Permit Support Document CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT L„,i& , Permit#: MST2019-00011
T 1 GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 .S lb Date Issued: 01/23/2020
Parcel: 2S106DA19200
Jurisdiction: Tigard
Site address: 13172 SW 165TH AVE
Subdivision: RIVER TERRACE EAST 2 Lot: 231
Project: River Terrace East No.2, Lot 231
Project Description: New SF. HOLD C of 0 until approval of street trees by planning. 5/14/2020: REPRINT permit to
add 330 sf deck. 5/16/2020: REPRINT permit to add mini-split system.
BUILDING
Floor Areas Reauired Setbacks Reauired
Stories: 1 Bedrooms: 4 First: 2779 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 18 Bathrooms: 3 Second: 0 sf Garage: 595 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2779 sf Value: $372,658.35 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: Y - Hoods: 1 Other Units: 0
Fum<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add''500 sf: 5 201-400 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 SF VB R-3 2779
Owner: Contractor:
WILLIAM LYON HOMES INC 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
PHONE: 802-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $36,347.58
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 952-001-0 �1�Yo_u_may obtain a copy of the rules or direct questions to OUNC by calling 503.232.199877or 1.800.332.2344. _ /
Issued By: �` . "-e_ A-°—'1 Permittee Signature: 17/✓ , -- ,e, rC�-7d iN
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Mechanical Permit Applicati( ECEIVED FOR OFFICE USE ONLY
City of Tigard ReceivedeBR
g Dat `s 46/I0
4,0 Permit No.: MST2019-00011
D
13125 SW Hall Blvd.,Tigard,OR 97223 APR 2 9 2020
11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Review
eview Other Permit:
TIGARF Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ]aria: ® See Page 2far
Internet: www.tigard-or.gov
BUILDING DIVISION Notified/Method0A66/20 fey Supplemental Information
f-"'747 l-- 7 7 t 749-
TYPE OF WORK COMMERCIAL FEE' SCHEDULE — USE CHECKLIST
Mechanical permit fees'are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description P Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 13172 SW 165th Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(duccvvents) 54.91
Heat pump 1 61.06
Suite/bldg./apt.no.: I Project name:River Terrace East 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:River Terrace East
Lot no.: 231 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
add mini-split to MST201 9-000 1 1 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 I ❑ TENANT Other. 23.32
Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
equipment 33.39
Address:7600 E Doubletree Ranch Road Clothes dryer exhaust 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(602)694-4031 I Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other- 23.32
Fuel piping:
Business name:William Lyon Homes,Inc. $14.15 for first four;$4.03 for each additional 1
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St Suite 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:Permitsubmlttals@taylormOrrison.corn Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Performance Insulation&Energy Services Other:
MECHANICAL PERMIT FEES*
Address:13939 SW Tualatin-Sherwood Rd. Subtotal
City/State/ZIP:Sherwood,OR 97140 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)707-6078 Fax:( ) State surcharge(12%of permit fee)
CCB Tic.: q g41a TOTAL PERMIT FEE
p application expires if a permit Is not obtained within 180
days after it has been accepted as complete.
Authorized signatur •This Fee methodology set by Tri-County Building Industry Service Board
Print name:��}� p y e� Date: 04/29/2020
p
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT �2" Permit#: MST2019-00011
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2020
��y/ Parcel: 2S106DA19200
Jurisdiction: Tigard
Site address: 13172 SW 165TH AVE
Subdivision: RIVER TERRACE EAST 2 Lot: 231
Project: River Terrace East No. 2, Lot 231
Project Description: New SF. HOLD C of 0 until approval of street trees by planning. 5/14/2020: REPRINT permit to
add 330 sf deck.
BUILDING
Floor Areas Required Setbacks Reaulred
Stories: 1 Bedrooms: 4 First: 2779 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 18 Bathrooms: 3 Second: 0 sf Garage: 595 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 2779 sf Value: $372,658.35 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 BckFlw Prevntr; 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Fum>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add.'500 sf: 5 201-400 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 8,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 SF VB R-3 2779
Owner: Contractor:
WILLIAM LYON HOMES INC 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
PHONE: 602-694-4031 PHONE: 360-695-7700
FAX:
Total Fees: $36,279.19
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: � �j iQ_ ( Permittee Signature: 4/A/ /9-/°7*./e}-7-7 a
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.
P1Pase 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.
