Permit (32) 71,7
rrio
CITY OF TIGARD14-?/?t057� �`Yg , MASTER PERMIT
1 .'1 ' COMMUNITY DEVELOPMENT ,�, Permit#: MST2019 00142
T!GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S 107AA06100
Jurisdiction: Tigard
Site address: 14225 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 61
Project: Polygon at Roshak Ridge, Lot 61
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: 25 Bathrooms: 3 Second: 634 sf Garage: 532 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors:
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'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
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 NFPA 13D Sprinklers
VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required
2 Geo Tech Report Required
Prior To Pour
PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175
FAX:
Total Fees: $25,116.23
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 OAR,952-001-0090. You may obtain a copy of the rules or direct questions to OU NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 7 Permittee Signature: OfJ ,,C"l r",r¢—!7e1 4
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.
NCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
i► _ " Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: GITy OF TI6AR ..— Pc•‘ DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
SEP 23 2019
FROM: C-7AVIN THOMES
CITY OF TIGARD
COMPANY: ALWANGE PLUMBItE' BUILDING DIVISION
PHONE: (So3) 5'1'1-1053 5 By: Syc
RE: 142.15 St.) I091H AVE MS72019- Oo1y Z
(Site Address) (Permit Number)
ROS%- t . t_oT lot ,1.-►k).,,o(\ "Ib
(Project name or subdivision name and lot numbe
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: PREvIo0S PLANS WERE Toa 1._16k4T '10 RE4.b
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑No Fee Description: Amount Due:
$ /3c, , S3
$
$
$
Special
Instructions:
Reprint Permit(per PE): ,*={es ❑No r 1+ufl, -
Applicant Notified: f0,cip9— Date: 9/2-7/t 9 niti.:41,7
I:\Building\Fonns\TransmittalLetter-Revisions.doc 05/25/2012
"'" . A L:05-1c'Cs, kC.
Plumbing Permit Application
Building Fixtures RECEIVE - FOR OFFICE USE ONLY
City of Tigard Date/Bed � '‘CA ����
- Permit No.: MST20I9-00142
ligw 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 9 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Q" 2(-/4 A-e_is, Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARC Date Ready/By: Juris: EI See Page 2 for
Internet: www.tigard-or.gov BL1tt,nING njvisir.j ottfied/Method:/ `�''/ c Supplemental Information
®New construction ❑Demolition 7t if, For special information use checklist
Description Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA �O r4H Co !_ ION ', 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(1385 sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATIONSite utilities:
Job site address:14225 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.: t,O 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.:61 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
r EI I OF
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® 1'ROP * 1:":OWNER TENANT ', Expansion 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
'''''Wrafoliittirorr 0 CONTACT PERSON 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
,,v Water closet 25.02
CQ'NSI" RACTOR
... '- --,,-i 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: t 7�! .1 TOTAL PERMIT FEE
Print name:Gavin Thomes Date:8.27.2019 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(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 Square Footage: Permit Fee•
Footing drain-1s'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 Fees
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional I00" 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 PlumbingInstallations
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 0 Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator 0 New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ® Any multipurpose fire sprinkler system.
Eye Wash ❑ 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 DiagrtiniA,
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
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_alliancepluml ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF PermitApp
(3).doc
101 iv CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019-00142
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S107AA06100
Jurisdiction: Tigard
Site address: 14225 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 61
Project: Polygon at Roshak Ridge, Lot 61
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: 25 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'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 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 NFPA 13D Sprinklers
VANCOUVER,WA 98660 VANCOUVER,WA 98660 Required
2 Geo Tech Report Required
Prior To Pour
PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175
FAX:
Total Fees: $24,979.70
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.fYou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ({�
Issued By: 1 ` Permittee Signature: �Uk�— s "
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 ApplicationA-Nk '\(.- \O t:0---\--- U
Residential RECEIVED FOR OFFICE USE ONLY
- City of Tigard Received
Illill • 13125 SW Hall Blvd.,Tigard,OR 97223FEB 0 7 2019 Plan Re l � S Nr Permit No.mc \ �,_('�at+ i
Plan Review(i t w `-Y
Phone: 503.718.2439 Far: 503.598.1960 y ` �/ Other Permitr '�.r. C
DateB -1 � �V �'�,
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy: '�,/ lues !3 See Page�forr �� �
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 47//? SCA/ i Supplemental Information
(<,1,9/l- eot rcod
TYPE OF WORK REQUIREt DATA:1-AND 2-FAMILY DWELLING i
®New construction ❑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/industrialValuation: $ 1 I f 3(Q(,f
El Accessory building ❑Multi-family Number of bedrooms: �J� t
❑Master builder 0 Other: Number of bathrooms: 97
JOB SITE INFORMATION AND LOCATION Total number of floors: tAP
Job site address: 1 (--i 7,-u-, 5l/1 , 1 (p 4/j � In ) New dwelling area: �(L square feet )o3(4
City/State/ZIP:Tigard,OR 97224 V V ` 1 I lig/ ► r/ Garage/carport area: "L square feet 4'7b
Suite/bldg./apt.no.: )-0 Project name:Polygon at Roshak Ridge Covered porch area: square feet t;. 0
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COM MIERCIA.L-USE CHECKLIST
Subdivision:Polygon at Roshak Ridge Lot no.: O I 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 SFR Valuation: $
Existing building area: square feet
New building area: square feet
0 ® PROPERTY OWNER ' 0 TENANT Number of stories:
r Name:Polygon WLH LLC Type of construction:
( - Address:703 Broadway Street Ste 510 Occupancy groups:
ti City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442
New:
Ei APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WLH LLC (Please rgjermfee scliedule
Or, Contact name:Amanda Gavin
Structural plan review fee(or deposit):
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
PHOTOVOLTAIC SOL RPANELL 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 Iic.:207247
Total fee due upon application: $201.60
Authorized si• � - This permit application expires if a permit is not obtained
.. within 180 days after it has been accepted as complete.
