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Permit n CITY OF TIGARD j I MASTER PERMIT 111 = COMMUNITY DEVELOPMENT Permit#: MST2015-00072 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2015 Parcel: 2S110BA11400 Jurisdiction: TIGARD Site address: 14172 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 7 Project: Medallion Meadows, Lot 7 Project Description: New SF. 11/5/15, REPRINTED to add a/c. BUILDING Floor Areas Required Setbacks Reauired Stories: 3 Bedrooms: 4 First: 767 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27.5 Bathrooms: 4 Second: 1319 sf Garage: 543 sf Front: 20 Smoke Dwelling Units: 1 Third: 1330 sf Right: 5 Detectors: Yes Total: 3416 sf Value: $413,368.03 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 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: Y 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 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 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 8 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 SF VB R-3 3416 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $24,539.87 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. ATT • . : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 6010 through O•- 9 001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.3 ■2344. Issued / ■ / Permittee Signatur C-"/( Call 503.639.4175 by 7:00 a.m.for the noxt 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. Mechanical Permit Application vEp FOR OFFICE USE ONLY City of Tigard Received / Permit No Date/By: /� 5—/7 M t: 6/5-0 0 0 7 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review II = Phone: 503.718.2439 Fax: 58.196) 2015 Other Permit Date/By: TI G A R[) inspection Line: 503.639.4175 Date Ready/By: 11IT„ ® Sec Page 2 for Internet: www.tigard-or.gt1,1,,/ s (, 1.1� ,AR0 Notified/Method: Supplemental Information 7 ; . - lbF WO i•�ge� .. 4.. SCHEDULE'' • Mechanical permit fees*arc based on the value of the work New construction ❑ Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* , 1 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: _ Air conditioning ` 46.75 Job site address: C . 1 J ) _ 5 tN l 1 b } irt— Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: 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: Lot no.: 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 El PROPERTY OWNER ❑ TENANT Other: 23.32 . Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum pennit fee($90.00) Phone: Plan review(25%of permit fee) ( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 c c days after it has been accepted as complete. Authorized signatur * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: 1:Building,Permits,MEC_PermitApp_0401I3.doc 440-4617r(I1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\M EC_PcnnitApp_040 113.doc 2 CITY OF TIGARD MASTER PERMIT 11111 * COMMUNITY DEVELOPMENT Permit#: MST2015-00072 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2015 Parcel: 2S110BA11400 Jurisdiction: TIGARD Site address: 14172 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 7 Project: Medallion Meadows, Lot 7 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 767 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27.5 Bathrooms: 4 Second: 1319 sf Garage: 543 sf Front: 20 Smoke Dwelling Units: 1 Third: 1330 sf Right: 5 Detectors: Yes Total. 3416 sf Value: $413,368.03 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach 1 Laundry Trays: 1 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 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: 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 3416 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $24,539.87 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 folio adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtai -copy of the rules• direct questions to OUNC by calling 503. 