IIIIII City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
•
Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
/� L Z rc { , ��� APR 6 2020
OM: t �15 k
�orls - l \l(J_i S CITY TIGARD
�OMPANY: n BUILDINNGG DIVISION
PHONE: --- 369 d to'155 7100 By:
RE: 13ti2 5w t1,.0s,-><. Pxvt IYIs—r 2,0tq -boot►
(Site Address) (Permit Number)
1116 � jf t f o liFt t-7 2-3 I
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. )( 2. Revisions: M Pr -C 60 44 f 6T-58
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
3 Other(explain): ,' RetAseo purr PLANS
REMARKS: To A-Ob, &-P'T t e'-. A2, 1J t GC PER. Srts Cur o cr Ova S
t 1 cc tc`-Lc....le_ -J -u, ra
FO OFFICE USE ONLY
Routed to Pe ' Technician: Date: $/�a-2c4 Initials:
Fees Due: Yes ❑ p
No Fee Descri on: Amount Due:
I/2 e - (L 4'.,( L ) $
$ Lis .CO
$
Special
Instructions:
Reprint Permit (per PE): Yes ❑No . Done
Applicant Notified: 7 V5j4-- ate: ,S�/y/TeJ Initials: �0
I:\Building\Forms1TransmittalLetter-Revisions 061316.doc
s -
City of Tigard
COMMUNITY DEVELOPMENTDEPARTMENT
II
I i`�� Building Permit Review — Residential
Building Permit #: �r+� 'l:.l i 4 p,fG -Y,L1 Guj . -Jt;¢i""r Site Address: 13 t7P Sw /651-1` 4va-
Project Name: • '
i Ver /G,-,-, Cn L ,,i - / 6• Lot #: , 31
(New =subdivision name;Addition or Alteratl'on=last name of owner)
Planning Review
Proposal: /1J �� 'y�(% Zvi s b s�r E f'�y>✓ i'Z' ,'914 .AEt° r
Verify site address/suite#exists and active in permit sysy m.
,J River Terrace Neighborhood: 0 No Lle es,See River Terrace Review Addendum Attached
Site Plan Elements:
89 hree(3)copies of site plan -��Brxtsttng Structures on site
a Ate plan Lug k on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
. prawn to scale(standard architect or engineer scale) floor elevations
J23Glorth arrow .0ttility locations&easements(required for new and additions)
-2Site address,project or subdivision name and lot number
-BSidewalk/driveway approach
."applicant information(name and phone number) -Elizr3tioa of wells/septic systems
BT t dimensions and building setback dimensions
—Bsees to be retained with drip line,and tree-es e footage of buildings to be demolished protection measures
, tot area,building coverage area,percentage of coverage and eet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40)
,c operty corner elevations(2 foot contour lines if more than >1,000 sf names
impervious area created or replaced?-Eves ❑No
4 foot differential)
If yes,is a storm water quality facility shown? DYes BNo
'Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995):
Required: s,applicant was notified ❑ No Received:
g- Public Facilities provement(PFI)Permit; 1] Yes 0 No
Required: es,applicant was notified 0 No Applied For.
PP -0 Yes ❑ No,stop intake
ErLand Use Case#: P -tomF7 a j1 ,_ 6000 7
P-zoning: (2-l�Lj, 5
ckRequired Setbacks: Front /2 Rear /O Side ? Street Side y Garage av
0"Landscape Requirement O
137cot Coverage Maximum: 70 % 176,rGe1 g
DV Building Height Maximum Height 30
-D Visual Clearance Actual Height S
-D-sensitive Lands: 0 Yes Li-Islo Type
rban Forestry Plan
Conditions rjor to iss nce of building pemvt
otes: 7 . >JJ 1 rT> h P 6 ns io `j ! r,o r U , .S.C/a r+GP
'Approved By Planning: 1 ( I-L1_I
�/�^�' Date: 1
Revisions (after Building Submittal only)
Reviewer Date
Revision 1: a-Approved 0 Not Approved f_(�f /,,,_ R-P4_ ,((U I�
Revision 2: 0 Approved 0 Not Approved '1 c
Revision 3: 0 Approved 0 Not Approved
I:1uildingl Forms 1BldeelmitRvw_RES 116I417.docx
Building Permit Submittal V
Original Submittal Date: 1
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit# above.Workflow Routing: ,,/
13/Planning Engineering Permit Coordinator I=J Building
Workflow Sign-off: [3'Sign-off for Planning(include notes from planning review)
Route Application Documents: [Engineering: (1) copy of permit application,(1) site plan, (1) building plan and
original plan review routing form.
