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Permit (182) r CITY OF TIGARD ,y MASTER PERMIT _' COMMUNITY DEVELOPMENT Permit#: MST2019-00040 TIG A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1. � \ . Date Issued: 04/25/2019 l� Parcel: 2S107AA12100 Jurisdiction: Tigard Site address: 14194 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 121 Project: Polygon at Roshak Ridge, Lot 121 Project Description: New SFA. 8/28/2019: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 646 sf Basement: 115 sf Left: 3 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 633 sf Garage: 543 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1394 sf Value: $195,042.10 Rear: 10 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 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 1394 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 70 ADW SaT€5 BROADWAY STRt T 3U4TC 414 1- _1410[-F area- 7 VANCOUVER,WA 98660 VANCOUVER,WA 98660 Ceiling 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,183.41 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 503.232.19877orr11.800.332.2344. 'rte Issued By: A� 1� 1�_ Permittee Signature: y\� \+--��.�t��t� 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_ ��E® �i'��V' Building Fixtures ® �� FOR OFFICE USE ONLY Cityof Tigard AUG 1. 3 Z019 Received G Q g Date/By: 6ii4 // Permit No.: MST2019-00040 '� gm 13125 SW Hall Blvd.,Tigard,OR 97223 �F TIGARD Plan Review Phone: 503.718.2439 Fax: 503.59C11�A�1 G IGAR�N Date/By: '��15/,47 '4'667 Other Permit No.: T I G A RD Inspection Line: 503.639.4175 g�ILDIN Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method. Supplemental Information ®New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total 0 Addition/alteration/replacement ❑ Other: New 1-2-familydwellings(includes 100 ft.for each utility g connection) CATEGORY OF'COItiFTI,Tt` `:.. SFR(l)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory ❑Multi-family Each additional bath/kjFC(en 25.02 E]Master builder 0 Other: Fire sprinkler(1394 sq.✓ ft.) Page 2 4,1,11fTTE TI ORkTJON N 3 LOCATION`; Site utilities: Job site address:14194 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.: 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.:121 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCIUPTION OP O r-'''''' Backwater valve 12.51 " "" '" Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ,►24 PROPERTY 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 ►I APPLICANT 0 .TACT PERSON Interceptor/grease trap 25.02 Business name:Polygon NW Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Jennifer Lopez 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 Phone:(360)695-7700 Fax::( ) Tub/shower/shower pan 12.51 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 Water closet 25.02 +CIFNTRACTOR` Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DWV 56.29 Address: 146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.:184601 Plumbing Lic.no.:PB732 State surcharge(12%of permit fee) Authorized signature: ----7"Z____) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thomes Date:8.07.2019 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Slit Ut€lit es Q Pee teat Total Squaia ootagee Permit Tea Footing drain-151 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 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' 37.52 valuation: rernoi*ee: 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 Qty Fee'( Total each additional$100.00 or fraction thereof,to Other to peetaton '• "ems 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 (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. 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 Type Fixturefor Race/ Work Pa medr Capped Added Relocate ptReview full'Plu ll> g tau 0044as Plan review is required for any of the following. Baptistry/Font Bath -Tub/Shower Please check all that apply. 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 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 fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" S�ibmit 2 sets of plans with any of the above. Car Wash Drain Isometric orRiser•Diagra Diagram Garbage -Domestic-non-food Disposal -Domestic-food related 0 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 Water Extractor *Note: If the fixture work under this permit results in an 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_allianceplum12ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc INCITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2019-00040 and OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 04/25/2019 T 6 O A T.O 9 Parcel: 2S 107AA12100 Jurisdiction: Tigard Site address: 14194 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 121 Project: Polygon at Roshak Ridge, Lot 121 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 