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Permit (23)
n.7 r = MASTER PERMIT ,,11 CITY OF TIGARD t. .? f COMMUNITY DEVELOPMENT 73i) /9 ",t,' . Permit#: MST2019-00133 'TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S107AA05200 Jurisdiction: Tigard Site address: 14119 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 52 Project: Polygon at Roshak Ridge, Lot 52 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: 670 sf Basement: 80 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 634 sf Garage: 532 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 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!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 Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1384 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 NFPA 13D Sprinklers 3 Geo Tech Report Required Prior To Pour PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,283.73 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: •`. `-''''' 0 ? Permittee Signature: " "7-16- 1--i ' — ci/it - 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. 'g 44 _ SuR 1 " A\C \($\ *CI Plumbing Permit Application Building Fixtures RECEIVE I FOR OFFICE USE ONLY City of Tigard Receivedy t I IC( S�� Permit No.: MST2019-00133 DateII Tigard,OR 97223 Plan R w 13125 SW Hall Blvd., AUG 2 9 2019 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Ci •.2�^1 °7 A 647 Other Permit No.: T I G A R D Inspection Line: 503 639 4175 CITY OF TI GAR D Date Ready/By' p Juris ® See Page 2 for Internet: www.ti ard or ov Notified/Method'/ 7 / Supplemental Information g g BUN RING OIVISInN � .. pp T ,O ylt,ORK j47/4�,..-. //77 EE* SCIIEDIJFE ®New construction ❑ Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) +ATECO 'OFCONSTRICTION ,-1 SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(1384 sq.ft.) Page 2 ,SOBI'I'B,11 MA AND,-4p3CATION Site utilities: Job site address:14119 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.: 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.:52 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 `DESCRIPTION OF WORK e Backwater valve 12.51 , Clothes washer 25.02 MILTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02ii ei PROPERTY OWN It,. 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Polygon Northwest 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 6 APPLICANT 1 ❑ CONTACT taSON Interceptor/grease trap 25.02 Business 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 1 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 4,2/, o CCB Lie.: 184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) / State surcharge(12%of permit fee) /y- (,3 Authorized signature: ` TOTAL PERMIT FEE j36, , S3 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(ea3 Total Square Footage: ! ,Fee Footing drain-15'100' 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' 37.52N*taPermit Fee: do: �., 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 Other Inspections or Fees Qty. Fee(ea) fiotal 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 ReviewReviewfoi 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 g 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-mysharepoint.com/personal/gavin_alliancepluml2ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc 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 of Transmittal Letter TIGA RD 13125 SW Ha11 Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-01 ov TO: C ITy OF Tr(GAR-D — DATE RECEIVED:�/ DEPT: BUILDING DIVISION RECEIVED ED SEP 2 3 2019 FROM: GAv r a Ti-►own ES CITY OF TIGARD COMPANY: ALL►ArJ ca T i.umstob BUILDING DIVISION PHONE: (503 ) 57-►-foS35 By:sr RE: 141/1 Si") lb9rr+ Ave MYr2.om-00/33 (Site Address) (Permit Number) RoS4M K L.07 52- '`°1 (Project name or subdivision name and lot numb ATTACHED ARE THE FOLLOWING ITEMS: 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. Other(explain): REMARKS: PRcv IOVS PLANS WERE Too LI61477ro READ FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑No Fee Description: Amount Due: $ /3 , 53 $ $ Special Instructions: Reprint Permit(per PE): ,es ❑Noone Applicant Notified: 77)//.?7- Date: ?