;sting trees to be retained with drip line,and tree 11'o uare footage of buildings to be demolished otection measures V Lot area,building coverage area,percentage of coverage and U S eet tree pervious area(applicable if R-7,R-12,R-25&R-40) treet eine,type and location Property corner elevations(2 foot contour lines if more than >1,000 sf names f impervious area created or replaced? EV/els ❑ lb 4 foot differential) If es,is a storm water uali facili shown? yes gNo lean Water Services—Service Provider Lettot platted prior to 9/10/1995): fdltv-P sqbliuiredFac: ❑iliti Yes pplicant wasrovement(PFnotifinped it: No Received: 0 Yes 0 No Public perm Required: Yes,applicant was notified 0 No Applied For: yeS 0 No,stop intake IZr/Land Use Case#: 1 ElizZoningMI I W ) maiKequired Setbacks: Front 1� Rear Side dscape Requirement _ j /o 4' Street Side Garage — �� ud Lont Coverage Maximum: �A 4 tuilding Height Maximum Height 0I fIr I'V's isual Clearance Actual Height ensitive Lands:Plan Yes 0 No r YP0. A / �UrbFPlane 147 G,0-t?� �44 car 0 Condition `Met"prior to issuance of b 'din g permit Notes: //� I _P / , , y 121 Approved ByPlanning: ng: �-- Date: 02 A' • Revisions (after Building Submittal o Revision 1: 0 Approved Reviewer Date PP 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved I:\BuildineForms\gldgPermitRvw_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: Date: By Permit Technician: Engineering Review �" Slope at building pad: ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat El Water Quality/Quantity Facility. Assess Water Quality Fee in-lieu: 0 Yes Ei No Assess Water Quantity Fee in-lieu: 0 Yes FS No LIDA Facility on lot 0 Yes 2 No ET Final Plat Recorded: Date: ❑ NOT Approved by Engineering: Notes: LOA L T F -4 IL N. '4 Feistc t5r-,c-5-s.,. Date: 2, �2 _.�� Approved by Engineering: 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 .. s'tions"Met"prior to issuance of building permitIi 5-Ar I Late: /2 A Approved,NOT Released: %%�1'I 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: g<DC Fees Entered: Wash Co Trans Dev Tax: LIYes 0 N/A Tigard Trans SDC: 0-Yes 0 N/A Parks SDC: [ 'Yes 0 N/A LIDA 0 Yes VN/A 71 OK to Issue Permit Approved by Permit Coordinator: 14,' oe Date: � � �� I:\Building\Forms\BldgPermitRvvvRES 010118.docx • IIICity of Tigard. III COMMUNITY DEVELOPMENT DEPARTMENT T.1 G A R o River Terrace Building Permit Review Addendum Building Permit #: Site Address: JL//(i 6 - S ) (?1d ( ,)-- fr ael Project Name: Ai �� Lot #: J�� (Ne�� K� g=subdivision name;Addition or Alteration= 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? [ Yes 0 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 dorme ❑ ❑ ❑ ❑ 2. Eyes on the street: a minimum qf 12%of each street facing facade must include windows or entrance doors. Percentage Shown: JQ e)a 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 ❑ Ijecessed entry area min. 5 ft.wide x 2 ft. deep D7all offset min. 16 inches V ormer min. 4 ft.wide Roof eave min. 12 inch projection IQ R 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. ❑ 5orizontal lap siding min. 3-7 inches wide ❑ Accent siding min. 40%of street facade VWindow trim min.2'/a"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. LYJ Yes No. If No (Check one): 0aMy extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. ay 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. Width: (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: Date: '...r//3/1/ 9 I:\Buildmg\Forms\B1dgPermitRvw_RES_RT_121417.docx 1 Plumbing Permit Applicatlu Building Fixtures 'm . FOR OFFICE USE ONLY City of Tigard 1 Li[ 1 6 ?(j 1 q Received_ +�' �� Date/By:�'I�t k�''t S) Permit No. O/� i 'I 13125 S W Hall Blvd.,Tigard,OR 97223J ��r ��-\1LA►� Re 2' Phone: 503.718.2439 Fax: 503. 9 T�960?1 s Date/By:Plan tew Other Permit No.: TIGARD Inspection Line: 503.639.4175 , F , 1 Date Read/e - Internet: www.tigard-or.gov • ` ; t -`'; a Ready/By: kris: Supplemental See Page 2 for Notified/Method: Information TYPE OF WORK FEE* SCHEDULE„,, ,„> ®New construction 0 Demolition n g For specialInforma/ion use checklist j Description 1 Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: f ", . �.. c'C \ 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/ind stria] SFR(2)bath 437.78 ❑Accesso buildin SFR(3)bath 500.32 rY g ®Multi-family . El Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION ` Site utilities: Job site address: \ L \0 ) GDOD es-t -i 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.: YS' I 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 I Lot no.: 12 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK' Backwater valve val12.51 e._ ke, j Z tri-N. 1 201 Uk ?�`' Clothes washer 25.02 11 J Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER 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 ®y 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 war _ Phone:(360)695-7700 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 Lie.no.:P13732 Plan review (25%of permit fee) 4iLState surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Robert Dishman Date: This permit application expires If a permit Is not obtained within 180days 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(I0/02/COM/WEB) Electrical Permit Application - d FOR OFFICE US ONLY "� City Of Tigard DReceived Permit# 't 13125 SW Hall Blvd.,Tigard,OR 97223 _ t'i Review:e�- \Ci � ' ��- ��j� : ` ' ;i IN Plan RRelated Permit#: ,;; Phone: 503.718.2439 Fax: 503.598:19b0 Date/B T GA[tD Inspection Line: 503.639.4175 Ready Date/By: Juris: El See Page 2 for c, Internet: www.tigard-or.govNotified/Method: Supplemental Information TYPE OF WORK a ,. , ®New construction ❑Addition/alteration/replacementPlease check all that apply(submit z sets of plans w/items checked): ❑Demolition Other: \\� 0 Service or feeder 400 amps or more 0 Building over three stories. 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 ❑Commercial-use agricultural amps for all other installations. buildings. E]Multi-family ❑Master builder ❑ 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: (s ,Os p� 04}5T i2 ❑Addition of new motor load of system. d��IQb V� Isla wf�v �'C/F+" 1001-IP or more. ❑••A,,,••E„ •`1.2,,,••1.3,,, City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. 0 Health-care facilities. ❑Recreational vehicle parks, Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 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 ( * New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#: ‘z.:' Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add']500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential ,� ,�� 6 m [ -7�, p (with above sq.ft.) �)n 75.00 2 .�V�AJ 301- Y\ ST NL `—to 0 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 • ® PROPERTY OWNER Renewable Energy 0 See Page 2 ❑ 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 ❑ 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'1 branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder 67.84 2 1 — ---67:84 ' __-2-r CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Alameda Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:3415 NE 44th ❑ 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(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871%8 specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee): - State surcharge(12%of permit fee): Authorized signature: r� TOTAL PERMIT FEE: This permit application expires If a permit is not obtained within 180 Print name: Kile Rood I Date: 03/08/2019 days after it has been accepted as complete.