Permit CITY OF TIGARD 44 9 + ,/%' H,. MASTER PERMIT
',... COMMUNITY DEVELOPMENT Permit#: MST2019 00136
T j iARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S107AA05500
Jurisdiction: Tigard
Site address: 14157 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 55
Project: Polygon at Roshak Ridge, Lot 55
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: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 1214 sf Value: $164,352.30 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
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'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 1214
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 Geo Tech Required Prior To
Pour
3 NFPA 13D Sprinklers
PHONE: 360-695-7700 PHONE: 360-695-7700 Required
FAX:
Total Fees: $24,670.76
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - Permittee Signature: eilj , ,Ll(.. ,170 "I
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.
71 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
F
" Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY of T(=Aab-- 'f DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: C,Avi N 'T-ioMES SEP 2 3 2019
COMPANY: ALAIAi'CE- PLUMBING CITY fl "IGARD
BUILDING DIVI ION
PHONE: (5o3) 5'17- ( 335 �By. Sy-
RE: 141S7 Sw Ibe r.4 AVE M T2019- 0013(0
(Site Address) (Permit Number)
ROS t4A K LOT SS --. .k.4-at,N: 4C\
(Project name or subdivision name and lot number
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: ...... .. Copies: Description:
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- 1°%•'S ptANS tor-R$ Too L-16HT -rb READ
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: n Yes ❑No Fee Description: Amount Due:
$ /2C 3
$
$
$
Special
Instructions:
Reprint Permit(per PE): es ❑No Done
Applicant Notified: 73A/T71 Date: ?/.2-91/4g nitials:
T:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard RECEIVED Date/By.civgilPermit No.: MST2019-00136
13125 SW Hall Blvd.,Tigard,OR 9722'�L�rC 2 9 Plan Review �1 ' , ,
' Phone: 503.718.2439 Fax: 503.598. L 2019 Date/By: q' "'AO"' I S A.Gtn Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: lues: 63 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method /?`,,//9 Supplemental Information
.... z� TYPE OP��"IJING DIAION &-Aielt..7.z. FEE*
SCIik;DEiLF;
®New construction ['Demolition s/777For special information use checklist
Description Qty. Ea. I Total
0 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 ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(1214 sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14157 SW 169th Ave 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.: CA 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 Lot no.:55 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTIOOF WORK Backwater valve 12.51
Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,PROPERTY OWNER I ' ` TA"�1T y Expansion tank 12.51
I
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
b:1 PLIC �. L` TACT 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
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%offee)
Authorized signature: C 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.doc 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 Q • Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I51 100 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100 3752 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Other Fixtures:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type
Fixture Type for Replace/ Plan Review for PlumbingInstallations
Work Performed: Capped Added Relocat
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_allianceplum12ng_net/Documents/Documents/Fire Sprinklers/RT/PLMF_PermitApp
(3).doc
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2019 00136
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S107AA05500
Jurisdiction: Tigard
Site address: 14157 SW 169TH AVE
Subdivision: ROSHAK RIDGE Lot: 55
Project: Polygon at Roshak Ridge, Lot 55
Project Description: New SFA.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 2 First: 562 sf Basement: 90 sf Left: 0 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 562 sf Garage: 430 sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors:
Yes
Total: 1214 sf Value: $164,352.30 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
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: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add''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 1214
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 Geo Tech Required Prior To
Pour
3 NFPA 13D Sprinklers
PHONE: 360-695-7700 PHONE: 360-695-7700 Required
FAX:
Total Fees: $24,534.23
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 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: ` JL� -"--- Permittee Signature: l?k—kL-L3.
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.
