Permit r •
1111 v CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit #: MST2009 -00075
T [ GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
Parcel: 2S112CC22300
Jurisdiction: TIG
Site address: 15749 SW 81ST AVE
Subdivision: Lot:
Project: GAGE FOREST
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 973 sf Basement: sf Left: 5 Parking Spaces:
Height: 26 Bathrooms: 3 Second: 1387 sf Garage: 408 sf Front: 2 Smoke
Yes
Dwelling Units: 1 Third: sf Right: 5 Detectors;
Total: sf Value: $0.00 Rear: 1
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: Catch Basins:
Lavatories: 4 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Drains: 1 Other Fixtures:
Tubs /Showers: 3 Garbage Disp: 1 . Water Heaters: 1 Water Lines: 100
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: Vent Fans: 4 Clothes Dryers: 1
NAT Heat Pump: Hoods: 1 Other Units:
Fum <100K: 1 Vents: Woodstoves: Gas Outlets: 4
Fum > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea addl 500 sf: 4 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea addl Br Cir:
601 -1000 amp: ` 601 +amp- 1000v:
10001-amp/volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: HVAC: Security Alarm: Vaccuum System: Garage Opener: All
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW Single Family VB R - 3 2360
Owner: Contractor: Required Items and Reports (Conditions)
J T ROTH J T ROTH CONSTRUCTION
TIGARD, OR 12600 SW 72ND AVE #200
TIGARD, OR 97223
PHONE: PHONE: 503 - 639 -2639
FAX: 503 - 624 -0239
Total Fees: $14,943.44 _
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 : • = in : • • nce with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
th= 180 days. ATTENTIO . 0 - !on w . quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• 2- 001 -0010 t ough OAR 001-0 A t may obtain a cop of the rules or direct questions to OUNC by calling 503. 99 or 1.800.332.2344.
I sued By: — _ , w 0 ;q
_ ■Permittee Signature: �—� -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS Z ,— 6o0 S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 iieto
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: IS SV-/ 81 s 1 CLASS OF WORK:
SUBDIVISION: ,(y4q f— t$16'T LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: 54.015126 O62Z
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time: 9
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
d6
t
SS 1 PARTIAL APPROVAL 71 CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/z) Inspector: ,e rwa Date: ;4ra- Phone #: (503) 718 - tit .��J
114.5126tfi---Doo
Oregon Residential Specialty Code 83
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, ; /9,7 /t ( 7 (',, am the general contractor or the owner- builder
at the following address:
Site Address: /59 q �}-
City:
Permit #: //9 r
Subdivision/Lot #: T[i 292 7
and/or
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
8318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture - sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: �;� Date:
Genera ontr 4' or • Y Owner- : uilder
/��� /04e/ )tom
mofd
/0, -o
�r
I: \Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08
ST ET TREE C
I 1., Owner A ernt. for
(PLEASE PRINT) ; (PERMIT HOLDER)
r
Do hereby certify that the 'followin location meets
City of Tigard land use and development standards
for street tree installation.
•
•
ADDRESS: ��r
SUBDIVISION: �� - /< LOT: _ /7
SIGNATURE: -7 j DATE: V2.0
(I WI\ ER /AGENT)
RECEIVED BY: / DATE:
(CITY OF TIGARD)
I: Building \ Forms \Streetl'reeCcrtificatc 01/19/07
Oregon Residential Specialty Code N1107.2
HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: x /r/27(2 •) y (l Jurisdiction: / 7
Site Address: 701/7 ( / /111
Subdivision/Lot #: /IA/W- 24:
and/or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: 'e i / Date:
Owner /Genera ' actor /Authorized Agent
Print Name:
' ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08
Bu i1 I Permit Application
Site Work RECEIVED FOR OFFICE: F SI :ON'I.1
City of Tigard Received 1 . Permit No l/ 1, i • •
lig r� DateB : _
• 13125 SW Hall Blvd., Tigard, OR 97223 FEB 3 ?0r•a Plan Revie (� ep
0 Phone: 503.639.4171 Fax: 503.598.1960 DateBy: � z - 1 Other permit: 22001. 00C30
T i G .n is D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: � ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVIS N Notified/Methodt•5 '09 1 '� Supplemental Information
/J p 9e,n_ W / �Qa tAc1. t.rven
TYPE OF WORK!7jpwJ, f d/ REQUIRED DATA: 1- AND 2- FAMILY DWELLING
New construction ❑ Demo rtion � /3114# 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
e 1- and 2- family dwelling ❑ Commercial/industrial
Valuation: $150,000
❑ Accessory building ❑ Multi - family Number of bedrooms: 4
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 15749 SW 81 New dwelling area: 2360 square feet
City/ State/ZIP: Tigard Ore. 97223 Garage /carport area: 408 square feet
Suite/bldg. /apt. no.: Project name: Gage Forest Covered porch area: 0 square feet
Cross street/directions to job site: Hall Blvd. and Langtree Deck area: 0 square feet
Other structure area: 0 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Gage Forest I Lot no.: 30 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.
Construction of New Single Family Resisdnce Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: J.T. Roth Const. Inc. Type of construction:
Address: 12600 SW 72 nd. Occupancy groups:
City/State/ZIP: Tigard Ore. Existing:
Phone: (503)639 -2639 Fax: (503)624 -0239 New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name: J.T. Roth Const. Inc. All contractors and subcontractors are required to be
Contact name: David Jensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 12600 SW 72nd jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/ State/ZIP: Tigard Ore, apply:
Phone: (503) 806 -0602 Fax: : (503) 624-0239
E -mail: davidj @jtrothinc.com
CONTRACTOR
Business name: J.T. Roth Const. Inc. BUILDING PERMIT FEES*
Address: 12600 SW 72nd (Please refer to fee schedule
Structural plan review fee (or deposit):
City/State/ZIP: Tigard Ore.
