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Permit CITY OF TIGARD MASTER PERMIT li , COMMUNITY DEVELOPMENT 1 Permit#: MST2015-00303 -ii(...;A rt.j- 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243. 6 /- ayi�1 Date Issued: 04/11/2016 Parcel: 2S110BA12200 Jurisdiction: TIGARD Site address: 14163 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 15 Project: Medallion Meadows, Lot 15 Project Description: New SF. 6/6/2016: REPRINT permit to correct number of bathrooms from 4 to 3. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1465 sf Basement 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 1625 sf Garage: 563 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3090 sf Value: $376,167.19 Rear: 15 PLUMBING Sinks: 2 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: 3 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 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 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: 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 3090 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: 503-720-7445 FAX: 503-590-1751 Total Fees: $24,937.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ter. Those les are set in OAR 952-001-0010 through 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 2 9 r 1.804 .23• Issued By: � � Permittee Signature: C • 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 completi•n of the project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT 1 Permit#: MST2015-00303 T t(1A R.f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243• G 4 L Date Issued: 04/11/2016 Parcel: 2S110BA12200 Jurisdiction: TIGARD Site address: 14163 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 15 Project: Medallion Meadows, Lot 15 Project Description: New SF. 6/6/2016: REPRINT permit to correct number of bathrooms from 4 to 3. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1465 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 3 Second: 1625 sf Garage: 563 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3090 sf Value: $376,167.19 Rear: 15 PLUMBING Sinks: 2 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: 3 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 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 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: 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 3090 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: 503-720-7445 FAX: 503-590-1751 Total Fees: $24,937.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification - ter. Those les are set in OAR 952-001-0010 through 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 , 2 9• •r 1.80. .23• . e «"�� c Issued By: 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 completi.n of the project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD MASTER PERMIT IN _ COMMUNITY DEVELOPMENT Permit#: MST2015-00303 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016 T f c.a II n 9 Parcel: 2S110BA12200 Jurisdiction: TIGARD Site address: 14163 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 15 Project: Medallion Meadows, Lot 15 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1465 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 25 Bathrooms: 4 Second: 1625 sf Garage: 563 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3090 sf Value: $376,167.19 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 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 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 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!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 3090 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 503-720-7445 FAX: 503-590-1751 Total Fees: $24,847.61 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y• .. -- -cop . •- ules or direct questions to OUNC by calling,-:.. .. or.332.2 , 11 Issued By: _ _ Permittee Signature: -- o-.,e 9.4175 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 project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential RECEIVED FOR DEPICT: 1 S1:O\1,1' • City of Tigard Received J /tey: `} D S Permit No.:/ fr � 303' 13125 SW Hall Blvd.,Tigard,OR 9 3r 3 O 2015 Plan Review `— Phone: 503.718.2439 Fax: 503.59 1'960 d i 16 Other Permit _v�/1/L r6 DateBy: T t G,t R u Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 2[,/ Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: p?