Permit III n
CITY OF TIGARD MASTER PERMIT
2 ' COMMUNITY DEVELOPMENT Permit#: MST2015-00098
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2015
-�
Parcel: 2S110BA12500
Jurisdiction: TIGARD
Site address: 14121 SW 118TH CT
Subdivision: MEDALLION MEADOWS Lot: 18
Project: Medallion Meadows, Lot 18
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1280 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1835 sf Garage: 719 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3115 sf Value: $386,826.42 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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: 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 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 3115
Owner: Contractor:
JT ROTH CONSTRUCTION INC J TROTH CONSTRUCTION Required Items and Reports(Conditions)
FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175
12600 SW 72ND AVE#200 TIGARD,OR 97223
TIGARD,OR 97223
PHONE: PHONE: 503-639-2639
FAX: 503-624-0239
Total Fees: $24,302.52
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 ccordance • 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. TTENTION: Oregon -w =quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01-0010 t ough OAR 952-•'1-00 0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�I" ,
Issued By: `l Permittee Signature: _ �%�L I� —
Call 503.639.4175 by 7:00 a.m.for the next available insp- '•n date. W
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.
1
Building Permit Application
- Residential . �� FOR OFFICE I .I (►N I l
('� Received
City of Tigard �L Date/B : 5 *T/ Pe"nit No: S //_ - .ems ,
■ 13125 SW Hall Blvd.,Tigard,OR 972 Plan Revte,5 ' ,D
: I � i`i Other Permit WYE— !�
Phone: 503.718.2439 Fax: 503.598.1960 15 Date/B : '
TIGARD
Inspection Line: 503.639.4175 ,UN 4 20 Date Reams' r _ ® See Page for
Internet: www.tigard-orgov Notified/Method: [�Q r 5 ,/NM Supplemental Information
TYPE OF Wilikillillit REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I-and 2-family dwelling ❑Commercial/industrial Valuation:` 1 � ,000 .
❑Accessory building ❑Multi-family
Number of bedrooms: 5
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 14121 SW 118`"Court New dwelling area: 3115 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 719 square feet
Suite/bldg./apt.no.: Project name: 1V)i'. /li.Q / ,_`�',Q, tt Covered porch area: 28 square feet
Cross street/directions to job site:Gaarde Road to 118th Court Deck area: 192 square feet 12,
Other structure area: -3 ?,4. square feet 2-7
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Medallion Meadows I Lot no.: 18 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
fax 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: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ 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*
(Please refer to fee schedule
Business name:J.T.Roth Construction Inc.
Structural plan review fee(or deposit):
Contact name:David Jensen
FLS plan review fee(if applicable):
Address: 12600 SW 72"Ave.
Total fees due upon application:
City/State/ZIP:Tigard,OR 97223
Phone:(503)806-0602 I Fax: :(503)624-0239
Amount received:
E-mail:davidjrajtrothinccom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR ' Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic 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.
Permit Fee(includes plan review $180 00
City/State/ZIP:Tigard,OR 97223 and administrative fees):
Phone:(503)639-2639 I Fax:(503)624 40239 State surcharge(12%of permit fee): $21.60
CCB lie.:31700 / Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
`�_, ;-•����L� :/r•-� within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:David Jensen Date:04-27-2015 Service Board.
l:\Building\Permits\BUP-RESPermitApp.. 02/24/2011 440-46 1 3T(1 1/02/COM/WEB)
r ,
Building Permit Application Checklist
One- and Two-Family Dwelling MR of l It 1 1 1 O\l.l
Received
City of Tigard Permit No.:
ill Date/By:
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960
r l 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist. _
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator,lot area;building coverage area percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑
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 ❑ ❑ 0
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. Cl _ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ R 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. ❑ Q ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ III ❑
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:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 44046 13T(l l/02/COM/WEB)
. s
Electrical Permit Application FOR OFFICE USE()NIA
City of Tigard lcP.' Received
Date/B : Permit No:
• ill .. • 13125 SW Hall Blvd.,Tigard,OR 97 CJ�� t' Plan Review
Phone: 503.718.2439 Fax: 503.598. Date/B Other Permit:
T I Ci A R D Inspection Line: 503.639.4175 C Date Ready/By: Juts- ® See Page 2 for
Internet: www.tigard-or.gov
1111..'i -- 4. ?l'\ t Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below)
❑Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition ❑Other: where the available fault cm-rent ❑Marinas and boatyards.
