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Permit
CITY OF TIGARD MASTER PERMIT IN 2. ' COMMUNITY DEVELOPMENT Permit#: MST2019-00036 ,' `. • t Date Issued: 04/25/2019 . TE I�.L� 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA11700 \VCts P*(6Jurisdiction: Tigard Site address: 14214 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 117 Project: Polygon at Roshak Ridge, Lot 117 Project Description: New SFA. 8/28/2019: REPRINT to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 646 sf Basement: 115 sf Left: 3 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 633 sf Garage: 543 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1394 sf Value: $195,042.10 Rear: 10 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 RainStorm 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: V BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1394 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) ---- ST-sTE-ase --- las s.T T,SUITS410 . 1 -1 fhaur€ire-RatatRoal VANCOUVER,WA 98660 VANCOUVER,WA 98660 Ceiling 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,422.41 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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19871or 1.800.332.2344. • r�-'1/� • Issued By: ��_, --- Permittee Signature: lJc J --.7J�L3-1 \ 1V+r- 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 ;1‘‘.-)zsvc (s., 4' Building Fixtures RECEIVED FOR OFFICE USE ONLY City g of Ti and Received r. //�`• /p Date/By: a Permit No.. MST2019-00036 1/ liga 13125 SW Hall Blvd.,Tigard,OR 97 ((�,�, y 2019 Plan Review I Phone: 503.718.2439 Fax: 503.591 60 1 Date/By: 8/ .BJI Cj A.LGj Other Permit No.: TIGARD Inspection Line: 503.639.4175 CITY OFTtGARD Date Ready/By. Juris El See Page 2 for Internet: www.tigard-or.gov t )� N tUt5t0 Notified/Method Supplemental a Information TYPE O FE * SCHEDULE • ®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) �_ ,_CA CATEGORY OF_CONSTRU •UQ SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 Accessory it ccessoY budin multi-family Each additional bath/k hen 25.02 ❑ Master builder ❑Other: Fire sprinkler(1394 sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:14214 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 Suite/bldg./apt.no.: ' - I 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:Roshak at River Terrace(Townhomes) I Lot no.: 117 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION O 'V C Backwater valve 12.51 Clothes washer 25.02 MULTIPIJRPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 2 PROPERTY OW) J R I TENANT ' Expansion tank 12.51 Name:Polygon NW Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.Suite 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 til,APPLICANT 0 CONTACT PEKSON1;• Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name:Polygon NW 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 -. - - - - - ----ate- -, Phone:(360)695-7700 Fax: :( ) Tub/shower/shower pan 12.51 E-mail:jennifer.lopez@polygonhomes.com Urinal 25.02 Water closet 25.02 Water heater 37.52 Business name:Alliance Plumbing,LLC WaterPip 1 to DWV 56.29 Address: 146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.:184601 Plumbing Lic.no.:PB732 State surcharge(12%of permit fee) Authorized signature: I 1 -3-7L, TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thornes Date:8.07.2019 after it has been accepted as complete. *Fee methodology set by Tri-County 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 utilities Qty. fee(ea) Total Square Footage; ;4 Permit ' Footing drain-I'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valnationf elt' +e et 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 Inspections or Fees Fee tea) 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: I 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 Replaeellal n Review'fo 1lumbing Ingtallath!ns 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 D New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic 0 Medical gas and vacuum systems for health care facilities. Drinking Fountain ® Any multipurpose fire sprinkler system. Eye Wash 0 Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" Submit 2 sets of plans with any of the above. Car Wash Drain Garbage -Domestic-non-food Ist metr t or-I2>tser DYagram ' 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/Lay -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the haps://allianceplumbing-my.sharepoint.com/personal/gavin_allianceplum15�5ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc a e CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2019-00036 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2019 TIGARD 9 Parcel: 2S 107AA 11700 Jurisdiction: Tigard Site address: 14214 SW GOLD COAST TER Subdivision: ROSHAK RIDGE Lot: 117 Project: Polygon at Roshak Ridge, Lot 117 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 646 sf Basement 115 sf Left: 3 Parking Spaces: 0 Height: 34 Bathrooms: 3 Second: 633 sf Garage: 543 sf Front 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1394 sf Value: $195,042.10 Rear: 10 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 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 SrvclFeeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add.'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 1394 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 1 Hour Fire Rated Roof/ VANCOUVER,WA 98660 VANCOUVER,WA 98660 Ceiling 2 Ersn Cntrl 503-639-4175 PHONE: 360-695-7700 PHONE: 360-695-7700 FAX: Total Fees: $25,240.88 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 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: GTS c-------- Permittee Signature: 0 !7/ . e---rC��7e)"/ 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. V f, BuiIdin Permit Application v....... _v_ i\.7.\ Residential ' '`� �F � FOR OFFICE USE ONLY Cityof Tigard Received r�� g Date/By: �t1 k CI J.\'C" Permit No �t \CI_ fl� III " 13125 SW Hall Blvd.,Tigard,OR 97223 F t a Plan Review R �A u Phone: 503.718.2439 Fax: 503.598.610„._ /� Other Perini T I G A RD Inspection Line: 503.639.4175 1 T O F 1 1(A ;J Date Ready/By: uris H See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:7 fI//' �+ - " Supplemental Information t}"7 L / C't'L'rt7"L'.V' TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 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: $ ) S� U IDAccessory building ❑Multi-family Number of bedrooms: 2 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION.AND LOCATION Total number of floors: t 37 Job site address: I q 21 LI 5Vy ` �O'A cr, �py /a�v New dwelling area: Mil- square feet C.4, 33 City/State/ZIP: 1-190 D� Iv - Garage/carport area: L. square feet (12(-1(0 3 Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area:X square feet t `S Cross street/directions to job site: Deck area: X Q square feet Other +�cfure V square feet 1 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge Lot no.: 1 11 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the 0 DESCRIPTION OF WORK work indicated on this application. Valuation: $ Existing building area: square feet /� New building area: square feet CA IZI PROPERTY OWNER ❑ TENANT Number of stories: Name:Polygon WLH LLC Type of construction: ftAddress:703 Broadway Street Ste 510 • Occupancy groups: ,J City/State/ZIP:Vancouver,WA 98660 Existing: p..— Phone:(360)695-7700 Fax:(360)6934442 New: 0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to feeschedule) Business name:Polygon WLH LLC Structural plan review fee(or deposit): Contact name:Amanda Gavin FLS plan review fee(if applicable): Address:703 Broadway St.Ste 510 Total fees due upon application: City/State/ZIP:Vancouver WA 98660 Amount received: Phone:(360)695-7700 Fax: :(360)693-4442 E-mail:permitsubmittals@polygonhomes.com PHOTOVOLTAIC SOLARPANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR 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 lic.:207247 Total fee due upon application: $201.60 Authorized signature: — This permit application expires if a permit is not obtained ,/ within 180 days after it has been accepted as complete. Print name:Amanda vin Date: //76//#?