' Date: ,r�t
*Pee metllo a w—t by Tn-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
.1 '
• Mechanical Permit Applicat'i:., ; E FOR OFFICE USE ONLY
City of Tigard i Date/?Mk* ReceivBed
Permit No. fr /? // 0
Y —COV
I 14_ 'I 13125 SW Ha11 Blvd.,Tigard,OR 97223 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 rA r K .4 '� Date/By: Other Permit:
F 1-1.;.A.1.17
Inspection Line: 503.639.4175 lur
fi+ Date ReadyBy: e E l See Page 2 for
Internet: www.tigard-or.gov ���� ,,,�� �I�^�ANohfied/Method. � Supplemental Information
BUILDING D MSl l
TYPE Ol+ W FEE*SCHE —
ORK
M11IER
Cfl G7AL I)ULE` [TSE CHECKLIST'; .
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS.FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
1 3 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION`AND LOCATION. Heating/cooling,:
Air conditioning 46.75
Job site address: \l `2:2,6 (SW ltoc\-rvi -(,,E 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.: (p 1 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
® 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
Ei APPLICANT 0.CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH,LLC
$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 FFFS*
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 lit.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
�• _ b days after it has been accepted as complete.
Authorized signature: (�('L� * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
I:'Building\Permits\ME.C_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
T
)
• Electrical Permit AppliefeltilF NED FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit#: /f^.<7V,
/9 Q 0/LIC -
•••U13125 SW Hall Blvd.,Tigard,O\®7p22 �o
t'-019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
1,3 "
Inspection Line: 503.639.4 V l,I .:1 ..-;ARD.- Ready Date/By: Juris: H See Pa
'L 11�,�.L_13 Internet: www.tigard-or. 1 s i/ Notified Method: Supplemental Information
I Page 2 for
i l L wt
@ c41
T 'PL'�'. .1F.WORK ', PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current
0 Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
E 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB_SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
f��15 �. J n 0 Addition of new motor load of system.
Job#: Job site address: "1 100HP or more.
City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. I...__ Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: 61 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 75.00 2
residential(with above sq.ft.)
0ISI TENANT 2
PROPERTY OWNERServRenewableices or feedersEnergy installation,alteration❑ SeePage,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 ) ❑ 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 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular
Email:permitsubmittals@polygonhomes.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
.;: : i.> -rz :i-A : =L .v: M. , ,, in 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. ❑ 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(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 Lie.: C760 Suprv.Lic.: 23'4,05, specifically listed(/Z hr min) 90.00/hr
/� C� ELECTRICAL PERMIT FEES
l�l.
Suprv.Electrician signature,required: t, 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: x MLLa�i,e_i a .& TOTAL PERMIT FEE:
Print name: MISHCHUK,SERGeyJi�
Date: 04/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
r
Plumbing Permit Applicatic C ., . L.
Building Fixtures APR 2+.) 2.019 FOR OFFICE USE ONLY
City of Tigard Received
IN
- ) Date/By: Permit No.:M_c tv '?
