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Permit (29) CITY OF TIGARD ,t,. MASTER PERMIT xi 2 COMMUNITY DEVELOPMENT Permit#: MST2019-00135 T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S 107AA05400 Jurisdiction: Tigard Site address: 14143 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 54 Project: Polygon at Roshak Ridge, Lot 54 Project Description: New SFA. 9/27/2019: REPRINT permit to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke DwellingUnits: 1 Detectors: Yes Third: 0 sf Right: 0 Total: 1214 sf Value: $164,352.30 Rear: 0 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 F u rn>=100 K: 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 1214 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 NFPA 13D Sprinklers VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required 2 Ersn Cntrl 503-639-4175 3 Geo Tech Report Required PHONE: 360-695-7700 PHONE: 360-695-7700 Prior To Pour FAX: Total Fees: $24,670.76 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through Oe' 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: 6,")- . / t.fe i--770N' Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard e COMMUNITY DEVELOPMENT DEPARTMENT ii R = Transmittal Letter 'Pi TI C;AANR t' 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: GI TY OF T 6ARD — cA0.-4.<\ DATE RECEIVED: DEPT: BUILDING DIVISION d E V L SEP 2 3 2°19 FROM: 'AvIN TftOME$ CI TY OF TIGARD COMPANY: ALLIANCE PLUMBING BUILDING DIVISION PHONE: (5o3) 517-A0535 By CZ))k RE: 14143 SW Ib9TN A-vE , IT7-ol9-00135 (Site Address) (Permit Number) IZO5UAIc LST 59 \ v-AC ..N�_7� c2` (Project name or subdivision name and lot numb r) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: X 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. Other(explain): REMARKS: PREvtov5 PL-A/45 wtR'E 7O0 LI6ftT TO READ FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes n No Fee Description: Amount Due: $ i? c 5,.3 $$ $ Special Instructions: Reprint Permit(per PE): es n NorDone Applicant Notified: jdAv .9 Date: V;)-7/17 ialse I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 '` ,got Lic1A i#-9 Plumbing Permit Application Building Fixtures RECEIVE , FOR OFFICE USE ONLY CityTigardAUG 2 9 2019 Received of � �� Sy- Permit No.: MST2019-00135 N 213125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19Date/By: 1 (PITY OF TIGARD Date/By: `1/24// Ct /4641Other Permit No.: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By7 Juris See Page 2for Internet: www.tigard-or.gov Notified/Method:y.2 7 / r t0 Supplemental Information a� TYP.E';OF WORK y/ft ®New construction ❑Demolition 0 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) + AEGORY O004TV3CTIO** SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(1214 sq.ft.) Page 2 JOB SITE4hOKBIKIION AND LOCATIONI- !' Site utilities: Job site address: 14143 SW 169th Ave 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.: Ci 1 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:Townhomes at Roshak Lot no.:54 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 ESCR $ Backwater valve 12.51 IPTION OF WORT( Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 i4 PROPERTY OWNER I :❑ TENANT , tank 12.51 Name:Polygon Northwest Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 Interceptor/grease 25.02 ►.r APPLI AI I ;;' �' I'E.� :. trap Business name:name:Polygon Northwest 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: :(360)816-7817 Tub/shower/shower pan 12.51 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 Water closet 25.02 CONT 4CTOR ,' Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DWV 56.29 Address:146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 CCB Lic.: 184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: /*---/ .-":7l ) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thornes Date:8.27.2019 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\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: Site Utilities Qty. Fee(ea) Total SquareFootage: Permit Fee: Footing drain-1 s`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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fix$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 Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to 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 Fixture Type for Replace/ Plan Review for Plumbing Installations 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 ❑ 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 ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -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 CITY OF TIGARD MASTER PERMIT IES COMMUNITY DEVELOPMENT Permit#: MST2019-00135 T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S 107AA05400 Jurisdiction: Tigard Site address: 14143 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 54 Project: Polygon at Roshak Ridge, Lot 54 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1214 sf Value: $164,352.30 Rear: 0 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Drains: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add''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 