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Permit (145) CITY OF TIGARDMASTER PERMIT IN;• . r 3. '.' COMMUNITY DEVELOPMENT moi* ' ,'" Permit#: MST2019-00207 Date Issued: 07/01/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 — \ ,c Parcel: 2S107AA11500 Jurisdiction: Tigard Site address: 14220 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 115 Project: Polygon at Roshak Ridge, Lot 115 Project Description: New SFA. 9/9/19: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 97 sf Left: 0 Parking Spaces: 0 Height: 37 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 8 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors. Yes Total: 1221 sf Value: $169,865.85 Rear: 5 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Fire sprinkler system MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 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 1221 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) STE-bi6-- <-: 709 8ROA13WAY BTRBET, CiS 1,0 —-1 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 1 Hour Roof/Ceiling PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $24,723.05 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: k 1A_ r,....„ Permittee Signature: C eS��X.C-X N Call 503.639.4176 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. z1l: \r\4 .C . U2 Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard Received 11111 q 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 9 2019 Date/By: )tei31 10 S) Permit No.: MST2019-00207 0 Phone: 503.718.2439 Fax: 503.598.19 Plan Review ulTY OF TIGARD Date/By: q...-41-/, 4..6 ., Other Permit No.: TIGARD Inspection Line: 503.639.4175 Date Read/B orris: See Page 2 for Internet. www.ti and-or. ov BUILDING DIVISION Ready/By. g g g Notitied/Method: Supplemental Information .: - . F TYPE OF WORK �E* SC IEDiIE ®New construction ❑ Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement El 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 CIAccessory building ❑ Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(1221 sq.ft.) Page 2 JOB.SITE INFORMATION AND LOCATION Site utilities: Job site address:14220 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 � � Footing drain(no.linear ft.:_) Page 2 USuite/bldg./apt.no.: J 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.: 115 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORKBackwater valve 12.51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 jj Ejectors/sump 25.02 did"PROPERT ,""OWNER P I 0 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 >;/?APPLICANT 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 a t W ter c ose 25.02 ON1'RACTOR:;; •, " Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DW V 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 Thomes Date:8.27.2019 after it has been accepted as complete. *Fee methodology set by Tri-Comity Building Industry Service Board, I_\Building\Permits\PLMU-PermitApp.doe 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'Utilit es . Qty. Fee(en) Total Square Footage: Permit Fee: Footing drain 1"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 (ether Inspections or Fees Qty. Fee(gal. Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Other Fixtures: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Fixture Type for Replace/ ;Plan Review for Plumbing`,Installations Work Performed; Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath Tub/Shower Please check all that apply. Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior'plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ 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_allianceplum12.ngnet/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc CITY OF TIGARD MASTER PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: MST2019 00207 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/01/2019 Parcel: 2S107AA11500 Jurisdiction: Tigard Site address: 14220 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 115 Project: Polygon at Roshak Ridge, Lot 115 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 562 sf Basement: 97 sf Left: 0 Parking Spaces: 0 Height: 37 Bathrooms: 3 Second: 562 sf Garage: 456 sf Front: 8 Smoke DwellingUnits: 1 Yes Third: 0 sf Right: 0 Detectors: Total: 1221 sf Value: $169,865.85 Rear: 5 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Bckflw Prevntr: 0 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 1221 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: $24,586.52 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 O R 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: e/ .- "\ `� =,v '''€'-g--_, � �� Permittee Signature: ' `.