/.7//9 nitialS 1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 CITY OF TIGARD MASTER PERMIT 14 41 i; COMMUNITY DEVELOPMENT Permit#: MST2019-00133 T R GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S107AA05200 Jurisdiction: Tigard Site address: 14119 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 52 Project: Polygon at Roshak Ridge, Lot 52 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 670 sf Basement: 80 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 634 sf Garage: 532 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 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: 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 Ecompasing: Y Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1384 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required items and Reports(Conditions) 703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 NFPA 13D Sprinklers 3 Geo Tech Report Required Prior To Pour PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,147.20 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ` Permittee Signature: 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 L L.Th Residential 1 '_ v',...D FOR OFFICE USE ONLY Cl of Tigard Received • ilia " 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 0120 9 Date/By: 1-4'��j \C� .j -� PemutNo.,O��rS; �(� - � Phone: 503.718.2439 Fax: 503.598.1960 PlanRy iew n Other Permi. Inspection 503.639.4175 CITY OF TIGARD DateB : yl(S �l ( �j ;t` �C�—�(j44 . TIGARD P Date Ready/By. , ^ Ju s: H See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method. ‘j2.I I,l C(\ R Supplemental Information .. CUA- C t lac 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: $ �� ` i 0 Accessory building 0 Multi-family Number of bedrooms: ElMaster builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: t 1 l`C Job site address: I I (01 5 VI) 1 W 1 A\iv New dwelling area: lqL (j square feet 2 City/State/ZIP:Tigard,OR 972241 Il Garage/carport area: -)2 square feet (0.7 Suite/bldg./apt.no.: � Project name:Polygon at Roshak Ridge Covered porch area: square feet $0 Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COi4MERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: S2 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 New building area: square feet E PROPERTY OWNER ❑ TENANT Number of stories: Name:Polygon WLH LLC Type of construction: ® Address:703 Broadway Street Ste 510 Occupancy groups: Pr- City/State/ZIP:Vancouver,WA 98660 Existing: Phone:(360)695-7700 Fax:(360)693-4442 New: V 0 APPLICANT ❑ CONTACT PERSONBUIFDLYG PERMIT FEES* Business name:Polygon WLH LLC (PleaserejferloJ�eschelrlule) Structural plan review fee(or deposit): Contact name:Amanda Gavin Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable): Or". City/State/ZIP:Vancouver WA 98660 Total fees due upon application: Phone:(360)695-7700 y, Fax: :(360)693-4442 Amount received: E-mail:permitsubmittals(aJ� rlygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CL3NTRACTOR 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 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: $201.60 Authorized signaillopI `/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Aman i a 1111 Date: / *Fee methodology set by Tri-County Building Industry r__2/��� ()� Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) I ak:CEIV Mechanical Permit Applica FOR OFFICE USE ONLY City of Tigard APR 2 b 2019III Received Date/By: Permit No. ' > '1 13125 SW Hall Blvd.,Tigard,OR 97223 ���, `� �� p�-� q Plan Review Phone: 503.718.2439 Fax: 503.598.1e9t� d OF TIRD Date/By: Other Permit: Y I,ti.i R. P Inspection Line: 503.639.4175 � p 1 l�1 DIVISION Date Ready/By: .tuns: Internet: www.tigard-or.gov 8 i LD'a°^ - y y' H See Page 2 for Notified/Method: Supplemental Information TYPE AF CORK" COMMERCIAL FEEL SCHEDULE-USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF; CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ixi 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist 1 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION"AND LOCATION"" Heating/cooling: (�11 C SV...) W %� TN n Air conditioning0 ,046.75 Job site address: _` 1t`1nv/�r/, Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Roshak Ridge Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision:Roshak Ridge Lot no.: 67_ Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIP ION 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 equipment 33.39 Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39 City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32 01 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 City/State/ZIP:Vancouver,WA 98660 Wall/suspended/unit err heater heater eater 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 Zww J Ql n I\inn. days after it has been accepted as complete. Authorized oPtl signature: - • Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I:\Shilling\Permits\s1BC_PermitApp_040113.doc 440.46I7T(11/02/COM/WEB) Electrical Permit Application , J FOR OFFICE USE ONLY City of Tigard APR 2 h 2019 Received ' 13125 SW Hall Blvd.,Tigard,OR 97223 DateB I Phone: 503.718.2439 Fax: 503.598.19 y. ,,. . Related Permit#: L II-L"-I-1 Inspection Line: 503.639.4175 fi' i je, ��l5� 10 1'eady Date/By: orris: ' L3I ,,,,„ See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYP1 OF WORK PLAN REVIEW ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition 0 Service or feeder 400 amps or more 0 Building over three stories. 