Permit (22) ,� CITY OF TIGARD MASTER PERMIT
111
q>6 /q j
. ' COMMUNITY DEVELOPMENT Permit#: MST2019-00138
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S107AA05700
Jurisdiction: Tigard
Site address: 14203 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 57
Project: Polygon at Roshak Ridge, Lot 57
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
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'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 Geo Tech Required Prior To
VANCOUVER,WA 98660 VANCOUVER,WA 98660 Pour
2 NFPA 13D Sprinklers
Required
PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175
FAX:
Total Fees: $25,283.73
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to oUNC by calling 503.232.1987, or 1.800.332.2344.
Issued By: (9 V . �_ Permittee Signature: ey/tf �f✓ z.-l'C7 -7e, p..(
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard e COMMUNITY DEVELOPMENT DEPARTMENT
4
Transmittal Letter
T I G A�R D 13125 SW Hall Blvd.• Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: GIT/ of TIGARD DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: GAVIN 'T1'oMES SEP 2 3 2019
COMPANY: ALL I ANCE. PLvM$IMG CITY OF TIGARD
BUILDING DIVISIPN
PHONE: (5o3) 5i7-b535 By. .
RE: !42.03 5141 1b9TH AVE MST 2o11-oo13`a
(Site Address) (Permit Number)
Ro.WAK 1.-OT Si 102A \—.2)
(Project name or subdivision name and lot numbe
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: PROViovs PLANS iNEIeE -Too 1.U&117 -to R.E.4D
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes n No Fee Description: Amount Due:
$
$
Special
Instructions:
Reprint Permit(per PE): lal' es ❑No ;?:(
Don—'
Applicant Notified:7"DAr bate: 9'/ 7;/'
- r Initials.-Isar
I:\Building\Fonns\TransmittalLetter-Revisions.doc 05/25/2012
,l�� ,0
Plumbing Permit Application
Building Fixtures RECEIVE I FOR OFFICE USE ONLY
City of Tigard Received
• - Date/By: Permit No.: MST2019-00138
III
13125 SW Hall Blvd.,Tigard,OR 97223
AUG292019 y. �11� 5
Plan Reviews
Phone: 503.718.2439 Fax: 503.598.1960CITY OF TIGARD DateBy: 9"�'•G_1 S 4GGa Other Permit No.:
Inspection Line: 503.639.4175 �C �
TIGARD BUILDING DIVISION Date Ready/By: ..y...),..7/2,/f' °y yluris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OWRf• � * 1IJ
,. ,.
®New construction 0 DemolitionFor special inrormation use checklst
Description I Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA. 'EGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(1385 sq.ft.) Page 2
ati _ 'OR N ANDLOCATION Site utilities:
Job site address: 14203 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.: `v 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 l Lot no.:57 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
,�6 ,...�,:• : ' ' �•�
- Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ri PROP RT NER " j ❑ TENANT` _ V 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
- Its, APPLICANT 0 CONTACT I`RI ` S 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
• Water closet 25.02
'CONTRACT**;,',-',
,..• - Water heater 37.52
Business name:Alliance Plumbing,LLC Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184601 Plumbing Lic.no.:PB732
^-�/!�/ - State surcharge(12%of permit fee)
>
Authorized signature: , � 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.
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 UtilitiesQ Fee(ea) Total Square t :Y s t o 'Nett
Footing drain-I'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to S5,000.00 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
OtherIns Inspections or Fees Qty. ' Fee(ea) Total each additional$100.00 or fraction thereof,to
hand 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 rub/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.