PL (... '-'7---
" Building Permit Application
,Residential RECEIVED
FOR OFFICE USE ONLY
. City of Tigard FEB 0 7 2019 Received (.�,
Date/By. \ k I 1 n Permit No.ws�
14
13125 SW Hall Blvd.,Tigard,OR 97223 t-�
Phone: 503.718.2439 Fax: 503.598.ORY OF TIGARD PlanRzview
Other Permi�����
Inspection Line: 503.639.4175 Date Re �� �� =kjk.. CI-L(.j��Gj
TIGARD
p BUILDING DIVISION DateReadyBy: �i Juris: 0 SeePage2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:I-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
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ l Ley t .JJ D® 1-and 2-family 0 Commercial/industrial
l/industrial
ElAccessory building 0 Multi-family Number of bedrooms: d.,
El Master builder 0 Other: Number of bathrooms: 2,
JOB SITE INFORMATION AND LOCATION Total number of floors:1 1 1( „LI
LI
Job site address: I LI i SE < V V I tJ f/� . j I'Q ) New dwelling area: Irl'l,l square feet"Gj Z
City/State/ZIP:Tigard,OR 97224 rl U t �'C/ Garage/carport area:ttl square feet c(iZ_
Suite/bldg./apt.no.: \ Project name:Polygon at Roshak Ridge Covered porch area: square feet -lv
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.: S� Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New SFA Valuation: $
Existing building area: square feet
New building area: square feet
1; ® PROPERTY OTENANT OWNER ❑ Number of stories:
Name:Polygon WLH LLC Type of construction:
_..../ Address:703 Broadway Street Ste 510 Occupancy groups:
Q City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 ,
!!!i New:
✓1
Eg APPLICANT ❑ CONTACT PERSONERSOBUII.AING PERAHT FEES*
Business name:Polygon WLH LLC fPr41e�/af�scheule)
• Contact name:Amanda Gavin
Structural plan review fee(or deposit):
Address:703 Broadway St.Ste 510 FLS plan review fee(if applicable):
City/State/ZIP:Vancouver WA 9866(1 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*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:William Lyon Homes,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St.Ste 510 Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442
State surcharge(12%of permit fee): $21.60
CCB lic.:207247
Total fee due upon application: $201.60
Authorized signator t This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete
Print name:Amanda Ga m Date: 0, *Fee methodology set by Tri-County Building Industry
(0 Service Board.
I:\Building\Permits\BUP-RESPermitApp_doe 02/24/2011 440-4613T(I1/02/COM/WEB)
Mechanical Permit Applicaf �
�� FOR OFFICE USE ONLY
City of Tigard Received Permit No. -� q
DDate/By: 'C/V A_� �tI VC
13125 SW Hall Blvd.,Tigard,OR 97223 ADp 2b Oly Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 [� Other Permit:
Inspection Line: 503.639.4175 t
Date/By:lr l iA r.r, CITY
Internet: www.tigard-or.gov
's�° Date Ready/By: Juris: H See Page 2 for
1V I C R, Notified/Method: Supplemental Information
BUILDING,. 4 @
"TYPE+ AF �3'?ORK _ COMMERCIAL FEE*SCHEDULE'=;USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 9 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION • RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
la 1-and 2-family dwelling 9 CommerciaUindustrial 9 Accessory building For special information use checklist.
Multi-family ❑Master builder
9 Other: Description Qty. Ea. Total
1013 SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: tt4SvJ I tpq ckt,e. 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.: 55 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
® PROPERTY OWNER
TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspendedhmit heater
City/State/LIP: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
vJ bu4 days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Td-County Building Industry Service Board
Print name:Elia Duran Date:04/08/2019
1:1Building\Permits\IVSEC_PermitApp_040113.doc 440-46I7T(11/02/COM/WEB)
Electrical Permit Applicatio>nEC
� FOR OFFICE USE ONLY
City of Tigard {D , {(� ReceivedCEIMIESINI
. . e1 L U I.7 DateB : 1
', 13125 SW Hall Blvd,,Tigard,OR 97223
� Plan Review
Phone: 503.718.2439 Fax: 503,598,'9 9 y-- f 1 Date/B : Related Permit#:
Inspection Line: 503.639.4175 V.,,I i' ite" '� f� i"
1 1133�.N-U p !6 �-q �� a �1 y, Ready Date/By: Juris: lid See Page 2 for
Internet: www.tigard-or.gov 13 9 LD!N ,�41,/ A e , ' Notified 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):
0 Service or feeder 400 amps or more El Building over three stories.
0 Demolition 0 Other: where the available fault current
❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
amps for all other installations, buildings.