//� *Fee methodology set by Tri-County Building Industry ()/ Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 44046131(11/02/COM'WEB) kI M L.LJ Mechanical Permit ApplicationrCITY 9 2��9 FOR OFFICE USE ONLY Cityof Tigard I°Y O�F Tt DIVISION Received Permit No.: lig5 g gUIL: LNG DIVISIA, N DateBy: 't 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: X I r r6 I:I r Inspection Line: 503.639.4175 Date Read By' Juris: Ei See Pent 2 It Internet: www.tigard-or.gov Notified/Method: Supplemental Info rmation J`. TYPE-OF WORK COM&fERC AL FEE* SCHFDULE— USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SiTE INFORMATION AND LOCATION Heating/cooling: c4'u� S� Air conditioning 46.75 Job site address: ` �(,L17 ( t p sc �� Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Roshak Ridge Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision:Roshak Ridge Lot no.: `11 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION.OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 El PROPERTY OWNER ❑ 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 23.32 121 APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name:Polygon WLH,LLC Fuel piping: $14.15 for first four;$4.03 for each additional Contact name:Tonja Morris Furnace,etc. Address:703 Broadway St.,Ste 510 Gas heat pump Wall/suspended/unit heater City/State/ZIP:Vancouver,WA 98660 Water heater Phone:(360)695-7700 Fax::(360)693-4442 Fireplace Range E-mail:permitsubmittals®polygonhomes.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:Pro Heating&Cooling Other. MECHANICAL PERMIT FEES* Address: NW Alociek Dr,Ste.1104 Subtotal City/State/ZIP:Hillsboro,OR Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(360)270-1590 Fax:( ) State surcharge(12%of permit fee) CCB lic.:209001 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: Wa bu'�'a'n' * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 l:\Building\Permits\MEC_PermitApp_040113.doc 440-4617f(11/02/COM/WEB) Electrical Permit Application RECEIVE0 FOR OFFICE USE ONLY City of Tigard ReceivedteB Permit#: '61 13125 SW Hall Blvd.,Tigard,OR 97223 APS L" 01� Plan Review 9 _ I. . . Phone: 503.718.2439 Fax: 503.598.1960 q RD Date B : Related Permit#: Inspection Line: 503.639.4175 CITY OF 1 I. I", 'eady DateBy: lurk: El See Page 2 for 111-54"-LI. Internet: www.tigard-or.gov BUILDING DIVISIO `,otified/Method: Supplemental Information TYPE OF WORK', PLAN REVIEW ®New construction ❑Addition/alteIation/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more ElBuilding over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONS'I"RUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 RVA or JOB sial, INFORMATION AND.LOCATION r 0 Emergency system. larger separately derived Job#: Job site address:+ �,'1 n c "'j'' /�� ❑Addition of new motor load of system. 1 lk §W Ga� i-s-r 1 L'F.l. I00HP or more. ❑ A,„E>, 1.2", 1_3„, City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more_ 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: '`”1 Includes attached-garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 il� PROPERTY OWNER 0 TENANT ' Services or feeders installation,alteration,and/or relocation Name:Polygon WLH,LLC 200 amps or less 100.70 2 Address: 703 Broadway St,Ste510 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2 Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ® APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service or feeder fee, each branch circuit 7'42 2 Contact name:Jolene Smith B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address:703 Broadway St,Ste.510 branch circuit City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax::(360)693-4442 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:permitsubmittals@polygonhomes.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Portland Electric Sign or outline lighting 67.84 2 Address:1915 E 5°'St Ste D pinnalalrcutts)or extension Cl 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 nun) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr Email:paul®portlandelectric.biz tf(/ S Industrial plant(1 hr min) 78.18/hr iz Inspections for which no fee is 90.00/hr CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.: - specifically listed('h hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: � � Subtotal: Print name: Alex Shalya Date: 04/08/2019 Cl Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: 1}1 & TOTAL PERMIT FEE: Thus permit application expires if a permit is not obtained within 180 Print name: MISHCHUK,SERE Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit • , . ` RECEIVED Plumbing Permit Application APR 9 2019 Building Fixtures CITY (`� FOR OFFICE USE ONLY g I � R© Received - Cityof Tigard DIVISION Permit No.: NI v 13125 SW Hall Blvd.,Tigard,OR 97223PlDate/By: Phone: 503.718.2439 Fax: 503.598.1960 Date/By:an Review Other Permit No.: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist. Description Qty. 