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 9 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: �j ' .^ ❑Addition of new motor load of system. IL t ` Sw �� I f"E 100HPormore. ❑ A„ E„ 1_�„ <1.3„ City/State/ZIP:Tigard,OR 97224 0 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 Qts'. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 52 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 I DESCRIPTION Or 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 I 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 IN 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 or 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 branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 ,,, , . r., ze.,-.r rakes: t� t,vtr s . ':"-.= 4 .4, iaktc Pump or irrigation circle 67.84 2 Business name:Portland Electric Sign or outline lighting 67.84 2 Address: 1915E 51h St.,Ste D Signal circuit(s)or limited-energy panel,alteration,or extension. El See Page 2 2 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(I hr min) 90.00/hr Email:paul@portlandelectric.biz Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: 194066 Electrical Lic.: C760 Suprv. Lic.:-.00.4:1/05 specifically listed('/hr min) 90.00/hr Clit., ELECTRICAL PERMIT FEES l�l Suprv.Electrician signature,required: ., 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: A, i - l,i,4...fix 414, TOTAL PERMIT FEE: ane. to :l 'tint name: MIS CHUK,SERG Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Pernuts\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB ,, 5, Plumbing Permit Application _ Building Fixtures h. RLIV EI - FOR OFFICE USE ONLY City of Tigard 2 f�1(] Received _ _t1!7 Permit No.. I 13125 SW Hall Blvd.,Tigard,OR 97223" � '� ` q y Date/By: �� 'f _ Phone: 503.718.2439 Fax: 503.59 Plan Review 3 Date/By: Other Permit No.: Inspection Line: 503.639.4175 TIGARD t /B kris:: 0 See Page 2 for Internet: www.tigard-or.govBUILDINGDIVISION Notified/Method:DateReadY Y Supplemental Information TYPE OF WORK 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 54 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: I t-t k.I.a 5 W tuct-,4 1- Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 T Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge I Lot no.: Cj Z Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 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(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: t TOTAL PERMIT FEE- Print name:Steve Fowler Date:04/08/2019 This permit application expires if a permit is not obtained within 180 days *Fee methodology set by Tri-County Building Industry Service Board. I:\Buildiug\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard II ~ COMMUNITY DEVELOPMENT DEPARTMENT ■ Building Permit Review — Residential TIGARD Building Permit #: k`(1STauQ -Wk,3` ) Site Address: 14. 1A1 'S',,d h Ave. Project Name: V,;ii A A 1,v4h1 r‘.-,Tie, Lot #: S 1 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Pro osal: id tui a\'kvik S . �.,1ii`j iiALL'A) les ,Ly4t Lid Verify address/suite# active in Accela. Win River Terrace: ❑ No Ld Yes,River Terrace Review Addendum Sit Plan Elements: _ rosion Control C113/copies of site plan on 8-1/2"x 11"or 11 x 17"paper aired trees with drip line and tree protection measures L'D wn to scale(standard architect or engineer scale) orth arrow �otprint of new structure(including decks) and FFE IJU ity locations&easements(required for new and additions) Sit address,project or subdivision name and lot number Sit approach plicant information(name and phone number) v' .cation of wells/septic systems t dimensions and building setback dimensions IM S eet tree size,type and location uare footage of buildings to be demolished elip `' sting structures on site Comer elevations(2'contours if more than 4'differential) Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es�❑-No impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑`�64:1No