19887 1.800. .2344. Issued By- _:jam Permittee Signature: / ,y .39.4175 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. Ruildih2 Permit Application Residential lUR (H.1.1( 1: 1 SF 0 V'L1 City of Tigard Received �/ _ Date/B : lI Permit No.: -,, *7- 13125 SW Hall Blvd.,Tigard,OR 97223 O Plan Review ► ' . Phone: 503.718.2439 Fax: 503.598.1960 V� Date/B : C j�� E, a'her Permit: '(A)C,Lo �U 'r-D FIG A R u Inspection Line: 503.639.4175 �!(�-�`v Date ReadyBy: ?7 /�� S 0 upplemental See Page 2 for Internet: www.tigard-or.gov GV �D� Notified/Method�o'/ ��r �j� Supplemental Iotormation TYPE OF Wall4.1. \�PpVO REQUIRED DATA:1-AND 2-FAMILY DWELLING 'New construction tmj tO\v\5\� Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 1:1 Addition/alteration/replacement t: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Ri 1-and 2-family dwelling 12 Commercial/industrial Valuation: $ . ❑Accessory building 1:1 Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: r -- JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /L,i,72 s: ,ie 1-id e-r-r New dwelling area: ((, square feet City/State/ZIP: —r"i(o f\i2._.0 l CAL_ 9722.y Garage/carport area: 54-7 square feet r,.- Suite/bldg./apt.no.: Project name: Covered porch area ,k2__ square feet(3(C Cross street/directions to job site: 1 ` l 1-1.1. 2 G R fA RQ a Deck area: 1610 square feet?LI Other structure area: .16ci square feeti-1.5 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: /A z:p A L k..1 O N M L/D 4.S Lot no.: -7, 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. Valuation: $ /VFW s',i'VOLE Fat-n1Ly 9-ES i17EN1--c Existing building area square feet New building area: square feet g PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: '1:).rye AS B Lu t,.i Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: cs,APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) _ Business name: r o u.rL D Co is/5 t P-a erl 0 Contact name: Structural plan review fee(or deposit): DF V IO DE H FLS plan review fee(if applicable): Address: 17)=0, ,B c X IS 7 -7 _ Total fees due upon application: City/State/ZIP: 2,ep yy g.. p t..3 ©c 9 7 0-7 S _ Amount received: Phone:($o3) 59 O -- D'O S Fax::(s 3) S9 0 17 5 1 E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* �o..( 1z DoCoNST- e. MSdj t co CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: ..— Submit two(2)sets of roof plan with connection details ti J(% and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: /p 1414''''' Permit Fee(includes planreview $180.00 y Phone:( ) J Fax: and administrative fees): ( ) State surcharge(12%of permit fee): $21.60 CCB tic.: `r 5`7 Total fee due upon appication: $201.60 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:D p v i o 3.. Dc_ 44 i-rf Date:S-e_ , c Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application Mk(1111(!. 1 tit: OM 1 City of Tigard 1` /E. Received - - • 13125 SW Hall Blvd.,Tigard,OR 97223 GC EN E% • G Plan Review Y ' '! = Phone: 503.718.2439 Fax: 503.598.196 ZO+C Date/By: Related Permit#: Inspection Line: 503.639.4175 v 1 1J Ready Date/By: T t< :�R[� Internet: www.tigard-or.gov MAl i y o J°"' I S See Page Supplemental Information •51 otified/Method: Supplemental Information TYPE OF WORK .� O DGlIS1O1.4 PLAN REVIEW New construction ❑Addition/alteration/rc Please check all that apply r�U pp y(submit o sets of plans w/items checked): ❑Demolition ❑Other: 3 ❑Service or feeder 400 amps or more ❑Building over three stories. CATEGORY OF CONSTRUCTION where the available fault current ❑Marinas and boatyards. ❑ 1-and 2-family dwelling ❑Commercial/industrial exceeds o nd,or exceeds e at s 14,000,0 0 or ❑Floating Commercial-use buildings. ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agicultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived Job#: Job site address: 11� l v ❑Addition of new motor load of system. � /7� Sax/ //U fit C.f 100HP or more. City/State/ZIP: T f�� n er Z Li' ❑Six or more residential units. occupancy. R. 1 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. ❑Supply voltage for more than Cross street/directions t0 Job Slte: 0� ❑Service or feeder 600 amps or more. 600 volts nominal. 