CATEGORY O 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 El Emergency system larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 14121 SW 1181h Court IOOHPormore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Gaarde Road to 118th Court Description I Qty. I Fee. I Total I • ,
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Medallion Meadows Lot no.: 18 1,000 sq.ft.or less I [ 168.54 14
Tax map/parcel no.: Ea.add]500 sq.ft.or portion (0 33.92 1
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) I 75.00 2
Limited energy,multi-family
75.00 2
Wiring of new single family residence residential(with above sq.ft.)
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 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:J.T. Roth Construction Inc. each branch circuit
B.Fee for branch circuits without
Contact name: David Jensen service or feeder fee,first 56.18 2
branch circuit
Address: 12600 SW 72"d Ave Each add'l branch circuit 7.42 2
City/State/ZIP:Tigard,OR 97223 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:(503)806-0602 Fax: :(503)624-0239 Reconnect only 67.84 2
E-mail:davidja@jtrothinc.com _ Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Dreamhouse Electric,LLC 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
City/State/ZIP: Beaverton,OR 97005 Additional inspection(I hr min) 66.25/hr
Investigation(1 hr mm) 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.: `ty-60.S specifically listed('A hr min) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Chris Mahoney Date: 04/27/2015 Plan review(25%of permit fee): ,
��r State surcharge(12%of permit fee):
Authorized signature: �7_� i//L`�- TOTAL PERMIT FEE:
Print name: Y This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I.\Building\Permits\ELC_PennitApp FIR FRE.doe Rev 05/21/2013 440-46151(11/05/COM/WER
A
a
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined $75.00 Description l Qty. l Fee 1 Total 1 •
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 to 25 kva 200.34 2
® Burglar Alarm 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: Each additional inspection is
charged at an hourly(I hr min) 6625/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(4 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
Fl D• ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ M• edical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013
Mechanical Permit Application 1.0R(I1.F1( 1 l sl O\l 1
City of Tigard 1{ , - Received
IN • 1�i DDate/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 J 4 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 (��F, DatelBy.
I I L.A I:1) JUN N •- 4 ?v,.! Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov U 1 Notified/Method: Supplemental Information
iATY Of Ilkih
TYPE OF WORK �`{fit DIVISION COMMERCIAL FEE` S DU E— um CHCCKI I'
Y2j ,f U Mechanical permit fees'are based on the value of the work
®New construction ❑Addition/alteratio en t performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RENDRNTIAL EQUIPMENT/SYSTEMS Fur
® 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: 14121 SW 118th Court Furnace 100,000 BTU(ducts/vents) r 46.75
City/State/ZIP:Tigard,OR 97224 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:Gaarde Road to 118th 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
Subdivision:Medallion Meadows Lot no.:18
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
HVAC installion for 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 , 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 72°d Ave. Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms, r
toilet compartments,utility rooms) 6J 23.32
Phone:(503)639-2639 Fax:(503)624-0239 Attic/crawlspace fans 23.32
0 APPLICANT ® CONTACT PERSON Other: 23.32
' Fuel piping:
Business name:J.T.Roth Construction Inc. $14.15 for first four,$4.03 for i each additional
Contact name:David Jensen Furnace,etc.
