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Permit (78) CITY OF TIGARD MASTER PERMIT 11 .11 COMMUNITY DEVELOPMENT Permit#: MST2015-00298 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2016 Parcel: 2S 110BA12800 Jurisdiction: TIGARD Site address: 14075 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 21 Project: Medallion Meadows, Lot 21 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1346 sf Basement: 0 sf Left: 10 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1904 sf Garage: 724 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 10 Detectors: Total: 3250 sf Value: $402,900.92 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: 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'l 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 3250 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: $25,252.10 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 may obtain a copy of the rules or direct questions to OU NC by calling 503.232.1987 or 1.:00.332.2344. Issued By: v��% Permittee Signature: �� t� i, 503.639.4175 by 7:00 a.m.for the next available in-,•'•n date. This permit card shall be kept in a conspicuous place on the job site until completion of the • .sect. Approved plans are required on the job site at the time of each inspection. , Building Permit Application /_5 /: /s— Residential FOR OFFICE l SE ON l.v ' City of Tigard Received Permit No.: M i_, `J g �/��� Date/By: 9 i t7 / ")SMO 1 5"Ck-�jg r ;� ■ w 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review 19 s, ,/7 1 Phone: 503.718.2439 Fax: 503.598.1�� O� DateBy: ] C Other Permit: doda,7 • A 1Z€� Inspection Line: 503.639.4175 q 0, Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov �C, B r ��® tified/Method 0 d"---- __c Supplemental Information eta 1; ,°.?,1,..!:,9,1!,_ � i. � New construction 0 D-�01. Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the ti � VOW work indicated on this_app�plliccaatiion_- ...)/ Valuation: �371 '�J }� ).1 1-and 2-family dwelling ❑Commercial/industrial f Number of bedrooms: 5 ❑Accessory building 0 Multi-family ❑Master builder 0 Other: Number of bathrooms: 3 401., I1*414FORIOtiON.�lF�'iCiOR ,N Total number of floors: 2 Job site address:14075 SW 1186 Court New dwelling area: 3250 square feet 39-7 el' City/State/ZIP:Tigard,OR 97223 Garage/carport area: 724 square feet Suite/bldg./apt.no.: Project name: eelekw:iCovered porch area: 53 square feet )9 o I- Cross street/directions to job site:Gaarde Road to 118th Court Deck area: 1 .97 12I6, square feet 13 4 mQ.y„a j Tip.rc t,./y I , �v:5 1'A) Other structure area: square feet CAlaVt V� C;), C4(C\, 1, i * Iti f l 1 a a !`i” S `_ Subdivision:Medallion Meadows i)/ t S Lot no.:21 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the " work indicated on this application. Construction of new single family residence Valuation: $ Existing building area: square feet New building area: square feet iii";PR1* `'f(WI `:. g. % 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: x. z 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 Amount received: Phone:(503)8060602 Fax::(503)6240239 E-mail:davidj@jtrothinc.com ,,,,:,;,,:, „,,,:,-!-,,,,,,,,-;;;,,,,;:•,•:,x:::,:::,':,,,,,',:-.''':-.-,,;:,',-'-',:-:;:f'.:',-,,,, Commercial and residential prescriptive installation of -� "�; �" .; , ", .': „ Ii8 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. 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: $201.60 Authorized signa -,-.. /' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. _ dir, *Fee methodology set by Tri-County Building Industry Print name:Da, • Jensen Date:12/22/2015 Service Board. I:\Building\Permits\BUP-RESPermi ,sp.doc 02/24/2011 440-4613T(11/02/COM/WEB) - Electrical Permit Application FOR OFFICE 1 SF.Oyl.v Received City of Tigard ® r DateB : Permit#: '+�,- ; „- , el 114 r" a 13125 SW Hall Blvd.,Tigard,OR 97223 !1 Plan Review Phone: 503.718.2439 Fax: 503 ':IV r 1 DateB : Related Permit#: 10 Inspection Line: 503.639.4175n Ic '3 Ready Date/By: Juns: Ed See Page 2 for T I G A R D Internet www.tigard-or.gov c 14�1 Notified/Method: Supplemental Information i ,. „- /oro 1 ¢ y 1 F} ®New construction ❑Addition/altera t�Qi�p Please check all that apply(submit 2 sets of plans w/items checked): Vim'' `,R`\'���777��� ❑Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: itia4O where the available fault current 0 Marinas and~ boatyards. 'IO[ '` ,< ){� , K h. exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-familydwelling0 Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or .404';';$.�1 .W 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 14075 SW 118"Court 100HP or more. ❑"A "E","1-z","1-3", City/State/ZIP: ar TI d,OR 97223 ❑Six or more residential units. occupancy. Tigard, ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Pro Project name: 0 Hazardous locations. 0 Supply voltage for more than J 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site:Gaarde Road to 118"Court ' Y EE D Description I Qty. I Each I Total 1 New residential single-or multi-family dwelling unit. Subdivision:Medallion Meadows Lot#:21 Includes attached garage. 