❑Multi-family 0 Master builder ❑Other:
El Fire pump. ❑Installation of 150 KVA or
JOE SITE INFORMATION AND LOCATION El Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: t4k151 ado 1 lob
10011P or more. ❑"A","E","I-2","I-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
El Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Roshak Ridge El Hazardous locations. ❑Supply voltage for more than
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. I Each J Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision:Roshak Ridge Lot#: 5.6 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
residential(with above sq.ft.) 75.00 2
TENANT Renewable Energy ❑ See Page PROPERTY' OWNERServices or feed
® feeders installation,alteration,and2/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
P®e APPLICANT 5 0 CONTACT PERSON Branch circuits-c 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
h ter ° ,v=h .. rff-.4,,,:,,,,,,t,0,!,, , t f ';,5-:. �r 34{ .4` Pump or irrigation circle 67.84 2
Business name:Portland Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 1915 E 5thSt.,Ste D panel,alteration,or extension. El See Page 2 2
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)314-4945 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:paul@portlandelectric.biz Industrial plant(1 hr thin) 78.18/hr
Inspections for which no fee is
CCB Lic.: 194066 Electrical Lie.: C760 Suprv.Lic.;A '431DS specifically listed('1,hr min) 90.00/hr
Q ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Q� }�
x Subtotal:
Print name: Alex Shalya Date: 04/08/2019 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: } 1 ..LQke_,LA,k, TOTAL PERMIT FEE:
i ms permit appneanon expires II a permit is not obtained within 180
Print name: MISHCHUK,SERG 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 Applicata P
Building Fixtures
nn n FOR OFFICE USE ONLY
City of Tigard ,U 17 Received
II . Date/By: ermit No.: ,('��
v 13125 SW Hall Blvd.,Tigard,OR 97 3 - d` ,^_y 1 F, �� < CiM- ��1
Phone: 503.718.2439 Fax: 503.59 4A .)� g DIVISION Plan Review Other Permit No.:
TIGARD Inspection Line: 503.639.4175 3U LD1NG .,PI�lI IO DateDate/Ready/By: kris: 0 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. I Ea. 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: i u(51 sw ((p rt4Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:Roshak Ridge
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
�� Water service(no.linear ft.:_) Page 2
Subdivision:Roshak Ridge Lot no.: 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)_
signature: 1
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 tt 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)
City of Tigard
Il COMMUNITY DEVELOPMENT DEPARTMENT
illiq III
T 1 A>z D Building Permit Review — Residential
Building Permit #: pM -c--Kc C .031
Site Address: NIS c,r,J 1604-)- Ave..
Project Name: Poll � ��-e3 k Ri{f Lot #: S
.S
(New welling=subdivision name;A" clition or Alteration=last name of owner)
Planning Review `' i ` I k
ro osal: k e,oa\ Ctt,{' Sr. . .\Ai,�� q ,t lu k� lois "2-'.-S.(,)
Lid Verify address/suite#active in Accela. Frlin River Terra e: ❑ No Yes River Terrace
Review Addendum
IP Ian Elements: Cyt rosion Control
opies of site plan on 8-1/2"x 11"or 11 x 17"paper aired trees with driplineandprotection measures
tree
D awn to scale(standard architect or engineer scale) LKF:otprint of new structure(including decks)and FFE,
rth arrow 1✓ •i'ty locations&easements(required for new and additions)
�e address,project or subdivision name and lot number 11 Sidewalk/driveway approach
plicant information(name and phone number) p! ation of wells/septic systems
Lldtot dimensions and building setback dimensions t -t tree size,type and location
i ..uare footage of buildings to be demolished `t€z #
, sting structures on site IP orner elevations(2'contours if more than 4'differ ntial)
LfdLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? les ❑No
�fimpervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑ ❑No
NJ Clean Water Services—Service Provider Le_ttt (lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified Lfd No Received: ❑ Yes ❑ No / t
Cy' Public Facilitie mprovement(PFI)Permit: 111.4 J
/Required: —/ '�'
q Yes,applicant was notified ❑ No /
17lied For: /Yes ❑ No,stop intake
LY Land Use Case#: 133� � �-�/Z
V ; -quired Setbacks: Front g/1 L ;dtear 0 Ride 0 street Side 3 L6arage
@' utldtng Height: Max.Height:
IJAz., Actual Height: 2...1„7-5
PCI Landscape Area: 2..0 % D Lot Coverage Max: 20
entrance ❑ 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
Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
jk ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
it!6�,J f ❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
Al
L `"` ❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave 0 Roof offset
I'Trrfttt I 0 Fire shingles 0 Lap Siding 0 Roof pitch 0 Gable,hip,or gambrel roof ❑ Dormer
❑ Accent siding ❑ 'window trim ❑ Window recess ❑ Window projection ❑ Balcony
,�/Visual Clearance CCi Urban Forestry Plan
Ltd'Sensitive Lands: ri-J Yes 0 No Type(d4 S &-,e',..4„, Litl,�
6 Conditions met prior
{ to issuance of building permit
/ ipprovedB'
ty Planning: Lvmmt
(24._ Date: cfl i-ii
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
IABuilding\Forms\BldgPermitRvw RES 022819.docx
Building Permit Submittal
Original Submittal Date: oZ
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: L"Planning ["Engineering El Permit Coordinator D'" Building
Workflow Sign-off: Et/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.
