Permit (76) CITY OF TIGARD MASTER PERMIT
' . COMMUNITY DEVELOPMENT Permit#: MST2015 00293
Date Issued: 06/23/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BA12400
Jurisdiction: TIGARD
Site address: 14137 SW 118TH CT
Subdivision: MEDALLION MEADOWS Lot: 17
Project: Medallion Meadows, Lot 17
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1325 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 1871 sf Garage: 728 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3196 sf Value: $411,400.04 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 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: 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: 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: 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 3196
Owner: Contractor:
JT ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION Required Items and Reports(Conditions)
FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175
12600 SW 72ND AVE#200 TIGARD,OR 97223
TIGARD,OR 97223
PHONE: PHONE: 503-639-2639
FAX: 503-624-0239
Total Fees: $25,295.27
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. You btain a copy of the rules or direct questions to OUNC by calling .1987 or 1.800.332.2344.
1/1
Issued By: Permittee Signature: ,----- Wit'/\
Cal . 39.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the proje
Approved plans are required on the job site at the time of each inspection.
►Building Permit Application LS a ' 8 c-
R,esidential G FOR OFFICE 1 SIE ONE)
` City of Tigard r , ` DateBy: �� o 1 '3r5 Permit No.:,/y1S' —clod ,,, dc2'1 3
11,1• ® . 13125 SW Hall Blvd.,Tigard,O ! ►T123 g 7,.. Plan Review,
p V /' Other Permit: +
Phone: 503.718.2439 Fax: 503.598.1'%". /� Date/By: it 14 j 4� ;S — .y�
Date Read B Juris: 0 See Page 2 for
1-1 li t, Inspection Line: 503.639.4175 -ck Ow` Ready/By: Ivr
Internet: www.tigard-or.gov F ; ``+ Notified/Method/...,
/4 tv 7-T'G 1 Supplemental Information
®New construction 0 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
TOR,, , ; :. work indicated o this application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: A $ 759 1�1 ) 4.
❑Accessory building 0 Multi-family Number of bedrooms: 4
❑Master builder 0 Other: Number of bathrooms: 3
INFORMATION Total number of floors: 2
Job site address:14137 SW 118`h Court New dwelling area: 3196 square feet 9
City/State/ZIP:Tigard,OR 97223 am Garage/carport area: 728 square feet
Suite/bldg./apt.no.: Project name://"y)�rt i�i' , '61c�t:++.�5 I LG-1" i 7 Covered porch area: ' square feet i V' 1
Cross street/directions to job site:Gaarde Road to 118`"Court Deck area: )-7 G square feet J 3A
Other structure area: square feet
ll''DATA c,#' I ! 9A 4C+ e t.T
Subdivision:Medallion Meadows Lot no.:17 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
s .yi t ON _' t, t work indicated on this application.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
►.+ 1 1 �� ,. .. „ . Number of stories:
Name:J.T.Roth Construction Inc. Type of construction:
Address:12600 SW 72.d Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)6392639 Fax:('503)6240239 New:
*+ le :.. to rll
N
Business name:J.T.Roth Construction Inca �
Structural plan review fee(or deposit):
Contact name:David Jensen
FLS plan review fee(if applicable):
Address:12600 SW 72.d Ave
Total fees due upon application:
City/State/ZIP:Tigard,OR 97223
Amount received:
Phone:(503)8060602 Fax::(503)6240239
E-mail:davidj@jtrothinc.com PHOTOVOLTAICSO P A
Commercial and residential prescriptive installation of
--:± Solar Panel System.
�, , , .,, ,,,; ,... ::',4,',.;,:'','`,''''',;'1.‘„:',,„-', a�:` ,,, -_� roof top mounted Photovoltaic
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.d Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)6392639 Fax:(503)6240239 State surcharge(12%of permit fee): $21.60
CCB lic.:31700
Total fee due upon application: $201.60
Authorized signa ,i.: - This permit application expires if a permit is not obtained
..�' �e�.__`— within 180 days after it has been accepted as complete.
Print name:David Jensen / Date:12/22/2015 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPe • itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application E I Received FOR OFFICE 1 SE O\E1
City of Tigard q Q '7 015 Date/B : '_ f. _I
® 13125 SW Hall Blvd.,Tigard,OR 97223 (� ( AOL Plan Review
C i� : E" Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 Date/
Inspection Line: 503.639.4175 �a �( T,�� 'Ready Date/Hy- I'M ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov
CITY NISI a trfied/Method: Supplemental Information
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition El Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
G> R' Ot exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
308` 1`I 1. &ir ''' O '` Emergency system. largerseparately derived
❑Emerenc se aratel
'� ❑Addition of new motor load of system.
Job#: Job site address:14137 SW 118th Court 100HP or more. ❑"A","E">"1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Gaarde Road to 118th Courtf 1 la
Descriptioa� � � � Qty.. Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Medallion Meadows Lot#: 17 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'1500
` . D > (Wi?'„t ,...,;` : Limited energy,ached garage. 4.
