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Permit _ ___ _ _ ' . . ` �P|mmbim2 Permit Applica� cT � � �� na'~ ��Q � ��6 . .� ' ' . '� i ^ . Site Utilities ~� .. � ��. ^�, � ��n��m�N$E ONLY' , | ' � • ;:,,, Cityo[Tigard � , � \ `� u",�, � ° �s�/ ox � � ~ � �` Phone: 503.718.2439 Fax: ny,�x�W@ � � .� �~m^ Plan Re,�° -_," mii'ZS7 Datelliy: — � �ei, �� w^='�~ v,. Inspection Line x^/u,. .,, � I` x � � �)(, �� tmssw� / �°n=*'w | loos | ma,,�"/v� � L��. "�"x� ~°"u�ou�"�n" � �� o\�� f \ x°.n"x��m* Supplemental Information ' ��. rrwcov �ORK FEE* SCIIEDULE - ____- [] New mo,`�c`ion Li Demolition [------ '----� '-------'' '- '---- ' 0„kwi,i.maxe,mi'xnircp/xce ----T mco� El Other:_ _ CATEGORY orCnNmuucr/ow 312.70 F | mrm ' D� � ^nuz'/�mi//o"ax”: []comm�,u,mn'm,mn| ---------� ---------- --------------- 5032 SFR(3)bath []a,c�,'xrboiming 0wu/,i'mmi/� --------' ---- ----- -- -- ---'---------' 25x2 -----�---- -- -- ]x"`tnbuilder []Other: ----� 1. Fire sprinkler ' s �/`` � �z -_ ' � - 6 JOB SITE /mrouxAnomAND LOCATION Site utilities: -- -- Catch basin.vunodram /x76o - sv //n^c^.� _ ----- 1 Job she 11 ine • -- , --o-----/'--�/ w�nchom/o mm1 ciwSm,ex/p:Tigard,ouvrzz4 � � � � -- -- � F "� x�,"+u»/-'�"v nroj",/. ="� 11- - w "u " -'cmamenuimxiwu*��,�:' ^^m,x"�'^// °/l�^ - | MatlhOleS 18.76 e utilities 50,03 | | ----- - 18 76 x linear o�� L -__' __ ___-_____ ---__ ____ / '�- � svx m,/mn� mumx/vovmo°.x --- -'~ ^r ^'�^ce i ~^'~~ '`-�'�^~ Page ^��^�~ 'mw°m.mn. __ - Taxmor�ov�/m,�� Back »o,mm / DESCRIPTION OF WORI | Rack---- -' i Clothes v.ashet 25.02 ' /^xoes,""m/".wn�/a:home i 25 02 1 L__-____-_'.________--_---.__-- ._--' ___�__- | /�"'�"�x�!*"" _- | Ejectors/sump | � ---'-' i �� p� tank 1 12.51 Or �� RothI Name: T Roth Construction Inc. Fixture/sewer^ `^' / �uo �v� cmmsvr��`" �� ---' -- npxmm/mxmvsink/tub 2502 | Garbage disposal 25.02 • Citx/Statcit,IP:Tigard,OR 97223 I • Hose bib 25.02 : Phone:(503)6392639 1 Fax:(503)6240239 lee maker 12.51 I O APPLICANT I � CONTACT PERSON I 25.02 . . ' /io/n�,mxnc�lcxwhcvnxvn�w /o� | ^""�"p~°"~` ` ) --- ------------ �------------ ---- pmou co • Contact name: David Jensen ------------' - ---- - Root' m"''mmnm.�a// oa | ' Auo�x: //umsvr-^". ------ �'---�---- ------~ s"k/n=ndu,^x 25 02 | | u'yfs'*"xn�l�i:xm.ouvo23 ------ ---------r .54 � Phone:(51/3) e.,��o �^o"z/v / '_- �m,o:o^.uk�j'"^uocn"" ' "'"" 25 02 ! Water closet -I 25 CONTRACTOR —02 - �--'-- . """== 3752 Business name:w / Plumbing/ �r gpipin' Water -' Other. 25.02 1 / _ [ity//mux/r� r""�"�ux"rzy/ �l�� _______ _______ ____ rh""c:,roomm�^� Minimum permit rec.: 172.50 i _. i ----- -- - ---'� nwn,le" '2��"/»o"xeo, cCu/-ic /,eov nmowou| io.m.:r ---------- '-_ --'-------- --- ------ -'-------------------- xm/",."cxx,u"(/z�.,/,:n,..o�/ Authorized signature: �p� ,...--,C7-7, [----- - - ---- --' i n/m/ rsx�m�no. ��. " / �.==�. L____-__.-___ � Lm�l��!��' | 'n,/"�"�c",//m/° � »mco*r/oo/s � m��" ^",*^ ^="'�,�",�"*�"°°m�=*.'*' w doss �__ . "^''^*^^�""�n"��°"p^° --i�/ �r/ '^==^hod^*r"^�/"�,�'x"u.,,/"a=.` �"=m=w ''v~ /"^tidules, ..^wAII:l'erteitelpp.h,.: .""= ^w°.^n'^07.n*^n,` /(103.1 L ^ ' l'illi n CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00078 Date Issued: 06/15/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ilOrMerta Parcel: 2S110BA13100 Jurisdiction: TIGARD Site address: 14053 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 24 Project: Medallion Meadows Lot 24 Project Description: Add 580 sq ft detached garage to existing house and connect existing house to public sewer. 9/28/15: Reprinted permit to include 50 ft. of water service, 50 ft. of storm sewer,and 50 ft. of BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 580 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $100,000.00 Rear 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 50 SF Rain Storm Sewer: 50 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 50 Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 2 Ea add/500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB U 0 Owner: Contractor: JT ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $2,699.49 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 .. ••twin a •• of the rules o ,irect questions to OUNC by callin 503.232.1987 or 1.800.332. 4. Issued By: _O 09 -+- ---- _u/ Permittee Signatur es Call ■-1.1175 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 compl n of the project. Approved plans are required on the job site at the time of each inspection. 