-‘,C--,PC. C_C- 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. kkbvcvG, � 1 C)--V \ \ Building Permit Application Residential Y r ':an .. a ,, rj , FOR OFFICE USE ONLY City of Tigard Received r� ��('� . y Date/By: •J' ,' 1G� % III131_5 SW Hall Blvd.,Tigard,OR 97223 —� f�� Plan Review e ew/Akik Permit No ��z/VC V'\ �, � STV D - Phone: 503.718.2439 Fax: 503.598 1960 r Other Penni V '.( 1 LQ�� TIGARD Inspection Line: 50 .639.4175 Cr� i f�7y tss: ) Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov W 11.) N( D€ViSdiii,' Notified/Method. Supplemental Information TYPE OF WORK & REQUIRED DATA:1-AND 2-FAMILY DWELLING ®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-famildwelling Valuation: $ 1_ ❑Commercial/industrial 0 Accessory building 0 Multi-family Number of bedrooms: 'Z 0 Master builder ❑Other: Number of bathrooms: 27 JOB SITE INFORMATION AND LOCATION Total number of floors:3 (j'77 Job site address: 1 l,I VIA) S1A)G DIP,( ,LY,/ {^1"`p�y1/y� /i) New dwelling area: I�� square feet S�Z City/State/ZIP:Tigard,OR 97224 �/ v �/�/1'0 li I l (/l.0 Garage/carport area: I jiU/J square feet SG a. Suite/bldg./apt.no.: \ ; Project name:Polygon at Roshak Ridge Covered porch area: �'�d square feet 9-7 Cross street/directions to job site: Deck area: -7,`7 square feet Atker-strttctur area• square feet REQL'1 DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: '`(S Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. New SFA Valuation: $ Existing building area: square feet New building area: square feet 0 PROPERTY OWNER 0 TENANT Number of stories: 0 Name:Polygon WLH LLC Type of construction: Address:703 Broadway Street Ste 510 Occupancy groups: 111 V' City/State/ZIP:Vancouver,WA 98660 Existing: Phone:(360)695-7700 Fax:(360)693-4442 New: ® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Polygon WLH LLC (Pleare refer Jo fee schedule) 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.corn 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 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 lie.:207247 Total fee due upon application: $201.60 Authorized signa 441, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Amanda :avin Date: *Fee methodology set by Tri-County Building Industry (' /�� Service Board. I:ABuildingAPermits\BUP-RESPermitApp.doc 02/24/2011 440-4613 T(11/02/COM/WEB) Mechanical Permit Applic '° 41 4. City of TigardtIVFn Received qTigard, Date/By: Permit No �-T'l,i q-, f Q\� 13125 SW Hall Blvd., OR 97223 ��OOVV` , \J`) ; Phone: 503.718.2439 Fax: 503.598.19¢I j� > 2019 DPlanate/By:Rcview Other Permit: - Y 1,ti.i1 i 5, Inspection Line: 503.639.4175 y Date Ready/By: loris. H See Page 2 for t'st. Internet: www.tigard-or.gov CITYOF I IGA Notified/Method: Supplemental Information it r.)!N£t f!Vic TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRTICTION . RESIDENTIAL EQU]PMENT(SYSTEMS FEES l 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist I j Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: t 12 Air conditioning 1 46.75 Job site address: L4 CoL (� D r�`� �..• � t 5V'42- Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: uz, Project name:Roshak Ridge Heat pump 61.06 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 t5 Other. 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 � ^G pa� Flue vent for water heater or gas r l�!T z I-1- 00207 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 0'TENANT Other. 23.32 Environmental exhaust and ventilation: Name:Polygon WLH,LLC Range hood/other kitchen Address:703 Broadway St.,Ste.510 equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32 0, 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 heat pump Wall/suspended/unit beater 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) Phone:(360)270-1590 Fax:( ) Plan review(25%of permit fee) CCB lic.:209001 State surcharge(12%of permit fee) TOTAL PERMIT FEE n.(�� This permit application expires if a permit is not obtained within 180 (�L. �u days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building industry Service Board Print name:Elia Duran Date:04/08/2(119 Electrical Permit Application .. 1 ' PP '� ,«,.�' . � ,. FOR OFFICE USE ONLY �� .'f City of Tigard Received Permit 13125 SW Hall Blvd.,Tigard,OR 97223 9 2019 Datee : ` "ilk. a,. • ' ]�J; •• Phone: 503.718.2439 Fax: 503.598.1960 ' PlannReview Date/B Related Permit#: Inspection Line: 503.639.4175 y i ) .: i i i-r s e Ready Date/By: ]uric: 'L1L pol..LS See Page 2 for _ Internet: www.tigard-or.gov R.� r-As Notified/Method:: 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): ❑Demolition 0 Other: ❑Service or feeder 400 amps or more ElBuilding over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. EA 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural 0 Multi-family ❑Master builder ❑Other: amps for all other installations. buildings. ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived '�� 0 Addition of new motor load of system. Job#: Job site address: (1p(�j ( .T TeRR 100HP or more. ❑'A', `E",~I-2", '1-3' City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: 4 Project name:Rosbak 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 I Qty. i Each 1 Total I - New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 1j 'c..1 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 Ea.add'l 500 sq.ft.or portion I 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 m�j� `�_ 007.47-1 (with energy,multi-family residential(with above sq.ft.) 75.00 2 0 TENANT Renewable Energy 0 See Page 2 ® PROPERTY OWNER 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 Branch circuits—new,alteration,_or extension,per panel ® APPLICANT ❑ CONTACT PERSON 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'l branch circuit 7.42 7 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:per mitsubmittals@polygonhomes.com 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 panel,alteration,or extension. 0 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(1 hr min) 90.00/hr Email:pail@portiandelectric.biz Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lie.: '�,05 specifically listed(t/hr min) 90.00/lir n ,,- ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: l.�l,C�.'!`. 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 M L, _c_44,__,6_ TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: MISHCHITK,SERC Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. laBuilding\PermhsVELC_PermitApp ELR_ERE.doe Rev 06/17/2015 440-4615T111/05/CfM/WR14 Plumbing Permit Application Building Fixtures $ - ` V r FOR OFFICE USE-ONLY City of Tigard Received 114 13125 SW Hall Blvd.,Tigard,OR 972231 tI N 1 9 2019 Date/By: Permit No. S C\.-0 � Plan Review Phone: 503.718.2439 Fax: 503.598 1960 Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 U 1 .i -a' . AH'I) Date Ready/By: auris: B See Page Z for Internet: www.tigard-or.gov "'Se 4D 9! ,,'( l,�',,.),,,, Notified/[vtethod: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction ❑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 tg 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 9 437.78 ❑Accessory building Multi-family SFR(3)bath - 500.32 ❑Master builderEach additional bath/kitchen 25.02 __ 0 Other: i Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14 e1 o„v RST Tr✓R.� 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.: ‘‘.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 Subdivision:Roshak Ridge Water service(no.linear ft.: ) Page 2 Lot no.: `i5 Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 1 12.51 YYk.ST �tq.-"VU 101 - Clothes washer 25.02 Dishwasher 1 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 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 Contact name:Tonja Morris Primer 12.51 Roof drain(commercial) 12.51 Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 1.- 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 2 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 a Water closet Z 25.02 CONTRACTOR Water heater I 37.52 Business name:G&B Plumbing&Sons Inc WaterDWV t m Pip g/ 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 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. t:,BuitdiogPermits`PLiMU-PermitApp.doc 10/01,09 440-4616T(10i02:COMiWEB) City of Tigard 111 1,„ COMMUNITY DEVELOPMENT DEPARTMENT ARD Building Permit Review — Residential Building Permit #: -c c. Site Address: /1/. .2-2 � :( ) .67 /6e Cera -71—7--enzaea_ Project Name: ,iAz/ k rr' �,e Lot #: //c ew d✓✓✓ subdivision name;Addition or Alteration= t name of owner) Planning Review 1�1`t'c1 Vi W1q: k 't, ,, St'1LXxO\CNLt ; C4. Pro sal: Ai0PTT- b"d Sc )` .3)X Verify address/suite# active in Accela. In River Terra e: ❑ NoIli Yes,River Terrace Review Addendum Sit Plan Elements: [ rasion Control 71 3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper 0 4- ained trees with drip line and tree protection measures 1. 1 awn to scale(standard architect or engineer scale) V ootprint of new structure(including decks)and FFE Ir orth arrow V d.lity locations&easements(required for new and additions) IQSi address,project or subdivision name and lot number 'Sid-walk/driveway approach VA•plicant information(name and phone number) 11 r, ,tion of wells/septic systems r sot dimensions and building setback dimensions SI 1„eet tree size,type and location 111:.,uare footage of buildings to be demolished II.street names bi ' sting structures on site 24Corner elevations(2'contours if more than 4'diffe tial) E of area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replace ? 