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Permit (26)
CITY OF TIGARD7ud1 MASTER PERMIT AI ik COMMUNITY DEVELOPMENT '�" ,� Permit#: MST2019 00137 TtGAR o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 2S107AA05600 Jurisdiction: Tigard Site address: 14179 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 56 Project: Polygon at Roshak Ridge, Lot 56 Project Description: New SFA. 9/27/2019: REPRINT permit to add fire sprinkler system. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 670 sf Basement: 80 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 634 sf Garage: 532 sf Front: 12 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Drains: 0 Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 1 Drywell-Trench Drain: 0 Other Fixture Units: Fire sprinkler system MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 2 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1384 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 NFPA 13D Sprinklers Required 3 Geo Tech Report Required PHONE: 360-695-7700 PHONE: 360-695-7700 Prior To Pour FAX: Total Fees: $25,116.23 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/�' 952 D01.-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: �( '�` 7"c ----- Permittee Signature: e� �lC ?e °� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. FOR OFFICE USE ONLY-SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. INCity of Tigard e 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: CITY OF -RDARD P1Cac DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: GAVIN 'T'NOMES SEP 2 3 2019 CITY OF TIGARD COMPANY: ALA-IANCE. Poiev\BI NCS BUILDING 0 ViSIO'• PHONE: (So3) 577-(o5? By.&,..S3._ RE: 14{(19 SW /69TH AvE MS T2o i 9 - o of 37 (Site Address) (Permit Number) RoS HAK tOT % •-,\ .r,°•4=\ t O (Project name or subdivision name and lot numbe ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Desctip X Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: PR:EviovS PLANS v-iagE Too LI 611T Tt> READ FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑No Fee Description: Amount Due: $/3& • 53 $ $ $ Special Instructions: Reprint Permit(per PE): Yes ❑No Done Applicant Notified: ij5, /Date: '/.,?_7/./9i nitials:, T:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY Cityof Tigard Received . g t,a S,:s.).-7. Permit No.: MST2019-00137 111 " AUG 2 9 2019 Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review //n!//� ^, Phone: 503.718.2439 Fax: 503.598.1960 fa /�r[� Other Permit No.: Date/By: TIGARD Inspection Line: 503 639.4175 Date Read/B / Internet: www.ti and or ov CITY OF TIGARD Ready/By: 7,-----, Juns: Supplemental See Page 2 for g g BUILDING DIVISION Notified Method' /� Information itri iWOak 4.---4= FEE* SCHEDULE ®New construction ❑Demolition 7-e Ar7/1 For special information use checklist. Description I Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)- ,a. CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 0 Accessory 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Firesprinkler span er(1384 sq.ft.) Page 2 +ulCiii'•cFFE'FSIIX `IEA'1"I `ia y r A C,P1'_... Site utilities: Job site address:14179 SW 169th Ave Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: ot 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:Townhomes at Roshak I Lot no.:56 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 ESCRI"TION OF.WWII( Backwater valve 12.51 Clothes washer 25.02 MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ►;1 °PROPERTY OWNER ❑ 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 ►1 APPLICANT ❑ 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 ' Water closet 25.02 C> `� d-` . . Water heater 37.52 Business name:Alliance Plumbing,LLC Water piping/DWV 56.29 Address: 146 W Historic Columbia River Hwy Other: 25.02 City/State/ZIP:Troutdale,OR 97060 Subtotal Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.:184601 Plumbing Lic.no.:PB732 State surcharge(12%of permit fee) Authorized signature: /��`�J TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gavin Thornes Date:8.27.2019 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\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: Permit Fee: Footing