Clean Water Services—Service Provider Lettek(lot platted prior to 9/10/1995): r 1A,1 equired: ❑ Yes,applicant was notifiedyi CNo Received: ❑ Yes ❑ No �p J`>e Lq' Public Facilitie mprovement(PFI)Permit: /Required: Yes,applicant was notified ❑ No Ap lied For: Yes ❑ No,stop intake L�' and Use Case#: `r�,k l J 00i c Z eiZo�g: R-« -� U Front Q/ . Rear (J Side 0 Street Side $ Garage 3 It : 'equired Setbacks: :� L' uilding Height: Max. Height: i Actual Height: 2,1„75 FIE Landscape Area: 2.,0 % Lot Coverage Max: 20 % l p/� 'entrance El back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less V�✓1i Windows ❑ Minimum 12%of area of all street-facing facades TIlls 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. iii- 'C ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. El Garage door width is ❑ 12'or less El 50%or less of facade ❑ 60%or less and includes 7 of following: (s'r,�i i',,,, ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset 6,---k tt ❑ Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ■ Window trim ❑ Window recess ❑ Window projection ❑ Balcony ?. sual Clearance !!* Urban Forestry Plan Sensitive Lands: [ ' Yes ❑ No Type�� r,�p u 1� <�41_ 1. i Conditions met prior to issuance of building permit L N o s: ( ;,S` 6 t,,c11,\$.1- t- r tfr.-1r- t,,11).+,‘,9 p t i'- is1,../ t IApproved By Planning: A..,,,..4 GIL_ Date: 9111 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved 0 Not Approved I:\Building\Forms\BldgPermitRvw_RES_022819.docx Building Permit Submittal Original Submittal Date: D.\ i lCt Site Plans: # 3 Building Plans: # Building Permit#: Q Enter building permit#above. Workflow Routing: C"Planning [Y Engineering Q'Permit Coordinator 2/Building Workflow S' off: �- [3/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: 1._)\.),._, _ Date: 41. 11g Engineering Review 9 Slope at building pad: 5V / E Conditions "Met"prior to issuance of building permit Ei Easements (encroachments)per engineering conditions of approval and plat [✓'Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No 4 Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: e Approved by Engineering: Date: A ( L i. Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review 0 Conditions "Met"prior to issuance of building permit El 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: gSDC Fees Entered: Wash Co Trans Dev Tax: I, Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA Wes N/A 1 OK to Issue Permit Approved by Permit Coordinator: A61,\A60e`-(/k— Date: 9 12 - lt GI I:\Building\FormslBldgPermitRvw RES 022819.docx City of Tigard N COMMUNITY DEVELOPMENT DEPARTMENT 11111 1 r 1 c A R D River Terrace Building Permit Review Addendum Building Permit #: 'MST a;A- ,u?;?, Site Address: ILO SV M �� ,4'p . Project Name: Pelf.:,,. al- AAalc '��Le Lot #: S 2... (Ne welling=subdivision name;Addition or Alteration=last name of owner) Planning Review of River Terrace Plan Discrict Design Standards (18.640.070.1): Is the project subject to the plan district design standards? [ Yes El No 1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch min. 5 ft. deepBalcony w/ access 2 Window Projection Vertical Wall Offset a ft. dee min. 2ft., 5 ft.wide min. 2 ft., Eft/wide Gabled dormer �� ❑ lid' ' ❑ Yues on the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: 250,7 ' it'll/ _J i 3. Entrances:// At least one entrance must meet both of the folio g standards: w'Max. 8 ft. setback from longest street- facing wall u Parallel to street,angle no more than 45° from street, ^ or open onto porch Entrance opens to a porch: LiXYes El No If yds,all the following apply: ©7. sq.ft.min. One street facing entry Jit/5 ft.max. roof above floor of porch Lt1'5 ft. depth min. '30%o min.porch roof coverage . 4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades: El hovered porch min. 5 ft.wide x 5 ft. deep El Recessed entry area min. 5 ft.wide x 2 ft. deep l all offset min. 16 inches F/5 ElDo er min.4 ft.wide �'R oof eave min. 12 inch projection j/3 .loof offset min. of 2 ft. F/} ❑ of shingles either tile or wood 2'6-able,hip or gambrel roof design j�/ / L��Y ° 3 of pitch oriented south min. 500 sq. ft.3 Ei orizontal lap siding min. 3-7 inches wider [I Accent siding min. 40%of street facade F/3 El Window trim min.2 2/2"wide by 5/8" deep El Window recess min. 3 inches for all street facing �❑ B�y window min. 5 ft.wide by 2 ft. deep El Balcony min. 5 ft.wide x 3 ft. deep with inside access L-Attached garage is 35%or less of street facade j"/ 14A- r. Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: Lr No closer to front or side lot line,than longest street-facing wall. ❑ Yes El No. If No (Check one): 41 El May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. ��L ❑ 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 ai'le)' above the garage that faces the street with a min. area of 12 sq.ft. Width: (Check one) ❑ 12-foot-wide garage door El 40%max. of street facade �❑ 50%max. of street facade with 7 detailed design elements Notes: Approved By Planning: C4r1L- Date: 9-11-1i I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx Plumbing Permit Application Building Fixtures R ($ 1z I) ,�.. .. FOR OFFICE USE ONLY INCity of Tigard Received . '� 13125 S W Hall Blvd.,Tigard,OR 97223,U L 1 6 2019 Date/By: �� �� ��� Permit No - e \q Phone: 503.718.2439 Fax: 503.598.1960 Plan Review TIGARD Inspection Line: 503.639.4175 (�I1f .a t Date/By:Ready/By: OtheNo.: Internet: www.tigard-or.gov r Date Juris: See Page 2 for Bull nI'c }- sp4 Fl ' r Notified/Method g Supplemental information TYPE OF WORK e«a' " M ..,FEE*"SGHEDUI:E VY, .. ®New construction ❑Demolition For special information use checklist - ElAddition/alteration/replacement 0 Other: Description I Qty. I Ea. I Total \ New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORYi OF CONSTRUCTION ; t3),,,,,,,\7\,,-,:t....,.; SFR 1 312.70 O bath ❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ®Multi-family SFR.(3)bath 500,32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION tt Site utilities: Job site address: (.{i, \ t lOa-r� Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: CA�. J 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.: �� Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OP WORK "" Backwater valve 12.51 1NAO inn ► II to la ,�� ? 2, -()O`�)3 Clothes washerr25.02 ^"'� V /r u.���. ` Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY;OWNER°,-~� 1 ❑ 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 I 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 Phone: Solar units(potablevra } _ i 6154 ,_ 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:Alliance Plumbing Water heater 37.52 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: 44111iState surcharge(12%of permit fee) �' TOTAL PERMIT FEE ilra 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. is\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB) Electrical Permit Applicata „.,. , 'ti . FOR OFFICE USE ONLY City ofTigard Received `J g j' i ''6 Date/B : ��Y° � Permit#:'" 13125 SW Hall Blvd.,Tigard,OR 972231 wl, Plan Review Phone: 503.718.2439 Fax 503 598 1,9{p Date/B : Related Permit#: TIGARD Inspection Line: 503.639.4175 Ready Date/By: rte: El See Page 2 for Internet: www.tigard-or.gov ' t • Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW E New construction 0 Addition/alteration/replacement �_i •i Please check all that apply(submit 2`sets of plans w/items checked): �' 1, 0 Service or feeder 400 amps or more 0 Building bver three stories. 0 Demolition ❑Other: \` where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION _ S ). exceeds 10,000 amps at 150 volts or 0 Floating buildings. 1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural ® 0 0 Accesso, s. ginggri ultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump.P PInstallation of 1 0 KVA 0 5 or - JOB.STYE INFORMATION AND-LOCATION 0 Emergency system. larger separately derived f 4 0 p S A` � � 000HAddition of new motor load of system. Job#: Job site address: 1 1 Vv 10oHP or more. ❑"A","E","1-z^,"1-3^, City/State/ZrP:Tigard,OR 97224 f ❑Six or more residential units, occupancy. 0 Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal: Cross street/directions to job site: '‘..1::-.:.. FEE SCHEDULE ' `'' Description 1 Qty. I Each Total New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge I Lot#: 51 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential � y� Q 2 r� with above s..ft. 75.00 2 Z ' e,ST l_` ootJv Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 Z 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 I 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 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'Ibranch 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 C0 CT�It_, 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:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 199188 Electrical Lie.: c923 Suprv.Lie.: 4871/S , specifically listed(%i 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. • * Number of inspections allowed per permit.