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Permit n CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00055 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/15/2015 Parcel: 2S110BA11100 Jurisdiction: TIGARD Site address: 14128 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 4 Project: Medallion Meadows, Lot 4 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1446 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height 22.5 Bathrooms: 4 Second: 1598 sf Garage: 765 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3044 sf Value: $383,898.59 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 F urn>=100 K: 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: 6 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL•RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing. V BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3044 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: $24,259.61 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. ATTE N: gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 through OA - 1- 90. You may obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.332.2344. Issued By. •_ a/� Permittee Signature: 1_� i (& !c9�� Call 503.639.4175 by 7:00 a.m.for the next available inspection da e. 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. r • Building Permit Application Residential 101 Ol:I I( I 1 SE()NL.l City of Tigard Bed L III IMINI.is, ! . = } I Blvd.,Tigard, r • Phone: 503.718.2439 Fax: 503.598.1 RECEIVE paWgan eyv;ew /l !� OhaP�mit: kt �o)�= . Inspection Line: 503.639.4175 Date ReadY/By / '• I ': la See Page 2 for T t G A R D Internet: www.tigard-or.gov Notified/Method. � f %." %"d Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New constniction ❑DeaIbTtt)IOF TIGARD Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all El Addition Addition/alteration/replacement U'9Qk . I equipment, 1 aterials,labor,overhead,and the profit for the work indica on this application. CATEGORY OF CONSTRUCTION �._ �� Valuation:, ll 1 s)2150‘ ® 1-and 2-family dwelling ❑Commercial/industrial mar , e _ ❑Accessory building ❑Multi-family Number of bedrooms: 4 ❑Master builder ❑Oar: Number of bathrooms: 3.5 1.89-Cb- JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: SW 118' Court New dwelling area: 3044 square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: 765 square feet Suite/bldg./apt.no.: Project name:Medallion Meadows Covered porch area: 196 square feet I 1,E Cross street/directions to job site:Gaarde Road to 118a Court Deck area: 166 square feet (44 Other structure area: 13E307 square feet 2 Z REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Medallion Meadows Lot no.:04 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Construction of new single family residence Valuation: S 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)639-2639 Fax:(503)624-0239 New: ❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name:J.T.Roth Construction Inc. (Please refer raJeeschedule) 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 Phone:(503)806-0602 Fax::(503)624-0239 Amount received: 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. Fee(includes plan review City/State/ZIP:Tigard,OR 97223 Permit administrative fees): S180.00 Phone:(503)639-2639 Fax:(503)624-0239 State surcharge(12%of permit fee): S21.60 CCB lic.:31700 3 9/ /2 Total fee due upon application: S201.60 Authorized signature: /� 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 Print name:David Jensen Date:04-14-2015 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46131(1 l/02/COM/WEB) r Building Permit Application Checklist One- and Two-Family Dwelling l OR (I 1 1 1( 1 I ,s l (l\I 1 Received 1 City of Tigard Permit No.: Date/By: 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: Phone: 503.718.2439 Fax: 503.598.1960 t �; 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: III:: 1:011,1,(M I\(; ITEMS I:AIS ,A RE laQt IREI) FOR 1'L.k\ RI VIF:11 1 c. v,, \ 1 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. -0 ❑ ❑ 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 ❑ 0 ❑ 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- ❑ ❑ ❑ 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 on and shall be shown to be a licable to the ro'ect under review. 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. ❑ ❑ ❑ 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. _ 1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) 1 _ I ` Electrical Permit Application FOR OFFICE 1 St. t l\1.1 City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 R�C w�E 1�'ateB Ian Review ESIMBIMIIMI = Phone: 503.718.2439 Fax: 503.598.196(7 Date/B : Other Permit: II GA R D Inspection Line: 503.639.4175 Date Ready/By: rwis ® See Page 2 for Internet: www.tigard-or.gov APR 2 2 2015 Notified/Method: Supplemental Information TYPE OF WORIt•ITYDF T�GARD PLAN REVIEW ®New construction ❑Addition/alteratik/�p at DIVISION Please check all that apply(submit 2 sets of plans w/items checked below): ['Service or feeder 400 amps or more ❑Building over three stories. ❑ 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 addres . 8 SW 1159th Court 100HP or more. occupancy. , ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97224 /lif, ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: Medallion Meadows ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site:Gaarde Road to 118th Ct. Description I Qty. I Fee. I Total I New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision:Medallion Meadows Lot no.:4 1,000 sq.ft.or less I 1 I68.54 4 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion E7 33.92 I Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 1 75.00 ■ 2 Limited energy,multi-family 75.00 2 Wiring of new single family residence residential(with above sq.fi.