711 y p CITY OF TIGARD MASTER PERMIT •' COMMUNITY DEVELOPMENT Permit#: MST2015-00078 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/15/2015 Parcel: 2S110BA13100 Jurisdiction: TIGARD Site address: 14053 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 24 Project: Medallion Meadows Lot 24 Project Description: Add 580 sq ft detached garage to existing house and connect existing house to public sewer. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 580 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $100,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker 0 Hose Bib: 0 Backwater Value: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<10OK: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 2 Ea add'l 500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB U 0 Owner: Contractor: JT ROTH CONSTRUCTION INC J TROTH CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 TIGARD,OR 97223 TIGARD,OR 97223 PHONE PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $2,535.53 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 don accor.- - 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 da ATTENTION: Ore.• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 -001-0010 through OAR 9' a01' %,i. You may obtain a copy of the rules or direct questions to OUNC by 50.232.1987 or 1.800.332.23444.�. I sued By: •J_�� 4 A Permittee Signature: ,e_ j�j[s-�� Call 503.639.4175 by 7:00 a.m.for the next available inspe ' 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 RECEIVED Residential MAY 21 2015 I ()R (r1 I I( I I `I 0\1 1 City of Tigard Received 6.a/ /s ,1 Permit • 13125 SW Hall Blvd.,Tigard,OR 97 ITY OF TIGARD Plan Ry: I Y d/�� Phone: 503.718.2439 Fax: 503.598.LD I N G DIVISION Plan e" •11 6 Other perm jea0vs Leasy I:I, Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: rrI r Supplemental Information t ; I . TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑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 CONSIR UCIION work indicated on this application. ® 1-and 2-family dwelling ❑Commercial/industrial Valuation: $100,000.00 ❑Accessory building ❑Multi-family Number of bedrooms: 0 El builder ❑Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: 14053 SW 1186 Court New dwelling area: 0 square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: 580 square feet Suite/bldg./apt.no.: Project name: ediy_a4,1 Covered porch area: 80 square feet Cross street/directions to job site:Gaarde Road to 118` Ct. Deck area: 0 square feet Other structure area: 0 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Medallion Meadows Lot no.:24 Permit fees'are based on the value of the work performed. Tax map/parcel no.: , 5`� Q �S�d Indicate the value(rounded to the nearest dollar)of all �ge/Q equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Construction of detached garage to serve existing home Valuation: $ Existing building area: square feet New building area: square feet © PROPERTY OWNER ❑ TENANT Number of stories: Name:J.T.Roth Construction Inc. Type of construction: Address: 12600 SW 72"Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(503)6392639 Fax:(503)6240239 New: ❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES* {/e'naePt*, fee de) Business name:J.T.Roth Construction Inc. Structural plan review fee(or deposit): Contact name:David Jensen FLS plan review fee(if applicable): Address:12600 SW 72 Ave Total fees due upon application: City/State/ZIP:Tigard,OR 97223 Amount received: 7/e, e? Phone:(503)8060602 Fax::(503)6240239 E-mail:davidj @jtrothinc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 12600 SW 72"Ave Solar Installation Specialty Code checklist. City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review $180 00 and administrative fees): Phone:(503)6392639 Fax:(503)6240239 State surcharge(12%of permit fee): $21.60 CCB lic.:31700 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained /� — within 180 days after it has been accepted as complete. Print name:David Jensen Date:0521/2015 *Fee methodology set by Tn-County Building Industry Service Board. I:\Building\Permits\BUP-RESPerm. .p ocd 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY Received 71 City of Tigard Permit No • 13125 SW Hall Blvd.,Tigard,OR 97223 Associat = Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: TIGARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district.etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ' ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. - ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. _ 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area building coverage area;percentage of coverage;impervious area existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ Cl ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore Lon and shall be shown to be:1.licable to the .ro'ect under review. .II ItISI)l( 11()\ kl, iPI..