-4"
Car Wash DrainIsometric 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 *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
https://allianceplumbing-my.sharepoint.com/personal/gavin_allianceplumt2ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp
(3).doc
CITY OF TIGARD MASTER PERMIT
11_0
COMMUNITY DEVELOPMENT Permit#: MST2019-00138
TE GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S107AA05700
Jurisdiction: Tigard
Site address: 14203 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 57
Project: Polygon at Roshak Ridge, Lot 57
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'l 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 Geo Tech Required Prior To
VANCOUVER,WA 98660 VANCOUVER,WA 98660 Pour
2 NFPA 13D Sprinklers
Required
PHONE: 360-695-7700 PHONE: 360-695-7700 3 Ersn Cntrl 503-639-4175
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: J '�
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.
, , . ..
, ig
Building Application A lication u L,b, `
7--_ -__.)----4-
Residential FOR OFFICE USE ONLY
Cl of Tigard
RECEIVE , Received
13125SW Hall Blvd.,Tigard,OR 97223 Date/By: �j �{ �\1 Permit No.MSk ,_
FEB 0 7 Plan Review ^^ .�,��
Phone: 503.718.2439 Far. 503.598.1960 2 9 Date/By: d Other PermirJF - `i
TIGARD Inspection Line: 503.639.4175 Date Ready/By: //'vi ` - Inns See Page 2 for
CITY OF TIGARD NotifiedJMethod:�J 7 � � �'" Supplementallnformation
Internet: www.tigard-or.gov BUILDING DIVISION
Z_----7'7, -/e_-. l'i'e yGQ/I
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: $ �9 � NO
( `
EDAccessory building ❑Multi-family Number of bedrooms: 'Z
❑Master builder El Other:
Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: t,C1 l (
Job site address: 1 I/1/05 C I l0 q fiil - New dwelling area: 13 1 square feet 651.
City/State/ZIP:Tigard,OR 97224 Garage/carport area: t Z square feet 61 p
Suite/bldg./apt.no.: I 00 Project name:Polygon at Roshak Ridge Covered porch area: square feet $Q
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
IST
Subdivision:Polygon at Roshak Ridge Lot no.: Si Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK J work indicated on this application.
New SF/t Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name:Polygon WLH LLC Type of construction:
�
0 Address:703 Broadway Street Ste 510 Occupancy groups:
d
lt City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 '
New:
igi APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Polygon WEB LLC (Please refer ofeeschedule)
Structural plan review fee(or deposit):
iii
Contact name:Amanda Gavin
FLS plan review fee(if applicable):
Address:703 Broadway St.Ste 510
City/State/ZIP:Vancouver WA 98660
Total fees due upon application:
Amount received:
Phone:(360)695-7700 Fax::(360)693-4442
E-mail:permitsubmittals@polygonhomes.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
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver W• 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247
Total fee due upon application: $201.60
Authorized Si Ur+ -1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Am da Gavin Date: ?-)/ lY j n / ( *Fee methodology set by Tri-County Building Industry
l Service Board.
I:ABuildingAPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit A hca , (` j VE FOR OFFICE USE ONLY
Cityof Tigard APR 2 1� Received PermitNo.fli O ( Z
'I 13125 SW Hall Blvd.,Tigard,OR 97223 !➢ 1.019 Date/By: �'r.,% qi "—cc 1 g
Plan Review iew
Phone: 503.718.2439 Fax: 503.598.1960 s".* Date/By;
Other Permit:
Inspection Line: 503.639.4175 CITY f ' t.,l,a1k-,t.? Date Ready/By:Y re: hIj
Suds H See Page 2 for
Internet: www.tigard-or.gov 8UILDING Drolslo.t,,, Notified/Method: Supplemental Information
TYPE OF,WORK , " COMMERCIAL FEE SCHEDULE "LYSE CHECKLIST"
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES*
.® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
i Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
[1
1'"l2 b3 S W U L9 -,-0 Airconditioning
1ti46.75
Job site address: �(�/ 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.: 5-i 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 J.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
ISI 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
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace
Range
E-mail:permitsubmittals®polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104 Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
s ., a 1 days after it has been accepted as complete.