FLS plan review fee (if applicable):
Phone: (503) 639 -2639 Fax: (503) 624-0239
CCB lic.: 31700 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: David Jensen Date: 1/26/09 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Permits4SIT- PermitApp.doc 12/27/06 440 -4613T(11 /02/COM/WEB)
1
Mechanical Permit Application FOR OFFICE (ISE ONLY
City of Tigard Received
Permit No.:
lig • 13125 SW Hall Blvd., Tigard, OR 97223
Date ■ Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit
Inspection Line: 503.639.4175 Date/By:
TIGARD Date Re ReadyBy: kris: H See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
N ew construction
® ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: �
Description I `lcy. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 159y e I / 57 Air conditioning or heat pump
/ ,5 % �W �� (requires site plan showing placement) 14.00
City/State/ZIP: TIGARD, OREGON Furnace 100,000 BTU (ducts/vents) ( 14.00 14,06
Suite/bldg. /apt. no.: Project name: GAGE FOREST Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Hall Blvd & SW Langtree Street Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: GAGE FOREST Lot no.:3 0
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater ‘ 10.00 V5.0:3
NEW SINGLE FAMILY DETACHED Flue vent for firepla 10.00 10 • of)
water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
® PROPERTY OWNER ❑ TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: J.T. ROTH CONSTRUCTION, INC. Environmental exhaust and ventilation
Address: 12600 SW 72" AVENUE, SUITE 200 Range hood/other kitchen
equipment 1 10.00 f0.(Xs
City/State/ZIP: PORTLAND, OR 97223 Clothes dryer exhaust 10.00 W. CO
Single -duct exhaust (bathrooms,
Phone: (503)639 -2639 Fax: (503)624 -0239 toilet compartments, utility rooms) '4 6.80 77
Attic/crawispace fans 10.00
1 APPLICANT ❑ CONTACT PERSON
Other: 10.00
Business name: J.T. ROTH CONSTRUCTION, INC. Fuel piping
Contact name: DAVID JENSEN $5.40 for first four; $1.00 for each additional
Furnace, etc. r 'SAO
Address: 12600 SW 72" AVENUE, SUITE 200 Gas heat pump
City/State/ZIP: PORTLAND, OR 97223 WalVsuspended/unit heater
Water heater I
Phone: (503) 639 -2639 Fax: : (503) 624 -0239 Fireplace r
E -mail: DAVIDJ@JTROTHINC.COM Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: THERMAL FLO, INC.
Other:
Address: 7236 SW DURHAM ROAD #100 MECHANICAL PERMIT FEES*
City/State/ZIP: TIGARD, OR 97224 Subtotal [
Minimum permit fee ($72.50)
Phone: (503) 670 -8343 Fax: (503) 670 -9864 Plan review (25% of permit fee)
CCB lie.: 151847 Kl State surcharge-Rita-of permit fee) ,6t3
TOTAL PERMIT FEE 61 b•i
Q , &----ityzo This permit application expires if a permit is not obtained within 180
Authorized signature: , M ; /�"` days after it has been accepted as complete.
• Fee methodology set by Tti-County Building Industry Service Board
Print name: i t v Date:
g \Ptt
1:\Buil dinmits\MEC- Penn 04/06106 440- 4617T(11/02/COM/WEB)
-PlunibinA Permit Application
Building Fixtures Folz oIFlci: us!: ()NIA
City of Tigard Received Date/By: Permit No.:
II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: kris: ® Se e Page 2 for
Internet: www.ti
T i G;\ ii D ardor. ov y Y S
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 1 399.00 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 15749 SW 81 Catch basin or area drain 16.60
City/State /ZIP: Tigard Ore. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Hall Blvd. and Langtree St.
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Gage Forest I Lot no.: 30 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Plumbing for new single family residence Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: J.T. Roth Const. Inc. Expansion tank 16.60
Address: 12600 SW 72nd Fixture /sewer cap 16.60
City/State /ZIP: Tigard Ore. 97223 Floor drain/floor sink/hub 16.60
Phone: (503)639 -2639 Fax: (503)624-0239 Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: J.T. Roth Coast. Ine.
Interceptor /grease trap 16.60
Contact name: David Jensen Medical gas (value: $ ) Page 2
Address: 12600 SW 72 nd Primer 16.60
City/State /ZIP: Tigard Ore. 97223 Roof drain (commercial) 16.60
Phone: (503) 806 -0602 I Fax: : (503) 624-0239 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: davidj @jtrothinc.com
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Malmedal Enterprises Inc. Water heater 16.60
Address: PO Box 207 Other:
CC
City/State /ZIP: Banks Ore. 97106 Subtotal 3
Minimum permit fee: $72.50
Phone: (503) 324- Fax: (503) 310 -9795 Residential backflow minimum permit fee: $36.25
n,en
CCB Lic.: 102535 Plumbing Lic. no.: 34-276-96 Q) Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4786
Authorized sigr+pt{tjg * TOTAL PERMIT FEE A4688
Print n 4' 4 'S � �'� Date: / j 9 This permit application expires if a permit is not obtained within
��� � D 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Boar4.
1:\ Building \Permits\PLIF- PermitApp.d6c 12/27/06 440-4616T(10/02/COM/WEB)
01/26/2009 03:18 5037628505 CASEY DAY , PAGE 01/01
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