646 sf Basement: 115 sf Left: 3 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 633 sf Garage: 543 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right 0 Detectors: Yes Total: 1394 sf Value: $195,042.10 Rear: 10 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 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 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 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>=10OK: 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 1394 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 1 Hour Fire Rated Roof/ VANCOUVER,WA 98660 VANCOUVER,WA 98660 Ceiling 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,046.88 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 OA 2-00 -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 '' "(�� e mittee Signature: l�-24/ t--77e 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. 0- • \/ Building Permit Application � --\--- �\ . ............ .. Residential 3 i,-*„ 'r i' w FOR OFFICE USE ONLY City of Tigard _ Received .„01„, y k Permit N III C a 13125 SW Hall Blvd.,Tigard,OR 92 0 7la 1 9 Date/By: , C �;T °� tC�_ � Plan Review Phone: 503.718.2439 Fax: 50 98 1960Other Perini -� a a� Date/By: Inspection Line: 503.639.4175 u I Y i.r1:" 6> ae` e"3 .� *44_ �� TIGARD � DateReady/By: Tuns: ® SeePage2for Internet: www.tigard-or.gov uILDBNG 03\1tS10N Notified/Method:y ,F49 Supplemental Information C?///j.,/L— ,0 L`//(7A/ - TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 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 0 Other: 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! V 7 oZ-- 0 Accessory building 0 Multi-family Number of bedrooms, V ❑Master builder 0 Other: Number of bathrooms: ; JOB SITE INFORMATION AND LOCATION Total number of floors: 3 ' 9 .3•--) Job site address: {LI j"I U U tu (lot ( / omf-e y /av /�/ New dwelling area: 1 1-1' square feet U 33 City/State/ZIP: -r-1 a /-� Ov 7ll a-a-, Garage/carport area: square feet (.0(-1(0Suite/bldg./apt.no.: Project name: Polygon at oshak Ridge Covered porch area: . square feet I 1G Cross street/directions to job site: Deck area: 43252. square feet t uct r C> square feet 1 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: i 7,1 Permit fees*are based on the value of the work performed. t Indicate the value(rounded to the nearest J Tax map/parcel no.: dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF.WORK work indicated on this application. 0 ,. et Valuation: $ Existing building area: square feet /� New building area: square feet LA El PROPERTY OWNER ❑ 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: e--- Phone:(360)695-7700 Fax:(360)693-4442 New: ® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Please refer lnfee scheaute) Structural plan review fee(or deposit): Contact name:Amanda Gavin FLS plan review fee(if applicable): Address:703 Broadway St.Ste 510 City/State/ZIP:Vancouver WA 98660 Total fees due upon application: 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 Photo Voltaic 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)65-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 Authorized sign.• e: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda C avin Date: //o,c//I°) *Fee methodology set by Tri-County Building Industry / Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received II Date/By: Permit No.: 13125 SW Hall Blvd.,Tigard, Plan Review III 2AEC Phone: 503.718.2439 Fax: 503.598.1960 EIVED Date/By: Other Permit: F_6�4 Inspection Line: 503.639.4175 app 9 2019 Date Read B 3�;5: Internet: www.tigard-or.gov APR Ready/13y: I H See Page 2 for Notified/Method: Supplemental Information CITY OF TIGARD 3 YP DIVISION" " COMMERCIAL FEE*SCHEDULE'- USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY"OF CONSTRUCTION " Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. V Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: (q� Air conditioning 46.75 Job site address: 1 41 5(A) GQ(rl' /�,,,�� -�►"T�T ��Z Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name:Roshak Ridge Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or 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.: (Z.t Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESC1 IP TON OF, WORK fireplace/insert 33.39 Flue Gas 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 0 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 Ei APPLICANT 0 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 SL,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 FF.F.S* Address: NW Alociek Dr,Ste.1104 Subtotal City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee) CCB lie.:209001 TOTAL PERMIT FEE ( ^ ^ N. This permit application expires if a permit is not obtained within 180 rf�JaiLeZ days after it has been accepted as complete. Authorized Signature: Zei. * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I:1Bnitrimg\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) D• Electrical Permit ApplicatiI FOR OFFICE USE ONLY City of Tigard 2 ? 