+/q/�Gj'L�/T� Supplemental Information km TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 'New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 7 �-/1-and 2-familydwellingValuation: $ p jj) ps;I ❑Commercial/industrial 3��/ '�w Number of bedrooms: s" ❑Accessory building IDMulti-family 0 Master builder 0 Other: Number of bathrooms: 4 JOB SITE INFORMATION AND LOCATION Total number of floors: Z 1 Job site address: ,L/163 S t w /, 3 1.1-4 C t- New dwelling area: 3r,-)90 r square fee 3e,QC City/State/ZIP: 1"i(0 ilk cep 1 O L 972z y Garage/carport area: 5-63 square feet Suite/bldg./apt.no.: Project name: Covered porch area: square feet c ac Cross street/directions to job site: ' 1 , -t-1.„‘ 2 C(A,(4,v_p C Deck area: '7 Q square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: lki)c D pt L1/4.10 0 M L A i iJ tom$ Lot no.: 15 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all I Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ /./e--':---Vs/ SiA/OLE 17=1NMIt.tZ 9-e-s IDeA.)c . Existing building area square feet New building area: square feet R PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: 5 c AS B Z to bJ Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: 4g,APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedulc) Business name: %p u1 _ D Co/45rP-tA(410i Structural plan review fee(or deposit): Contact name: SAY 10 DE HprzPP0g-i FLS plan review fee(if applicable): Address: F'0, <c X IS-1? Total fees due upon application: City/State/ZIP: 13 e,,y,-_g -i t3 ©F-.. 97 07 S (J 3) 59 0 _ D S 0 S (S.133) S9 0 1-7 51 Amount received: "CO Phone: Fax:: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: 0...( 12 flC,,„osr e_ MSJu t CO Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel Syste Business name: i Submit two(2)s- of roof plan with conn- 'i n details Address: � .U it -- and fire department:ccess,Ain. ' e 2010 Oregon Solar Installation Spe. . •• ode checklist. City/State/ZIP: 1„'Lv Permit Fe ua-s plan review $180.00 s and adminis 4 .five fees): Phone:( ) Fax:( ) _ State surcharge(12%of pe ' fee): $21.60 CCB lic.: 7 i 0 7 Total fee due upon application: $201.60 Authorized signature: ✓ �� This permit application expires if a permit is not obtained i� within 180 days after it has been accepted as complete. T) p v, t D 3 ) �T f �^2,9-L5 *Fee methodology set by Tri-County Building Industry Print name:.J Date: Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ON1.1 City of Tigard Received 3 13125 SW Hall Blvd.,Tig.i;l►/i; �I��//C� DateB : lyz� Permit#: r ��,�030 Phone: 503.718.2439 F. }• G Plan Review DateB Related Permit#: T t G A R D Inspection Line: 503.639.4175 ReadyDate/ By:www.tigard-or.gov p E C 3 0 2015 y Juris: H See Page 2 for Notified/Method: Supplemental Information ❑AdYg .,, .• { Ag PLAN REVIEW tirNew construction Please check all that apply+ pp y(submit 2 sets of plans w/items checked): ❑Demolition 0 Otlr. 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION1 ❑ 1-and 2-family dwelling 0 Commercial/industrialexceeds ground, or exceeds eat s114,000 volts or 0 Floatingmme buildings.a-ue ❑Accessorybuildingless to ground, exceeds ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived Job#: I Job site address: ❑Addition of new motor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: yi(0A-1?..-0 OR et--/ Z z 9 Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal. 1 I` tit+ t & ROC FEE SCHEDULE 1Y/6 _� St W 1%8[.� i R i C r Description 1 Qty. I Each I Total 1 New residential single-or multi-family dwelling unit. Subdivision: 1 v D A L L-j43 NJ ME POilw S I Lot#: /5 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 DESCRIPTION OF WORK Ea.addl 500 sq.ft.es orde portion 33.92 1 Limited energy,residential /yEIN1 S t NG(�' ppm I Ly Q,L i 04,1)J(,C' (with above sq.ft.) ) 75.00 2 / Limited energy,multi-family residential(with above sq.ft.) 75.00 2 li PROPERTY OWNER I 0 TENANT Renewable Energy 0 See Page 2 Name: Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 Address: J'A IY1- p$ n LO 201 amps to 400 amps 133.56 2 City/State/ZIP: C7 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 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 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: F'OLt 12, j ce. 'Qs-y-124i sitar J above service or feeder fee, each branch circuit 7.42 2 Contact name: 0/sVI,b De 19...prb2T B.Fee for branch circuits without Address: Pc) , !, J x is 7 .7 branch or feeder fee,first 56.18 2 branch circuit Clty/State/ZIP: c 1✓�� 3 ,^�0Each add'I branch circuit 7.42 2 Phone:(sea) /0 OS os Fax: : Miscellaneous(service or feeder not included) 3) s� 17 $ I Each manufactured or modular Email: vu D �d#4-sr C NIA.. ` dwelling,service and/or feeder 67.84 2 ' Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 6 LSi n Te �G tcl:rptL �pr2.