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Permit , .. 1 I inin v CITY OF TIGARD �"�` ' MASTER PERMIT ''1 E' • COMMUNITY DEVELOPMENT Permit#: MST201500073 T IUARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2015 Parcel: 2S110BA11800 Jurisdiction: TIGARD Site address: 14270 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 11 Project: Medallion Meadows, Lot 11 Project Description: New SF. 11/5/15, REPRINTED to add a/c. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24.5 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2621 sf Value: $166,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 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: 5 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: 5 201-400 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 2621 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $21,543.15 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 . •N: • :.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those, rules are set forth in OAR 952-001-0 10 through OAR ••2-r• -0090. You may obtain a copy of the rules or direct questions to OUNC by • 5 . 987 or 1.800.332.2344 Issued B • 6' / Permittee Signature: e5"P.r r41-12----/ Call 503.639.4175 by 7:00 a.m.for the next available inspection da y P 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 ApplicathiRECEIVEP FOR OFFICE USE ONLY City of Tigard Received Date/By: // J C/ Peit" v ill 1 3 —COO 7 3 13125 SW Hall Blvd.,Tigard,OR 97223 O1 5 20 15 Plan Review = • Phone: 503.718.2439 Fax: 503.598.1960 N 0 V Date/By: Other Permit. Inspection Line: 503.639.4175 TIGARD g g �l V OF II RO Date Ready/By: luris: Ed See Page 2 for Internet: WWW.tI and Or. OV I �ji Notified Method: Supplemental Information '"! .I t I ' 1 ► CQ..-MIME, RCIAL FEE* SCHEDULE — USE CHEC,J,,iST Mechanical pennit fees*are based on the value of the work /0 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 ��{{ CA RY OF 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 I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: j -2 V S e �,� / I h I , Furnace 100,000 BTU(ducts/vents) GGG 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 r Flue vent for water heater or gas (''i, �2 _(/` t' /4/0-- fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/Iiner/flue/vent 23.32 ❑ 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:I 1 Attic/crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $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 ,.._.r_.. 1•CONTRACTOR Clothes dryer(gas) Business name: FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax: Plan review(25%of permit fee) ( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Authorized signature: �� * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: I:Building Pmnits,MEC_PermitApp_0401 13.doc 440.46177(I 102 COMCWEB) 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_PermitApp_0401 13.doc 2 U CITY OF TIGARD MASTER PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: MST2015-00073 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2015 Parcel: 2S110BA11800 Jurisdiction: TIGARD Site address: 14270 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 11 Project: Medallion Meadows, Lot 11 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First 1206 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height: 24.5 Bathrooms: 3 Second 1415 sf Garage: 628 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2621 sf Value: $166,000.00 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 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: 5 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 SrvclFeeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add.]500 sf: 5 201-400 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 2621 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $21,543.15 This permit ued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accorda - 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 day . ATTENTION: 0 go requires you to follow the rules adopted by the Oregon Utility Notification C:' - -..se rules are s= forth i. OAR 95 -001-0011;through O' ' 952-•• 0010. