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Permit CITY OF TIGARD MASTER PERMIT V Permit#: MST2019-00208 IN 111.:'. COMMUNITY DEVELOPMENT '� ` 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ,. �' .<\.>•\( Date Issued: 07/01/2019 T jA CA ' Parcel: 2S107AA11600 Jurisdiction: Tigard Site address: 14218 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 116 Project: Polygon at Roshak Ridge, Lot 116 Project Description: New SFA. 9/9/19: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks _ Required Stories: 3 Bedrooms: 2 First: 646 sf Basement: 101 Sf Left: 0 Parking Spaces: 0 Height: 37 Bathrooms: 3 Second: 633 Sf Garage: 547 sf Front: 8 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1380 sf Value: $194,005.20 Rear: 5 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 Rain0 Storm Sewer: 100 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Fire sprinkler system MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn>=100K: 0 • ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1380 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 1 Hour Roof/Ceiling PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,156.08 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 OA 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: \ \,.....A . Permittee Signature: � > K...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. Plumbing Permit Application n(� Building Fixtures RECEIVED FOR OFFICE. USE ()NIA City of Tigard AUG 2 9 2019 Received Date/By: 54' 01 k k �.S--- Permit No.: MST2019-00208 111111 m 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ` Phone: 503.718.2439 Fax: 503.598M OF TIGARD Date/By: 9-q"/of 46.67 Other Permit No.: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: loris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information ' -,TYPE-OF-WOE - FEE*. SCHER� • 0 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) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building E1Multi-familySFR(3)bath 500.32 El Master builderEach additional bath/kitchen 25.02 E Other: Fire sprinkler(1380 sq.ft.) Page 2 • JOB SITE INFORMATION.AND LOCATION' Site utilities: Job site address:14218 SW Gold Coast Terrace Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 1 , Footing drain(no.linear ft.:_) Page 2 \ Suite/bldg./apt.no.: .ic 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 I Lot no.: 116 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DECRIPTION OF WORKBackwater valve 12.51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 eil-,I*ROPERTY OWNER ' ,.:.1 ❑..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 :t APFLIIeA1NIT' ❑ CONTACT PERSON .' Interceptor/grease trap 25.02 Business name:Polygon Northwest Medical gas(value:$ ) Page 2 Contact name:Jennifer Lopez Primer 12.51 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 ax::�7 Tub/§Tiower7sTiower pan Ti2.5 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR 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 Lie.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) .--.7-74___, State surcharge(12%of permit fee) Authorized signature: 1TOTAL 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:ABuilding\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(I0/02/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-Pt 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$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 Inspectionsor Fees Qty. Feae{ � 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 Fn Review for Plumbing Installations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath -Tub/Shower Please check all that apply. -Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ® Any multipurpose fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related 0 Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the https://allianceplumbing-my.sharepoint.com/personal/gavin_allianceplumnng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc CITY OF TIGARD MASTER PERMIT :111111 '14 ' COMMUNITY DEVELOPMENT Permit#: MST2019 00208 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/01/2019 Parcel: 2S107AA11600 Jurisdiction: Tigard Site address: 14218 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 116 Project: Polygon at Roshak Ridge, Lot 116 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 646 sf Basement: 101 sf Left: 0 Parking Spaces: 0 Height: 37 Bathrooms: 3 Second: 633 sf Garage: 547 sf Front: 8 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1380 sf Value: $194,005.20 Rear: 5 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1380 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 1 Hour Roof/Ceiling PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,019.55 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: '._-.- ,,k_.