19 Received B Date : Permit#: ' 13125 SW Hall Blvd.,Tigard,OR 972234 R 1 Plan Review Phone: 503.718.2439 Fax: 503.59$, "�"TIGARD Date/B : Related Permit#: Inspection Line: 503.639.4175 % I Ready Date/By: Juris: H See Page 2 for '11Lii.`11-L1- Internet: www.tigard-or.gov 3UILDING DI /IS�� 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 ❑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 to ground,or exceeds 14,000 0 Commercial-use agricultural industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 1501 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address:ktAntk �) Gaya 01sT -rte 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. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge ❑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#: V2% 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 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 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 Branch circuits—new,alteration,or extension,per panel 12:1 APPLICANT- 0 CONTACT PERSON 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 Address: 703 Broadway St,Ste.510 branch circuit City/State/ZIP:Vancouver,WA 98660 Each add'!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 Address:1915 E Su'St.,Ste D Signal circuit(s)or limited-energy ❑ 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(I hr min) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:paul®portlandelectric.biz tri �f"' Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lie.: 49625" specifically listed('A hr min) 90.00/hr �-} ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: alt.. �� 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: }k& dem...9„,_*. 7)1" 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 Application Building Fixtures RECEIVE 1 FOR OFFICE USE ONLY Cityof Tigard Received !� . g A PR 9 2019 Date/By: Permit No.: `I a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.ttry Other Permit No.: Lv� y-++/ /� n DateBy: T I GARD Inspection Line: 503.639.4175 1 1 L:iT1�Rp Date Ready/By: Jugs: H See Page 2 for Internet: www.tigard-or.gov BUILDING DJVISIG\4otified/Method: Supplemental Information TYPE OF WORK +l V FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist Description I Qty. Ea. I Total 0 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 7,11-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 CJ Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ILkIg4 5W Goa) CT' ea, 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 R.:_) 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.: (2/ 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 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 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR 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: ..,`_ 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 10/01/09 440-4616T(l0/02/COM/WEB) City of Tigard 114 I( COMMUNITY DEVELOPMENT DEPARTMENT TIGA :1 Building Permit Review — Residential Building Permit #: - ��t-k �...�:>.�..g� .,xa ..�.i, �c;. Site Address: � fi�\� — 0004 0 t CO �7 01(1 is 1r At., Project Name: Qa, ai" g,g,‘k,,IL. /1/44e (NetVdtvelling=subdivision name;Addition or Alteration=last name of owner) Lot #: Z Planning Review Proposal: (W . a hut erify site address/suite#exists and active in permittem. gr Igir River Terrace Neighborhood: ❑ NoI!d Yes,See River Terrace Review Addendum Attached ite Ian Elements: Li) ee(3)copies of site plan 'sting structures on site rI}te plan must be on 8-1/2"x 11"or 11 x 17" [ paper ootprint of new structure(including decks)with finished wn to scale(standard architect or engineer scale) 9oor elevations arrow Unity locations&easements(required for new and additions) rKe address,project or subdivision name and lot number Ipplicant information(name and phone number) '.coli n ofweway approachsystems Lot dimensions and building setback dimensions dig '•cation wells/septic systems V Existing trees to be retained with drip line,and tree I'74)uare footage of buildings to be demolished rotection measures IV' t area,building coverage area,percentage of coverage and i:. . eet tree size,type and location "pervious area(applicable if R-7,R-12,R-25&R-40)perty comer elevations(2 foot contour lines if more than >1,000 sf names impervious imi4 foot differential) pervious area created or replaced? L�lYes❑No If es,is a storm water uali facili shown? ❑ No Clean Water S rvices—Service Provider Letter(lot platted prior to 9/10/1995): prod /Required: Yes,applicant was notified ❑ No �4pPt,,t,( �.; Received: 0 Yes 0 No Public Faciliti Improvement(PFI)Permit: /Required: ElYes,applicant