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Permit (181) CITY OF TIGARD MASTER PERMIT ' '< COMMUNITY DEVELOPMENT 4; Permit#: MST2019-00039 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 `S' • Date Issued: 04/25/2019 TIGARD Parcel: 2S107AA12000 Jurisdiction: Tigard Site address: 14200 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 120 Project: Polygon at Roshak Ridge, Lot 120 Project Description: New SFA. 8/28/2019: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 97 sf Left: 0 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1221 sf Value: $169,483.45 Rear: 10 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 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 1221 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) --. 70S-BROADWW'STSTE-NAO . St# €{40 # 1--1-iiOuFFifa Z( . VANCOUVER,WA 98660 VANCOUVER,WA 98660 Ceiling 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $24,722.59 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 R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987or�1.800.332.2344. Issued By: \ _ /J---, Permittee Signature: AL- \or'`� � '\CPCV\0.,C- ' 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 R E C E I V . +3 ,.`.- *k1IL,A 71- Building Fixtures FOR OFFICE USE ONLY AUG 1 3 20IN received -+ City of Tigard Date/B er lb /p / G Pennit No.: MST20I9-00039 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGAR�an R view `, _ Phone: 503.718.2439 Fax: 503.598.1960 BUILDING DIVISI( /By 8- $ oZ -/`7 kez? Other Permit No.: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris 10 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information . T'YPP OF WO;I <. . OIII) ®New construction ❑Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) TE EIRY,O ,°CO CUT; , i.` SFR(1)bath 312.70 ® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building ElMulti-familySFR(3)bath 500.32 ❑Master builderEach additional bath/I j then 25.02 ❑Other: Fire sprinkler(1221 sq.ft.) Page 2 OI . ITE iSitORMATION AIS? L A" JOI Site utilities: Job site address:14200 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.: 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.: 120 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0. VROPERTY OWNER N " Q 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 dAPI"LkiklVT QNTACT PESO 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 ` one: i 1 695-77011 Fax::( ) Tub/shower/shower pan 12.51 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 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) Authorized signature: / / �+�� 777 , State surcharge(12%of permit fee) 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. 1:\Building\Permits\PLMU-PermitApp.doe 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: Site'-Utilities Qty• Fee(eai Total Square Footage• Permit Fee: Footing drain-1"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:: ., Permit Fee: Storm&Rain Drain- I st 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 Other Inspections or Fens Q fee(ca} notal each additional$100.00 or fraction thereof,to p �<.. 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: I 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 Replace! l ;ll fle w `piumb I08tallations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath -Tub/Shower Please check all that apply. Jacuzzi/Whirlpool 1:1 •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 ® 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 biOnlOrie or iffier 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/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_allianceplungng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc 1 CITY OF TIGARD MASTER PERMIT g ' COMMUNITY DEVELOPMENT Permit#: MST2019-00039 13125 SW Hall Blvd.,Ti Date Issued: 04/25/2019 T i t11.T and OR 97223 503.718.2439 9 Parcel: 2S 107AA 12000 Jurisdiction: Tigard Site address: 14200 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 120 Project: Polygon at Roshak Ridge, Lot 120 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 97 sf Left: 0 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1221 sf Value: $169,483.45 Rear: 10 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 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>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1221 Owner: Contractor: 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: $24,586.06 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 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.34 Issued By: '/%-/—/-4—/° -- Permittee Signature: e7/ifpG'lC�T7G2�'V 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. -- \ - ' Building Permit Application W--..\ O ✓ ' Residential A G t-,,..,,"—c," x ,..., ., N ,s ., FOR OFFICE USE ONLY City of Tigard Received ( M( (`, t 1 t Date/By: a�kk IR Sc Permit No\��V��1,A�'1'(Q 11111 13125 SW Hall Blvd.,Tigard,OR 97223 E_ � j V w Plan Review Phone: 503.718.2439 Fax: 503.59§..116K, Date/By: 01/74/)41 �. — Other PermiiS1,�,G`t� T 1 G A R D Inspection Line: 503.639.4175 k." "�I S(•2" M1-) Dateead B JAS: Ready/By: H See Page 2 for Internet: www.tigard-or.gov 6UI LD I N�` DIVISION Notified/Method:7 y , Supplemental Information £ 714(c-- rho L.-/c c,,/ - 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 0 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 ❑Commercial/industrial Valuation: $ �Ct 1/. S ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: ' /(F' 77 .C.' JOB SITE INFORMATION AND LOCATION Total number of floors: (1.