33.92 1
Wiring for new single family residence (with above sq.ft.) 1 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy
0 See Page 2 ,
1%.4 - O E 1'Y,OWER, Services or feeders installation,alteration,and/or relocation
Name:J.T.Roth Construction Inc. 200 amps or less 100.70 2
Address: 12600 SW 72"d Ave 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)63926389 Fax:(503)6240239 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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
Branch circuits—new,alteration,or extension,per panel
- � - A Fee for branch circuits with
Business name:J.T.Roth Construction Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name:David Jensen B.Fee for branch circuits without
Address:12600 SW 72"d Aveservice or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Tigard,OR 97223 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)8060602 Fax: :(503)6240239 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:davidj@jtrothinc.com Reconnect only 67.84 2
.� Pump or irrigation circle 67.84 2
Business name:Grizzly Electric Sign or outline lighting 67.84 2
Address:8002 NE Hwy99#248 Signalnel,alct
eration,
or extension. ❑ See Page 2 2
panel, or extension.
City/State/ZIP:Vancouver,WA 986645 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)9094080 Fax:(360)6948939 Investigation(1 hr min) 90.00/hr
Email:grizzlyelectricinc@msn.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 186218 Electrical Lic.: Suprv.Lic.: 37446 specifically listed(V2 hr min)
.., . ,
Suprv.Electrician signature,required: Subtotal:
---',
Print name: Ron Nelson Date: 12/22/2015 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
,ii This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
$ Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Mechanical Permit Application FOR OFFICE 1 SF 0y1.N
Received _
Ciof Ti and Permit No.: �{
`.7 g Date/By: `J r 1
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
5 Phone: 503.718.2439 Fax: 503.598.1960DateBy: Other Permit:
TIG A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: Fa See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OFW6 ` C b r
' I 4., T
" _ —4.4,„r.,_ 4 .w,. ,.., xr
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
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
�y i •7 4 It T 4+ Heating/cooling:
: . ,. ,,n ,.--,,--„4,,,-v, "` ' Air conditioning 1 46.75 •
Job site address:14137 SW 118th Court Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard,OR 97223 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.:17 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
�y, s. <._,� sC ,,, tom'-.. :,. ',,,,,,,,.z—,:,,,',.';-1,,,,,,,,,,„,...; ..' Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
HVAC installation 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
iitat Q : [[ �J . . s : Other: 23.32
Environmental exhaust and ventilation:
Name:J.T.Roth Construction Inc. Range hood/other kitchen
equipment i 33.39
Address:12600 SW 72°d Ave Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)6392639 Fax:(503)6240239 Attic/crawlspace fans 23.32
;APIE!f"c1W kjt i Other: 23.32
Business name:J.T.Roth Construction Inc. Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:David Jensen Furnace,etc.
Address:12600 SW 72°d Ave. Gas heat pump ,
Wall/suspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater i
Phone:(503)8060602 Fax::(503)6240239 Fireplace 1
Range
E-mail:davidj@jtrothinc.com Barbecue
� x ,.CI4 , t > Clothes dryer(gas)
Business name:All Time Heating LLC Other:
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)2082276 Fax:(503)2082276 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: y * Fee methodology set by Tri-County Building Industry Service Board
Print name:Aaron Svobova //1 Date:12/22/2015
I:\Building\Pern its\MEC PermitApp 040113.doc 440-4617T(1I/02/COM/WEB)
Plumbing Permit Application
Building Fixtures FOR OF FR F. I SF OS I-1
City of Tigard Received
Permit No.: /h,57: i‘3--.....6:67-43
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
: = Phone: 503.718.2439 Fax: 503.598.1960Da[eBy: Other Permit No.:
t 1 C A R D Inspection Line: 503.639.4175 Date Ready/By: luris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
. _ . r, �'o� . } ? ' �
11 New construction 0 Demolition For special information use checklist
Description I Qty. Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�`4 OF C3iiCI'If1T„ SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath x 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
J(ltB Std I „r . ,. Site utilities:
Job site address:14137 SW 118th Court Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 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 I Lot no.:17 Fixture or item:
Tax map/parcel no.: Backflow preventer x 31.27
��0 ,i Backwater valve 12.51
_, '.. ... 4 „' . .., Clothes washer 25.02
Plumbing installation at new single family residence Dishwasher 25.02
Drinking fountain 25.02
] Ejectors/sump 25.02
i R�� 'tom OWNER ... � . ..�,. 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 72ed Ave.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)6392639 Fax:(503)6240239 Ice maker 12.51
Interceptor/grease 25.02
❑.�t+��T . .W.;��4 fit°� --,, t,:-, y ,, of trap
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)8060602 Fax::(503)6240239 Tub/shower/shower pan 12.51
E-mail:davidj@jtrothinc.com Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name:A.L.L.Plumbing LLC Water piping/DWV 56.29
Address:9312 NW Skyline Blvd Other: 25.02
City/State/ZIP:Portland,OR 97231 Subtotal
Phone:(503)5200313 Fax:(503)7067764 Minimum permit fee: $72.50
CCB Lic.:194089 Plumbing Lic.no.:PB1022 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ] ( � TOTAL PERMIT FEE
Print name:Gary Luchs ✓__ - Date:12/22/2015 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.