Address:12600 SW 72ad Ave. Gas heat pump
WalUsuspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater
Phone:(503)806-0602 Fax::(503)624-0239 Fireplace i
Range i
E-mail:davidj @jtrothinc.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:All Time Heating LLC MECHANICAL PERMIT MS*
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 lic.:184575 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:Aaron Svobova I Date:04-27-2015
I:\Building\Pern its\MEC_PennitApp_0401 13.doe 440-4617T(1 1/ovcoM/WEB)
J
Plumbing Permit Application
Building Fixtures Cluck FOR OFFICE USE °Nl.l•
City of Tigard Received
Date/By: Permit No.:
+ 13125 SW Hall Blvd.,Tigard,OR 97223 RYA Plan Review
M. Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 Date/By:T I G A R D Internet: www.tigard or.gov �UN .. 4 20\5 Date Ready/By: Juris 10 See Page 2 for
Notified/Method: Supplemental Information
----------
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
El Accessory building SFR(3)bath { 500.32
ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14121 SW 118th Court Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Gaarde Road to 118th Court 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 1 Lot no.: 18 Fixture or item:
Tax map/parcel no.: Backflow preventer r 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing work 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°d Ave Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)639-23639 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 72°d 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 108'h 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
CCB Lic.: 182846 Plumbing I.ic.no.:PB-562 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Gabriel Bogdan / Date:0487/2015 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information -
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(a) Total Square Footage: Permit Fee:
Footing drain-1°100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(a) Tom each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower - ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
-Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
4„ Isometric or Riser Diagrom
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Dave\Downloads\PLMF_PermitApp(I).doc 2
City of Tigard
UPI �' COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
1 1( , \ 1 1)
Building Permit #: A75-7,26/S-- qg
Site Address: )4-1 'd I 50 i 1 g+' C4 .
Project Name: N( cd a,l(r owl M.te 0,A;s Lot #: t 8
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: Ne-LJ 5F2—
&--Verify site address/suite# exists and active in permit system.
❑ River Terrace Plan District: ❑ Yes g No
Site Plan Elements:
,Three(3)copies of site plan xisting structures on site
Site plan must lie on 8-1/2"x 11"or 11 x 17"paper / Footprint of new structure(including decks)with finished
lkinrawn to scale(standard architect or engineer scale) floor elevations
forth arrow LIUtility locations(required for new,may apply for additions)
(mite address,project or subdivision name and lot number % •cation of wells/septic systems
Applicant information(name and phone number) ■: rosion control(including drainage-way protection,silt fence
Nto dimensions and building setback dimensions design,location of catch basin,etc.)
.ott area,building coverage area,percentage of coverage and 7a Street names
r
pervious area(applicable if R-7,R-12,R-25&R-40) 1 i eet tree size,type and location
'roperty corner elevations(2 foot contour lines if more than •! xisting trees to be retained with drip line,and tree
4 foot differential) protection measures
'Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified l No Received: ❑ Yes El No
P Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified Jl No Applied For: ❑ Yes 0 No,stop intake
,ErLand Use Case#: 5 U.B.U 1 3 -o ov o(,
i Zoning. R- t{ ,S
Setbacks: Front a a Rear 15 Side � Street Side IS Garage d v
Landscape Requirement:
,Lot Coverage Maximum:
,Building Height: Maximum Height 30 Actual Height .2 7
a Visual Clearance
k'Easements
►! Sensitive Lands: ❑ Yes Er No Type
a.
to Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: II — Y A/ ,1 Date: 6 q l 5
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\BldgPermitRvw_RES_031015.docx
Building Permit Submittal
Original Submittal Date: ei2A.j I5
Site Plans: #
Building Plans: # �
Building Permit#: nter building permit#above.
Workflow Routing: 0-15ianning [ gineering 4% Yermit Coordinator C1
Workflow Sign-off: off for Planning(include notes from planning review)
Route Application Documents: [gineering: (1) copy of permit application, (1) site plan,(1) building plan and
on al plan review routing form.
wilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: _ Date:
Engineering Review
Slope at building pad: 2-5- '7,6
❑ Conditions"Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ,0'No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes ,ErNo
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: tb{` [,v Date: 6 i
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:
K to Issue Permit
Approved by Permit Coordinator: / Date:
I:\Building\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
14121 SW 118TH CT, TIGARD, OR, 97224
Residential - Master Permit
199 Electrical final
PASS
MST2015-00098
Chip Barnett
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
14121 SW 118TH CT, TIGARD, OR, 97224
Residential - Master Permit
699 Mechanical final
PASS
MST2015-00098
Chip Barnett
Note: No A/C installed at this time
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
14121 SW 118TH CT, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
PASS - C of O
MST2015-00098
Chip Barnett
Violation Summary:
Inspector Contractor