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .:00.33 4. I � Is ed B \ I / Y ` Permittee Signature: �� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion.f the project. Approved plans are required on the job site at the time of each inspection. t Building Permit Application • Residential FOR OFFICE l St: ()NIA City of Tigard RECOVED Received m� 13125 SW Hall Blvd.,Tigard,OR 9722 DateB ilia Permit No.: ,. I s 7 .1Ih • Plan Revi w ink Phone: 503.718.2439 Fax: 503.598.1960 Y 1 1 2015 Date/I3 : War Other Permit:5 we do 1 s_ a 7( T I C;A R D Inspection Line: 503.639.4175 MA 1 Date Ready 7.: 0 See Page 2 for Internet: www.tigard-or.gov DI� OC�IGA�Q*t Notified/Method: 1' �, Supplemental Information TYPE OF WVRi4�-DING DIVI_I t�t apt7r....c„ • /4 REQUIRED DATA:1-AND 2-FAMILY DWELLING ( New construction El Permit fees'are based on the value of the work performed. Indicate the value(rotuded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. WI 1-and 2-family dwelling Valuation: $ g ❑Corrunercial/industrial ❑Accessory building El Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: ''L ,, Job site address: I 11'2-70 S W. //9 .7.y c.7 New dwelling area: 2021 square feet City/State/ZIP: I(D P%RD l CAL- 972.2.y Garage/carport area: 628 square feet Suite/bldg./apt.no.: Project name: Covered porch area '72_ square feet (Atk15 Cross street/directions to job site: ' 1 ( TH 9, FA A iz.,0 C Deck area: 2e0 square feet lyou Other structure area: square feet 24 F, REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: /V)`p ps L L 1 O ),J M`p,D0 w5 Lot no.: 4 Permit fees*are based on the value of the work performed. Indicate the value(routded 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. A Valuation: $ Existing building area square feet New building area: square feet R PROPERTY OWNER ❑ TENANT Number of stones: Name: Type of construction: Address: c,)lit As B E(-.ti t-J Occupancy groups: City/State/Z1P: Existing: Phone:( ) Fax:( ) New: APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee scheduled Business name: r©u e_ D 60N s 1'1 ct I o Structural plan review fee(or deposit): Contact name: t)py 1 p J)E H A p p( ezt- FLS plan review fee(if applicable): Address: F'U. .6 X 1 s-7 -7 Total fees due upon application: City/State/ZIP: 2, 'yy RTO tJ ©v._ 9 7 07 5 Phone:(503) Q. 0 5 I Fax::G.50,3) S9 0 `-7 S 1 Amount received: E- t : n.4 1Z D C d N S T e. M 5 N l <o t∎�- PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR - roof-top mounted PhotoVoltaic Solar Panel System. Business name: /1 Submit two(2)sets of roof plan with connection details J(� i r� 7 ` and fire department access,along with the 2010 Oregon Address: �Z+ 1 1 Solar Installation Specialty Code checklist. City/State/ZIP: M►V Permit Fee(includes plan review $180.00 Sp and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 7 a 0 3 _ 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. 5.--46^� *Fee methodology set by Tri County Building Industry Print name: a V D � Date: 5 Service Board I:1Building\Permits'BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • Electrical Permit Application City of Tigard QQ EC Received S li • 13125 SW Hall Blvd.,Tigard,OR 9722j1 Date/B : Permit#: ai . 6 1^ 2 Phone: 503.718.2439 Fax: 503.598.1960 1 �O�C Plan Review Inspection Line: 503.639.4175 1 1 J Date/B : Related Permit#: T I G,1 K D Internet: www.tigard-or.gov MAY Ready Date/By: !aria: 0 See Page 2 for T�GAI• Notified/Method: Supplemental Information int TYPE OF WORK, o� t.."I PLAN REVIEW — WNew construction ❑Addition/alteratr ment Please check all that apply pp y(submit j sets of plans w/items checked): ❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. CATEGORY OF CONSTRUCTION where the available fault current ❑Marinas and boatyards. exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural 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#: I Job site address: ' Z 70 S _ ❑Addition of new motor load of system. v 1'V //Q c� l 00HP or more. ❑ A E l_2„ 1_3„ City/State/ZIP: 1-10Al2-0 ©2 cr 7 z `i ❑Sixormore residentialunits. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: 1 Project name: ❑Hazardous locations. ❑Supply voltage for more than Cross street/directions[O job Slte: e0 ❑Service or feeder 600 amps or more. 600 volts nominal. 1 U--i`1- tO 6 F 1 R-De. FEE SCHEDULE Description I Qty. I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: /'LL p A L L,Zu N l-E"A00 w g I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less ( 168.54 4 DESCRIPTION OF WORK add'I 500 sq.ft.or portion add'I ... 33.92 I Limited energy,residential n 75.00 MEl,1 S Nit �pM I ti/ (with abovesq.ft.) 2 F 100-ic-� Limited energy,multi-family residential(with above sq.ft.) 75.00 2 10 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 iA P/2e p S eEzu 201 amps to 400 amps 133.56 2 City/State/ZIP: 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 1 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 12 APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel Business name: y� A.Fee for branch circuits with F01't 1J C-0 t+vSTr eti�N above service or feeder fee, each branch circuit 7.42 2 Contact name: D/Vl l7 D - Pr\i2Pfb2T" B.Fee for branch circuits without Address: �� X 'S service or feeder fee,first branch circuit 56.18 2 City/State/ZIP: BC 4we z ioit-3 O lz p 70-7 s Each add'I branch circuit 7.42 2 Phone:(S,3) �q _ �S�S Fax: : , 1 _ Miscellaneous(service or feeder not included) I (53) 59 r7 S I Each manufactured or modular Email: r ou D �o NS...r_ �s IL.� LA3 6 dwelling,service and/or feeder 67.84 2 ' Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 _ Business name: &L E T� ELEC wk._ &lac,'p Sign or outline lighting 67.84 2 Address: (p I S-• n /t E , 9 Z MD D l -1 V Signal circuit(s)eta or limited-energy ❑ See Page 2 2 /u - 0 panel,alteration,or extension. City/State/ZIP: 1::30 RT.L♦,� t �� Qr z Z Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( 2-7") _378e, I Fax:(1(63-2,) 70 i — ,p/ L j Investigation(1 hr min) 66.25/hr Email: EL E7'EaLC L I j2l�.f� u P �y� y� 5?/ Industrial plant(l hr min) 78.18/hr Inspections for which no fee is CCB Lic.: I q i Z7,/ I Electrical Lie.: C (p3 9 l Suprv.Lie.: 576-2, s specifically listed(/2 hr min) 90.00/hr Suprv.Electrician signature,required i ELECTRICAL PERMIT FEES Subtotal: Print name: ! O. – p _ Date: S•_,9_/5 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signatur• ••_ / TOTAL PERMIT FEE: Print name: '�pv�� f-�� . This permit application expires it a permit is not obtained within 180 c NV �J iii • Date: 5 /_ I days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\BuildingTennits1Et.C_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(r I/05/COMIWEB Mechanical Permit Application FO1 OFFICE USE ONLY City of Tigard RECEIVE Ep eacteeived Permit No.: f YI 3 T S'-ctp 7 • 13125 SW Hall Blvd.,Tigard,OR 97223 �1 Plan Review 1141 Phone: 503.718.2439 Fax: 503.598.1960 MAY 2 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov Q OF TIGA"®tified/Method: Supplemental Information CITY TYPE OF WO COMMERCIAL DING OM • ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* CR/1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating cooling: Air conditioning 46.75 Job site address: (4 2:7 5,‘,t/ 1 i S 1-14- f. 1r Furnace 100,000 BTU(ducts/vents) t 46.75 City/State/ZIP: •-r^i&4‘2--D OF. 9'7 2- Furnace 100,000+BTU(ducts/vents) 54.91 f Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: I ICJ T H G Ap RD 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: G D ALL i a N r p tv 5 Lot no.: Other: 23.32 !�r"L^ Other fuel appliances: Tax map/parcel no.: Water heater t 23.32 DESCRIPTION OF WORK Gas fireplace/insert t 33.39 _ Flue vent for water heater or gas /t=- S/SO 61-e M 1 ty 47--fit+/ pG'/ULC fireplace 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen �r equipment 33.39 J Address: I°' & P•5 BE-1-0 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 5 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 E5i;APPLICANT ❑ CONTACT PERSON Other: 23.32 _ Business name: k"CI.I.C2- D C- ST CT I0 Fuel piping: �-l� $14.15 for first four;$4.03 for each additional Contact name: T Av 1 D 22)e N p_T Furnace,etc. 1 Address: P 0 33 aX 1 S? -7 Gas/cuspump Wall/suspended/unit heater City/State/ZIP: Z EP`v uO 17■D 1 • :%,P.