'Yes ❑ impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? Yes I/, o `�� lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): ,Zequired: ❑ Yes,applicant was notified 1! No Received: ❑ Yes ❑ No I.14 Public Facili,�ti Improvement(PFI) Permit: 'equired: I10 Yes,applicant was notified ❑ No Applies For: Yes ❑ No, topintake ;e/L /, and Use Case#: QGt', 4l 00(X). I% Zoning: — .2 Pb equired Setbacks: Front: 0 Rear: _ Side: 0 Street Side: Garage: a C. Euilding Height: Max. Height: Actual Hei ht: Landscape Area: 4 C % Lot Coverage Max: 0/0 Entrance 5 et back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows ❑ Minim ,°_. of area of all street-facing facades Garage ❑ Garage door is behin. " t street-facing wall 3\Pr0 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 1'/0 or less of faca.- 0 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. 0 Dormer al Accent siding E Window trim ❑ Window recess ❑ Window projection • :, -.. IVAi isual Clearance 1► Urban Forestry 1- an 110,ensitive Lands: ❑ Yes 7. No Type: rA Conditions met prior to issuance of building permit N es: Approved By Planning: �� Z ! Building Permit Submittal Original Submittal Date: .1.-4-1 I a Site Plans: # ______k___ Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: 2'Planning ['Engineering El Permit Coordinator Building Workflow Sign-off: R' Sign-off for Planning(include notes from planning review) Route Application Documents: II 'Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. R7Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: ff By Permit Technician: `. - Date: ) 1?\� Engineering Review7 Er-Slope at building pad: 1- Z Conditions "Met"prior to issuance of building permit a Easements (encroachments)per engineering conditions of approval and plat O'Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes E. No Assess Water Quantity Fee in-lieu: ❑ Yes 'Er No LIDA Facility on lot: ❑ Yes 0 No tf Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: --❑ Approved by Engineering: t/t& I V.)rz- Gt_i , Date: 112-E/1 Revisions (after Building Submittal only) Reviewer Date Revision 1: leApproved ❑ Not Approved BA,,,,, .. Eft gp�/s/9 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: Revision Notice 3: Date Sent to Applicant: KSDC Fees Entered: Wash Co Trans Dev Tax: gf Yes ❑ N/A Tigard Trans SDC: b" es ❑ N/A Parks SDC: I 'Yes 0 /A LIDA ❑ Yes LJ'N/A OK to Issue Permit i(f LIDA "t r Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES_0228I 9.docx 111111 City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT T 1 c River Terrace Building Permit Review Addendum Building Permit #: h 'c7,-`- C(ye \Ci- L / Site Address: z/-- Cs -21,( ) co/01 07.9x-i- �6race Project Name: Pe/ 7 nI��e � Q Lot #: // (Ne . . g=subdivision name;Addition or Alteration= name of owner) Planning Review ofRiver Terrace Plan Dist" t Design Standards (18.640.070.1.): Is the project subject to the plan district design standards?Of Yes ❑ No 1.Articulation: a minimum of 1 element per each street-facing façade that has 30-60 ft.of frontage.An additional element required for lots with over 60 ft. of street frontage shall be provided every 30 ft. Porch min. 5 t. dee Balcony w/ access 2 Window Projection Vertical Wall Offset a p ft.cisiir6 min.2ft., 5 ft.wide min. 2 ft.,6ft.wide Gabled dormer CI ❑ ❑ Ce*"( 2. Eyes on the street: a minimum of 12%of each street facing façade must include windows or entrance doors. Percentage Shown: t: > /o e' ' > /2 %, 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 ❑ No If yes,all the following apply: [ 5 sq.ft.min. VillOne street facing entry Vit.max. roof above floor of porch rig 5 ft. depth min. 30%min.porch roof coverage 4. 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 0 Recessed entry area min. 5 ft.wide x 2 ft. deep 0/Wall offset min. 16 inches 0 Dormer min. 4 ft.wide fRoof eave min. 12 inch projection Of, 0 :oof offset min. of 2 ft. ❑ Roof shingles either tile or wood 7 9able,hip or gambrel roof design fl-g-- ❑ ' sof pitch oriented south min. 500 sq. ft. l rizontal lap siding min. 3-7 inches wide L Accent siding min. 40%of street facade/ I1d Window trim min. 2 1/2"wide by 5/8"deep' 0indow 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 10-0 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. , C - _ Setbacks: _ _ _. N closer to front or side lot line,than longest street-facing wall. ❑ Yes SCJ No. If No(Check one): iMay extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch. 0 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 ❑ 40%max. of street facade ❑ 50%max. of street facade with 7 detailed design elements Notes: Approved isy Planning: — _A; Date: �--_ I:\Building\Forms\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 ilh = . Transmittal Letter T 1 G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov i TO: ,, j ,. .1a4 � 1 • ` � , DATE RECEIVED: DEPT: BUIL IIA G DIVISION RECEIVED FROM: , 014-41, � S JUN 1,22019 COMPANY: • 4,40 CITY BUILDING DIVE, 'i PHONE: -1,0 _ -95 -T7D b By:SA-- RE: 114a° 5lA) G01,b C A.S T M57"moo/ 9- OOZ°7 rte Address) (Permit Number) /�5WC 4 -- / J 7 ) 1 Lo (Project name or subdivisio I e and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. X Revisions: j,TE -Ptil-N 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: 61- -PLAIN) 1 I'b Irl 07 L/ m/yr-7 ZN® Fttrv-e_ 'brcy....