drain-1St 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 Storm&Rain Drain-1st 100' 62.54 valuation: Permit Feettk, $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(ea) Total each additional$100.00 or fraction thereof,to P 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 ❑ 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 ❑ 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 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 https://allianceplumbing-my.sharepoint.com/personal/gavin_alliancepluml5G5ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp (3).doc CITY OF TIGARD MASTER PERMIT ;9 111 ..' COMMUNITY DEVELOPMENT Permit#: MST2019-00137 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019 Parcel: 26107AA05600 Jurisdiction: Tigard Site address: 14179 SW 169TH AVE Subdivision: ROSHAK RIDGE Lot: 56 Project: Polygon at Roshak Ridge, Lot 56 Project Description: New SFA. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 2 First: 670 sf Basement: 80 sf Left: 0 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 634 sf Garage: 532 sf Front 12 Smoke Dwelling Units: 1 Third: 0 sf Right 0 Detectors: Yes Total: 1384 sf Value: $189,364.40 Rear: 0 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 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>=10OK: 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+am p/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SFA VB R-3 1384 Owner: Contractor: POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions) 703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175 VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 NFPA 13D Sprinklers Required 3 Geo Tech Report Required PHONE: 360-695-7700 PHONE: 360-695-7700 Prior To Pour FAX: Total Fees: $24,979.70 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: .1_, . Permittee Signature: liC )l_.-1,Ci \ 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. &, Building Permit Application L L \ - ..iL Residential RECEIVED FOR OFFICE USE ONLY . City of Tigard Received FEB 0 7 2019 Date/By. 4,I cj'1 S)T Permit No.Nygxi`1_(i\,j) 13125 SW Hall Blvd.,Tig.ard,OR 97223 iv1 LA 1 Plan Review Phone: 503.718.2439 Fax: 503.598.1 (-y 111 O F TI GAR D DateBy: y' t (1 Other Perm K X.ACI, `)G,1 TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyBy. Juris: 0 See Pagb2for l Internet www.tigard-or.gov Notified/Method: 1,G Supplemental Information Ctc� - ger) TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLPc4G ®New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ V t �) ❑Accessory building ❑Multi-family Number of bedrooms: 2-, c `� t ❑Master builder 0 Other: Number of bathrooms: 3 JOB SILL INFORMATION AND LOCATION Total number of floors: 1 v Le Job site address: 1 -4 fl q c)1/0 tool hie)/n/) New dwelling area: 13 k•-k square feet (a3L,) City/State/ZIP:Tigard,OR 97224` '' Garage/carport area:() Z square feet tfi Suite/bldg./apt.no.: 0\ Project name:Polygon at Roshak Ridge Covered porch area: square feet taC) Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Polygon at Roshak Ridge ( Lot no.: Seo Permit fees*are based on the value of the work performed. Tax map/parcel no.: J 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 SF/ Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER I 0 TENANT Number of stories: Name:Polygon WLH LLC Type of construction: 40 Address:703 Broadway Street Ste 510 Occupancy groups: ri City/State/ZIP:Vancouver,WA 98660 Existing: /+ Phone:(360)695-7700 Fax:(360)693-4442 V New: ® APPLICANT 0 CONTACT PERSON BUILDING PERJIIT FEES* Business name:Polygon WLH LLC (Plane refer toteeschednle) Contact name:Amanda Gavin Structural plan review fee(or deposit): '(1Address: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.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Q ©R 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 and administrative fees): $180.00 Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:207247 Total fee due upon application: $201.60 Authorized signaturlik This permit application expires if a permit is not obtained within 180 days after it has been acce s ted a i ii i • 'rut name: • mania am Date: dw7 / iee met o o ogy set by Tri-County Building Industry l f i Service Board. I:\Building.