13125 SW Hall Blvd.,Tigard,OR 970 T Y I._ MAN,
;R,� y' ! y C
�- g{i€i9ry Plan Review
Phone: 503.718.2439 Fax: 503. y i t4 t t.,1 !.1't ev Date/By: Other Permit No.:
Inspection Line: 503.639.4175 4
TIGARD Internet: www.tigard-or.gov Date Ready/By: Jugs: El See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 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
,tg 1-and 2-family dwellingSFR(2)bath 437.78
0 Commercial/industrial
0 Accessory building Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,L{ 1:1E S (lock-1-4 kA/5 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.: k_01 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:perinitsubmittais@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 a permit is not obtained within 180 days
Mier it hs,bees ec..opted an evstp1
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMtJ-PeimitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
in
III COMMUNITY DEVELOPMENT DEPARTMENT
g
T G D Building Permit Review — Residential
Building Permit #: MT ,1q_ 11
Site Address: I112S Sw 161k *t
Project Name: Pc I y n tA R0,kok \;iQ Lot #: 6
(New welling=subdivision name,Addition or Alteration=last name of owner)
Planning Review
Proposal: Iti.J e,\'-�tLd S f
E_ Verify address/suite#active in Accela. UY In River Terrace: ❑ No 2/Yes,River Terrace Review Addendum
Si Plan Elements: E osion Control
opies of site plan on 8-1/2"x 11"or 11 x 17"paper
3 g [ tamed trees with drip line and tree protection measures
awn to scale(standard architect or engineer scale) [Qotprint of new structure(including decks)and FEEAi Ii
e rth arrow 'ty locations&easements(required for new and additions)
. address,project or subdivision name and lot number L�1Stdewalk/driveway approach
LAG .plicant information(name and phone number) Ankocation of wells/septic systems
IS •t dimensions and building setback dimensions Ergyeet tree size,type and location
u"•uare footage of buildings to be demolished [ et names
L'7dsting structures on site Romer elevations(2'contours if more than 4'differential),,_,,re/
INIt area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? L!d'Yes ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? 0 tiikNo
LV' Clean Water Services-Service Provider Letter of platted prior to 9/10/1995): L5 a__n ,,,ARequired: ❑ Yes,applicant was notified [V No Received: ❑ Yes ❑ No4 44
' �f
Lid'Public Facilittie-Improvement(PFI)Permit: IA
equired: [ Yes,applicant was notified ❑ No Applied For: 5-1.Yes ❑ No,stop intake
Li and Use Case#: PDk24iS-00002_ 112/Zoning:Zoning: - 2- FP)
equired Setbacks: Front: ivRear: 0 Side: 0 Street Side: Garage: ..
Di Building Height: Max.Height: V Actual Height: Z,L1
12"-Landscape Area: 2) % Lot Coverage Max: g0
' Entrance ❑ 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
kr 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.
Irate • Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
O Fire shingles ❑ Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof 0 Dormer
•.-� ❑ Accent siding �] Window trim ❑ Window recess ❑ Window projection ❑ Balcony
isual Clearance ®/Urban Forestry P an
6 Sensitive Lands: ❑ Yes V No Type:
Conditions met prior to issuance of buildingi$ermit
les: G�411-1 p'If ,r, r- 'IA11J. ritml- i31v Ct.
Approved By Planning: C. Date: LI`11'11
Revisions (after Building Submittal only) 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: \�4�q
Site Plans: # T
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: 11/Planning R'Engineering IR/Permit Coordinator CY Building
Workflow Sign-off: Er 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.
[3 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ?� ` � Date: 11s I n
Engineering Review
Slope at building pad:
Conditions "Met"prior to issuance of building permit
ErEasements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes XI No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes �No
,2r Final Plat Recorded:
CI NOT � l
NOT Approved by Engineering: Date:
Notes:
,Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
l�. 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: Yes 0 N/A
Tigard Trans SDC: [e Yes 0 N/A
Parks SDC: L Yes ❑ N/A
LIDA 0 Yes .1 N/A
131.OK to Issue Permit
Approved by Permit Coordinator: Aarv.0 Date: (-11(3a 19
I:\Building\Forms\BldgPermitRvw_RES 022819.docx
I al
City of Tigard
74 COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D River Terrace Building Permit Review Addendum
Building Permit #: 'MSS a oAq- vOl a.
Site Address: 'NUS Sk\1 1616 Avt-
Project Name: Polyp^ ett. R.aik�ak YZ ��P Lot #: 6'1
(New'd(velling =subdivision name,Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan DisOct Design Standards (18.640.070.1):
Is the project subject to the plan district design standards? IV Yes ❑ 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 t. deep Balcony w/access 2 Window Projection Vertical Wall Offset a Gabled dormer
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide T/
IDElCIai
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: ZS0/ . 1 '.'1 Y
3. Entrances:At least one entrance must meet both of the folio ' g standards:
Pi Parallel to street,angle no more than 45° from street,
Max.l8 ft. setback from longest street- facing wall
or open onto porch
Entrance opens to a porch: LIYes Cl No /
ITLf y�,all the following apply: sq.ft.min.