*-----._ Permittee Signature: .. k---k \ 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. (SZ L. Building Permit Application LT ` � Residential ," ( . - FOR OFFICE USE ONLY IIICity of Tigard t ,r, Received — `-�,,{, {''� . o FE.:., !. F r' '1 9 DateBy I � I �"1 J Permit No.K.N le% C ;Xicc r 13125 SW Hall Blvd.,Tiard,OR 97223 Plan Review / ^ ,A' l l v n Phone: 503.718.2439 Fax: 503.598.1960,_ x., Date/By. ��/ N YT Other Permit _V `, q TIGARD Inspection Line: 503.639.4175 Date Ready/By: ` tuns H See Page 2 for Internet: www.tigard-or.gov BUIL r;`` Notified/Method. Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLLNG ®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/industrial Valuation: $ tqi ` 00 S ❑Accessory building 0 Multi-family Number of bedrooms: 2 0 Master builder 0 Other: Number of bathrooms: 92 JOB SI 1"L INFORMATION AND LOCATION Total number of floors: 19 ,".7 Job site address: I U 2( Sly (- (�l/,� LI�rt A --Fei /�Iy' /I n ) New dwelling area:\ square feet 3� City/State/ZIP:Tigard,OR 97224 ` iL�� V` 1 t/ p V l/` x Garage/carport area:9-7 square feet 62 v co Suite/bldg./apt.no.: .� Project name:Polygon at Roshak Ridge Covered porch area: square feet t a Cross street/directions to job site: Deck area: �'� square feet OQU� y" ar °Q....� .square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: V`(/� Permit fees*are based on the value of the work performed. Tax map/parcel no.: `C 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 ' ® 1\PROPERTY OWNER 0 TENANT Number of stories: Name:Polygon WLH LLC Type of construction: 0 Address:703 Broadway Street Ste 510 Occupancy groups: /4 City/State/ZIP:Vancouver,WA 98660 Existing: ( n Phone:(360)695-7700 Fax:(360)693-4442 New: C/ T( APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Please refer tofee schedule) Structural plan review fee(or deposit): Contact name:Amanda Gavin or'. 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)695-7700Amount received: Fax: :(360)693-4442 E-mail:permitsubmittals( polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photovoltaic 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: $201.60 Authorized ignature: , This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Ama i a Gave Date:C31011,q *Fee methodology set by Tri-County Building Industry Service Board. C\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(Il/02/COM/WEB) Mechanical Permit Applica ' t ,rrgy3 Received Cityof Tigard +, '��—C kek-0Q g Date/By: Permit No. 't 13125 SW Hall Blvd.,Tigard,OR 97223 '! Plan Review Phone: 503.718.2439 Fax: 503.598.1960114 2019Date/By: Other Permit: Y ICA 141 Inspection Line: 503.639.4175 e Date Ready/By: Iris: 21 See Page 2 for Internet: www.tigard-or.gov ! FT V 9 "s !'''-'A"41..1 Notified/Method: Supplemental Information h' TYPE OF WORKCOMMERCIAL FEE*'SCHEDULE'— USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION 17,11-and 2-familyRES]DENTIA! EQUIPMENT!SYSTEMS FEES* dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. I j Multi-family ❑Master builder ❑Other: Description Qty. Ea, Total JOB SITE INFORMATION AND LOCATION ' Heating/cooling: ��Z`Cy Air conditioning ' 46.75 Job site address: D �p(.rj l\s-c -in,� 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.: 4 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.: 1 i(p 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 e' ' U fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: ®. PROPERTY OWNER 0TENANT2332 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 ® 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: Address: NW Alociek Dr,Ste. 1104 MECHANICAL PERMIT FEES* Subtotal City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee) CCB lie.:209001 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: �Q' �u � . Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 — i ' -- l Electrical Permit Applicata JL : , _"" '` " " - �_ � ��r FOR QFFICE USE ONLY City of TigardD1lJN t 9 ?_019 Received a _• 13125 SW Hall Blvd.,Tigard,OR 97223 a Plan Review t l Phone: 503.718.2439 Fax: 503.5 169 € 1 1 ii7„•$1"/a .�l Date/13 : Related Permit#: Inspection Line: 503.639.4175 Rzad DateB Lurie: 2 for .I11'14I.0 Internet: www.tigard-or.gov pp gp � i. '7 olviSIQClt Notified/Method: H See Supplemental Information Supplemental Information • TYPE OF WORK PLAN REVIEW ®New construction ❑ Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): (3 Service or feeder 400 amps or more ID over three stories. ❑Demolition ❑ Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. El 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Muhl family ❑ Master builder amps for all other installations. buildings. ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address:��?,�1 pLp 0 Addition of new motor load of system. l.k)AS(' 1�Q— IOOHP or more. ❑"A",`'E';"1-2","1-3", City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Li 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 l Qty. I Each 1 Total 1 * New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 1 Ito Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 Ea.add'l 500 sq.ft.or portion 1 33.92 1 DESCRIPTION OF WORK '^ Limited energy,residential r ,^�� t'— 0 MO% (with above sq.ft.) 75.00 2 I Limited energy,multi-family 75.00 residential(with above sq.ft.) 2 ® PROPERTY OWNER ❑ TENT Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name:Polygon WLH,LLC 200 amps or less 100.70 2 Address:703 Broadway St,Ste510 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2 Phone: (360)695-7700 Fax: ( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ® APPLICANT- 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service 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 Phone:(360)695-7700 Fax: : 360 Miscellaneous(service or feeder not included) ( )693-4442 Each manufactured or modular Email:permitsubmittais@polygonhomes.com dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 CONTRACTOR 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 ❑ 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 mut) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:pail@portlandelectrie.biz Industrial plant(1 hr min) 78.18/hr // Inspections for which no feeds CCB Lic.: 194066 Electrical Lic.: C760 Suprv. Lic.y f�DS specifically listed('/s hr min) 90.00/hr /� �� ELECTRICAL PERMIT FEES l�l. Suprv.Electrician signature,required: ee..'�- 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 "TrL i„..4. /1.Gi.&. TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: MISHCHUK,SERC Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 410-46151(11/05/COM/wEB 4 1. Plumbing Permit Application Building FixturesEt �.�'. FOR OFFICE USE.ONLY City of Tigard Received II 't 13125 SW Hall Blvd.,Tigard,OR 97223 I N 1 9 2019 Date/By: Permit No.\i\C„3 i i Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: TLGARD Inspection Line: 503.639.4175 i i ti Al's a , & , Date Ready/By: loris: B See Page 2 for Internet: www.tigard-or.gov r a,!;S,f„-, Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction ❑Demolition For special information use checklist. Description ❑Addition/alteration/replacement ❑Other: Q. Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ISr 1-and 2-family dwelling ❑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 INFORM1L4TION AND LOCATION Site utilities: Job site address: lL�'u$ CjcC,b OD -c -T Z 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.: 1 Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitarysewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Pae 2 Subdivision:Roshak Ridge Lot no.: g 1t(� Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 1 12.51 •tYls-C �tt\-00 2-0.% Clothes washer 1 25.02 Dishwasher i 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 r 25.02 Phone:(360)695-7700 Fax:( ) Ice maker ` 12.51 IZ 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 3 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 3 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: 572.50 CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee) n State surcharge(12%of permit fee) Authorized signature: ��(.tl,Cj^..,`1 TOTAL PERMIT FEE - This permit application expires if a permit is not obtained within 180 days Print name:Steve Fowler Date:04/08/2019 after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. t:,BuildingTerm its`PLMU-PermitApp.d°c 10/01,09 440.1616T(10/02'COt1/WEB) City of Tigard : im 14 �� COMMUNITY DEVELOPMENT DEPARTMENT '''''''.-4,-4 c RI) Building Permit Review — Residential Building Permit #: 10t- f-al Site Address: ?() c< ) 67,ke _Coa-C71— 7-?.. /702-(0_ Project Name: ,.- J7 - , 4�dq ? Lot #: ii Le ew d1. _=subdivision name;Addition or Alteration= Y name of owner) Planning Review k EV ISKXI. ti.\S,la %.-TS. Stlov. C, Pro 6 .sal: () �PT`7— , C "RCC 2) Verify address/suite# active in Accela. In River Terra e: 111No 1!t Yes,River Terrace Review Addendum Sit Plan Elements: 11QEr,sion Control Ada opies of site plan on 8-1/2"x 11"or 11 x 17"paper 0% ained trees with drip line and tree protection measures 7 ! awn to scale(standard architect or engineer scale) totprint of new structure(including decks) and FFE n i orth arrow ail:II-Walk/driveway ' locations&easements (required for new and additions) 'PESi address,project or subdivision name and lot number approach 11VA.plicant information(name and phone number) i1 ri4 ,tion of wells/septic systems X ot dimensions and building setback dimensions Ii .„eet tree size,type and location III .uare footage of buildings to be demolished 1T.;rreet names f1 "sting structures on site .Corner elevations (2'contours if more than 4'diffe tial) V ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace.? BQYes ❑ impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? II Yes IT, o lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): ,equired: ❑ Yes,applicant was notified 1CJ No Received: ❑ Yes ❑ No Gig Public Faciliti Improvement(PFI) Permit: 'equired: �y s,applicant was notified ❑ No Applie. For: Yes ❑ No, to intake /, , P YAand Use Case#: QG�, 2,d l =`0x I! Zoning: - ,..2_ Pb equired Setbacks: Front: 0 Rear: _ Side: 0 Street Side: Garage: )0C- wilding a c wilding Height: Max. Height: JO Actual Hei ht: " Landscape Area: o % Lot Coverage Max: is Entrance et back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows ❑ Minim °_4 of area of all street-facing facades ��/ Garage ❑ Garage door is behin. t street-facing wall \ f 1 ❑ Yes ❑ No, ..