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 ❑ 1-and 2-family dwelling SFR(2)bath 437.78 g 0 Commercial/industrial ❑Accessory building ®Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: (4 214 5u0GjOL) GDt 5T T-s Catch basin or area drain 18.76 t 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 1 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge Lot no.: l l-i Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St.,Ste 510 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Tonja Morris Roof drain(commercial) 12.51 Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:G&B Plumbing&Sons Inc WaterPip P�r in WV 56.29 Address:P.O.Box 92 Other: 25.02 City/State/ZIP:St.Paul,OR 97137 Subtotal Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.:184372 Plumbing Lic.no.:pb634 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Steve Fowler Date:04/08/2019 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 11111 City of Tigard 4 COMMUNITY DEVELOPMENT DEPARTMENT TIG ARD Building Permit Review — Residential Building Permit #: -- `"� Site Address: PI 12/ :5-to 64/(6475 Ir-/(6475 f ice,-.tee-c.-_ Project Name: P ;r) 0 / ,7051-K, 4- R,c- dwellii = i� � l st Lot #: (New �r� subdivision name;Addition or Alteration last name of owner) C Planning Review Proposal: A f /�( ii t C2"---Verify site address/suite#exists and active in permit system. kr-River Terrace Neighborhood: ❑ No EYes,See River Terrace Review Addendum Attached Site Plan Elements: ,Three(3)copies of site plan anteplan must �'atrufures on site ,,���t Le on 8-1/2"x 11"or 11 x 17"paper otprint of new structure(including decks)with finished 2 yawn to scale(standard architect or engineer scale) floor elevations Al North arrow ,l� �,� '6Ttility locations&easements(required for new and additions) .IJStte address,project or subdivision name and lot number ����r- ICfStdewalk/driveway approach .applicant information(name and phone number) -�carion of wells/septic systems dimensions and building setback dimensions —Dt2tisling trees to be retained with drip line,and tree .4;16ga0e rootage of buildings to be demolished .rotection measures t area,building coverage area,percentage of coverage and w a, impervious area(applicable if R-7,R-12,R-25&R-40) a treetnames ,type and location ctli roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? C ❑No G ?' 4 foot differential) If yes,is a storm water quality facility shown? ❑Yes 21Vo Clean Water Service —Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ es,applicant was notified 0 No Received: 3, �Puublic Facili,_ti,,e�s Im rovement(PFI)Permit: �— 0 No Required: des,applicant was notified 0 No Applied For: Yes 0 No,stop intake ErLand Use Case#: PPR :700 j -0006" 10 20 IS-000011 la—Zoning: .Required Setbacks: Front 10.. Rear /L) Side O/? Street Side Garage 4 1,6.- Eci.madscape Requirement 0 % J l of Coverage Maximum: 7D— % r � T --- t: Maximum Height 3S Actual Height j C( Visual Clearance fa Sensitive Lands: 0 Yes io Type Urban Forestry Plan - Conditions "Met"prior to issuance of buil / g permit Notes: r �L'7 i .015. 7 !y1 - ui rtes 1..;1 IK) tt,, 1Ilu{ t� ° v-,,,ki,j), (.,/,t , n5 Approved By Planning: .d 1pCi Date: 2,-3- 0 Revisions (after B)dlding Submittal only) Revision 1: g Approved 0 Not Approved ,fJjy,,,,( Reviewer Date ii Revision 2: 0 Approved 0 Not Approved 1'V �� L�� Revision 3: 0 Approved ❑ Not Approved I:\BuildineForms1BldgPermitRvw_RES_061417.docx 1 Building Permit Submittal Original Submittal Date: 1-" 1'‘C� Site Plans: # _. Building Plans: # Building Permit#: 21 Enter building permit#above. Et/Building Routing: Er Planning Engineering S Permit Coordinator Workflow Sign-off: S Sign-off for Planning(include notes from planning review) Route Application Documents: [i Engineering: (1) copy of permit application, (1)site plan, (1)building plan and original plan review routing form. 0JBuilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. 1 11a -t" Notes: By Permit Technician: \.. pi. A �/...