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ® PROPERTY OWNER ❑ TENANT 200 amps or less 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 72"d 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)639-2639 Fax:(503)624-0239 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 I 0 CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name:J.T.Roth Construcion 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 72"d Ave. Each add'I branch circuit 7.42 2 City/State/ZIP: Tigard,OR 97223 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)806-0602 Fax: :(503)624-0239 dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:davidj(ajtrothinc.com Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Dreamhouse Electric 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)648-5144 Fax:(503)648-9723 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.Lie.: specifically listed CA hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Chris Mahoney Date: 04/14/2015 Plan review(25%of permit fee): , State surcharge(12%of permit fee): Authorized signatur v t_ ___ 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. I\Building\Permits\ELC Permit App_FLIt_ERE.doc Rev 05/21/2013 440.4615T(11/05/COM/WEB ■ • Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE scn m i Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I • Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ® Audio and Stereo Systems* 15.01 w 25 kva 200.34 2 ElAlarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ® Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 ® Heating,Ventilation and Air Conditioning OAR 918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ® Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ® Other: Landscaping Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(V2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL. PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation (� HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Prnnits\ELC_PermitAPP_ELR_ERE.doc Rev 05/21/2013 1 Mechanical Permit Application I ()Ii Ol 11( 1 I ,,I O\1 1 City of Tigard Received Date/By: Permit No.: S l III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review s Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: Date/By: 1 I i ,I,I) Inspection Line: 503.639.4175 RECEIVE �,'ae Ready/By: ruris: ® See Page 2 for Internet: www.tigard-or.gov otificd/Method: Supplemental Information TYPE of wows APR 2 2 2015 COMMERCIAL FSi*sums ME CHECKLIST Mechanical permit fees*are based on the value of the work ®New construction ❑Addition/alteration,4'L*r6t TIGARD performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: BUILDING DIVISION mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION TIAL EQUIPMENT/SYSTEMS FEW ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checIdIsx ❑Multi-family ❑Master builder ❑Other: Description I Qty. 1 Ea. 1 Total (•11!24 JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address:1 SW 118"'Ct. Furnace 100,000 BTU(ducts/vents) ( 46.75 City/State/ZI Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Medallion Meadows Duct work 23.32 Cross street/directions to job site:Gaarde Road to 1886 Court 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 Oth Subdivision:Medallion Meadows Lot no.:04er' _ 23.32 Other fuel appliances: Tax map/parcel no.: Water heater ( 23.32 DESCRIPTION OF WORK Gas fireplace/insert t 33.39 • Flue vent for water heater or gas HVAC installation at new single family residence 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 I 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name:J.T.Roth Construction Inc. Range hood/other kitchen equipment ' 33.39 Address: 12600 SW 72d Ave. Clothes dryer exhaust ( 33.39 City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(503)639-2639 Fax:(503)624-0239 Attic/crawlspace fans 23.32 ❑ APPLICANT ® CONTACT PERSON Other: 23.32 Business name:J.T.Roth Construction Inc. Fuel piping: $14.15 for first four,$4.03 for each additional Contact name:David Jensen Furnace,etc. Address: 12600 SW 72n Ave. Gas heat pump Wall/suspended/unit heater City/State/ZIP:Tigard,OR 97223 Water heater Phone:(503)806-0602 Fax::(503)624-0239 Fireplace Range lv E-mail:davidj @jtrothinc.com Barbecue CONTRACTOR Clothes dryer(gas) Business name:All Time Heating LLC Other: MECHANICAL PERMIT FEES' Address:PO Box 1341 Subtotal City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)208-2276 Fax:(503)208-2276 State surcharge(12%of permit fee) CCB lie.:184575 11! /7 l( TOTAL PERMIT FEE r This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svobova Date:04/14/2015 I m 16uilding�Pe ,a [�. slC_PermitApp_04o113.doc 440-46177(11/02/COM/WEB) . • • Plunibing Permit Application Building Fixtures RECEIVED I OIZ t)II I( I I • I ON1 1 City of Tigard Received ty g Date/By: Permit No.: M 1 S ■ 13125 SW Hall Blvd.,Tigard,OR 97223 P R 2 2 2 015 Plan Review ` '�Tj S� Phone: 503.718.2439 Fax: 503.598.1 Other Permit No.: Date/By: Inspection Line: 503.639.4175 CITY OF TIGARD Ii. I,I� Internet: www.ti and-or. ov Date Notified/Method: runs: Supplemental See Page l for 8 g Notified/Method: Supplemental Information 'TYPE OF W t- .' ` ` 1 • • FEE' SCHEDULE ®New construction ❑Demolition For special information use checklist Description I Qty. I Ea. 1 Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CON/F*11010N SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath x 500.32 ❑ ry ildin g ❑Multi-family Each additional bath/kitchen 1 25.02 ❑Master builder ❑Other: Fire sprinkler(3044 sq.ft.) Page 2 11/f9, JOB S INFORMATION AND LOCATION Site utilities: Job site address:1 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:Medallion Meadows Manufactured home utilities 50.03 Cross street/directions to job site:Gaarde Ronde to 118th Couert 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:Medallion Meadows I Lot no.:04 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Plumbing installation of new single family residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ 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)639-2639 Fax:(503)624-0239 Ice maker 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:David Jensen Roof drain(commercial) 12.51 Address:12600 SW 72d Ave. Sink/basin/lavatory 25.02 City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503)806-0602 Fax::(503)624-0239 Tub/shower/shower pan 12.51 E-mail:davidj@jtrothinc.