Authorized signature: (�W * Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/O2/COM/WEB)
Electrical Permit Ap licatioEr FOR OFFICE USE ONLY
'" Received
City of Tigard "' '�° DateBy: Pennit#i S.r-! : 1 __c c, ,,....3p
13125 SW Hall Blvd.,Tigard,OR 97223 ., s� Plan Review
l . . Phone: 503.718.2439 Fax: 503.598.196(1' 4, 0 1.0 1 DateBy: Related Permit#:
Inspection Line: 503.639.4175 rs` Ready Date/By: Juris: H See Page 2 for
.L ILiAL1..La Internet: www.tigard-or.gov CITY Or i I �'.."'t") Notified/Method: 1 Supplemental Information
TXP)?,OIt€44t6PNG DIVISION PI AN R VIEW
®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 ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 14203 5U.) l Lockm-1 441/6 100HP or more. ❑"A","E "I-2","1-3",
City/State/ZIP:Tigard,OR 97224 El Six or more residential units. occupancy.
❑Health-care facilities. ❑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 Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: 6 7 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy181 ❑ See Page 2
PROPERTY OWNERTEAIANT` Services or feeders installation,alteration,and/or relocation
Name:Polygon WLH,LLC 200 amps or less 100.70 2
Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
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,
7.42 2
each branch circuit
Contact name:Jolene Smith B.Fee for branch circuits without
sAddress: 703 BroadwaySt,Ste.510 brancheaice or feeder fee,first 56.18 2
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
Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder
Reconnect only 67.84 2
r.'-. • t!',vF, oft€. k.. .e.
--;:i5^k^�� 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 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(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 90.00/hr
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.:....0g431,05
specifically listed(4 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Q x A n��,� Subtotal:
Print name: Alex Shalya Date: 04`/08/2019 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: "A it-Lj (j 4_, TOTAL PERMIT FEE:
, This permii mpplicatioe cxpirce if at permit m not obinim:d within 180
Print name: MISHCHUK,SERGY 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
Plumbing Permit Applic.tjriiir y \
dam., L.
Building Fixtures FOR OFFICE USE ONLY
��lR ") j01g Received
City of Tigard Permit No.:
- .. 13125 SW Hall Blvd.,Tigard,O� F F �+ i,L; Date/By: /7 S"� Z c (J-fJ C+ �
2�t� t�'
.2439 Fax:
� ,l t Plan Review
Inspection Line: 503.639.4175 j U (-)0.4 0 fN 1 t el` ;A'( Date/By: Other Permit No.:
T I GARD Internet: www.ti and-or. ov Date Ready/By: Juris: H See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description I 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
igr 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: 1,44 Zo',> Sw (lo c.,TN 14-1/6 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
Stonn sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Roshak Ridge I Lot no.:6-7
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Waterg/
Pip 1 in DWV 56.29
Address:P.O.Box 92 Other: 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:184372 Plumbing Lic.no.:pb634
__ State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Steve Fowler Date:04/08/2019 This permit application expires if a permit is not obtained within 180 days
after it has bees aeeepMi as eompiete.
*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)
ih itt
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
-ri GRD
A Building Permit Review — Residential
Building Permit #: —r 1Q- �. ,. .. . ,
,21
Site Address: ILLI 2.03 Si„/ I obit Av. ..
Project Name: P,:(,-, Lot #: 5
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review ii
Proposal: P4ty y 1,\ j l.usiAttN kits j 1)W L —1 A-k Ct"
Lid'Verify site address/suite#exists and active in permit ystem.