\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) imilmmomilimin Mechanical Permit Applic 3 FOR OFFICE USE ONLY City of Tigard Received Permit No. III ▪ '� 13125 SW Hall Blvd.,Tigard,OR 97223 R , �� Date/By: 1ST�U�_�A�\� ▪ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit: Inspection Line: 503.639.4175 CITY T ' - F 1 ii r6 P.I a C(1 I F i 6 aiAl 3 3.<+ Date Ready/By: kris: H See Page 2 for Internet: www.tigard-or.gov y 11 � DIVISION Notified/Method: ����,,,,,��t4� Supplemental Information TI'PE.OF VfrORK COMMERCIAL FEE*SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. , . Value:$ CATEGORY OF'CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* IN 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist. Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: A Air conditioning 46.75 Job site address: I LI ri Q J l� t 1.O O�-1 4 ii tiG 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.: 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.: 5t. Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRH'TION 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 la PROPERTY OWNER Q 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 El APPLICANT ❑.CONTACT PERSON Other:h 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 C` This permit application expires if a permit is not obtained within 180 AnthnrivPof A c; _r„�..• ( b days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board Print name:Elia Duran Date:04/08/2019 I:1Building\Permits\lvta.C_PemvtApp-040113.doc 440.46I7T(11/02/COM/WEB) Electrical Permit Application A ,, — e FOR OFFICE USE ONLY CityofTigard CTIVE 1 g �y Date/By: Permit#:W� L ` 'I 13125 SW Hall Blvd.,Tigard,OR 97223 P R , ') Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#: Inspection Line: 503.639.4175 - l l` a g RD Read Date/BY Juris: H See Page 2 for11Li IL Internet: www.tigard-or.gov ' r I` Icy allotified/Method: Supplemental Information TYPE,OF WORK PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSi'RUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived 1�� ' l ❑Addition of new motor load of system. Job#: Job site address: SW 1 Q P e I OOHP or more. City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Roshak Ridge ❑Hazardous locations. ❑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 1 Qty. 1 Each I Total I *_:: New residential single-or multi-family dwelling unit. Subdivision:Roshak Ridge Lot#: 560 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 El PROPERTY OWNER TENANTServices 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 otl APPLICANT - .❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:Polygon WLH,LLC above service or feeder fee, 7.42 2 each branch circuit Contact name:Jolene Smith B.Fee for branch circuits without 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 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 Reconnect only 67.84 2 'tea t t .- 4,P. s.. ‘4%).0 44 t„'t i Pump or irrigation circle 67.84 2 Business name:Portland Electric Sign or outline lighting 67.84 2 th Signal circuit(s)or limited-energy Address: 1915 E 5 St.,Ste D ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(360)314-4945 Fax:( ) Investigation(I hr min) 90.00/hr Email:paul@portlandelectric.biz Industrial plant(I hr min) 78.18/hr Inspections for which no fee is CCB Lie.: 194066 Electrical Lie.: C760 Suprv. Lic.sig 2g' 05 specifically listed('/1 hr min) F.I 90.00/hr n A- FCTI2ICAL PERMIT FEES Suprv.Electrician signature,required: (�l��, Subtotal: Print name: Alex Shalya Date: 04/08/2019 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: }i ,i.