was notified 0 No Applied For: �a OR �C 0Yes 0 No,stop intake /Land Use Case#: p �)S_Q 00 0Z I V/ oning. ' -1 Z Eilrequired Setbacks: Front Rear 1 0 dscape Requirementg o 2 ! Side Street Side Garage Ig c 24 7 �/Lot Coverage Maximum: W LIiJ Building Height Maximum Height 3S j -sual Clearance Actual Height Pi li' Sensitive Lands: 0 Yes Lid—/No Type EV Urban Forestry Plan Conditions Met" rior to issuance of building permit otes: `d r-i Dill,- i'o il! la "Ni Approved By Planning: �v„�„ y Revisions (after Building Submittal only) +r Date: 21,4---I Revision 1: 0 A rovedReviewer Date PP 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved I:\Building\FormslBldgPermitRvw_RES_061417.docx Building Permit Submittal Original Submittal Date: c7 a' 1 Site Plans: # Building Plans: # Building Permit#: Ei Enter buildingppee nit#above. i2/Permit it Coordinator �B g Workflow Routing: Planning LTJ engineering Workflow Sign-off: 1g/Sign-off for Planning(include notes from planning review) Route Application Documents: [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: ' By Permit Technician: .J Date: G' , Engineering Review 712 Slope at building pad: ❑ Conditions"Met"prior to issuance of building permit 0 Easements (encroachments)per engineering conditions of approval and plat ❑'"Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes Er No Assess Water Quantity Fee in-lieu: 0 Yes .B'No LIDA Facility on lot: 0 Yes GI-"N o Zr Final Plat Recorded: Date: 0 NOT Approved by Engineering: Notes: u-r41r -rt,22 pG nay t 60 6 (1J 4-40--fc Date: .22 Ci 2 Approved by Engineering: -124. Date Revisions(after Building Submittal only) Reviewer 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 0 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 ,,� rSDC Fees Entered: Wash Co Trans Dev Tax: LJ Yes 0 N/A Tigard Trans SDC: [VY 0 N/A Parks SDC: es 0 N/A LIRA 0 Yes T/A OK to Issue Permit Date: 3 Al 1 Approved by Permit Coordinator: 41jiALZ RES 010118.docx 4 �� t, I:\Building\Forms\BldgPeimrtRvw City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT N . T I G A R D River Terrace Building Permit Review Addendum Building Permit #: \ � -? ,CA - cco_1 Q Site Address: `�ich � ,,/GA Ca= 4' It.av Project Name: dol �]a4 a� 4 .4� '. . e. Lot #: 124 (N4 dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan Dist "ct Design Standards (18.640.070.1.): Is the project subject to the plan district design standards? ( Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing façade 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. Balcony w/access 2 Window Projection Vertical Wall Offset a Porch min. 5�ft. deep Gabled dormer ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide 2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: 241 /J Z.I.1. 3. Entrances:At least one entrance must meet both of the foliog standards:ilvin Parallel to street,angle no more than 45° from street, GA/Max. 8 ft. setback from longest street- facing wall or open onto porch Entrance opens to a porch: Yes ❑ No Iff y s,all the following apply: sq.ft. min. [ '2ne street facing entry [7'32 ft.max. roof above floor of porch U/5 ft. depth min. L(d'30%min.porch roof coverage 4. Detailed Design:All buildings shall include a min. of five oe following elements on all street-facing facades: ❑/Covered porch min. 5 ft.wide x 5 ft. deep F gy.ecessed entry area min. 5 ft.wide x 2 ft. deep P- 0/Wall ❑ all offset min. 16 inches Ltd"Dormer min. 4 ft.wide S g Roof eave min. 12 inch projection FA ❑ycoof offset min. of 2 ft. ❑ Roof shingles either tile or wood Dr9able,hip or gambrel roof design F S ❑ oof pitch oriented south min. 500 sq. ft. [ 'Horizontal lap siding min. 3-7 inche wide g Accent siding min. 40%of street façade F ❑ Window trim min. 2 1/2"wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑yay window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access IC:Attached garage is 35%or less of street facade,S 5. Garages and Carports: May face the front or side lot line on a corner lot. Setbacks: Noo loser to front or side lot line,than longest street-facing wall. ❑ Yes No. If No (Check one): E! May 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. Width: (Check one) 0)2-foot-wide garage door ❑ 40%max. of street facade 50%max. of street facade with 7 detailed design elements Notes: Approved By Planning: Date: 2=0--II I:\Building\Forms\B1dgPermitRvw_RES_RT_121417.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 ransmittal Letter 1 ;r;AR n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 2 ,0V If€'V a� 2-1514 f � DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FEB 252019 FROM: Itvw vw (/�p 60', V I r Vl1 CITY OF TIGARD COMPANY: pp i ()n u),v w, vui.)C. S 1- BUILDING DIVISION PHONE: (0 0 ( I J DO By: RE: 1141 SVV C I01A CDa -ev \f'su M5T2b1c— DOO Q (Site Address) (Permit Number) 7()1Ce 1)KJ at lam-a- ..