1214 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 NFPA 13D Sprinklers VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required 2 Ersn Cntrl 503-639-4175 3 Geo Tech Report Required PHONE: 360-695-7700 PHONE: 360-695-7700 Prior To Pour FAX: Total Fees: $24,534.23 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(DAR 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: �� Permittee Signature: e\-\N- AC-"K-VACS, 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 Ucv 3 Residential RECEIVED FOR OFFICE USE ONLY 11 . City of Tigard CCCC Received 4t��tt C 4 *I 13125 SW Hall Blvd.,Tigard,OR 97223-8 O 7 2019 DateBy: ; PermitNo. C�� , �� Phone: 603.718.2439 Fax: 503.598.1960 Plan Review DateBy: I({rj (4 f .A., Other Perau �k tf or�("ti t i t+ TIGARD Inspection Line: 603.639.4175 CITY OF TIGARD Date Ready/By. `� z r"'+ 7uris: t� See Page t2-for V 1 L Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method. (5 • , �-}—� Supplemental Information - • tx� L\ '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 0 Conunercial/industrial Valuation: $ k( (41 (' c� ❑Accessory building ❑Multi-family Number of bedrooms: V[ ❑Master builder 0 Other: Number of bathrooms: 3 JOB ST1L INFORMATION AND LOCATION�QTotal number of floors: 3 I ca 4 Job site address: 1 L4 I L{'/ CIA/ ) (��-fr` ) J New dwelling area: Ili 9 square feet 5( ,,�2 City/State/ZIP:Tigard,OR 97224 d t Y Garage/carport area: 1)-b square feet 4(12,2„i Suite/bldg./apt.no.: t\ Project name:Polygon at Roshak Ridge Covered porch area. square feet CI b Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COM�'ISEIERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge I Lot no.: )y 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 DESCRIPTION OF WORK work indicated on this application. New SFA Valuation: $ Existing building area: square feet ® PROPERTY OWNER 0 TENANT New building area: square feet Number of stories: � Name:Polygon WLH LLC I Type of construction: l Address:703 Broadway Street Ste 510 Occupancy groups: ^ / City/State/ZIP:Vancouver,WA 98660 -r j695-7700 Phone: 360 ( ) Fax:(360)693-4442 Existing: New: (J /1 El APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Pleacerelrrrol�sckedrite) Contact name:Amanda Gavin Structural plan review fee(or deposit): Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable): Of City/State/ZIP:Vancouver WA 98660 Total fees due upon application: Phone:(360)695-7700 I Fax::(360)693-4442 Amount received: E-mail:permitsubmittalspolygonhomes.com PHOTOVOLTAIC SOLAR 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 Address:703 Broadway St.Ste 510 and fire department access,along with the 2010 Oregon Solar Installation Specialty Code checklist. City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review and administrative fees): $180.00 Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lie.:207247 -- Total fee due upon application: $201.60 Authorized si: ature: Ai, This permit application expires if a permit is not obtained within 180 da s after it has been : i •1 : i n.r e: man a ►avm Date: e-I! O) ee methodology set by Tri-County Building Industry I Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) t Mechanical Permit Ap licationFOR OFFICE USE ONLY City of Tigard d V r-.-5 Received - , Ill 'I 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: PermitNo. � r'ry'-�` t-., Phone: 503.718.2439 Fax: 503.598.1960 ^ }R ��)) Plan Review 1 � VL• Y 1P 6 h I Inspection Line: 503.639.4175 H( L 2019Date/By: Other Permit: Date Ready/By: ]u is: H See Page 2 for Internet: www.tigard-or.gov CITY OF IGARD Notified/Method: Supplemental Information BUILDING i)IVLSi ON TYPE OF.WARK COMMERCIAL FEE* SCHEDULE-USE CHECKLIST ` ®New Construction Mechanical permit fees*are based on the value of the work ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRTICLION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. I j Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: i c i t+� �j w i (O�'1�} .,, Air conditioning 46.75 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: Hydropic 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.: 59 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ig 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 IZ 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 City/State/ZIP:Vancouver,WA 98660 Wall/suspended/unit heater Water heater Phone:(360)695-7700 Fax::(360)693-4442 Fireplace E-mail:permitsubmittals®polygonhomes.com Range Barbecue CONTRACTOR Clothes dryer(gas) Business name:Pro Heating&Cooling Other Address: NW Alociek Dr,Ste.1104 MECHANICAL PERMIT FEES* 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 A- This permit application expires if a permit is not obtained within 180 Authorize W� days after it has been accepted as complete. si:nar,,,P * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I:13nilrliugTermits\IvIEC_PermitApp_040113.doc 440-46I7T(11/02/COM/wea) s Electrical Permit ApplicationL c FOR OFFICE USE ONLY City of Tigard J ?019 Received .A APR2 t DateB : 13125 SW Hall Blvd.;Tigard,OR 97223 l MEMIll 9 Phone: 503.718.2439 Fax: 503.598.1215,0,_ Plan Review Inspection Line: 503.639.4175 "�"( l,,,l f IGARD DateB : Related Permit#: q! `� m Ready Date/By: tors: El See Page 2 for I-U Internet: www.tigard-or.govBV`pka ^ 4fVICC { V° Notified/Method: Supplemental Information . ., TYPE OF WORK PLAN RE W ®New construction 0 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 ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑Commercialindustrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi-familyamps for all other installations. buildings. ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: �+ � (�_ 0 Addition of new motor load of system. �`i l� SW 1( (`� 1� ,,u 100HP or more. ❑ A„ E„ 1.2„ `1.3„ City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 51-4Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 DESCRIPTION OF Ea.add'l 500 sq.ft.or portion 33.92 1 Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 0-PROPERTY OWNER 0 TENANT Renewable e 2 Services or feedersEner.installation,altera❑ Stieon,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 City/State/ZIP:Vancouver,WA 98660 401 amps to 600 amps 200.34 2 601 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 El APPLICANT 0 CONTACT PERSON: Branch circuits-c new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service or feeder fee, Contact name:Jolene Smith each branch circuit 7.42 2 B.Fee for branch circuits without Address: 703 Broadway St,Ste.510 service or feeder fee,first branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Phone:(360)695-7700Miscellaneous(service or feeder not included) Fax: :(360)693-4442 Each manufactured or modular Email:permitsubnlittals of - dwelling,service and/or feeder 67.84 2 @P ygOnhomes.COm .2' f•la l? t6 t _ Reconnect only 67.84 2 &,""!)i-ft,' , -'`'r ''''f'''','"--'.'' " Pump or irrigation circle 67.84 2 Business name:Portland Electric Sign or outline lighting 67.84 2 Address: 1915E 5th St.,Ste D Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 Each additional inspection over allowable in any of the above City/State/ZIP:Vancouver,WA 98661 Additional inspection(I hr min) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:paul@portlandelectric.biz Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.s1 g,' 0,5 specifically listed('/hr min) 90.00/hr Suprv.Electrician signature,required: X4✓., � a._ _ ELECTRICAL PERMIT SEB lA Subtotal: Print name: Alex Shalya Date: 04/08/2019 0 Plan Review Required(25%of permit fee): State surcharge(l2%of permit fee): Authorized signature: ��^„, k, TOTAL PERMIT FEE: Print name: MISHCHUK,SERG Y is permit application expires if a permit is not obtained within 180 Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. LABuildingTermits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB r h Plumbing Permit Applicatio. Building Fixtures FOR OFFICE USE ONLY 11 - City of Tigard APR 2 b 2019 Received 14 v 13125 S W Hall Blvd.,Tigard,OR 97223 Date/By: Permit No..' -�� n J� Phone: 503.718.2439 Fax: 503.59 Plan Review ��s\�t �Nei,_,� ) �� Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 RD C� RtDIVISION Internet: www.tigard-or.gov B U�LD 6 S G Date Ready/By: Juris: I E3 See Page 2 for Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist ❑Addition/alteration/replacementDescription I Qty. I Ea. 1 Total 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 lg 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: t 3 g LAD t I V!_Q r {�_ Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 1 Vl/ Drywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: I Project name:Roshak Ridge Footing drain(no.linear ft.: ) Page 2 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 Subdivision:Roshak Ridge Water service(no.linear ft.:_) Page 2 Lot no.: 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 City/State/ZIP:Vancouver,WA 98660 Garbage disposal 25.02 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 Address:703 Broadway St.,Ste 510 Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)695-7700 I Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Business name:G&B Plumbing&Sons Inc Water heater 37.52 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) Authorized signature: State surcharge(12%of permit fee) TOTAL PERMIT FEE I Print name:Steve Fowler Date:04/08/2019 This permit application expires ifs ermit is not obtaine .i atter it has,een 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) City of Tigard .114 a COMMUNITY DEVELOPMENT DEPARTMENT T l c n Building Permit Review — Residential Building Permit #: --c-'?sOK-A_cCl k..> , Site Address: 1'1113 SJ i ?Vit, Ave Project Name: R;;kige,, A WAS tills Lot #: S (New welling=subdivision name;Addition or Alteration=last name of owner) Planning Review P�rooposal: � ak�, sr. .;�U k., l it lv�"ia� 1�3 2- S Lid Verify address/suite#active in Accela. lain River Terrace: 0 No Yes,River Terrace Review Addendum Sit can Elements: i2`E sion Control 3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper Gained trees with drip line and tree protection measures It •. .wn to scale(standard architect or engineer scale) L .