— Date: 3"'-` ' `C'1 Engineering Review Slope at building pad: ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes 1 No Assess Water Quantity Fee in-lieu: 0 Yes -3- No LIDA Facility on lot: 0 Yes P-No .Et-Final Plat Recorded: Date: ❑ NOT Approved by Engineering: Notes: LA}14T fOrL, VLAYPI,1•319s, ►N rte')3', 7) 1 ' Approved by Engineering: Date: 3 (ta l I Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review Conditions"Met"prior to issuance of building permit 0 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: 4DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 0 N/A Tigard Trans SDC: fid"Yes 0 N/A Parks SDC: Yes 0 FA LIDA Ll Yes N/A OK to Issue Permit /67/ �Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES 010118.docx � a City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT r c A R o River Terrace Building Permit Review Addendum Building Permit #: Site Address: 11/,9 J `/ `� Gti (20/6/0 q5/ %6-�4 - Project Name: ft j/ / k crs het 4 pricy Lot #: 117 (New dwelling E, bdivision name;Addition or Alteration=last/name of owner) Planning Review of River Terrace Plan Dist' t Design Standards (18.640.070.1.): Is the project subject to the plan district design standards? LI 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. Balcony w/ access 2 Window Projection Vertical Wall Offset a Porch min. 5 ft. deep Gabled dormer ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide 240 pi the street: a minimum of 12%of each street facing facade must include windows or entrance doors. Percentage Shown: 2.1. * Z Z� 3. Entrances:At least one entrance must meet both of the following standards: ALJ 1Vlax. 8 ft. setback from longest street- facing wall , l5arallel to street,angle no more than 45° from street, / or open onto porch Entrance opens to a porch: If Yes ❑ No If yes,all the following apply: sq.ft.min. ' One street facing entry 12 ft. max.roof above floor of porch ft. depth min. min.porch roof coverage 4.Detailed 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 ',ecessed entry area min. 5 ft.wide x 2 ft. deep ❑EWall offset min. 16 inches g Dormer min. 4 ft.wide S ^'CJ Koof eave min. 12 inch projection S ❑ Roof offset min. of 2 ft. ❑ Roof shingles either tile or wood $Gable,hip or gambrel roof design S ❑ oof pitch oriented south min. 500 sq. ft. ..01Iorizontal lap siding min. 3-7 inches wide. g Accent siding min. 40%of street facade -ErVindow trim min.2 1/2'wide by 5/8"deep ❑ Window recess min. 3 inches for all street facing ❑ $ay window min. 5 ft.wide by 2 ft. deep ❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access g Attached garage is 35%or less of street façade S 5. Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: Nogcloser to front or side lot line,than longest street-facing wall. ❑ Yeso. If No (Check one): Z1 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. tlt;ic.,4404one) ❑ 12-foot-wide garage door ❑ 40%max. of street facade V.510°/0 max. of street façade with 7 detailed design elements Notes: Approved By Planning: Cl/71)C— Date: 2,-71q 1:\Building\Fonns\B1dgPermitRvw_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 IN Transmittal ansmlttal Letter r („n R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ro VV y OK b V l l t DATE RECEIVED: z 'ti DEPT: BUILDING DIVISION RECEIVED FROM: frnriPi V I CU fi d v i lit FEB 2 5 2019 COMPANY: FO I (j in NC) vi-14 \Ai eGARD BUILDINNG DI V SION PHONE: "J W L" OC1S 1 1 C) 0 By:S)-1— RE: Iu21 `1 1 V (--1 00_LC)CkThv r CL MSI 2-01q 0Op (Site Address) (Permit Number) • r 4 t - IDA- I n (Project 1 e .r subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: I Coies: p 1 Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculatio s. Other(explain): S 1✓)0 1,71,/ l ill V\ "(, V co u o A Y 1 , S WP- Al REMARKS: COY- VQ Y. e tVoifil ) �Soo S .FfR �: ..a .. -rtQ> . . - uvukok . ._ . , ;. Routed to . it Technician: Date: Initials: Fees Due: 11 Yes D No Fee Description: Amount Due: Z Tioni rzuro_t-.) $ Lis---:- vv$ $ Special Instructions: Reprint Permit(per PE): D Yes ViNo D Done Applicant Notified: Date: Initials: I:\BuilditteForms\TransmittalLetter-Revisions 061316.doc Plumbing Permit Application Building Fixtures ., FOR OFFICE USE ONLY City Of Tigard 1 it 4:' 2.0'' Received �-�I1. y 1Ct S Permit No.mc...)-70.c.,,�,� 'r 13125 SW Hall Blvd.,Tigard,OR 97223i 1 ( Date/By: ` M_(-v..� ' • Phone: 503.718.2439 Fax: 503.598 , . Plan Review J 1 �+�l t,' Inspection Line: 503.639.4175 "' ' e ° ' Date/By: Other Permit No:: TIGARD ;s1 gt r �t > s ,r ;., Date Read 1B Internet: www.tigard-or.gov 3 )i t �, 1 d -. t_ Ready/By: Juris: I S See Page 2 for ed/Method l Supplemental Information TYPE OF WORK k ' " 1 ..