� e street facing entry L+1 1 ft.max. roof above floor of porch
F_ZL'5 ft. depth min. 30%min. porch roof coverage
4. Detailed Design:All buildings shall include a min. of five of tlye following elements on all street-facing facades:
FE,Covered porch min. 5 ft.wide x 5 ft. deep F. g/Recessed entry area min. 5 ft.wide x 2 ft. deep F
El "11 offset min. 16 inches 4ormer min. 4 ft.wide S
oof eave min. 12 inch projection FSS E Roof offset min. of 2 ft.S
❑ Roof shingles either tile or wood I14/6-able,hip or gambrel roof design F)S
CIRoof pitch oriented south min. 500 sq. ft. L2' orizontal lap siding min. 3-7 inches wideS
Iccent siding min.40%of street facade F ❑ Window trim min. 2 1/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access El Attached garage is 35%or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
No closer to front or side lot line,than longest street-facing wall. ❑ Yes Lid No. If No (Check one):
❑ IV�ay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
A
ay extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
With: (Check one)
Ltd'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: Date. 1-(1-1 I
I:\Building\Fortes\BldgPermitRvw_RES_RT_121417.docx
tion -,
Plumbing Permit Application a
- i -,Li1„ter ',
Building Fixtures x , FOR OFFICE USE ONLY
14 City of Tigard 1 8 •1 n q Received I, i hi
III 13125 S W Hall Blvd.,Tigard,OR 9723 ;_)019 Date/By: \r Permit No. +j�: r(`,_ �`y
Phone: 503.718.2439 Fax: 50 5 60 Plan Review J ``31
��?P �,az DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639 417$., t
Internet: www.tigard-or.gov "31.34:,S) !q!,,,, ,r Date Ready/By: Juris: I E! SeePage2for
Notified/Method: Supplemental Information
cll1 TYPE OF WORK �*
'' FEE* i. liiii m 4'
gi New construction 0 Demolition -
For special information use checklist
11:1Addrtian/alteration/replacement 0 OtherDescription I Qty. l Ea. Total
��,' r _ New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF.`CONSTRUCTION , r SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: It 142„ J ( , 1 TH r1_ _ Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 �L�l Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: `O I Project name:Roshak Ridge Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision:Roshak Ridge I Lot no.: Water service(no.linear ft.: ) Page 2
�� Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
� �� ����DESCRIPTION OF WORK: Backwater valve 12.51
OlAO%JA 2 J�CJli t, 'tY\..
v moi? ,�1�y,_ ()()/112.-
4'�� Clothes washer 25.02
,1 �`'� ` "� (� Dishwasher 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
-� PROPERTY OWNER (
0 TENANT . , Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660
Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker
12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$ ) 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(notable watery -- _
Phone:
(360)69S-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals rr polygonhomes.com Urinal 25.02
CONTRACTOR', Water closet 25.02
Business name:Alliance Plumbing Water heater 37.52
56.29
25.02
Address: 146 W Historic Columbia River Hwy Other:
City/State/ZIP:Troutdale,OR 97060 Water piping/DWV
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:
State surcharge(12%of permit fee)
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.
I:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/wEB)
Electrical Permit Applicata r.T. _ ' `'.: , ti FOR OFFICE USE ONLY
City of TigardPlan Review
Received � � �� �
IBRIM
't 13125 SW Hall Blvd.,Tigard,OR 97223't' Date/B : -9-k ,AS T
C
Phone: 503.718.2439 Fax: 503.59&)96011114
Date/B : Related Permit#:
TIGARD Inspection Line: 503.639.4175 Ready Date/By: Juris: El See Page 2 for
v Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK -
- PLAN REVIEW _
El New construction 0 Addition/alteration/replacement - srPlease check all that apply(submit 2 sets of plans w/items checked):
"°511' 0 amps Building bstories.
0 Demolition - 0 Other: C whereService theor availablefeeder fault400 currentormore ❑M❑ arinas andeer boathreetyards.
CATEGORY OF CONSTRUCTION -\t ;..' exceeds 10,000 amps at 150 volts or CI Floating buildings.
1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
® 0 0 Accesng
amps for all other installations.
0 Multi-family 1:Master Master builder 0 Other: tngs.
Fire pump. El of 150 KVA or
. JOB .SITE INFORMATION AND LOCATION ' ` 0 Emergency system. larger separately derived
14 l .J 6 W 't . ❑Addition of new motor load of system.
Job#: Job site address: 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. DRecreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: (p ( Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK
�C r Limited energy,residential 75.00 2
C•.)ki\f",U9_. VeACktirSQ., 1 `
1 v i SO(a—6011-
{ V Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: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- ` - Branch circuits-new,alteration,or extension,per panel
0 CONTACT.PERSON
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact
name:Nichole Thorpe B.Fee for branch circuits without
Address:703 Broadway St Suite 510 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ermitsubmittals@P Yg of onhomes.com
P
Reconnect only 67.84 2
L _.-CONTR 'z'QR- __:___ -- - —
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 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871/S , specifically listed('s hr min)
ELECTRICAL PERMIT.FEES _
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee)i
Authorized signature: ir 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.