•otprint of new structure(including decks)and FFE C .rth arrow It Utility locations&easements(required for new and additions) I! address,project or subdivision name and lot number L id/ ewalk/driveway approach L •plicant information(name and phone number) I cation of wells/septic systems .t dimensions and building setback dimensions curs eet tree size,type and location ii4 are footage of buildings to be demolished sting structures on site C. 1:400014 41 orner elevations(2'contours if more than 4'differ ntial) Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? lyes ❑No � impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑ No NJ Clean Water Services—Service Provider Le_ttt/(lot platted prior to 9/10/1995): L 1 j_ iequired: ❑ Yes,applicant was notified c!d No Received: ❑ Yes ❑ No � � ,..„14,,, L►�' Public Facil,�it,ie�mprovement(PFI) Permit: 114 dg. [9/Required: L4'Yes,applicant was notified ❑ No Ap lied For: 2/Yes ❑ No,stop intake .nd Use Case#: i 1 s- opo2_ [. Z nin , K_I� It ' -a uired Setbacks: Vt''ront g/ j "Rear � e 0 t,8'treet Side $ i4rage EU/Building Height: Max.Height: VA/ Actual Height:.2-4•115 EV Landscape Area: 2.,0 % Q Lot Coverage Max: go IV ntrance CI Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows ❑ Minimum 12%of area of all street-facing facades T.►lis Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage. ih ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. tG ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade CI60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset kfir Tett 0 Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer ❑ Accent siding ■ $ indow trim ❑ Window recess ❑ Window projection ❑ Balcony /Visual Clearance Ct Urban Forestry Plan Ltd'Sensitive Lands: [ ' x es ❑ No Type G-p Conditions met prior{ to issuance of building permit �� `�'`�� W1�" Alai °'�/ No s: Cams iIi?ry 6- r d fr-.1,- \ t-A6tkj trr.if- tSbvNr at. Approved By Planning: LiAmmtt Date: (1—(_11 Revisions (after Building Submittal only) Lir Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES 022819.docx Building Permit Submittal Original Submittal Date: Site Plans: Building Plans: # Building Permit#: ❑ Enter building permit#above. Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building Workflow Sign-off: ❑ 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: Date: Engineering Review o� Slope at building pad: ST' /U f2" Conditions "Met"prior to issuance of building permit /J' Easements (encroachments)per engineering conditions of approval and plat QV Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes zr No Assess Water Quantity Fee in-lieu: ❑ Yes )2 No LIDA Facility on lot: 0 Yes No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: f '`Approved by Engineering: `, Date: ! 7 / Revisions (after.Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved 0 Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: bit Yes ❑ N/A Tigard Trans SDC: ems, Yes ❑ N/A Parks SDC: ilkYes ❑ N/A LIDA ❑ Yes gt N/A OK to Issue Permit Approved by Permit Coordinator: ACIY\44 Date: tj /U?J, L� I:\Building\Forms\BldgPermitRvw_RES_022819.docx City of Tigard ■ " COMMUNITY DEVELOPMENT DEPARTMENT UPI T l A R D River Terrace Building Permit Review Addendum Building Permit #: Off--T \0t- l?3t:) Site Address: ` � 3 S i �b`1 A-Je. Project Name: PotI�o,, �ikalc 't;4 e Lot #: (2`f (Ne dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan District 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. 5t. deep ft.dee min.2ft., 5 ft.wide min.2 ft.,6ft wide Gabled dormer 4 ❑ �� ❑ . Eyes on the street: a minimum,o 12%of each street facing façade must include windows or entrance doors. Percentage Shown: 2.3°0 . ' 19tIl�, r7,L- �� Entrances:At least one entrance must meet both of the foliog standards: sss"' /Max. 8 ft. setback from longest street- facing wall '=' 1 arallel to street,angle no more than 45° from street, [� ,� or open onto porch Entrance opens to a porch: IJ Yes 0 No ��- IL7s,s,all the following apply: I.i�'25 sq.ft.min. L e street facing entry 2'1/-2 ft.max.roof above floor of porch R'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: O 5overed porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep IV all offset min. 16 inches F/43 0Dormer min.4 ft.wide LV Roof eave min. 12 inch projection,/3 12/Roof offset min. of 2 ft. r73 ❑^, Roof shingles either tile or wood [ ible,hip or gambrel roof design i// /3 L_'d_,'//�.00f pitch oriented south min. 500 sq. ft.3 IV/Horizontal lap siding min. 3-7 inches wide L�" , Accent siding min.40%of street facade FA ❑ Window trim min.2 1/2"wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑ T.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 facade r/3 IAA 5. Garages and Carports:May face the front or side lot line on a corner lot. ger Setbacks: 141,14No closer to front or side lot line,than longest street-facing wall. ❑ Yes ❑ 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. 