'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: � L ,� Date: r\ 't�`
Engineering Review c
`Slope at building pad: 573 l 0
�1 Conditions"Met"prior to issuance of building permit
Er Easements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes Er No
Assess Water Quantity Fee in-lieu: 0 Yes No
LIDA Facility on lot: 0 Yes Ca'No
J' Final Plat Recorded:
0 NOT Approved by Engineering: Date:
Notes:
g" Approved by Engineering: Date: /
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: c' Yes 0 N/A
Tigard Trans SDC: at Yes 0 N/A
Parks SDC: dEEK Yes 0 N/A
LIDA 0 Yes N/A
fk OK to Issue Permit
Approved by Permit Coordinator: Arra Q — Date: Li, la-cX,\lc1
I:\Building\Forms\BldgPermitRvw_RES 022819.docx
r ?
City of Tigard
1111 r COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 c a R D River Terrace Building Permit Review Addendum
Building Permit #: (\c,T rQ_ COVDDLe
Site Address: Nt IS. \f✓ 0-41` A-ix,
Project Name: Pci I` a} �oiika1c 12e Lot #: S-S
(Ne�+ welling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Dis Oct Design Standards (18.640.070.1.):
Is the project subject to the plan district design standards? g Yes ❑ 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.�de,p min.2ft., 5 ft.wide min. 2 ft., 6f de
u6 ►.J " ❑ Ila /` ❑
2. Eyes on the street: a minimum of 12%of each street facing facade must include windows or entrance doors.
Percentage Shown: 2-1'07/j HA X) ILL/.
3. E trances:At least one entrance must meet both of the folio g standards:
NJ Max. 8 ft. setback from longest street- facingwall IU' arallel to street,angle no more than 45° from street,
f or open onto porch
Entrance opens to a porch: l Yes ❑ No
If yes,all the following apply: E(25 sq.ft.min.