( IFI( ' 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. _ ❑ CI 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9,1995. - - I:�BuildinglPemtitslBUP-RESPennitApp.doc 02/24/2011 440-46131(11/02/COM/WEB) 1 ECEIVET� Electrical Permit Applicatio FOR 01.1 I( I 1 ',I ()N11 City of Tigard AA^^ n Received Permit• 13125 SW Hall Blvd.,Tigard,OR 97223r'A' 21 2015 Date/B �T //S.—elm�� g Plan Review 114 = Phone: 503.718.2439 Fax: 503.598.1960 u Date/B : Other Permit: 1 I IZ l Inspection Line: 503.639.4175 CITY OF i 111ARU Date Ready/By: Juris: ® See Page 2 for Internet: www.ti ard or. ov i Notified/Method: Supplemental Information g TYPE oo DING DIVISION pp PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): ❑Service or feeder 400 amps or more ❑Building over three stones. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: 14075 SW 118th Court 100HP or more. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site:Gaarde Road to 118th Court Description I Qty. I Fee. I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision:Medallion Meadows Lot no.:24 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 New underground service to existing building and wiring of new detached garage residential(with above sq.ft.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ® PROPERTY OWNER 1 ❑ TENANT 200 amps or less 1 100.70 2 201 amps to 400 amps 133.56 2 Name:J.T.Roth Construction Inc. 401 amps to 600 amps 200.34 2 Address: 12600 SW 72nd Ave. 601 amps to 1,000 amps 301.04 . 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or Phone:(503)6392636 Fax:(503)6240239 relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,per panel ❑ APPLICANT 1 ® CONTACP PERSON A.Fee for branch circuits with above service or feeder fee, 2 7 42 2 Business name:J.T.Roth Construction Inc. each branch circuit B.Fee for branch circuits without Contact name:David Jensen service or feeder fee,first 56.18 2 branch circuit Address: 12600 SW 72nd Ave Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP:Tigard,OR 97223 Fach manufactured or modular 67.84 2 Phone:(503)8060602 Fax: :(503)6240239 dwelling service and/or feeder Reconnect only 67.84 2 E-mail:davidj @jtrothinc.com Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Dream House Electricv Signal circuit(s)or limited-energy See panel,alteration,or extension. Page 2 _ 2 Address: 13075 SW Canyon Road Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP: Beaverton,OR 97005 Investigation(I hr min) 66.25/hr Phone:(503)6485144 Fax:(503)6489723 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 196726 Electrical Lie.: C-848 Suprv.Lic.: specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Chris Mahoney Date: 05/21/2015 Plan review(25%of permit fee): State surcharge(12%of permit fee): Authorized . TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1.1 Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440.46t57(11/05/COM/WEB i Plumbing Permit Applicati ttECEIVEP Site Utilities I ii (I I I I( I 1 ',1 O\I 1 City of Tigard SAY 21 2015 Received PetmitN 13125 SW Hall Blvd.,Tigard,OR 972 I! Date/By: 10��/5�00 zp Plan Review Phone: 503.718.2439 Fax: 503.5i_i1�(tO OF 1 IGARU Date/By: Other Permit No.: Inspection Line: 503.639.4175 ] Date Ready/By: orris: ® See Page 2 for TIGARD Y Y 8 Internet: www.tigard-or.gov �l�vt�� Notified/Method: Supplemental Information TYPE OFILDING - 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 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 - Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 14075 SW 118th Court 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.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site:Gaarde Road to 118H Court Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:30) Page 2 Storm sewer(no.linear ft.: Page 2 Water service(no.linear ft.:30) Page 2 Subdivision:Medallion Meadows I Lot no.:24 Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Utilities conection to existing home Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 N PROPERTY OWNER [ ❑ TENANT Expansion tank 12.51 - Name:J.T.Roth Construction Inc. Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 12600 SW 72"Ave. Garbage disposal 25.02 City/State/ZIP:Tigard,OR 97223 Hose bib 25.02 Phone:(503)6392639 Fax:(503)6240239 Ice maker 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name:J.T.Roth Constuction Inc. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:David Jensen Roof drain(commercial) 12.51 Address: 12600 SW 72"Ave. Sink/basin/lavatory 25.02 City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503)8060602 Fax::(503)6240239 Tub/shower/shower pan 12.51 E-mail:davidj @jtrothinc.com Urinal 25.02 CONTRACTOR Water closet 25.02 -- Water heater 37.52 Business name:ALL Plumbing LLC Water piping/DWV 56.29 Address:9312 NW Skyline Blvd. Other: 25.02 City/State/ZIP:Portland,OR 97231 Subtotal Phone:(503)7067764 Fax:(503)4691470 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: 194089 Plumbing Lic.no.:PB-1022 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Gary Luchs Date:05/21/2015 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 1 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT - Building Permit Review — Residential Building Permit #: AISTzp i5- 9O2 7/ Site Address: /4/053 S'A.., //BA a+ - Project Name: Meet�.IlkY1 /111a20Cel It)c Lot #: / (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review / / _ ,fi Proposal: �l1-S e �� d-P d07�G.hJ '1 1VQ -eX /Z¢�—Q �rify site address/s exists and active in permit syste . ver Terrace Plan District: ❑ Yes Od No Site ' an Elements: P: -e(3)copies of site plan sting structures on site ✓ i plan must be on 8-1/2"x 11"or 11 x 17"paper footprint of new structure(including decks)with finished 10 • .wn to scale(standard architect or engineer scale) fl..r elevations P .rth arrow II ,:.ty locations(required for new,may apply for additions) 1R S address,project or subdivision name and lot number ' II '' .lion of wells/septic systems licant information(name and phone number) p rosion control(including drainage-way protection,silt fence Ila .t dimensions and building setback dimensions d ign,location of catch basin,etc.) 1f et area,building coverage area,percentage of coverage and tr names ervious area(applicable if R-7,R-12,R-25&R-40) t et tree size,type and location roperty corner elevations(2 foot contour lines if more than xisting trees to be retained with drip line,and tree 4of differential) protection measures Ifa Clean Water Services—Service Provider Lctte of platted prior to 9/10/1995): wired: ❑ Yes,applicant was notified IfQ No Received: ❑ Yes ❑ No Public Facilitie Improvement(PFI)Permit: ,_/Required: Yes,applicant was notified ❑ No Applied For: I Yes ❑ No,stop intake [ nd Use Case#: aO/3—oao LIB Setbacks: Front c>70 Rear /5— Side Street Side ��" Garage (QC Si indscape Requirement: It / •t Coverage Maximum: % I ! • uilding Height: Maximum Height Actual Height _ tit 3 k. /3 isual Clearance �:.sements F Sensitive Lands: ❑ Yeso Type i II 'P rban Forestry Plan '/ Conditions "Met"prior to issuance of building permit Notes: y• A Approved By Planning: c"-- ---:' ��_ Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:1Buil ding\Forms\BldgPermitRvw RES_031015.docx Building Permit Submittal Original Submittal Date: ..51, yC$ Site Plans: # 3 Building Plans: # 2 Building Permit#: Enter building permit#above. Workflow Routing: Planning 0--Engineering ia15ermit Coordinator Building Workflow Sign-off: '0"Sign-off for Planning(include notes from planning review) Route Application Documents: ,0- Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. .2"Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: .e_— Date: :21/4s Engineering Review pppe at building pad: _ 77 onditions "Met"prior to issuance of building permit ' E ments (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Celgo Assess Water Quantity Fee in-lieu: ❑ Yes E:I■LIDA Facility on lot: ❑ Yes [ o ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: leZ Date: 7.-/5 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ 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: Oil to Issue Permit Approved by Permit Coordinator: .j��1/4; , / Date: 0 V1' ... 1:\Building\Forms\B IdgPerm itRvw_RES_031015.docx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14053 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection FAIL MST2015-00078 David Young Provide approved ﬁnal erosion control inspection. All else ok. Re call building ﬁnal when ﬁnal erosion control is approved. Backﬂow devise, Wilkins model 350, serial # A512864 right side by light pole. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14053 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection FAIL MST2015-00078 David Young Waterline under working pressure test. Provide approved erosion control ﬁnal inspection. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14053 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - No C of O MST2015-00078 David Young Final erosion control approved. Other corrections complete. Garage ﬁnal approved. Violation Summary: Inspector Contractor