61117 ❑ 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) O 12-foot-wide garage door 0 40%max. of street façade 50%max. of street façade with 7 detailed design elements Notes: Approved By Planning: 9 Date: `1'i 1- I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx ` Plumbing Permit Application Building Fixtures _ �� FOR OFFICE USE ONLY City of Tigard s Received _ 11 'r 13125 SW Hall Blvd.,Tigard,OR 97223 'l )r ( Date/By: �t \t c Permit No. i j L I. 6 2 0 1 9 Plan Review �� ` `�� Phone: 503,718.2439 Fax: 503.598.196ll Other Permit No.: Inspection Line: 503.639.4175 Date/By: TIGARD 1', Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov 4''' ` .„ � yis a - 1 n Notified/Method:,: � y tp, � Supplemental Information :.�. TYPE OF 0 ,=. ' � ,,,,i ....,;.'1,,:? . - , FEE* SC8ED1.tLE; :ig #"----4"''-'-::- ®New constructionFor special information use checklist ❑Demolition � - `t Description I Qty. I Ea. I Total _ IDAddition/alteration/replacement 0 Other > �`' \(,� J New 1-2-family dwellings(includes 100 ft.for each utility connection) ' '. ' , CATEGORY:OF CONSTRUCTION ' ' ( SFR(1)bath . �-- l 312.70 o 1-and 2-family dwelling 0 Conunercial/industrial SFR(2)bath 437.78 IDAccessory building EI Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0Other. Fire sprinkler( sq.ft.) Pae 2 - JOB SITE INFORMATION AND LOCATION Site utilities: g es: Job site address: `ik 1 LA 3 •l `-..� 1\ _ Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 �V� Drywell,leach line,or trench drain 18.76 Suite/bldg./apt,no.: tom( I Project name:Roshak Ridge Footing drain(no.linear ft.:_) Page 2 ` 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 Subdivision:Roshak Ridge I Lot no.:61.-I Water service(no.linear fr.:_) Page 2 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12 51 Clothes washer 25.02CAcVC.iNA�� bYti -c 2-01 clrbb(36 Dishwasher _ 25,02 Drinking fountain 25.02 Ejectors/sump 25.02 CI PROPERTY OWNER J,.' 0 TENANT'. Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 510 Floor drain/floor 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 APPLICANT0 CONTACT PERSON .. Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Contact name:Tonja Morris Primer 12.51 Address:703 Broadway St.,Ste 510 Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) Phone:(J60)695-7700 Fax: :(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 3 7.52 Business name:Alliance Plumbing Water piping/D WV 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.:PB732 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: J 4 Pi TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Robert Dishman Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. \:\Building\Permits\PLMU-permitApp.doc 10/01/09 440-1616T(I0/02/COM/WEB) Electrical Permit Application ? '' FOR OFFICE USE ONLY City of Tigard Received �a � . I r, ; Date/B : ). • \ . r�t..l_, i,____ 't 13125 SW Hall Blvd.,Tigard,OR 97223 .i l.i ? /is;1' 11111 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: TIGARD Inspection Line: 503.639.4175 1 t Ready Date/By: Juris: 21 See Page 2 for n Internet: www.tigard-or.gov "+ t y Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW El New construction 0 Addition/alteration/replacement ,tom Vc lease check all that apply(submit 2 sets of plans w/items checked): ❑Demolition - 0 Other: • Service or feeder 400 amps or more 0 Building over three stones. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION , ., tGf • exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory s 1 less to ground or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE'INFORMATION AND LOCATION ' •, ❑Emergency system. larger separately derived • ❑Addition of new motor load of system. Job#: Job site address: t Lk\�.l3 SW �.b� R 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. [3/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 • 1 Qty. 1 Each 1 Total 1 * - New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge l Lot#: .4" Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ee:add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK • - Limited energy,residential m (with above sq.ft.) 75.00 2 6n, ��0�� 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 Broadwa St Suite 201 amps to 400 amps 133.56 y 5102 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 I 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., I ❑'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 dwelling,service and/or feeder 67.84 2 Email:permitsubmittals@polygonhomes.com Reconnect only 67.84 2 • CONTRQR ... .• .-- Pe+aP er lttf�eeiefl e�eie __ �_._. ti'f:S4 Z R Business name:Alameda Electric Sign or outline lighting 67.84 2 Address:3415 NE 44th Signal circuit(s)or limited-energy ❑ 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:solarpdz@me.com Industrial plant(1 hr min) 78,18/hr Inspections for which no fee is CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871,8'S , specifically listed('V2 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: :.,.._,,...,r 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. - * Number of inspections allowed per permit.