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Delta Plumbing Inc. Water piping/DWV 56.29 Address: 12205 SE 108th Ave. Other: 25.02 City/State/ZIP:Happy Valley,OR 97086 Subtotal Phone:(503)998-0683 Fax:(503)698-2354 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 182846 Plumbing Lic.no.:PB562 State surcharge(12%of permit fee) Authorized signature: / TOTAL PERMIT FEE Print name:Gabrie gda Date:04/148015 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. 1:\Building\PermitsU'LMU-PermitApp.doc 10/01/09 440-4616T(10/O2ICOM/WEB) 1 . . IN City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: ew—Gty,)3 Site Address: /00 S(,, 19-rte Cl, Project Name: Red cdl is 4 Nerd o .Js Lot #: 4 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: )%1 P j 5FR xVerify site address/suite#exists and active in permit system. N'River Terrace Plan District: ❑ Yes )No Site Plan Elements: Three(3)copies of site plan xisting structures on site IlitSite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished lDrawn to scale(standard architect or engineer scale) floor elevations [North arrow Utility locations(required for new,may apply for additions) Site address,project or subdivision name and lot number ri 'cation of wells/septic systems Applicant information(name and phone number) OA. control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions design,location of catch basin,etc.) tot area,building coverage area,percentage of coverage and ltStreet names impervious area(applicable if R-7,R-12,R-25&R-40) 4 etreet tree size,type and location Property corner elevations(2 foot contour lines if more than RExisting trees to be retained with drip line,and tree 4 foot differential) protection measures NI/Pc Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No Jr Public Facilities Improvement(PFI)Permit: Required: brYes,applicant was notified ❑ No Applied For: V.—Yes ❑ No,stop intake 'Land Use Case#: 5U-BaO l 3 " 000 0 Co 4- Y2 tC rt d 2( J f r e -r kr Zoning: -P.— 4 . S AI Setbacks: Front ( .p Rear 5 Side 5 Street Side 01)(5 Garage a a Landscape Requirement: 4I1„4, ,12-"Lot Coverage Maximum: — Building Height: Maximum Height 30 Actual Height .2.)-5.-S Visual Clearance Easements Sensitive Lands: ❑ Yes ,n No Type CO Urban Forestry Plan — 5+1-.2.4 -Ray w 404 Ask `4- glievf Li 04-a m; ti 5 c-k m "t 1 !' Conditions"Met"prior to issuance of building permit Notes: Approved By Planning: nil d o', c I3 i c o Gam— Date: y L Z L I I S Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved 0' Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw_RES_031015.docx Building Permit Submittal Original Submittal Date: It �� Site Plans: # � Building Plans: # 3 Building Permit#: [ 1 Titer building permit#above. Workflow Routing: [-15lnning [ E gineering e ut Coordinator 0 .uilding Workflow Sign-off: [ ' n-off for Planning(include notes from planning review) Route Application Documents: —gineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. H'Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: �-. Date: / 2A,--- Engineering Review Slope at building pad: 11„ ❑ Conditions "Met"prior to issuance of building permit Et' sements (encroachments) per engineering conditions of approval and plat 114,..Z ater Quality/Quantity Facility: ,/ Assess Water Quality Fee in-lieu: El Yes [ Assess Water Quantity Fee in-lieu: El Yes LIDA Facility on lot: ❑ Yes 10 I NOT Approved y Engineering: Ael ,Z7 Date: 44-.271:—/,E Notes: >r.�r,,x,a) 2 0 7 2 , _.rte/ 5 ' • i�'��= - t. - 'Approved by Engineering: Ala II V, ,, Date: __ _ 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) !/r »20vE.b /70 (O�Revision Notice 1: Date Sent to Applicant: -1 L.5 is t A �/a Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: l OK to Issue Permit Approved b Permit Coordinator: /�� Date: 0:577.:211. PP Y 1:\Bui l ding\Fonns\BldgPermitRvw_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 14128 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00055 Jeff Grove 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 14128 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal FAIL MST2015-00055 David Young Provide duct seal test report for ductwork in crawl space, or blower door test report. AF 103.4.8 Seal ceiling penetrations in garage at mechanical equipment. R 302.5 Extend dryer duct thru cabinet base and mark net aggregate length on approved tag. M1502.4.5 Note: no AC installed at time of ﬁnal inspection, permit and inspection required at time of installation. 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 14128 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection FAIL MST2015-00055 David Young Provide approved mechanical ﬁnal inspection. Provide permit, approved back ﬂow test results and approved ﬁnal inspection for lawn irrigation back ﬂow devise. Seal penetrations in garage. R302.5 Slider pane by deck stairs to be tempered at less than 50" above steps. R308.4.1(7) Provide positive connection at deck ledger to house. No approved crawl drain inspection on record. Provide approved inspection. Provide grade to code right side of house. R401.3 Provide approved plans on site for 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 14128 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00055 Jeff Grove Violation Summary: Inspector Contractor