-. 9 )0 7 S Water heater Phone:(S u3) 590 „ a 9 0 S Fax::(53) „S-9C) ._ 1. S I Fireplace i Range E-mail: O to(L b CO ts-)sr , Avis,,..), c Or...A._ Barbecue CONTRACTOR Clothes dryer(gas) Business name: Other: � �`"A L 4442_ 2'!tit- MECHANICAL PERMIT FEES* Address: P_os B 433 Subtotal City/State/ZIP: C C�lpc. _A iAAS 3 V— et 7© l Minimum permit fee($90.00) p Plan review(25%of permit fee) Phone:(j( ) ( 5 _ I L o (Fax:6J3) e05 0 --3>? State surcharge(12%of permit fee) CCB lie.: 17 0 1,2-14 TOTAL PERMIT FEE 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: Davin `-,_ - '.-.v :-,_i,'If`.c a Date: $-8 -- 1 Plumbing Permit Application . Building Fixtures FOR OFFICE: USE ONLY City of Tigard Received ,v� 14 i g tit elBy: Permit No.:/ 'srobi S -.' .1 13125 SW Hall Blvd.,Tigard,OR 97223 E0 az' Review Phone: 503.718.2439 Fax: 503.59> r EN Other Permit No.: Inspection Line: 503.639.4175 v Date/By:Re T I G A R D n�� Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.gov U Notified/Method: Supplemental Information TYPE OF WORK MAY FEE* SCHEDULE ty4i tiG F T►GAS`ON For special information use checklist 'New construction ❑I 1NG DNl Description I Qty. Ea. I Total ❑Addition/alteration/replacement1p 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 y g ❑Commercial/industrial El 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: ./ Catch basin or area drain 18.76 'y Z7 S• /lU Drywell,leach line,or trench drain 18.76 City/State/ZIP: '-r((L f D 0�` 1 / Z 2 y 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: t i g 1"\ 2, (,j A�IC�Q 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.: ) f Page 2 Subdivision: fyi e)A L`iO& A va S I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 /tt ,S'1 C.,L L FiQiisii /L Y ��E_ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Er PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sir /hub 25.02 Address: S p N L C P S l 3 .- • ' 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 Business name: ,{ Medical gas(value:$ ) Page 2 D SST auct Primer 12.51 Contact name: P•V 1.0 D Roof drain(commercial) 12.51 Address: 66 >6 1S7 Ti Sink/basin/lavatory 25.02 City/State/ZIP: sf3a ,i/ -of.) o ear'7 0-TS S Solar units(potable water) 62.54 Phone:(53) 5'9v ei 8 p'5 Fax::(5�3) 5-9U , '-2 S I Tub/shower/shower pan 12.51 E-mail: r0,411-- [�CO/`1�-y-- /�I 5")r CO N"1 Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: `1-H e IA u C.L i.j 4j,,,,p A N y Water piping/DW V 56.29 Address: I COO I A S. E . A 1■ �--(Z. .4Rd - Other: 25.02 City/State/ZIP: 141 L LS BeszV / 0P- ct 7 j,Z 3 Subtotal Phone:X03) yo -co U i 3 Fax:( ) Minimum permit fee: $72.50 c� Plan review (25%of permit fee) CCB Lie.: /2_6p 8 9 Plumbing Lic.no.:39_260 Pg / State surcharge(l2%of permit fee) Authorized signature: _ TOTAL PERMIT FEE Print name: �vt1� - 1.- p ,�'-f-'- is® _)s-� This permit application expires if a permit is not obtained within 180 days ri •t `I ® -1 after it has been accepted as complete. 'Tee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(IWO2ICOM/WEB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review — Residential 1 I( , AI: I) Building Permit #: 8-j�/5, 7 3 Site Address: ( 42,'70 S?J tC64rl C+. Project Name: ,pa,Ajp ) Meildows Lot #: 11 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: nt?VU SF ❑ Verify site address/suite# exists and active in permit syste River Terrace Plan District: ❑ Yes 01 No Siye Plan Elements: BVhree(3)copies of site plan xisting structures on site e plan must he on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished I' il rawn to scale(standard architect or engineer scale) floor elevations l'Iorth arrow Utility locations(required for new,may apply for additions) .tte address,project or subdivision name and lot number cation of wells/septic systems Vpplicant information(name and phone number) Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions esign,location of catch basin,etc.) $Lot area,building coverage area,percentage of coverage and l eeet names pervious area(applicable if R-7,R-12,R-25&R-40) pQ treet tree size,type and location Nit