[River Terrace Neighborhood: 0 No LSI Yes,See River Ten-ace Review Addendum Attached
Sit lan Elements:
gplree(3)copies of site plan
sting structures on site
e plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished
awn to scale(standard architect or engineer scale) fl or elevations
rth arrow tility locations&easements(required for new and additions)
ite address,project or subdivision name and lot number Sidewalk/driveway approach
plicant information(name and phone number) jWI • ation of wells/septic systems
arLot dimensions and building setback dimensions E+
xisting trees to be retained with drip line,and tree
‘r!.quare footage of buildings to be demolished
tection measures
16 Lot area,building coverage area,percentage of coverage and
•,s pervious area(applicable if R-7,R-12,R-25&R-40) eet tree size,type and location
Street names �
1E 'roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [ Yes ❑No
4Joot differential) If yes,is a storm water duality facility shown? ❑ No
Clean Water Services—Service Provider Letttte of platted prior to 9/10/1995):
)equired: 0 Yes,applicant was notified [ No Received: 111' `� rij�1
Public Facilities provement(PFI)Permit: ❑ Yes 0 No
LctN,A .l}t.
Required: Yes,applicant was notified 0 No Applied For: ,�
Yes 0 No,stop intake
[-�'J LTJ
d Use Case#: POU-01S- 0000 L
"�oning: K- (no)
g. Required Setbacks: From 1I Rear ( Side
0 Street Side VA Garage '
. dscape Requirement 2- %
II Lot Coverage Maximum: (3 0 %
tPli :uilding Height: Maximum Height
V � Actual Height(,
'sual Clearance EK-No I� nsitive Lands: 0 Yes L�" No
Type
Urban Forestry Plan
Conditions "Met"prior o issuance of building permit
otes: Ai 1 � II�
1 4 YhcT ;pr�jr- 46,,,litl inn f tr;wt 4 :(
lid Approved By Planning: LDa • -
Date: �-( 1I q
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: a l-4-1 iCt
Site Plans: #
Building Plans: liEnter
Building Permit#: building�peermit#above.
M
/Engineering 1 Permit Coordinator a-Building
Workflow Routing: g Planning gm g
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.
['Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
. Date: 4k,�` ABy Permit Technician: \ 1-J ., _.�
Engineering Review
..21-lope at building pad: S/7
0
Conditions"Met"prior to issuance of building permit
[Easements (encroachments)per engineering conditions of approval and plat
[Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes ,0'No
Assess Water Quantity Fee in-lieu: 0 Yes ,B'No
LIDA Facility on lot: 0 Yes j21--No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering:
Date:
Notes:
4—
B—Aroved Engineering: Date: 17 1
PP b Y
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
JK-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: 0 Yes 0 N/A
Tigard Trans SDC: Yes 0 N/A
Parks SDC: c --Yes 0 N/A
LIDA 0 Yes cg:,N/A
4 OK to Issue Permit
Approved by Permit Coordinator: i/1/1--
Date: y 12-21n
I:\Building\Forms\BldgPermitRvw_RES 010118.docx
Y .
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A aD River Terrace Building Permit Review Addendum
Building Permit #: MST?i•O - (-,V)J
Site Address: (y7,tj3 S'w ((y`"l " Ave.
Project Name: One, ds�,,I._ c Je Lot #: 15.7
(New dwelling=subdivision name;A dition or Alteration=last name of owner)
Planning Review of River Terrace Plan Distfict Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? 121 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.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch min. 5 ft. deep Gabled dormer
ft. deep min. 2ft.,5 ft.wide min. 2 ft., 6ft.wide
❑ ❑ ❑
0 Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: ZS 0 ) 2:tii It 17
3. E trances:At least one entrance must meet both of the folio ing standards:
Ld Max. 8 ft. setback from longest street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: "Yes ❑ No
Iffy yes,all the following apply: E.65--sq.ft.min.
ne street facing entry V11 ft. max. roof above floor of porch
EI 5 ft. depth min. 30%min.porch roof coverage
4.Detailed Design:All buildings shall include a min. of five of Sae following elements on all street-facing facades:
Covered porch min. 5 ft.wide x 5 ft. deep F M/1.ecessed entry area min. 5 ft.wide x 2 ft. deeps
❑ all offset min. 16 inches L1VDormer min. 4 ft.wide S
LJ Roof eave min. 12 inch projection,Fi 3 E�, ':oof offset min. of 2 ft.