„ ,k, TOTAL PERMIT FEE: rMs permit appfcanon expires n a permit is not obtained within 180 Print name: MISHCHUK,SERC Y Date: 04/08/2019 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Plumbing Permit ApplicatiED nom' . .. Building Fixtures � � FOR OFFICE USE ONLY City of Tigard APR 2 b 2019 Received permit No II . v 13125 SW Hall Blvd.,Tigard,OR 97223 � Date/By: {� c "� (%� � a i",)): ..f i pt) Plan Review Phone: 503.718.2439 Fax: 503.59 Other Permit No.: S Date/By: TIGARD Inspection Line: 503.639.4175iF Igo"' �� � Internet: www.tigard-or.gov I Date Ready/By: Juris: Ed See Page 2 for Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist. Description I 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 jg 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14 not E w (1k.oR-TI1 (� Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Pili Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 1 Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge 1 Lot no.:5(.p 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 Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02 Phone:(360)695-7700 Fax:( ) Ice maker 12.51 ® APPLICANT 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 25.02 City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:G&B Plumbing&Sons Inc Water piping/DWV 56.29 Address:P.O.Box 92 Other: 25.02 City/State/ZIP:St.Paul,OR 97137 Subtotal Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: $72.50 CCB Lic.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: IbtAfeb^.......... TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Steve Fowler Date:04/08/2019 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) I City of Tigard . " COMMUNITY DEVELOPMENT DEPARTMENT T r c K n Building Permit Review — Residential Building Permit #: Site Address: I L1(11 .cW Wit,. Ave, Project Name: Rp,.4,,, ;h � f ;i� Lot #: g 6 (Newg=subdivision name;A tition or Alteration=last name of owner) Planning Review q Pro osal: i` ti�-c� SF. •;�\ttk I iAc�Lt k �ci3 NL� , i lie Verify address/suite#active in Accela. Ifif In River Terrace: ❑ NoIg4 Yes,River Terrace Review Addendum Sit,Plan Elements: sion Control lld3 opies of site plan on 8-1/2"x 11"or 11 x 17"paper aired trees with drip line and tree protection measures awn to scale(standard architect or engineer scale) otprint of new structure(including decks)and FFE rth arrow . ty locations •&easements(required for new and additions) e address,project or subdivision name and lot number I! idewalk/driveway approach A plicant information(name and phone number) ocation of wells/septic systems FV' t dimensions and building setback dimensions : t tree size,type and location .•are footage of buildings to be demolished is M sting structures on site A orner elevations(2'contours if more than 4'differential),.,��,re� 7, .t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [ ccs ❑No � impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑I c ]No NJ Clean Water Services—Service Provider Lette (lot platted prior to 9/10/1995): (A _, equired: CIYes,applicant was notified [ No Received: ❑ Yes ❑ No 1� 1 t'` Lq' Public Facilitieyrmprovement mprovement(PFI) Permit: Id� t /Required: Yes,applicant was notified 0 No Ap lied For: 11 Yes ❑ No,stop � intake and Use Case#: �p Ok 2(S_00002_ a Zoning: K-(Z V. Required Setbacks: Front , Rear �Z Side 0 Street Side 3 Garage 3 ! "wilding Height Max. Height: I,JA Actual Height: Landscape Area: % [ Z � Lot Coverage Max: go ntrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows ❑ Minimum 12%of area of all street-facing facades f k s Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: (a ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage. i; ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor. (j4. ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following: ��ry T ❑ Covered porch ❑ Recessed entrance 0 Wall offset ❑ 1'Roof eave ❑ Roof offset fl`Ulr Wy�cl 0 Fire shingles ❑ Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Window projection Cl Balcony ,J)i'sual Clearance IS Urban Forestry Plan L)d"ei) Sensitive Lands: [ Yes ❑ No Type Go S &--3,‘-',4-11„,, - -1 ' r Conditions met prior to issuance of building permit � Gt 41 ( � IA Approved By Planning: Y� Date: y_I -(9 Revisions (after Building Submittal Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: 0 Approved ❑ Not Approved I:\BuildingTonns\BldgPennitRvw_RES_022819.docx Building Permit Submittal Original Submittal Date: fl--A-11c) Site Plans: # :) Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: R'Planning a Engineering C`Permit Coordinator R"Building Workflow Sign-off: Ia Sign-off for Planning(include notes from planning review) Route Application Documents: [Y Engineering: (1) copy of permit application, (1) site plan, (1)building plan and original plan review routing form. ["Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: k� �� � Date: l\ '\C\ Engineering ReviewST 70 -Slope at building pad: „E'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 yNo Assess Water Quantity Fee in-lieu: 0 Yes X No LIDA Facility on lot: 0 Yes No Final Plat Recorded: 0 NOT Approved by Engineering: Date: Notes: / Approved by Engineering: 4-1- (--- '.