-- . t e following is met: ❑ Door extends no more than wall and there is a covere. .: extending beyond garage. ❑ Door extends no more than 5'from wall an. .- . sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or less I'/o or less of faca. • 60%or less and includes 7 of following: ❑ Covered porch ■ ' - essed entrance ❑ Wall offset ❑ 1' ' s. •.ve ❑ Roof offset ❑ Fire • • -s ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel ro. El Dormer a Accent siding PWindow trim ❑ Window recess ❑ Window projection a ii. e. IV isual Clearance 1► Urban Forestry an 14'0sensitive Lands: ❑ Yes No Type: FA Conditions met prior to issuance of building permit Nies: pproved By Planning: ®� Date: a Revisions (after�Bu kung Submittal only) Revi ate Revision 1: UL( Approved ❑ Not Approved 4/6 �3 Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw RES 022819.docx Building Permit Submittal Original Submittal Date: a.' 'VC\ Site Plans: # 'j Building Plans: # ,,,_a_ Building Permit#: Enter building permit#above. Workflow Routing: R' Tanning Engineering E? Permit Coordinator LVBuilding Workflow Sign-off: R' Sign-off for Planning(include notes from planning review) Route Application Documents: R"Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ['Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: t`j it _J--- Engineering Review .( Slope at building pad: j2rtonditions "Met"prior to issuance of building permit D'Easements (encroachments)per engineering conditions of approval and plat (Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes .2'No Assess Water Quantity Fee in-lieu: ❑ Yes .0' No LIDA Facility on lot: ❑ Yes E'No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: -approved by Engineering: AdLA- a Date: / 1 Revisions (after Building Submittal only) Reviewer� �erbate Dr-Approved Revision 1: ❑ Not Approved � '^ 'rp8 v__ Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: evision Notice 3: Date Sent to Applicant: SDC F Entered: Wash Co Trans Dev Tax: "Yes ❑ N/A / Tigard Trans SDC: "Yes ❑ N/A Parks SDC: [ "Yes ❑ A LIDA CI G�/`i�l/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: 12v l I:\Building\Forms\BldgPermitRvw_RES_022819.docx City of Tigard 1,1 N COMMUNITY DEVELOPMENT DEPARTMENT I GAlz�` River Terrace Building Permit Review Addendum Building Permit #: 'MSS 2\4CA-( ,( %,$ /c/Site Address: 1 //0 L) Goa-c-1- �f70a Project Name: Peir1r ),` , P Lot #: (Ne a 7. g=subdivision name;Addition or Alteration= alname of owner) Planning Review of River Terrace Plan Dist. t Design Standards (18.640.0701): Is the project subject to the plan district design standards?VJ Yes 0 No 1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch min. 5 t. deep Balcony w/ access 2 Window Projection Vertical Wall Offset a tz( ft. cElve(f min.2ft., 5 ft. wide min. 2 ft., 6ft.wide Gabled dormer 0 0 ❑ 2. Eyes onthe street: a minimum of 12%of each street t facuig facade must include windows or entrance doors. Percentage Shown: F' > ' > )a 3. E trances:At least one entrance must meet both of the follo - g standards: Max. 8 ft. setback from long street- facing wall Parallel to street,angle no more than 45° from street, or open onto porch Entrance opens to a porch: Yes 0 No If yes,all the following apply: [) 5 sq.ft.min. giOne street facing entry t.max.roof above floor of porch Or 5 ft. depth min. 30%min.porch roof coverage i4. etailed Design:All buildings shall include a min. of five of the following elements on all street-facing facades: Covered porch min. 5 ft.wide x 5 ft. deep ❑ Recessed entry area min. 5 ft.wide x 2 ft. deep 0/Wall offset min. 16 inches 0 Dormer min. 4 ft.wide VRoof eave min. 12 inch projection f 0 :oof offset min. of 2 ft. 0 Roof shingles either tile or wood 7 C' ble,hip or gambrel roof design f..�'�-- ❑ ' sof pitch oriented south min. 500 sq. ft. rizontal lap siding min. 3-7 inches wide F— IE Accent siding min. 40%of street facade f Ltd Window trim min. 2'/2"wide by 5/8"deep f Yg- indow recess min.3 inches for all street facing 0 Bay window min. 5 ft.wide by 2 ft. deep Balcony min. 5 ft.wide x 3 ft. deep with inside access 10.--0Attached 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: loser to front or side lot line,than longest street-facing wall. 0 Yes No. If No (Check one): May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. ❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story above the garage that faces the street with a min.area of 12 sq.ft. Wid : (Check one) 12-foot-wide garage door 0 40%max. of street facade 0 50%max. of street facade with 7 detailed design elements Notes: -1::-/—_ Approved By Planning: - . Date: J I:\Building\Fomvs\BldgPermitRvw REs RT 121417.docx FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT = � Transmittal Letter TIGARD, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: / A. 4/JI / I, DATE RECEIVED: DEPT: BUI !LG DIVISION II RECEIVED FROM: Wt.: / S JUN 13 2019 --ct CITY OF TIGARD COMPANY: / / BUILDING DIVISION PHONE: 3p0I, ,9 S -TV 0 By: ST RE: i'4il`d S ) COLD Q p -r [ r,e12_ 5720/ '- (262,08' (. ite Address) (Permit Number) b 51a-k- K( ' — Lit 7 '1 (Project name or subdivisio (t e and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. X Revisions: jI.TE "PLA-1..) 