�, I pi- 12-4 (Project n (or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: I Copies: Description: - Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculation Engineer's calculations. ?C, Other(explain): , 10 1 I V1 V qp v-0�.- CO V REMARKS: - - le UL — 011154 C.o ofi0(A U� o v S � �'� -rr3L I2/v\i Routed to ' ',it Tec Date: (. �(0 Initials:�` "-- Fees Due: es to o Fee Description: Amount Due: . ' $ ''��ii,.,5-i-sti%, '----_ $ _4101111fr Special D $ Instructions: Reprint Permit(per PE): ❑ Yes g ► o 0 Done Applicant Notified: Date: Initials: IABuildineForms\TransmittalLetter-Revisions 061316.doc Plumbing Permit Applicat' n . BuildingFixtures 1, - ? FORIOFFICE USE ONLY City of Tigard ' 2019 Received Date/By: "Ik V..I t, 1 S�'�' Permit No.Mt C C .ICi II - 13125 SW Hall Blvd.,Tigard,OR 97213 � �" • Phone: 503.718.2439 Fax: 501:74:i,940)?: f t Plan Review Other Permit No.: RI Date/By: TIGARD Inspection Line: 503.639.4175. K ,,, Date Ready/By: Internet: www.tigard-or.gov -'x.=i ., .1 Oji.:.1 it3'.,' or N7 See Page 2l Informationnr Notified/Method: Supplemental TYPE OF WORK Mt.. FEFit SG) D1;,ILE VIt4' '`. ®New construction ❑Demolition :' ,`� ', Fors ecial information use checklist. ;, (��, •,7 Description -� Qty. Ea. I Total ❑ Addition/alteration/replacement 0 Other: �\`"-, „r 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 IDAccessory 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 ,° Site utilities: Job site address: I\.oq q ( p0D Ct t -r ---refez 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 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.: 1 21 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTIONOF`:;WORK Backwatervalve 12.51 �A LNC tY �1(A-,co0 Clothes washer 25.02 t,W Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 rPROPERTY 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 ® 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/ZIPS Vancouver,WA 98660 _ Solar units(potable watery _6 5d Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail permitsubmittals rr 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 PIan review (25%of permit fee) State 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 180 days after It has been accepted as complete. *Fee methodology set by Td-County Building Industry Service Board. I:\Building\Permits\PLM1J-PermitApp.doe 10/01/09 440-46161(10/02/COM/WEB) Electrical Permit Applicaticy& , , FOR OFFICE USE ONLY : City�, OTI and Received `�� of g DateB �� . a \%CI� T Permit#�\ V!v et—�; c x: 13125 SW Hall Blvd.,Tigard,OR 9722 i r- n-,s� II y Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503,598,1960 Date/B : T G R Inspection Line: 503.639.4175 Ready Date/By: Ju is: H See Page 2 for r, Internet: www.tigard-or,gov : Notified/Method: Supplemental Information TYPE OF.WORK E New construction ❑Addition/alteration/replacement " , Please check all that apply(submit 2 sets of plans w/items checked): . . ' E ❑Service or feeder 400 amps or more ❑Buildin over three stories.❑Demolition ❑Other i where available utcurent ❑Marinas and boatyards. . CATEGORYOF-CONSTRUCTION _ F' � - exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accesso'y"butlding less to ground,or exceeds 14,000 0 Commercial-use agricultural Fire amps forall other installations. buildings. 0 Multi-family ❑Master builder 0 Other: 0 pump. ❑Installation of 150 KVA or JOB SUE.INFORMATION-AND'LOCATION � 0 Emergency system. larger separately derived �� ❑Addition of new motor load of system, Job#: Job site address: Gt�� CA S 100HP or more. ❑"A","E,"l-2","l-3", 0 Six or more residential units, occupancy. City/State/ZIP:Tigard,OR 97224 ❑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. I Each I Total I t New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot##: `A 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 r DESCRIPTION OF WORK Limited energy,residential C�1/eA �/\, �E—T '�,kjP.�-00 04o (with above sq.ft.) 75.00 2 UU Limited energy,multi-family 75.00 2 residential(with above sqft.) Renewable Energy 0 See Page 2 ® PROPERTY OWNER-'.... ❑ 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 I 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps i 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 Branch circuits—new,alteration,or extension,per panel ® APPLICANT ❑ CONTACT PERSON 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 dwelling,service and/or feeder 67.84 2 Email:permitsubmittals@polygonhomes.com — ,nnly 67.84 2 CONTRACTOR Pump or irrigation 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 panel,alteration,or extension. ❑ See Page 2 2 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(Y.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: �/"` ` TOTAL PERMIT is not 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,