1 tU file to 611144ROC FEE SCHEDULE Description I Qty I Each I Total I New residential single-or multi-family dwelling unit. • Subdivision: (il'(.D fl L L_j N /Vk�a,puw S I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less I 168.54 4 DESCRIPTION OF WORK Ea.Limited energy,sq.es ft.or portion lD 33.92 I Limited energy,residential ///EA,! S i f..)61_4=-- Fpt'ei 1 t/ 3 SS O'7J-C (with ne gy, lt) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 far PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Page 2 Name: Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 Address: S A Nl� P S n LO 201 amps to 400 amps 133.56 2 City/State/ZIP: l7 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) I 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 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps I 1 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or ex_tension,per panel A.Fee for branch circuits with Business name: FUI,I 12, D ST-1211 CIL�N above service or feeder fee, Contact name: P VI (7 (� each branch circuit 7.42 2 ✓E 14-P%R-pfba-T B.Fee for branch circuits without Address: ID�,C7 . P...,X 'S 7 "7 service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: BC'11✓t7 V—TO1`.3 00- q-70.7 s Each add'l branch circuit 7.42 2 Phone:(St+3) Jr`� oy OS Fax: : I �,— Miscellaneous(service or feeder not included) 3) S� 17 S ( Each manufactured or modular Email: �` � � ` - dwelling,service and/or feeder 67.84 2 L vu IL. D c NSr &3 , Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 Business name: 6.L 2 T� LEI;n2 lL CoR,.,P Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 2 Address: I � y t E , 9 Z N/() Q{ - # y panel,alteration,or extension. ❑ See Pa g e 2 City/State/ZIP: 0 RT�� 7 ,1 Each additional inspection over allowable in any of the above t Z- Additional inspection(I hr min) 66.251 hr Phone:(5,,,y3) _-7 ) _,375e I Fax:��/3) g J — 5/ y Investigation(1 ) 66.25/hr V Investi anon 1 hr min Email: EL E%-EELSC.Tizi Lev Kcal' tC cv I�A 1L , Lv M\ Industrial plant(I hr min) 78.18/hr Inspections for which no fee is CCB Lic.: f 9 i L7e/ I Electrical Lic.: C (,3 91 I Suprv. Lic.: S76 5 specifically listed(Y2 hr min) 00/hr Suprv.Electrician signature,required:7C214 . ELECTRICAL PERMIT FEES Subtotal: Print name: °B AQM eND4g 12..... Date: 5...9, _,, ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: • --.. TOTAL PERMIT FEE: ��a _ -/ S This permit application expires if a permit is not obtained within 180 Print name: ,4 V/ ili,e,.:_ia i_L Date: _ days after it has been accepted as complete. ' Number of inspections allowed per permit. I:\BuildinglPermiulELC_PermitApp_ELR ERE.doe Rev 04/21/2014 440-4615T(II/05/COM/WEB Mechanical Permit Application FOR OFFICE 1 SE O\I,\ City of Tigard Received I'DateBy: • �� I 13125 SW Hall Blvd.,Tigard,OR 97223 DECEIVE plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: DateBy. TI G A R D Inspection Line: 503.639.4175 1 1 2015 Date Ready/By: kris: ® See Page 2 for Internet: www.tigard-or.gov MAY Notified/Method: Supplemental Information r�/ �F(„D1VA51DN TYPE OF WORK C�1 , COMMERCIAL FEE* SCHEDULE - USE CHECKLIST BUILDIN Mechanical permit fees"are based on the value of the work KNew construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* CceI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: Air conditioning 46.75 9 I,72, S, y1/, /I�3 T N C T: Furnace 100,000 BTU(ducts/vents) ( 46.75 City/State/ZIP: •-'--i(, 4 2 ) U , 9.7 -Z$/ Furnace 100,000+BTU(ducts/vents) 54.91 1 �jj Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: 1 I i3 .,i-H V.9 G AR Cz-D Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: NI G p A LL( a IJ A�L P Do w S Lot no.: Other: 23.32 !