El/Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
Date: 1 \tCl
At.•
Engineering Review `�'o
_a Slope at building pad: 1
0 Conditions"Met"prior to issuance of building permit
0 Easements (encroachments)per engineering conditions of approval and plat
,(Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes LI No
Assess Water Quantity Fee in-lieu: 0 Yes P9 No
LIDA Facility on lot: 0 Yes o
2 Final Plat Recorded: Date:
❑ NOT Approved by Engineering: (� may,
Notes: 43 P,LT ' L 6, `. �t A P4N4 IV 65' 1-6_,
Approved Engineering: - Date: Z 7/ lei
by � Date
Submittal �
Revisions(after B ngonly)
Revision 1: I1Q Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
Permit Coordinator Review
❑ C ditions"Met"prior to issuance of building permit
proved,NOT Released:
71CDate: /! 1 <`l'
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revisi otice 2: Date Sent to Applicant:
R .sion Notice 3: Date Sent to Applicant
SDC Fees Entered: Wash Co Trans Dev Tax: 'Yes 0 N/A
Tigard Trans SDC: Tr/Yes 0 N/A
i Parks SDC: E Yes ❑_, N
LIDA 0 Yes L►'N/n
OK to Issue Permit y ,/�jDate:a ��l�r
Approved by Permit Coordinator. h I��I l�
i).1 `r
I:1BuildingWorms\BldgPamitRvw_RES oro1is.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
s
T i A D River Terrace Building Permit Review Addendum
Building Permit #: MST2-G\C1-Cep k t
Site Address: 1317, 5 cv /6,S+i1 A Le
Project Name: iz z ve✓ Te,•' ce f ,4J,. Lot #: a,
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan District Design Standards (18.640.070.1):
Is the project subject to the plan district design standards? 0 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 ft. deep Balcony w/access 2 Window Projection Vertical Wall Offset a Gabled dormer
ft. deep min. 2ft., 5 ft.wide min. 2 ft.,6ft.wide
r� 0 0 .a— —a'
2. Eyes on the street: a minimum, of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: LSD'
3. trances:At least one entrance must meet both of the folloyring standards:
Max. 8 ft. setback from to st 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: sq.ft.min.
V ne street facing entry [ 12 ft.max.roof above floor of porch
5 ft. depth min. IC 0%min. porch roof coverage
4. Detailed Design:All buildings shall include a min.of five of,he following elements on all street-facing facades:
IFVCovered porch min. 5 ft wide x 5 ft. deep Recessed entry area min. 5 ft wide x 2 ft. deep
❑ )Z/all offset min. 16 inches 0 Dormer min. 4 ft.wide
Roof eave min. 12 inch projection �❑ f offset min.of 2 ft.
O Roof shingles either tile or wood Ltd Gable,hip or gambrel roof design
O Roof pitch oriented south min. 500 sq. ft. 0 Horizontal lap siding min. 3-7 inches wide
0 Accent siding min. 40%of street facade 0 Window trim min.2'/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing �❑ y window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft. wide x 3 ft. deep with inside access Li3"Attached garage is 35%or less of street facade
5. Garages and Carports: May face the front or side lot line on a corner lot.
Setbacks:
Noid to front or side lot line, than longest street-facing wall. 0 Yes Lld No. If No (Check one):
Ne 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.
Width: (Check one)
❑ 12-foot-wide garage door Ili 40%max. of street facade
❑ 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: st4iyuAstit L te_ Date: i't1-1'1
B \Fm I:\ uildingmc\BldgPmni1Rvw_RES_RT_I 21417.do x 1
Electrical Permit Application
rEIVED FOR OFFICE USE ONLY
City of Tigard A E�/ Received e � Permit#:�S r
��
14
a "I 13125 SW Hall Blvd.,Tigard,OR 97223 Date B ` 9 2.? '�1l c'/9—f Ud
Phone: 503.718.2439 Fax: 503.598.1960MAR 6 202° Plan Review Related Permit#:
Date/B :
TIGARD Inspection Line: 503.639.4175 p,.ITY OF TIGARQ Ready Date/By: finis: 0 See Page 2 for
c, Internet: www.tigard-or.gov .., O' Notified/Method:
Supplemental Information
TYPE OF WORKliaQWG QIV1S1
PLAN REVIEW`.
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building 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 I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Coat Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder 0 Other: El Fire
pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 151 1 Z j C-rH 100HP or more. ❑"A","E',"l-2",•`Id",
City/State/ZIP:Tigard,OR 97224 ❑S x or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:East River Terrace 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 Qtty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:East River Terrace Lot#: z3 f Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Change contractor on MST 2,0( g—000 it (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ TENANT Renewable Energy 0 See Page 2
El 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 I
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, 7.42 2
each branch circuit
Contact name:Tonja Morris B.Fee for branch circuits without
Address:703 Broadway St,Ste.510 bran
bce or feeder fee,first branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: permitsubmittals@polygonhomes.com
polygonhomes.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Si panel,alteration,or or extension.limited-energy ❑ See Page 2 2
Address:3415 NE 44thAve.