I:1Buiiding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
V
City of Tigard
11111 e q COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G n It n Building Permit Review — Residential
Building Permit #: p)57- .j[,--x 0243
Site Address: /4'/3 9 ,`1Q //E3-4 alit 4--
Project Name: eds46?) ,4 i Lot #: f 7
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
SPA-
Verify
Proposal: ,Gc)
IIG permitY
site address/suite# exists and active in s ste .
Witiver Terrace Neighborhood: ❑ Yes No
Sit Plan Elements:
[tree(3) copies of site plan PZ isting structures on site
1e plan must be on 8-1/2"x 11"or 11 x 17"paper 0 ",otprint of new structure(including decks)with finished
rawn to scale(standard architect or engineer scale) .or elevations
orth arrow 1F, otility locations (required for new,may apply for additions)
e address,project or subdivision name and lot number p ✓i cation of wells/septic systems
Tr
plicant information(name and phone number) 1,Erosion control(including drainage-way protection,silt fence
( ot dimensions and building setback dimensions d ign,location of catch basin,etc.)
Sot area,building coverage area,percentage of coverage and S eet names
impervious area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location
Ooperty corner elevations(2 foot contour lines if more than fisting trees to be retained with drip line,and tree
4 foot differential) protection measures
Pl)lean Water Services—Service Provider Lette of platted prior to 9/10/1995):
�t'equired: ❑ yes,applicant was notified No Received: ❑ Yes ❑ No
VPublic Facilitie mprovement (PFI) Permit:
'-quired: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
Velnd Use Case #: Z1'Q-0/3-- 00000
oning: k—4, g-
I!Q Setbacks: Front p?C) Rear /5"- Side Street Side /5—Garage 76
0) andscape Requirement: 0/0
III/ of Coverage Maximum:
VA Building Height: Maximum Height 30" Actual Height cps—,
ff1,Visual Clearance
Ill asements
111 4 -nsitive Lands: ❑ Yes ViNo Type
I/. Urban Forestry Plan
EV Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: (' ("-..--.1,0�,--, Date:
‘427____)_c
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
l:\Building\Fonns\BldgPennitRvw_RES_070915.docx
Building Permit Submittal
/1SSiOriginal Submittal Date: /14/15--
Site
te Plans: #
Building Plans: # 3
Building Permit#: 1...-EiTrer g permit# a e.
Workflow Routing: anning ngineering N,--Pert Coordinator 1=4.-Bttilthrig`
Workflow Sign-off: [sign-off for Planning(include notes from planning review)
Route Application Documents: gineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
al-15uldmg: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: - ;F:..-..-2....1.----
.01•*--
:..-..,,...1te: 41,o7Y /S'
Engineering Review
yrSlope at building pad: 71
Conditions "Met"prior to issuance of building permit
(_,/Easements (encroachments) per engineering conditions of approval and plat
2 Water Quality/Quantity Facility:
/ Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Wt. 0 Date: /2_:.,36-2:/
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:
DC Fees Entered: Wash Co Trans Dev Tax: WYes ❑ N/A
1
Tigard Trans SDC: ❑ Yes I N/A
Parks SDC: Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: / Date: 1Z/31
1:\Building\Fonns\BldgPennitRvw_RES_070915.docx
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
14137 SW 118TH CT, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
FA I L
Comments:
Tel: 503.718.2439
Inspection Date:
February 28, 2017 at 10:42:46
AM
Record ID:
MST2015-00293
Inspector:
David Young
Provide permit, Backflow test report and approved plumbing final inspection for lawn
irrigation Backflow device installed without permit.
Provide grading to code around house, slope away from house 6" in 10' or approved
drainage swale. R401.3
Seal line set penetration in garage ceiling with living space above. R703.1
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
14137 SW 118TH CT, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS -CofO
Comments:
Corrections completed
Final erosion control passed
Street tree certificate received
Moisture content form received
High efficiency lighting form received
Insulation certification verified
Blower door or duct seal test certificate received
C of O left on counter.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
March 2, 2017 at 10:39:45 AM
Record ID:
MST2015-00293
Inspector:
Aaron Cillo-Gobel
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
14137 SW 118TH CT, TIGARD, OR, 97224
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
PASS
Comments:
Tel: 503.718.2439
Inspection Date:
February 3, 2017 at 11:59:45
AM
Record ID:
MST2015-00293
Inspector:
David Young
Note: no AC installed at this time. New AC permit required at time of installation.
Violation Summary:
Inspector Contractor