=;v1 pg or outline lighting 67.84 2 Address: I✓D 1 s1/4 9 Z NQ D.g, -11 /0 y Signal Meru t(s)or limited-energy nitpanel,alteration,or extension. ❑ See Page 2 2 , �y 7 zZl Each additional inspection over allowable in any of the above City/State/ZIP: po��-L�� I Additional inspection(1 hr min) 66.25/hr Phone:(+��). 2 7"7 I Fax: L 1 - 7 9/ 7/ Investigation( ) 66.25/hr ) C.1 1 hr min Email: C L C7.EeL Gr�l(-6(24n4-4' �f, IFIL I� ' ��� Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: 19 i -/-7,1I Electrical Lie.: C (23(i I Suprv.Lic.: 572. S specifically listed(%hr min) 90.00/hr Suprv.Electrician signature,required ELECTRICAL PERMIT FEES �'` Subtotal: - R�� jz� Nn ,l�_-- Date: /2-7 /....5 ❑Plan Review Required(25%of permit fee): Print name: State surcharge(12%of permit fee): Authorized signature: , ..../ TOTAL PERMIT FEE: Print name: I This permit application expires if a permit is not obtained within 180 pti;n rA rt -I Date: /Z-Z y • is J days after it has been accepted as complete. Number of inspections allowed per permit. t:\Building\Permits lELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(I 1/05/COM/WEB Mechanical Permit Application FOR OFFICE ISE ONLY City of Tigard REGbI M ED Received Date/By: / Q /5— C Permit N°4-6/ 1s ao3v3 13125 SW Hall Blvd.,Tigard,OR 97223 UCy 3 0 2015 Plan Review Phone: 503.718.2439 Fax: 503.59Date/By: Other Permit: T l c n Et D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.govCITY Of CIGApry Notified/Method: Supplemental Information flL� S BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ,New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 01-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATIONHeating/cooling: Air conditioning i 46.75 Job site address: I Li 163 S t W /10 Iii 6 r Furnace 100,000 BTU(ducts/vents) j 46.75 City/State/ZIP: •-r^I£49-D OF. 9 7 `,-Z Furnace 100,000+BTU(ducts/vents) 54.91 j Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: I I t3 --HA 1Z, G Ap v. :- 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: "6C D pi LA.,j a Nj IAEA pow S Lot no.: /S Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater ) 23.32 DESCRIPTION OF WORK Gas fireplace/insert i 33.39 Flue vent for water heater or gas A/,--CJ 61 f.)t.1.,� FPM I Ly -_eI� Si PE, L- fireplace 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 (PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Sp-NA 1-- AS Be-to Clothes dryer exhaust I 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 I51:APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: �' ��ST 2. I ct 01.....) $14.15 for first four;$4.03 for each additional Contact name: T A!1 D .a .E N p. Fot - - Furnace,etc. Address: fl O -13z)->eI S 2--7 Gas heat pump Wall/suspended/unit heater City/State/ZIP: , P.V&-:42.4-73 ID 1 ©a_ 9 .7 0'7 S Water heater Phone:(j43) 590 _ 090 S Fax::(5-43) „S90 - 1'7 S i Fireplace Range E-mail: out p CO 0Sr-C. kSi1/4.)r 60I Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: ---EM rr AA L 1 Ll2_ cv^X INK.- MECHANICAL PERMIT FEES* Address: 12 o ax, LI, B -33 Subtotal City/State/ZIP: +C C�pc,icp,to,AS Qv__ 9'7® is Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(803 (Qs.- ...... ',clog (Fax: i3) (050 .-3v'j?t State surcharge(12%of permit fee) CCB lic.: 17 5 ‘,2-Li 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: ppV/04 Date: / 2SJ Plumbing Permit Application ' Building Fixtures RECEIVED City of Tigard Received ��.y Date/By: /pZ D /� Permit No.: LJ�/'�IJ!'_��� lig13125 SW Hall Blvd.,Tigard,OR 'int.€ 3 0 2015 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.: Date/By: Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris• 0 See Page 2 for TIGARD Y y 8 Internet: www.tigard or.govBt tIt f1ING fIVISION Notified/Method: Supplemental Information TYPE OF WORK �7 V 1�+ FEE* SCHEDULE `New construction ❑Demolition For special information use check/isL Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 tz 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath J 500.32 0 Accessory 0 Multi-family Each additional bath/kitchen ) 25.02 0 Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: / 9/63 5 r W i f i f H e--r- Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: t��n 0 I� 1r� z 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: 1 1 '6 T\ , L,)z A-VD C 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: 4.:-:13 A Lt 1 oij A 7dt v,s I Lot no.: >S Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 _ _ Clothes washer 25.02 _ �CW S'i/Q t`C= 1�M I t y I2C 1LENLC Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Eif PROPERTY OWNER I 0 TENANT - Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: SiC)/it% P S 13_sex,--) Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: rte Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: 4D1 J 1 �� }�.