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 hrmin) 90.00/hr
Email:solarpdx@me.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 199188 Electrical Lie.: c923 I SuDrv.Lie.: 48715 specifically listed(Vs hrmin) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ��r"--! Subtotal:
Print name: Kirk Rood I Date: 05/09/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: /'c/k. /7aoe-,f, TOTAL PERMIT FEE:
This permit application expires If a permit is not obtained within 180
Print name: Kirk Rood Date: 05/09/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
C\Building\Perrnits'ELC PermitAppELa_ERE.doc Rev 06/17/2015 440.4615T(I 1/05/COM/WEB
Plumbing Terniii Application
Building Fixture RECEIVE
City of Ti andMAR 62020 ,RZ,r, Y �0/2e) QIa PemitNn s� .y-OOpi!
3125 SW Ball Blvd.,Tigard,OR 97223
aI` tem 503.718.2439 Faa 303.598.1 Yate/By aw
Inspection 96�1TY OF TIGARD��-a Other Permit No.:
' rti: ,„,. Internee nIM1iG fll\/tSlO\boteiteady/B
Internet: www.ligard-or.gav BUII c S See Page fof
Nad5edlMathad:: . - Supplemental talormadoo
1 TYPE OF WORK FEE* SCHEDULE
lk New antis ruction ' 1 ❑Demolition For special iuformarioa 4se check/isi
Description I Oty I Ea. i Total
❑Addition/alteration/replac nt ❑Other. -
New 1-2-lamilydwellings(includes IOO tt for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
!'and2-famil dwelling SFR 2.bath
Y li_ I 0 Cgmmerciallindustrial O 437:78
- - SFR(3)bath 50032
❑Accessory building .I Multi•1`amily
Fach additional bath/kitchen 25-02
❑Master builder 1 0 other:
ther Fire rinkl x( s
aP 4 ft.) Page-2
JOB SITE INFORMATION-AND LOCATION Site utilities:
r 31 Catch basin or area drain
Job site address: I/p5-n-I �- 18.76
.... Drywall,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
- Footing drain(no.linear ft.:_) Page 2
Suite Bldg./apt.no.: • Project name: dkar'(.4ereuce e g .St y„ Mawfaetutcd home utilities 50,03 - -
l
Cross street/directions to. ob site: Manholes 18.76
I. I R m dtain Eolu ector _ 18.76
- 1 ' ' Salutary sewer(no.Emeriti__ ). . Page;
-
Storm sewer(no.linear IL: .J Page 2
i Water service(na linear R: . ::.1 Page 2
Subdivision:'( lutr ""{l,rtatr. Gast. *'. Lotno.:
} 2,1 F1iilrite or item:
fa);mep/patrelno.; I llackfow preventer 31.27
DESCRIPTION OF WORK Backwater Valve 1251
-
1115(4019PDOo( ! althea washer z5.o2
tF , CO Ail` 1-4 D(ahwagfo 25.02
�— Thirikingfotmtain 25.02
j Ejectors/sumP 25.02
® PROPERTY O*NER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC i Fixturelsewer.eaP_ 25.02
Address:703 Broadway St.,Site 510 Floor drain/tltior sink(hub 25.02
Garbage disposal 25,02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25,02
Phone:`(36,0)695-7700 Fax ( ) Icce maker 12.51
El APPLICANT 0 CONTACT PERSON Interceptor/grease hap 25:02
Business name:Polygon W1J9,LLC Medical,gas(values S, ) Page 2 '
Contact name:Tanja Morris Primer _ 12.51
Roof drain(commercial) 12.51
Address;703 Broadway St.,Ste 510 S{rrl</t as n lavatory 25.02
City/State/ZIP:Vancouver,WA 9B660 - 2
Solar Volts(potable water) 62.54
Phone:(360)695-7700 ; ' Fax::(360)6934442 Tub/shtiwer/shower pan 12.51
E-mail:permitsubmlttits®polygoonbomea.cain Urinal 25.02
CONTRACTOR Water.closet 25.02
Business name 1 w Water heater
25.02 '
Address:. �� B ,{ e
37
O „ 6 n 1
water, 56.29
s> 2;.az
City/SlatttZIP (of he, ' Uri 9 ii / y ,. Subtotal
Phone:(1X-/ ,r
) .4.5 Gj 61 y Fax: Minimum permit fee: 57250
ceB Lin.: /so)
-/, Pltttnbing Lie,no....
o. / 0L Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: : _ "S-- TOTAL PERMIT'FEE
Print Marne ...w•..lb I! .-MI �t /i~R,f.L Date: This permit applicationexpires if a permit 4 not obtained withla lap days
after It au bete accepted u complete.�- 'Fee methodology eat byte-Comity Building Industry Service Board.
LV BilikkaglPermal.M slPU-PamkApp.doe Be@IA9 VVVV 440-4616T(1 ab"JCOMPwER)