‘ Date: �/ 1 /1 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: SDC Fees Entered: Wash Co Trans Dev Tax: cEr Yes 0 N/A Tigard Trans SDC: Ca Yes 0 N/A Parks SDC: Yes 0 N/A LIDA 0 Yes Ca N/A OK to Issue Permit � �aa.� 19 Approved by Permit Coordinator: Date: T I:13uilding\Forms\BldgPennitRvw_RES 022819.docx City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT 111X T 1 G A a D River Terrace Building Permit Review Addendum Buildmg Pem --v.21--00,‘.— , rmit #: 'MST :1 - w l � Site Address: H V 71 s;,J 16'14- Ave. Project Name: Poky,, 1LSkaik � e Lot #: b (Ne wellinname; ' g=subdivision Addition or Alteration=last name of owner) 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 ft.deems min. 2ft., 5 ft.wide min. 2 ft.,6f1.wide Gabled dormer ❑ �k 0 y/P_ lanning . yes on the street:a minimum of 12%of each street facie facade must include Percentage Shown: 23:0 ; PH 17,j�_ I Z L�� windows or entrance doors. 3. E er Yito street,an ances:At least one entrance must meet both of the folio street- facingg standards: i i Max. 8 ft. setback from longestParallel le no more than 45° from wallg street, or open onto porch Entrance opens to a porch: liYes 0 No _� If yes,all the following apply: [ 25 sq.ft.min. 'One street facing entry i2 ft.max.roof above floor of porch VS-ft. depth min. 40%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 0 Recessed entry area min. 5 ft.wide x 2 ft. deep ErWall offset min. 16 inches PA ^❑�Dormer min.4 ft.wide �oof eave min. 12 inch projection V.3 [ 'R f offset min.of 2 ft. r/S ❑/Roof shingles either tile or wood ,IL/rabble,hip or gambrel roof design f /3/ 3 Ltd oof pitch oriented south min. 500 sq. ft.] Lid Horizontal lap siding min. 3-7 inches wide S Lid Accent siding min.40%of street facade p73 0 Window trim min.2 1/z" " wide by 5/8deep ❑ Window recess min. 3 inches for all street facing �❑ B window min. 5 ft.wide by 2 ft. deep 0 Balcony min. 5 ft.wide x 3 ft. deep with inside access [ 'Attached garage is 35%or less of street facade r/3 Milli . Garages and Carports:May face the front or side lot line on a corner lot. Setbacks: No closer to front or side lot line, than longest street-facing wall. 0 Yes 0 No. If No(Check one): t0 0 May 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 buildin and there is a alit7 above the garage that faces the street with a min. area of 12 sq.ft, g window at the second story Width: (Check one) 0 12-foot-wide garage door 0 40%max. of street facade 0 50%max. of street facade with 7 detailed design elements Notes: A roved B P ' • Date: 170-11 1ABuildmg\Forms\BldgPermitRvw_RES_RT_121417.docx Plumbing Permit Application Building Fixtures e...4,-,.C,(m, 4, .P ° ,._ _' FOR OFFICE USE ONLY City of Tigard Jul 1 W ?019 Received 1 III 's 13125 SW Hall Blvd.,Tigard,OR 97223 ' Date/By: �'`\ i tCA (,T Permit No.��.` `C` _ W I J` 2 : Phone: 503.718.2439 Fax: 503 �$ 60 �,. Plan Review V �� Inspection Line: 503.639.4175 to t �� s Date/By: Other Permit No.: TIGARD p r f' Date Ready/By:Internet: www.tigard-or.gov ci Li i in, (5-:, t f 6 ,t. N Jur s: S See Page 2l r obfied/Method Supplemental Information TYPE OF WORK ` " . : ' :FEE* SCaEb1 tE; 4 * P 7� For special information use checklist. ®New construction ❑Demolition Description - ❑Addition/alteration/replacement ❑Other: \� Qty. Ea. I Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION ' ' SFR(1)bath 312.70 ❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 o Accessory building ®Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 tk k.-1 C t a "CT14- CA-LE. Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: C\ I 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.