�` Other fuel appliances: Tax map/parcel no.: Water heater 1 23.32 DESCRIPTION OF WORK Gas fireplace/insert ( 33.39 w l _ Flue vent for water heater or gas �cJf"3 LS(tom z-GT M I L-y / Pe-MCC fireplace 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ig.PROPERTY OWNER ❑ TENANT Other: 1 23.32 1 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment I 33.39 Address: ..$'/(P l- 15 B 4.i t_o Clothes dryer exhaust ( 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, // toilet compartments,utility rooms) 4, 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 %APPLICANT ❑ CONTACT PERSON Other: _ 23.32 Business name: Fuel piping: �`OrA k2 C(d1N ST Cr I O I_) $14.15 for first four;$4.03 for each additional Contact name: T) i W 1 D `1t� )4 ,, ,p_-t•- Furnace,etc. I Address: 0. o ' 1.S --7 Gas heat pump L` Wall/suspended/unit heater City/State/ZIP: Z alp t/ -0, 1 0P._ 9 -107 S Water heater Phone:(5'03) 570 70 .. el 9 0 S Fax: :(5.3) ,sqo - 1-is j Fireplace Range E-mail: r Q Lt 12 p CO NJ S T C, /1/6S/JS r C 0-e` Barbecue CONTRACTOR Clothes dryer(gas) Business name: /- Other: '� L viz MECHANICAL PERMIT FEES* Address: P-0. Bnx t.},3 3 _ Subtotal I City/State/ZIP: G'�,p,L,.�,A mAS 0. Cis 7© l s Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(5t Y3 ( ç(,.._. [Rog (Fax:6i3) (05 a 3>5'S State surcharge(12%of permit fee) CCB lic.: 17 1=72- ! TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 1S0 days after it has been accepted as complete. Authorized signature: " Fee methodology set by Tri County Building Industry Service Board Print name:pip V/n _ -r-- Date:S g i_5 r 11 •11. ••_r•rt,n n____•.•__ n•n11-.1__ .rsn.tr'R iv I NN •nasisfrcos ■ ■ Plumbing Permit Application Building Fixtures I.FoR oFFICF: USE OM.). E City of Tigard :RECEIVED Received Permit No.: Date/By: S 71 13125 SW Hall Blvd.,Tigard,OR 9 2 2��5 Plan Review /hSTt3a� CX�D °1 Phone: 503.718.2439 Fax: 503.598.196Q r g 1 Other Permit No.: �VI i11 Date/By: Inspection Line: 503.639.4175 y y _ I I li n R D Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov OF TIGAR� Notifted/Method: Supplemental Information TYPE OF WO �iNG v,„..3 FEE* SCHEDULE New construction Demolition For special information use checklist Description 1 Qty. I Ea. 1 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 SFR(2)bath 437.78 g ❑Commercial/industrial ❑Accessory building ❑Multi-family SFR(3)bath ` 500.32 Each additional bath/kitchen 1 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 tI I '7 2-. S` v/ //B r-H C 7' Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 'T I('ARD 012, 917-2 `i 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: l i S T\ $ GSA f & 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: i Er)AL..10A) meppdt.v S ( Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 NCW �j - �� Clothes washer 25.02 .Si 51 N 4`L �M Icy y f ?5/t E 1 L t Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 I PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: j'p/yl L� p. BE:(_(y(,�J Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 [ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ Business name: rr� g ( ) Page 2 `J �TrL46� Primer 12.51 Contact name: -.D AU I D Alt t"642-T'" 4-- Roof drain(commercial) 12.51 Address: fi.0 s cee»0 157 -1 Sink/basin/lavatory 25.02 City/State/ZIP: 43 Va IJ 6'L 9'7 Ci S Solar units(potable water) 62.54 Phone:( ,3) 590 .- 0 8 p S Fax::(5:3) 5"90 _ 17 51 Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: ('°a(L DCONSD C /-3/.)r Co Art Water closet 25.02 EaIJ CONTRALTO 9CLeeMt.iN� Water heater 37.52 Business name: `-r'H e pi IA L LS. (-UM to AN y Water piping/DWV 56.29 Address: I 60 I A S. E . R I VL-(Z RC/ - Other: 25.02 City/State/ZIP: 14i L.LS Beta) t 0 r-- c ) i a.3 Subtotal Phone:(5 j3) fp yo -0 t i 3 Fax:( ) Minimum permit fee: $72.50 q Plan review (25%of permit fee) CCB Lic.: !Zj0 8 Plumbing Lic.no.:31/-2.Go pg State surcharge(12%of permit fee) Authorized signature: 401111P ': TOTAL PERMIT FEE Print name: YiC� , J.)gpJ)j p .f Date: S _$ -I S 