°EFkE".CHEDULE ®New construction �s � �� � m- �>� ,` ` 0 Demolition ��'`� ��� ., For special information use checklist. ki, Description Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other `k 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 ❑Accessory building ®Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION ANDLOCATION" Site utilities: Job site address: ‘42,1t4 C-,DL-1 . n „ �"'Jr Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 �- Drywall,leach line,or trench drain 18.76 Suite/bldg./apt.no.: ---4.,7J Project name:Roshak Ridge Footing drain(no.linear ft.:_) Page 2 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:i) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision:Roshak Ridge /�1 Water service(no.linear ft.: ) Page 2 Lot no.: Il 1 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK" Backwater valve 12.51 ` 'e 1 ,,kc�c 1 Clothes washer 25.02 V ut-c 2.0k 04-6003(a Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER ❑"TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 510 Floor drain/floorsink/hub 25.02 City/State/ZIP:Vancouver,WA 98660 Garbage disposal 25.02 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 Address:703 Broadway St.,Ste 510 Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable waterl _ one: 03-7700 . Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Business name:Alliance Plumbing Water heater 37.52 Water piping/DWV 56.29 Address: 146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee) / lavt,,,L.Authorized signature: State surcharge(12%of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is notobtained within 180 days Print name:Robert Dishman Date: pl co after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1.\Building\Permits\PLMU-PermitApp.d°c 10/01/09 440-46I6T(10/02/COM/WEB) Electrical Permit Application � � �� ` FOR OFFICE FUSE ONLY • � � �II City Of Tigard ,i.,1 Received 'i 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R -} �1Ct S Permit#,MST�G\Cc_ Plan Review ' " I Phone: 503.718.2439 Fax: 503.598:19,60''; Date/B : Related Permit#: TIGARD Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for w c Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK : F _ PL.4N;I2EVIE 9V.::, E New construction El Addition/alteration/replacement ' Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition Quer; d "' �'s,‘ •V \ 0 Service or feeder 400 amps or more 0 Building over three stories. \N 1 where the available fault current ❑Marinas and boatyards. •. CATEGORY,OF-CONSTRUCTION - exceeds 10,000 amps at 150 volts or ❑Floating buildings. 1-and 2-familydwellingt.,---- El less to ❑Commercial/industrial ❑Accessory building ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: ❑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: lt7J(.k C00(.c CO 1% C. '�" . l00ItP or more: ❑"A",`'E^, 'i-2","1-3", City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑S Recreational vehicle parks. Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge Lot#: ``1 Includes attached garage. Tax map/parcel#: 1,000 sq.ft,or less 168.54 4 Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF•WORK • Limited energy,residential C CS\ Y7Y\ST -tic bb �(Da (with above sq. ti 75.00 2 l Limited energy,mullti-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 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 • Branch circuits—new,alteration,or extension,per panel ® APPLICANT 0 CONTACT.PERSON A Fee for branch circuits with Business name:William Lyon Homes,Inc. above service or feeder fee, each branch circuit 7.42 2 Contact name:Nichole Thorpe • B.Fee for branch circuits without Address:703 Broadway St Suite 510 service or feeder fee,first 56.7 S 2 branch circuit City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder 67.84 2 — 6.64 2_` — _ . , CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Alameda Electric Sign or outline lighting 67.84 2 SignacircuitAddress:3415 NE 44th pannel,alteration,or or extension � 0 See Page 2 2 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.: 487I1 S specifically listed('h 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: /Zre-1 �� TOTAL PERMITFEE:t ( This permit application expires If a permit is not obtained within 180 Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.