- � � � Roof drain(commercial) 12.51 Address: 1}tO .i>6 iS7 7 Sink/basin/lavatory 25.02 City/State/Z1P: 1311/&--- ONJ 6 C`7 O'7 S Solar units(potable water) 62.54 Phone:(,<,.3) 5"9(.:, c)S p S Fax::(53) 5-90 t.- _ 1-7 S I Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: -o,,.t e-- D C_o NST Cr" I-4 SN, co N'1 Water closet 25.02 F44f/��CONTRACTOR - Water heater 37.52 Business name: /(11 LA Lt .1.1 GvM e AN.)y Water piping/DWV 56.29 Address: I (9(,7 I A S. E . R 1 / 1Z -R - Other: 25.02 City/State/ZIP: - Subtotal y LLS Z. �1 d� I 3 Phone:(503) 6.,�l� -C9 11' Fax:( ) Minimum permit fee: $72.50 CCB Lie.: !Zea 9 . _ 111 d Plumbing Lic.no.:3q ZG 0pg4, ,..-&47,,e____ Plan review (25%of permit fee) State surcharge(12%of permit fee) ii g Authorized signature: TOTAL PERMIT FEE Print name: ✓�i D /- D e Date: IL-2_9- /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. 1.\Building\Permits\PLMII'PermiiApp.doc 10/01/09 440-4616T(10/O2JCOM/WEB) \/ City of Tigard 711 COMMUNITY DEVELOPMENT DEPARTMENT T l c n R n Building Permit Review — Residential Building Permit #: 1--f -r,90/6"-0.0 303 Site Address: / L-//t9 3 5A- i/O Project Name: i-1/1 0-O/4-tLfa7 v <<-re/Vi>a i Lot #: /...5- (New $(New dwelling=subdivision name;.Addition or.\Iteration=last name of owner) Planning Review Proposal: rt ;)e-G h`ou( ,I2--Verify site address/suite # exists and active in permit system. ❑ River Terrace Neighborhood: ❑ Yes tg No Site Plan Elements: Three(3) copies of site plan 1A----'Existing structures on site ate plan must be on 8-1/2" x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished lDrawn to scale(standard architect or engineer scale) floor elevations North arrow --Pi-Utility locations (required for new,may apply for additions) .©Site address,project or subdivision name and lot number N f.-❑Location of wells/septic systems eDApplicant information (name and phone number) -Erosion control(including drainage-way protection,silt fence ,0-Lot dimensions and building setback dimensions design,location of catch basin,etc.) of area,building coverage area,percentage of coverage and —RStreet names impervious area (applicable if R-7,R-12,R-25&R-40) s? y. ) 'Street tree size,type and location ..DProperty corner elevations(2 foot contour lines if more than Mirkisting trees to be retained with drip line,and tree 4 foot differential) protection measures / I lean Water Services —Service Provider Letter(lot platted prior to 9/10/1995): R aired: 1 Yes,applicant was notified ❑ No Received: ®, Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: K1 Yes,applicant was notified ❑ No Applied For: [ . Yes ❑ No,stop intake 12"--Land Use Case #: )L) 1.S 2 - (3-06 .2- Zoning: l2 Cr, 5 a Setbacks: Front 20 Rear ( Side Street Side 1 5 Garage LD 0 Landscape Requirement: ,, 0/0 Lot Coverage Maximum: J`) 1, --E Building Height: Maximum Height ?C) Actual Height 5 Visual Clearance ,"Easements ,I2---Sensitive Lands: ❑ Yes \No Type Urban Forestry Plan „El—Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: ----- 7,(ia p) Date: 12 L - (S Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\Building\Fonns\BldgPennitRvw RES 070915.docx Building Permit Submittal Original Submittal Date: /4/1 Site Plans: # Building Plans: # 5 Building Permit#: rEnter building permit#above. Workflow Routing: L3 Planning .1Engincering 1mit Coordinator wilding Workflow Sign-off: [Sign-off for Planning(include notes from planning review) Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1) building plan and riginal plan review routing form. U Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: . �I _.0 ! , Date: / j/5 Engineering Review Slope at building pad: 67; Conditions "Met"prior to issuance of building permit fle Easements (encroachments)per engineering conditions of approval and plat Zr Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes No Assess Water Quantity Fee in-lieu: ❑ Yes opNo LIDA Facility on lot: E Yes IC No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: fit- Z Date: l2-323-.4..4- Revisions LRevisions (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: SDC Fees Entered: Wash Co Trans Dev Tax: ❑ N/A Tigard Trans SDC: E Yes ®'N/A Parks SDC: 'Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: Date: Aff----- / -*/3e-2/1--5-- I:ABuilding\Fonns\BldgPennitRvw_RES_0709I5.docx , City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request q t for Permit Action T 1 C ARP 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: /� /� INVOICE TO: (Business or Individual) j JE ��i 6-0A/fp Mailing Address: / e /5-72 City/State/Zip: e� ��; � o/� ?7e 75 Phone No.: ✓—',��� 7 -y PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): VOID PERMIT APPLICATION. REFUND RMIT FEES (attach copy of original receipt and provide explanation below). ■ v - OR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: /t7--C-7- 0/-5-'— 00 3043 Tt, Site Address or Parcel #: /// 3 s" Subdivision Name: /t/ e9-64-/0/Lif e9-..6‘774.1.3 Lot #: /3 EXPLANATION: e Signature: _ Date: A74 Print Name: _.= ,,c AwAritrd Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee fo 'ss ed �rior to any inspron requests.- u A 2. All refunds will be returned to the original payer in the tl�check is S postal servi ll�"' 3. Please allow 3-4 weeks for processing refund requests. S a 5,3 y — SD 5; 0-2- 43 .0 -2__43 .0 - 4,0 D ' 7 .7- 0--V a2,. caz FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date 7 -9 , , By, - Refund Processed: Date 7/ -9/jBy ' ' Invoice Processed: Date By Permit Canceled: Date it9-- B -- Parcel Tag Added: Date By 1:ABuilding\1,orms\RegPcrmitAction2 92314.doc 11,11 TIGARD,' City of Tigard July 29, 2016 Four D Construction Attn: David Deharpport PO Box 1577 Beaverton, OR 97075 Re:Permit No. MST2015-00303 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 14163 SW 118th Ct. Project Name: Medallion Meadows,Lot 15 Job No.: N/A Refund: 1/ Check#221837 in the amount of$28.02. ❑ Credit card "return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Corrected permit from (4) to (3) bathrooms and refund difference. If you have any questions please contact me at 503.718.2430. Sincerely, ,t (/ ill 4/ Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refuna n t \ilk �fiLigAig4r4lpfiegon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Four D Construction DATE: 7/21/2016 Attn: David Deharpport PO Box 1577 REQUESTED BY: Dianna Howse Beaverton, OR 97075 TRANSACTION INFORMATION: Receipt#: 403142 Case#: MST2015-00303 Date: 4/11/2016 Address/Parcel: 14163 SW 118th Ct. Pay Method: CreditCard Project Name: Medallion Meadows,Lot 15 EXPLANATION: Correct permit error to reduce number of bathrooms from (4) to (3). Refund 100%of the difference. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. kefand Example: 'Buildig Permit Fee Example 2300000-43104 "$Amount Plumbing Permit Fee 230-0000-43101 $25.02 12% State Surcharge 100-0000-24001 3.00 TOTAL REFUND: $28.02 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: //?.._?//, By: .. L_ I.\Building\Refunds\RefundRequest.doc x 09/01/2010 FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT aS 11 Transmittal Letter 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: 7-0 DATE 'Remy D DEPT: BUILDING DIVISION ��--� APR 1 4 016 CITY • 1IGARD FROM: `DPv n DeAr,dz-ta-1---- BUILD 0 OIVISION COMPANY: Fou42- r) (c $1124,G c...-77 o KJ PHONE: 5 ----22.0 -- -7 4 V S By: _ Si_ / RE: ) 4 1 3 St W, 1181 k1 c1- )`1 /5-p°3a 3 (Site Ad ress) (Permit um er) J/tEC)4 LU del�an� s - 1.5 (Project name or subdivision name d lot number) ATTACHED ARE THE FOLLOWING ITEMS: r,.. 1 .',:1111 4q1), 1 ' ( I 1_ , S'' 1 ` 1 '' -r ';''''41"„,'e . �, n sy?.�Y `,1 , �1 Additional set(s)of plans. ir Revisions: Cross section(s) and detai . / ' Wall bracing and/or lateral analysis. Floor/roof framing. \r` Basement and retaining walls. Beam calculations. A Engineer's calculations. Other(explain): REMARKS: 14MEv.Jri .ta '(-At- 2eviSloNJ S to 1 tiAr 1 c r^«r c.,).-U,.S . , / r..)t 5/-. [.w /TJr - , ' --h Lc.ao-r Je•t .2 i Routed to Permit Technici 1 : Date: 4 ) q _ Initials: Fees Due: M Yes U o Fee Description: Amount Due: L r p)ch re..V : c`,J $ r,OQ. $ `7 $ $ Special Pr Instructions• Reprint Permit(per PE): ❑ Yes ❑No ❑ Done Applicant Notified: ,a2_,A f Date: y//114- Initials:.. I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 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 14163 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final PASS MST2015-00303 Herb Stabenow 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 14163 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final PASS October 13, 2016 at 10:55:20 AM MST2015-00303 Herb Stabenow Violation Summary: Inspector Contractor