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-PennitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) • City of Tigard 141 Re COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review — Residential IIi ,AR.t) Building Permit #: mss--aniS 000-7a, Site Address: 14 172 SW I l&-I-h C+. Project Name: Med al i i on Meadows Lot #: 7 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: heW SF ❑ Verify site address/suite# exists and active in permit syste . MRiver Terrace Plan District: ❑ Yes g No Side Plan Elements: gi jhree(3)copies of site plan xisting structures on site .V a plan must b on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished rawn to scale(standard architect or engineer scale) ;.or elevations Mite rth arrow i'4 Utility locations(required for new,may apply for additions) address,project or subdivision name and lot number Zi .cation of wells/septic systems ' pplican t information(name and phone number) •Erosion control(including drainage-way protection,silt fence Miaot dimensions and building setback dimensions sign,location of catch basin,etc.) 'Btot area,building coverage area,percentage of coverage and reet names ,A pervious area(applicable if R-7,R-12,R-25&R-40) M reet tree size,type and location OOProperty corner elevations(2 foot contour lines if more than [ Existing trees to be retained with drip line,and tree 4/foot differential) protection measures Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: El Yes,applicant was notified 'No Received: ❑ Yes ❑ No Ce Public Facilitip Improvement(PFI)Permit: Required: LYes,applicant was notified ❑ No // M Applied For: L" Yes ❑ No,stop intake Land Use Case#: SUB2 �b O13— b oning: R-y ,5 V Setbacks: Front 20 Rear 1 5 Side 5 Street Side — Garage 20 • Landscape Requirement: % $Lot Coverage Maximum: cyo /Building Height: Maximum Height 35' Actual Height 21.EE l L`f Visual Clearance Easements ensitive Lands: 'Yes ❑ No Type Slcx. �a i'4' rban Forestry Plan J Ltd Conditions "Met"prior to issuance of building permit Notes: / Approved By Planning: ii Date: � _ . Yb� .. 5IIII5 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved l:\Building\Forms\BldgPennitRvw_RES_031015.docx Building Permit Submittal Original Submittal Date: :a/its-- Site Plans: # Building Plans: # 3 Building Permit#: C er building permit#above. Workflow Routing: C 'lanning C `ngineering La—Permit Coordinator [n—Br ding Workflow Sign-off: CLT'SiS g off for Planning(include notes from planning review) Route Application Documents: eering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ..-- �� Date: . `hi /;r— Engineering Review Ni Slope at building pad: /1 Z LP' onditions "Met"prior to issuance of building permit Its Easements (encroachments)per engineering conditions of approval and plat Later Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes la4 Assess Water Quantity Fee in-lieu: ❑ Yes LrNo LIDA Facility on lot: ❑ Yes L Vo ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: G rr I2 Date: .5—./9_—/-___G- 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: /,V5!)K to Issue Permit Approved by Permit Coordinator: /?y� taf ■/ Date: 1/.::7:A� 1:1Building\Forms\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 14172 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00072 David Young Finish installing master bath lighting. Will check at building ﬁnal. 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 14172 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2015-00072 David Young Call in plumbing ﬁnal for lawn irrigation Backﬂow devise. PLM 2015-00408. 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 14172 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00072 David Young 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 14172 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00072 Jeff Grove Street tree Moisture content Lighting efﬁciency Duct leak test All reports recieved Violation Summary: Inspector Contractor