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: I- .LJ ) t I'1a N UT £L L. O'vtr ZN£ FLW-IZ FOR OFFICE USE ONLY Routed to Permit Technic'an: Date: 4 i Initials: Fees Due: ❑ Yes No Fee Description: Amount Due: -- 99 0 $ V � $ 25' Special Instructions: Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions 061316.doc Plumbing Permit Applicatl Building Fixtures FOR OFFICE USE ONLY City of Tigard UL 1 7 i f 19 Received Date/By: i Or I‘0, \t Permit No.: 5 {` 'l.lt Y \ . 's 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503 91I3f$l6Q ', < -,:, Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175>-,+., I i ), P,r Date Ready/By: AnEd See Page 2 for Internet: www.tigard-or.gov - Notified/Method: Supplemental Information . .,.,: :.:TYPE OF WORK ,...,. .FEE* St'NFD17LE;..4,•:,14,,:4,...-,..::,.',.-,,,;,,:;".:',41',.. 7-V � � For special information use checklist ®New construction ❑Demolition .,-1 7-V7--' - escription Qty. I Ea. Total ❑ Addition/alteration/replacement 0 Other: \ ew 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑ Accessory building ®Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB,SITE INFORMATION AND LOCATION c p Site utilities: Job site address: fa 11-211 Goa) ,, � Te_` t-g. Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: (Q Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge I Lot no.: 11(00 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF�WORK- Backwater valve 12.51 � �� Clothes washer 25.02 C� U \ ty\, --c `0A-00 ZO'S Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 .'® PROPERTY OWNER I, 0 TENANT Expansion tank 12.51 - Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.,Ste 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 _ Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Tonja Morris Roof drain(commercial) 12.51 Address:703 Broadway St.,Ste Q S 51100�� [Sink/basin/lavatory 225.002 e1Zi ;Vauc,ouier,VVA9-8660 -._r _. __ z r-.olar=unite�o water) ++2.44 Phone:(360)695-7700 Fax: :(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals®polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Alliance Plumbing WaterPiP�to WV 56.29 Address:146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) aft„ 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. C\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY Cl ofTigard Received ganDate/B .• 6 S . Permit#:M�1 s�� y 13125 SW Hall Blvd.,Tigard,OR III r City97223 '' ? t i to Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503.598.1960 - Date/B TIGARD Inspection Line: 503.639.4175 Jan Ready Date/By: y: H See Page 2 for r; Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK'' .. • _., a ,pLAN,REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked) ❑Demolition ❑Other: c ��G� Service or feeder 400 amps or more El Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY..OF CONSTRUCTION . ...1—'" exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder ❑ Other. 0 Fire pump. 0 Installation of 150 KVA or JOB SITE':INFORMATION-AND LOCATION 0 Emergency system. larger separately derived n I'% ( _ _ ❑Addition of new motor load of system. Job#: Job site address: (� UGo ` .� 100IIP or more. ❑"A",'B","1-2^,"1-3'; City/StatelZlP:Tigard,OR 97224 ElSix or more residential units. occupancy. 0 Health-care facilities. Er Recreational vehicle parks. Suite/bldg./apt.#: Project name:Polygon At Roshak Ridge ❑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 New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#: ,k`P 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 w p6 (with above sq.ft.) 75.00 2 ��- �1S� �tJ 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 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: - Date: 401 amps to 599 amps 168.54 2 ® APPLICANT ❑ 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'1 branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:permitsubmittals@polygonhomes.com —140.06111101-9131y— ——6944 1 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Alameda Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:3415 NE 44th 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP: Portland,OR 97213 Each additional inspection over allowable in any of the above Additional inspection(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(Y4 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Kile Rood Date: 03/08/2019 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: //, ....c..,, TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Kile Rood I Date: 03/08/2019 days after it has been accepted as complete.