Property corner elevations(2 foot contour lines if more than gtExisting trees to be retained with drip line,and tree 4 foot differential) protection measures Ltd Clean Water Services-Service Provider Lettef,(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified 2'No Received: ❑ Yes ❑ No M Public Faciliti s Improvement (PFI) Permit: �,( (Required: 1'Yes,applicant was notified ❑ No Applied For: UA Yes ❑ No,stop intake CO and Use Case#: SUg2-01S-CCj()% F_2(./Land R_Li 5 I.rJ Setbacks: Front 20 Rear 15 Side 5 Street Side — Garage 20 $ Landscape Requirement: /Lot Coverage Maximum: % t I Ni/Building Height: Maximum Height 35 I Actual Height Zvi .S s N: Clearance ments L -1 ensitive Lands: "Yes ❑ No Type 311, o c 1 -a, crban Forestry Plan U onditions"Met"prior to issuance of building permit Notes: Approved By Planning: -r-j m 4.S Arb,U` Date: t I Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_031015.docx Y Building Permit Submittal Original Submittal Date: Site Plans: Building Plans: # 3 Building Permit#: nter ding permit .above. Workflow Routing: arming ngineering Coordinator -13 i g Workflow Sign-off: off for Planning(include notes from planning review) Route Application Documents: [-Enigtneering: (1) copy of permit application, (1) site plan, (1) building plan and on al plan review routing form. L�• Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: - _ Date: --V/l/sue Engineering Review IL�S'Slope at building pad: y L��S,' onditions "Met"prior to issuance of building permit L7 r cements (encroachments) per engineering conditions of approval and plat IV-Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes C4lclo Assess Water Quantity Fee in-lieu: ❑ Yes EtiClo LIDA Facility on lot: ❑ Yes LH"No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: ` , _ i_ Date: .5-117—/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 El 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: K to Issue Permit Approved by Permit Coordinator: 1 Date: S_ /9 / 5 1:\Building\Forms1B1dgPermitRvw_RES_031015.docx Page 1 of 1 /145-/ 0;140/- -- -) 73 atil$, , I .'''. Am mertenme..0•40.0...40V01..............,... CCB # 1,78624 rentra/Ar P 0 Box 433 itIC ricAng anti Air C.-1i Iti100.00,q Clackamas, OR 97015 .,........,_,..... .s. Phone: (503) 6564908 Fax: (503) 650-3898 4 I Techni c i a W.: .- - ,..,441f7 a t e: :LW/ s Builder Name: , 2)- , Site Address: / 11270 C7-. Duct Leakage Cond. Floor Area (sq.ft) i., - yes no Air Handler in conditioned space? IyesX no Air Handler present during test? ' if "yes"for either, then floor area x 0.06 = CFM@50 Pa Target CFM is the above or 75 CFM@50 pa, whichever is greater If"no"for either, then floor area x 0.06 = CFM@50 Pa Target CFM is the above or 50 CFM@50 pa, whichever is greater . Circle Test Metho'. ': Leakage to Outside_ c Total Leakage .. Test Result _ (61- 1 CFM@50Pa Fan Pressure /00 Pa ' 3 Ring (circle one) Open 1 40 , , 1 'Duct Blaster Location /9/P411/ IPressure15)C40,090,49 3 Tap Location __ ,... _,,,,,„...„.._,..,___ file://C:\Documents and Settings\Administrator\Local Settings\Temporary Internet Files\OL... 12/4/2015 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 14270 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2015-00073 David Young Note: for ﬁnal inspection, seal master shower valve trim to wall. 310.4 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 14270 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2015-00073 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 14270 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00073 David Young Note: for ﬁnal install missing duct registers, and label net aggregate length of dryer vent. M1502.4.5 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 14270 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00073 David Young Corrections from other ﬁnals complete. Final erosion control approved. Street tree certiﬁcation received. Moisture content form received. High efﬁciency lighting form received. Insulation certiﬁcation checked. Duct seal test report received. C of O left with plans on site. Violation Summary: Inspector Contractor