-- FO4 OF ICE USE ONLY Routed to Permit Technician: Date: W l-1 Initials: Fees Due: ❑ Yes allo Fee Description: Amount Due: J Y 0 W $ Y-.)$ Special Instructions: Reprint Permit(per PE): n Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1:\Building\Forms\TransmittalLetter-Revisions o61316.doc Plumbing Permit Application Building Fixtures . FOR OFFICE USE ONLY Cityof Tigard i i 1 7 i Received i pertnitNo.: g i d a 1 Date/By: 11-'''�t S� - MCT -W n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review g I Phone: 503.718.2439 Fax: 504-.51/:1,96107, ,s\. Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 1 t Date Ready/By: Juris: See Page 2 for Internet: www.tigard-or.gov D :t,- .%.` - Notified/Method: Supplemental Information ,2,3r.',' TYPE"OF WORK .,: : FEE* SCHED4 ,1'.'2Y,,,';',:' 4,'; ' 's For special information use checklist ® New construction 0 Demolition � P f �. S Description Qty. Ea. I Total ❑ Addition/alteration/replacement 0 Other: V( 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 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑ Accessory building ®Multi-family Each additional bath/kitchen 25.02 ❑ Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: LI 2?,0 (� 1 Catch basin or area drain • 18.76 Job site address: 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.: 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 I Lot no.: ``5 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK.' '" Backwater valve 12.51 t r �� i� �,ct�b�� Dis hes erher 25.02 A.�j� V ,i �J Dishwasher 25.02. ��JJ Drinking fountain 25.02 Ejectors/sump 25.02 ►t PROPERTY OWNER ❑4TENANT" 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: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 idirtfl - Plumbing Lic.no.:PB732 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Thls 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.\Buildina\Permits\PLMU-PermitAoo.doc 10/01/09 440-4616T(10/02/COM/WEB1 3 Electrical Permit Application ` .. '." FOR OFFICE USE ONLY • Cl O Tigard �� Received /�� `J f g i '7 /,‘';',-... M : DateB : � s Permit#: ��l `�' 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 11 Phone: 503.718.2439 Fax: 503.598.1960; DateB : Related Permit#: TIGARD Inspection Line: 503.639.4175 Ready Date/By: Juris: El See Page 2 for c Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF.WORK PLAN REVIEW d f ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑ ❑Other: ��,e, Service or feeder 400 amps or more 0 Building over three stories. Demolition thefa 1 . ;, u t currentMarinas and boatyards. where0 . ..:.:CATEGORY OF-CONSTRUCTION �\ t--' exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 1-and 2-family dwelling ❑Commercial/industrial ❑Accessoryring 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived �� GO /o ..yam� 0 Addition of new motor load of system. Job#: Job site address: �,, (,��ST 1 1�• 100HP or more. ❑"A","E","1-z^,"1-3", City/State/ZIP:Tigard, OR 97224 ❑Six or more residential units, occupancy. 0 Health-care facilities. ❑'Recreational vehicle parks. Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than • ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I QtY. I Eacb I Total I * New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#:`k C) Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add']500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (^� �/� p _6� � (with above sq.ft.) 75.00 2 �-^� �\ l f KAT 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 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 ❑ 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, each branch circuit 7.42 2 Contact name:Nichole Thorpe B.Fee for branch circuits without service or feeder fee,first Address:703 Broadway St Suite 510 branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:permitsubmittals@polygonhomes.com 01Noe4G41– 67.84 —2--- CONTRACTOR Pump or irrigation circle 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(1 hr min) 90.00/hr • Email:solarpdx@me.com Industrial plant(]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('A 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): Authorized signature: (/i. 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.