❑ Roof shingles either tile or wood 'R�able,hip or gambrel roof design,Fi.
�;S n
oof pitch oriented south min. 500 sq. ft. Horizontal lap siding min. 3-7 inches wide 3 S
Accent siding min. 40%of street facadee-c 3 ❑ Window trim min. 2'/2'wide by 5/8"deep
LI Window recess min. 3 inches for all street facing ❑ ay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access LJ Attached garage is 35%or less of street facade 3
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 2 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.
aMay 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)
12-foot-wide garage door ❑ 40%max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes: )? nL/-J
ApprovedBy Planning: . Lk Date: `H HI
I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx
Plumbing Permit Application
Building Fixtures t E a 'r ¢ : FOR OFFICE USE ONLY
City of Tigard Received
U I i g 4Permit No - �_ �
'I 13125 SW Hall Blvd.,Tigard,OR 97223.�U t 201",. Date/By:e�,>ry,�G S\� iV C
Phone: 503.718.2439 Fax: 503.5984940, Plan Review J
), Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 ( I 1 r ! , ,x Date Read/B
Internet: www.ti and-or. ov t i ,-- Ready/By: Juris: El See Page 2 for
g g 1i,,-OP\1( ! ll\i,C Notified/Method: Supplemental Infnrmahon
TYPE OF WORK Irl FEF,* CiiED[J,L4
®New constructionx For special information use checklist.
0 Demolition t; p f
f,_0-' Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: v \LA New 1-2-family dwellings(includes 100 ft.for each utilityconnection)
CATEGORY,OF CONSTRI;JCTION ` „ SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building ®Multi-family SFR(3)bath 500.32
El 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: k- jo-3 it -rvi Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: \C) I Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
��Subdivision:Roshak Ridge Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer
�� f.Q�keke Z bv\ "-c 201 �,- 00135 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY.OWNER 1 , 0 TEr'4ANT 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 ❑ CONT ACT 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 unts4lQtable water) 42.54:
r I ____ ___
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittais@polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing
Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date: This permit application expires if a permit Is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board,
1:\Building\Permits\PLMU-PemitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Electrical Permit Application i ,`: ' - FOR OFFICE USE ONLY
City of Tigard Received -�"
IN '� 13125 SW Hall Blvd.,Tigard,OR 972231�- i._ cl. , ':'�I Date/BB : T k kc(S — Permit#:uk _ t
PlaReview
Phone: 503.718.2439 Fax: 503.598.1960Related Permit#:
Date/B
TIGARD' Inspection Line: 503.639.4175 Y ` Ready Date/By: kris: 10 See Page 2 for
a Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW,'
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition - 0 Other: \01/4S 11❑Service'or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION " exceeds 10,000 amps at 150 volts or 0 Floating buildings.
E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: Firepump. •
,. . .. _ _ Installation of 1 0 KVA
❑ 5 or
JOB.SITE INFORMATION AND;LOCATION • ' ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: . " I Job site address: 1 5l J hoc,-l4 , 100HP or more. ❑"A","E "1-2 "1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
1
0 Health-care facilities. ❑'Recreational vehicle parks.
Suite/bldg./apt.#: -I 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: .;v - FEE SCHEDULE:.
Description I QtY. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge I Lot#: 5 7 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
&(1111 ST t 41_O u'2 7 75.00 2
l 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 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
_, IBranch circuits-.new,alteration,or extension,
., ®-APPLICANT" . per
D CONTACT.PERSONpanel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
each branch circuit 7.42 2
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'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 I 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
.,• -- s ,_,CQNTRACTOB _ - - -- , p
- - or4nigation tittle 67.84- 2 '
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(I 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.: 487V5 , specifically listed(14 hr min)
ELECTRICAL PERMIT' FEES `i'.
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: (/sr`,.. TOTAL PERMIT PJ;E:
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.