6ne street facing entry 03/12 ft.max.roof above floor of porch
Ir 5 ft. depth min. D40%0%min.porch roof coverage
4. Detailed Design:All buildings shall include a min. of five of the following elements on all street-facing façades:
❑//Covered porch min. 5 ft.wide x 5 ft. deep CI Recessed entry area min. 5 ft.wide x 2 ft. deep
Vi[ Vall offset min. 16 inches 1', ❑ ormer min.4 ft.wide
Roof eave min. 12 inch projection SV 3 [B'oof offset min.of 2 ft. 1f
❑ Roof shingles either tile or wood L_G.A'/Gable,hip or gambrel roof design 170
C� oof pitch oriented south min. 500 sq. ft.3 Ind'Horizontal lap siding min. 3-7 inches wide S
Ll9 Accent siding min.40%of street façade V) ❑ Window trim min. 2'/2"wide by 5/8"deep
❑ Window recess min. 3 inches for all street facing ❑pay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access L "Attached garage is 35%or less of street facade T/
J
ivA . Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
r No closer to front or side lot line,than longest street-facing wall. ❑ Yes 0 No. If No (Check one):
❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
le kW ❑ 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
At/ above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ 12-foot-wide garage door ❑ 40%max. of street facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Plaimit,g; _ Ubtj..---4Dare: C-(H1
I:\Building\Forms\BldgPermitRvw_RES_RT_121417.docx
Plumbing Permit Application
BuildingFixturesa I 5 t
K @ z_ xr„ FOR OFFICE USE ONLY
City of Tigard Received
II1113125 SW Hall Blvd.,Tigard,OR 97223,1t i t., 1 6 2019 Date/By: �,\\,s,‘r \G (\ � Permit� \l No.M\�;�,C,..W\-)-3U
• Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 t f rte; .- i P,t _
Internet: www.tigard-or.gov •3j it (' •y�t
Date Ready/By: kris. Eli See Page 2 for
t 1 , )t 's l /! Notified/Method:
, +`i�a • .t � _ Supplemental Information
_, ...,.k... TYPE OF WORK "!H ' ' '� ,< a� . ;, f,.:- '14,"/ �,
,.)SEE k4SC1tEDULR � �� , . ;.k
®New construction ❑Demolition ,;?1 For special information use checklist
Description -
� I Qty. � Ea. I Total
❑Addition/alteration/replacement 0 Other G
\\.9,L 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
ElAccessorY buildin SFR(3)bath 500.32
g ®Multi-family
El 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: ktkA 5-1 l.lii)tTl-4 Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
CA� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: v l Project name:Roshak Ridge
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Roshak Ridge I Lot no.: 55 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF'WORK' Backwater valve 12.51
•,;
C , t A4-QZ Clothes washer 25.02
w` ` �,�� 13 Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
e PROPERTY OWNER 1 ❑,TENANT t ', 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
h. 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 T
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan _ 12.51
E-mail:permitsubmittals@polygonhomes.com polygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Alliance Plumbing
Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50
CCB Lic.:184601 Plumbing Lic.no.:PB732 Plan review (25%of permit fee)
‘ )I4F 7.... State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Robert Dishman Date: This permit application expires If a permit is complete. within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L\Building\Permits\PLMU-permitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
Electrical Permit Application ,r.,,. FOR OFFICE USE ONLY
City of Tigard Received
�, /111 of Date/By: 1-k I �� Permit#: c� )l`1-(\�
'� 13125 SW Hall Blvd.,Tigard,OR 97223 `'` ' , Plan Review T
Phone: 503.718.2439 Fax: 503.598,19b0,,. Date/By: RelatedPennit#:
TIGARD' Inspection Line: 503.639.4175 Ready Date/By: Juris B See Page 2 for
n Internet: www.tigard-or.gov Notified/Method: Supplemental Information
,
TYPE OF WORK �i"� ..�r�
�� -PLAN REVIEW'
®New constructiont " h'
0 Addition/alteration/replacement l S Please check all that apply(submit 2 sets of plans w/items checked):
1--",.`, \� _ ❑Service or feeder 400 amps or more 0 Building bver three stories.
0 Demolition - 0 Other: •,. .may, where the available fault current
CATEGORY OF CONSTRUCTION "\` � ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fre pump. 0 Installation of 150 KVA or
JOB.SITL INFORMATION AND'LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system -
Job#: Job site address: ii M\bi c3W k(19 --1- R 100HP or more. ❑"A', E, l-2',"1-3
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑r 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: a FEE SCHEDULE:.
Description - I Qty. I Each 1 Total ( +
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 55 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
Cj,ernt (with above sq.ft.) 75.00 2
1�� �� i"n`5���c -bb(?,lo Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ 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 i Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: ` Date: 401 amps to 599 amps 168.54 2
-APPLICANT ❑ CONTACT•PERSON Branch circuits-new,alteration,or extension,per panel
- A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
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 56.18 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
Email:permitsubmittals@polygonhomes.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
. CONTRACTQR —_� . -,
.-- , ;imp of irrrgenaa etrek - trt04 --- 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/hr
Phone:(503)319-2192 Fax: ( ) Investigation(1 hr min) 90.00/hr
Email: solarpdx@me.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871/EeS specifically listed(A hr min)
' `ELECTRICAL PERMIT,FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: [l s..�. TOTAL PERMIT FEE:
�" 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.
- * Number of inspections allowed per permit.