-fc. Job site address: 142 D0 t/) J 0 A C/1/t st' ;1�q r tLe. New dwelling area: 1 0)11 square feet City/State/ZIP: �j/l (`l�/'/I Garage/carport are. CiCV square feet s(4,2 Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area square feet et`7 Cross street/directions to job site: Deck area: Ul square feet Othr arioa'xi +r( , square feet REQUIRED DATA:COMMERC'IAL-USE CHECKLIST 1 Subdivision:Polygon at Roshak Ridge Lot no.: l 11}0 Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the (. -3 " DESCRIPTION OF WORK" work indicated on this application. Valuation: $ (\- Existing building area: square feet New building area: square feet ® 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: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Plreserefer rofee schedule) Structural plan review fee(or deposit): Contact name:Amanda Gavin Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable): 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 PHOTOYOLTAIC,SflLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of 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)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda G in Date: /// y//i *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit ApplicatEl FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: '! 13125 SW Hall Blvd.,Tigard,OR 97223 APR 9 2019 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: .1 I Inspection Line: 503.639.4175 CITY OFR../4 NC)) Date Ready/By: 1uris: Internet: www.tigard-or.gov H See Page 2 for BUILDING DIVISION Notified/Method: Supplemental Information TXPE OF.BUILDING ORK COMI1IERCIAL FEE*SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION, RESIDENTIAL.EQUIPMENT 7 SYSTEMS FEES* 1 and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist It Multi-family 0 Master builder ❑Other: Description P Qty. Ea. Total JOB SITE,INFORMATION AND LOCATION. Heating/cooling: ILA�G00 5,1 \ �� Air conditioning 46.75 Job site address: l W emST t�� 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.: I LC. Other23.32 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 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 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 FEES* 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 ( .Qi b( .J 1. 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) • Electrical Permit ApplicatioelEGEIVED FOR OFFICE USE ONLY City of Tigard L\PR 1 2 Z019 Received Permit#: 21 13125 SW Hall Blvd.,Tigard,OR 97223 Da Plan Review • • Phone: 503.718.2439 Fax: 503.598.1,9,60, ��qr�q Inspection Line: 503.639.4175 (1 i { O F•�IGA1 D Re Readye/B : Related Permit#: g DIVISION Date/By: rnris: RI See Page 2 for L11-i-M tJ Internet: www.tigard-or.gov '3Ul9 l3NG Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition Other: 0 Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural Other: amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: 4 5W C 0�.� ❑Addition of new motor load of system. ejoBsT &,g. 100HP or more. ❑"A","E'>,"I-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. ❑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 Qtv. I Each I Total I + New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: ,20 Includes attached-garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'1500 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.ft.) 75.00 2 ® PROPERTY OWNER 0 TENANT Renewable Energy ❑ See Page 2 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 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 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 APPLICANT' 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service orr feeder fee, each branch circuit 7.42 2 Contact name:Jolene Smith B.Fee for branch circuits without Address:703 Broadway St,Ste.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 Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder 67-84 2 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 56'St.,Ste D Signal circuit(s)or limited-energy panel,alteration,or extension. ❑ See Page 2 2 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:paul@portlandelectric.biz `/cf j.SIndustrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.: 49025 specifically listed('A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: ate. .... 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: L' 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 bas been accepted as complete. * Number of inspections allowed per permit. Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard q PR 9® Z 0 n Received g 4{ J Permit No.: q 13122 5 SW Hall Blvd.,Tigard,OR 9722 Date/By: Plan Review Phone: 503.718.2439 Fax: 503.5difyOF TIGARD Date/By: Other Permit No.: TIG ARD Inspection Line: 503.639.4175 BUILDING Date Ready/By: Juris: PI See Page 2 for Internet: www.tigard-or.gov DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist. Description Qty. I 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 $,1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building *Multi-family SFR(3)bath 500.32 Each additional bath/ldtchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14209 5(A) CioLD CDA-5 T Ti E. g. Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 1 Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge 1 Lot no.: j Z0 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK, Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.,Ste 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) 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 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 CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature:• TOTAL PERMIT FEE Print name:Steve Fowler Date:04/08/2019 This permit application expires if s 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(10/02/COM/WEB) City of Tigard II +r COMMUNITY DEVELOPMENT DEPARTMENT ■ l. R 1Dt Building Permit Review — Residential w. Building #. � --�.. - �4...w�w� �--,�,.� -� Permit � w: : . Site Address: 200 rLi ( jiJ Ce, i1' rrai Project Name: Co ,i, A} 1 iktkk ,..:Q Lot #: ILO (N-. ening=subdivision name;A..'tion or Alteration=last name of owner) Planning Review Proposal: tW SK, a LI eerify site address/suite#exists and active in permit tem. g River Terrace Neighborhood:: ❑ No Yes,See River Terrace RevieryAddendum Attached 'Lan Elements: e*.• -e(3)copies of site plan Ls sting structures on site jte plan m S �e on 8-1/2"x 11"or 11 x 17" aper t! P P ootprint of new structure(including decks)with finished wn to scale(standard architect or engineer scale) 5oor elevations rth arrow Unity locations&easements(required for new and additions) ler }Ce address,project or subdivision name and lot number [� Q plicant information(name and phone number) idl'�/of y approachsystems+��" ,tion of wells/septic systems fU' t dimensions and building setback dimensions n `:.sting trees to be retained with drip line,and tree e footage of buildings to be demolished •rotection measures in •"pervious t area,building coverage area,percentage of coverage and l, .. et tree size,type and location area(applicable if R-7,R-12,R-25&R-40 'roperty ) PI treet names comer elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [ Yes❑No 4 foot differential) If'es,is a storm water M Clean Water S �i ces—Service Provider Letter(lot platted prior to 9/10/1995): f a� moo ? J❑ . �No equired: IQ Yes,applicant was notified 0 No `� I>a Public Faciliti Improvement(PFI)Permit: Received: ❑ Yes 0 No iii14 aired: Yes,applicant was notified 0 No O j( Applied For. 0 Yes 0 No,stop intake dUse Case#: cotL0 S_00002 H -Ii . �equired Setbacks: Front dscape Requirement � V° Q Z. RRearI Side d Street Side Garage ��•S p e9 � 1:0Lot Coverage Maximum: 0 RI Building Height Maximum Height 3S �;, isual Clearance Actual Height P1 sensitive Lands: 0 Yes No Type Urban Forestry Plan Conditions "Met" .rior to issuance of building permit otes: 'GM/ I a 1. iMr ,, ,✓111C4 Approved By Planning: I ,..r. ` Date: -1,1.11 Revisions (after Building Submittal only) 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\Forms\gldgPermitRvw RFS_061417.docx Building Permit Submittal Original Submittal Date: ______?-11/2i.—___ Site Plans: # —_-- Building Plans: # Building Permit#: g Enter building permit#above. �Buildin g d Planning [3`Engineering d Permit Coordinator Workflow Routing: Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: d Engineering: (1) copy of permit application,(1)site plan, (1)building plan and original plan review routing form. [Bengineer and uilding original permit application,site plans,building plans, beam calculations and trust details,if applicable,etc. Notes: Date: � � IG By Permit Technician: _ _ Engineering Review clo lope at building pad: ❑ Conditions"Met"prior to issuance of building permit ❑ Easements(encroachments)per engineering conditions of approval and plat _.12'Water Quality/Quantity Facility. Assess Water Quality Fee in-lieu: 0 Yes Er No Assess Water Quantity Fee in-lieu: 0 Yes l' No LIDA Facility on lot 0 Yeso .-Ll Final Plat Recorded: Date: O NOT Approved by Engineering: Notes: V 'T - pi. p No, S 1-00 = l N 6.4 Ai Ni Date: � 0 1 qjY �,Approved by Engineering: 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 '!i Conditions"Met"prior to issuance of building permit I ❑ 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 VgDC Fees Entered: Wash Co Trans Dev Tax: y,,-------Z;:---1:7;7A-7 Tigard Trans SDC: Q Yes 0 N/A Parks SDC: DKres ❑ N LIDA 0 Yes /A / / ' to Issue Permit WDate: 3/(r//� 7 /Approved by Permit Coordinator. I:Building\Farms\BldgPermitR"w RES 010118.docx a ^ UPI City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGARD River Terrace Building Permit Review Addendum Building Permit #: S T ;\ck_ OCc` k Site Address: i1L(iti .Si„J G- ti l,044t jef-r tt Project Name: fa s oj- hp..,J� 94 Lot #: 1 Z0 (Ne welling=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? rUi 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 dee Balcony w/access 2 Window Projection Vertical Wall Offset a p ft. deep min. 2ft.,5 ft.wide min. 2 ft.,6ft.wide Gabled dormer 0 0 0 ❑ 2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors. Percentage Shown: 10 q/J 1.1-2,7 3. Entrances:At least one entrance must meet both of the follo ' g standards: 2/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 0 No Iff y,s,all the following apply: �6sq.ft.min. Vine street facing entry C2' 2 ft.max.roof above floor of porch U5 ft. depth min. L(d'30%min.porch roof coverage 4.Wtailed Design:All buildings shall include a min. of five of)he following elements on all street-facing façades: IllIrCovered porch min. 5 ft.wide x 5 ft. deep F Recessed entry area min. 5 ft.wide x 2 ft. deep P' ❑07all offset min. 16 inches Ltd Dormer min. 4 ft.wide S [ Roof eave min. 12 inch projection FA ❑ycoof offset min. of 2 ft. O Roof shingles either tile or wood ,'able,hip or gambrel roof design P S ❑ oof pitch oriented south min. 500 sq. ft. Ltd Horizontal lap siding min. 3-7 inche wide-5 Lel Accent siding min. 40%of street façade F 0 Window trim min.2 1/2"wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑ ay 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 facades 5.Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: No loser to front or side lot line,than longest street-facing wall. 0 Yes L 'No. If No (Check one): [ 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) ❑ .2-foot-wide garage door ❑ 40%max. of street façade Iff 50%max. of street façade with 7 detailed design elements Notes: Approved By Planning: jgM4..vtL C Date: Z-ZI--{I I:\Bui1dwg\Forms\BldgPermitRvw_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 1 _ Transmittal Letter i !(,,,a ,) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: V`e Y V V p tn-, DATE RECEIVED: Z ZS'14 V t Y I I I DEPT: BUILDING DIVISION RECEIVED FROM: hy vygu en vIt4 FEB 252019 'f� �� ) CITY OF TIGARD COMPANY: Po7ov'\ 1N V Y- f V `cam BUILDING DIVISION PHONE: D (dc -in )0 BY:s p-- RE: I (-1700 SIO (10 lo, CDaf Y rC (Q- AA 51-2DI'- b (Site Address) ,) (Permit Number) -70►V (7[�. .IZ'Shck — -1 --b- \N.- ZO (Project iarb.0or 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 calculations. . Engineer's calculations. 2( Other(explain): SA 1M ) .1-1 vwl f(?y ( 01A-\---0 t \I I 10I.: DA s _4 REMARKS: CO V r v -e' V. 11 Tiv 0 \A. 5t rI ..... _ . _ . . I. , s � y , Routed to Permit Tec .• Date: '%' Initials: Fees Due: - es j • No Fee Descriptio : Amount Due: p e--- $ $ r----2 ter p S ecial O Instructions: Reprint Permit(per PE): ❑Yes al o ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions 061316.doc Plumbing Permit Application sf; Building Fixtures ` , l`x. FOR OFFICE USE ONLY City of Tigard i ' •?O 1 Q Received •( ,� �1 1 L ,„ Date/By: l( 'l 1 Permit Nop� Q ((�'�(v�^�� 7 - 13125 SW Hall Blvd.,Tigard,OR 97223"" l C �T "l�T�� _-l Phone: 503.718.2439 Fax 503(3 Plan Review o-` Date/By: Other Permit No.: Inspection Line: 503.639.4175 a �' T I GARD R r t t o Date Ready/By: kris: H See Page 2 for Internet: www.tigard-or.gov 3 t,i x_4 ,,,y Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE` ®New construction 0 Demolition f }t, ', 'i "V For special information use checklist. Description 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 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ►ii Multi-family ❑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: t112.O0 C DL ._.e1 n Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 I��• 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 20 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORKBackwater valve 12.51 Clothes washer 25.02kJ: J .a0Zt \ `y\,. ` 2.01G1rb6039 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 e 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 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(notable viared . 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: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 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: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 Tri-County Building Industry Service Board. IaBuildingIPermits\PLMU-PermitApp.doe 10/01/09 440.46161(10/02/COM/WEa) - ,.. ,. " "Electrical Permit Application '" FOROERICEUSONLY ' ' R R City of Tiand Date/Be� � ��c � Permit#: ,;T \0% A 111 't 13125 SW Hall Blvd.,Tigard,OR 97223 S Plan Review Phone: 503.718.2439 Fax: 503.598:1960,. Date/B Related Permit#: TIGA :Q RL7 Inspection Line: 503.639.4175 Ready Date/By: mum: El See Page 2 for , Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK ;PI AN;REVIEW. :` A.; ®New construction 0 Addition/alteration/replacement < Please check all that apply(submit 2 sets of plans w/items checked): J 0 Service or feeder 400 amps or more ❑ Buildingover three stor i es.❑Demolition ❑Other. t where the availableau current0 Marinas andboatyards. CATEGORY OF.-CONSTRUCTION ��. - exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling ❑ Commercial/industrial Uindustmial ❑Accessolyburl8"mg less to ground,or exceeds 14,000 0 Commercial-use agricultural l amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑ Other: 0 Fireum . p p 0 Installation of 150 KVA or JOB SITE,:INFORMATIONS AND'LOCATION. ❑Emergency system. larger separately derived 4 s`O /ti ^' ' CO ,I TG z g 0 100Addition of new motor load of system. Job#: Job site address: (,� Iv-/,VlN IlJ4�'Isy!�'' [..�-ice- lOOHP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. 0 Health-care facilities. ❑'Recreational vehicle parks. Suite/bldg./apt.#: _ I Project name:Polygon At Roshak Ridge 0 Hazardous locations. ❑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 I Lot#: \Iv 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 GYMMST ZO.p 1" 666 � Limited 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 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 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'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 �y 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 0 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(I 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 CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871/S specifically listed(14 hr min) _ 90.00/hr - 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 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.