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Subdivision:Roshak Ridge Water service(no.linear ft.: ) Page 2 Lot no.: Gip Fixture or Item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIP!ION OF-WORK Backwater valve 12.51 Clothes washer 25.02C\ary n"�pVIVaq021 � 21°‘-00t1 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ®,.PROPERTY OWNER ,. I ❑,TENANT Expansion tank 12.51 Name:Polygon WLH,LLC Fixture/sewer cap 25.02 Address:703 Broadway St.,Ste 510 Floor drain/floor sink/hub 25.02 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 t=uts(potable water) _ _ Phone:1360)695-7700 I Fax::(360)693-4442 Tub/shower/shower pan 12.51 E-mail:permitsubmittals@polygonhomes.com Urinal 25.02 a 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 Lie.no.:PB732 Plan review (25%of permit fee) Authorized signature: State surcharge(12%of permit fee) TOTAL PERMIT FEE Print name:Robert Dishman Date: I This permit application expires If a permit Is not obtained within 180 days after if has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:113uilding1PennitskpLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Electrical Permit APPilcatia ,- � R • 1 �`' a ° ��� FOR OFFICE USE ONLY'. City of Tigard Received•'�1 t�� 4,\nt,�� Permit#:lv T� C _Q-J(.11, III 13125 SW Hall Blvd,,Tigard,OR 97223 II '' ) 1l Date/B i �� Phone: 503.718.2439 Fax: 503.598.1960' t g' '`' Plan Review Date/B : Related Permit 4: TIGARD Inspection Line: 503.639.4175 0 ,; Ready Date/By: Iw-is: lE See Page 2 for c Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OFWOItIC :; , :. PLAN REVIEW, • ' . ®New construction 0 Addition/alteration/replacement '. �;;,a G� `please cheek all that apply(submit 2 sets of plans w/items checked): 0 Demolition - 0 Other: ' 0 Service or feeder 400 amps or more 0 Building over three stories. "' where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. El 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations• buildings, 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. ,.. larger separately derived Job#: Job site address:,t viet Sup ` ?rti. (�,,, t� 0 Addition 00H oo moew motor load of system. i ��./r. 100HP or more. ❑"A","E","1-2","1-3", City/State/Z1P: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: Description I Qty. I Each i Total I * New residential single-or multi-family dwelling unit. Subdivision:Polygon at Roshak Ridge I Lot#: 51, Includes attached garage. Tax map/parcel#: 1,000 sq.R.or less 168.54 4 DESCRIPTION OF WORK Ea addI 500 sq.ft.es orde portion 33,92 1 Limited energy,residential (`_V 1 c OYl 1 c�T (C.`e Opt. .1 (with above sq.ft.) 75.00 2 v Limited energy,multi-family residential(with above sq.ft.)Energy 0 See Page75.00 2 I . 2 Renewable 1 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 City/State/ZIP:Vancouver,WA 98660 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:(360)695-7700 I Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: • Date: 401 amps to 599 amps 168.54 2 ®APPLICANT I 0 CONTACT.PERSON` Branch circuit's—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 Address:703 Broadway St Suite 510 service or feeder fee,first branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98660 Each add']branch circuit 7.42 2 Phone:(360)695-7700Miscellaneous(service or feeder not included) I Fax: : (360)693-4442 Each manufactured or modular Email:permitsubmittals of dwelling,service and/or feeder 67.84 2 @P ygonhomes.Com Reconnect CONTRACTOR ' . e ect only 67.84 2 67,84 —2- - Business name:Alameda Electric Sign or outline lighting 67.84 2 Address:3415 NE 44th Signal circuit(s)or limited-energy panel,alteration,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/br Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90,00/hr CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871$ ,. specifically listed(%hr min) Suprv.Electrician ELECTRICAL'PERMIT.FEES psignature,required: Subtotal: Print name: Kile Roodj Date: 03/08/2019 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): ,/, Authorized signature: _.....„...--e***41#--- r Date: 03/08/2019 TOTAL PERMIT FEE: Print name: Kile Rood This permit application expires If a permit not obtained within 180 days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELC_Pe,mitAnn ELR ERE.doc Rev 06/17/201i