1,000 sq.ft.or less 1 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 6 33.92 1 D RIP ON f F" � ,x ^, . ,, , i" ` Limited energy,residential �� 1 75.00 2 (with above sq.ft.) Wiring for new single family residence Limited energy,multi-family 75.00 2 residential(with above sq.ft.) td PROI"�1°HERR a.„.„..,,,,,..,.,„..„:„.„,,,,„,,„,„,,,,..,„AND' Renewable Energy 0 See Page 2 ... - Services or feeders installation,alteration,and/or relocation Name:J.T.Roth Construction Inc. 200 amps or less 100.70 2 Address: 12600 SW 72nd 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 i 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 rcuits—nw,alteration,or extension,per panel , .:' - ®,4 A.Fee for cibranch 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 72nd Ave branch ciorcuder fee,first 56.18 2 City/State/ZIP:Tigard,OR 97223 Each add'1 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 . 0 ,. . _ Ppmp or irrigation circle 67.84 2 Business name:Grizzly Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address:8002 NE Hwy 99#248 panel,alteration,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(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 186218 Electrical Lic.: 3-7//%,:_ Suprv.Lic.: 37446k.. 24+1 .-speclfical listed(%hrmm) 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: 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.doe Rev 06/17/2015 440-4615T(I 1/05/COM/WEB Mechanical Permit Application EOR OFFR E t SE ONE 1 • City Tigard TI and ON Received Date/By: Permit No.: = 13125 SW Hall Blvd.,Tigard,0 I.' 1,% Plan Review • Phone: 503.718.2439 Fax: 503:1.. 60 C A (� ,,,,kDaBy, Other Permit: T i G A R D Inspection Line: 503.639.4175 O�G Y `e,I4 O\4 Date Ready/By: Jas: 0 See Page 2 for Internet: www.tigard-or.gov ®�� e�®� Notified/Method: Supplemental Information ''l"; ' .1? , _ ,., f 1<, * : EiR 1 1, "`"''''''''''''''''"?"-'•` ' ` ' Mechanical permit fees*are based on the value of the work /4 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. TE(4, if o t1 Value:$ ® 1-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 , ,c Heating/cooling: v ., . �,.,.. r Air conditioning 46.75 Job site address:14075 SW 118thCourt Furnace 100,000 BTU(ducts/vents) 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.:21 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 4 EA' Gas fireplace/insert 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 Other: 23.32 ' ��'° � ; � °1,Ig *** n Environmental exhaust and ventilation: Name:J.T.Roth Construction Inc. Range hood/other kitchen °d equipment 33.39 Address:12600 SW 72 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 C : x ,40,0 k f Other: 23.32 ... r. Fuel piping: Business name:J.T.Roth Construction Inc. $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 Phone:(503)8060602 Fax::(503)6240239 Fireplace Range E-mail:davidj@jtrothinc.com Barbecue x, ;;:':0 �;,, i `. 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: 7 * Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svobova J Date:12/22/2015 I:\BuildinglPermits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Plumbing Permit Application Building s Fixtures ' FOR OFFICE t SE ONI.) why.1 l T Received City of Tigard ! Date/By: Permit No.: M = 4 13125 SW Hall Blvd.,Tigard,OR 97 " JTa �� c Phone: 503.718.2439 Fax: 503.598. •.1 p 1� Plan Review J O Date/By: Other Permit No.: Inspection Line: 503.639.4175 C l 1 C A K I� �� (n� .;: ReadyBy Juns ® See Page 2 for Internet www hgard or gov 1� r �fiedllvlethod Supplemental Information @ New construction 0 D1 For special information use checklist. Description Qty. I Ea. Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) y. q . ,. +': i' .`s ... .�� ..... SFR(1)bath 312.70 11 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath x 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 tE'O 1Ol4- LOC ,.. '. j . . Site utilities: Job site address:14075 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.: 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 ( Lot no.:21 Fixture or item: Tax map/parcel no.: Backflow preventer x 31.27 D� flOI ', Backwater valve 12.51 .. ., Clothes washer 25.02 Plumbing installation at new single family residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 rt kitor Y3 i g4 ( 1 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)6392639 Fax:(503)6240239 Ice maker 12.51 ( otticOr ra t 0 I! ° 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 72m1 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 +I 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 Plan review (25%of permit fee) CCB Lic.:194089 Plumbing Lic.no.:PB1022 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:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard / ill 71COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: /iS F(1bi s--..a-,241g Site Address: C 1 n---1 5 sw ( V 5Th C--- Project Name: viedal l i 01l lyke;c0aj 3 Lot #: 2 (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: ne N S -- ciVerify site address/suite# exists and active in permit system. River Terrace Neighborhood: ❑ Yes 12C No Sit Plan Elements: ree(3) copies of site plan 2 sting structures on site tx o plan must be on 8-1/2" 11"or 11 x 17"paper IC Footprint of new structure(including decks)with finished awn to scale(standard architect or engineer scale) oor elevations Orth arrow Utility locations(required for new,may apply for additions) i.te address,project or subdivision name and lot number r. •cation of wells/septic systems information(name and phone number)2L1) r Erosion control(including drainage-way protection,silt fence ot dimensions and building setback dimensions design,location of catch basin,etc.) ^g•Lot area,building coverage area,percentage of coverage and Street names /impervious area(applicable if R-7,R-12,R-25&R-40) -BS eet tree size,type and location NJ Property 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 X.No Received: ❑ Yes ❑ No LI Public Facilities Improvement (PFI) Permit: equired: ❑ Yes,applicant was notified ❑ No Applied For: ['Yes E No,stop intake 2 Land Use Case#: J U S3 2.0\S`00006Voning: R— IA , S Setbacks: Front 201 Rear \ 5' Side gi1 o' Street Side Garage '0' -E3'Landscape Requirement: $ of Coverage Maximum: % , • Building Height: Maximum Height 3'0 Actual Height 214 I • Visual Clearance - Easements EAensitive Lands: Yes ❑ No Type (OW --\f(�,�\Il V ,S\ I(( . �}tCr T • Urban Forestry Plan IA Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: , -rj fyl LeArl rb()lc,1 Date: v2`2 c 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\BldgPennitRvw_RES_0709I 5.docx Building Permit Submittal Original Submittal Date: 0/2-4/1 5— Site Plans: # 7 Building Plans: # Building Permit#: tenter building permit#above. _ � Workflow Routing: [t]-Manning eering eLc� rm--Coordinator 1E-Buil Workflow Sign-off: -off for Planning(include notes from planning review) Route Application Documents: Bring: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. g--Iluti1 ing: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: 71;554-2,3 d. By Permit Technician: Date: /,�/ i3-- Engineering Review [r Slope at building pad: p 7, 1 Conditions "Met"prior to issuance of building permit yrEasements (encroachments)per engineering conditions of approval and plat 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: iifi'L 27 Date: (2-34:1—/G Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: ( Yes ❑ N/A Tigard Trans SDC: ❑ Yes 'N/A j Parks SDC: Yes CI N/A l�OK to Issue Permit Approved by Permit Coordinator: f----- Date:1 , I I:\Building\Fonns\BIdgPennitRvw RES 070915.docx City of Tigard ' COMMUNITY DEVELOPMENT DEPARTMENT r EEIVED 111 Request for Permit A '1�«�' q ctlon LIG A i l) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 tigardo g 2 2016 BUILDING DIVISION 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: X❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: J.T. Roth Construction Inc. INVOICE TO: (Business or Individual) Mailing Address: 12600 SW 72nd Ave ��(• ' City/State/Zip: Tigard, OR 97223 Phone No.: (503)639-2639 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. ® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR • RMIT (do not cancel permit). Permit#: MST 2015-00298 ..,5441A1.7,2-015-'Qo a2 a 7 Site Address or Parcel#: 14075 SW 118th Court Project Name: Subdivision Name: Medallion Meadows Lot#: 21 EXPLANATION: After applying for the building permit it was discovered that the plan submitted for permits did not conform well to the site. The applicant has elected to construct a different house plan that will work better with the site Signature: - —� J Date: 08/19/2016 Print Name: David Jensen Refund Policy 1. The city's Community Develop ent 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 for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date at�. (P l Route to Records: Date ID 7 /k _ By Refund Processed: Date/p/7//' 1 Invoice Processed: Date By Permit Canceled: Date09 By .r'" ' Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 2314.doc III - 41 TIGARD City of Tigard September 23,2016 J.T. Roth Construction Atm: David Jensen 12600 SW 72"d Ave., #200 Tigard, OR 97223 Re: Permit No ST2015-00298 c SWR2015-00227 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14075 SW 118th Ct. Project Name: Medallion Meadows,Lot 21 Job No.: N/A Refund Method: ® Check#222422 in the amount of$28,786.68. ❑ Credit card "return" receipt in the amount of$ . Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ . Comment(s): Per applicant's request as building plans did not fit on lot and plans were resubmitted under MST2016-00306/SWR2016-00269. Refund 100% of permit fees except for plan review that was already completed when request to cancel permit was received. If you have any questions please contact me at 503.718.2430. Sincerely, "woo 4 , - 4r / " Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 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: J.T. Roth Construction DATE: 8/18/2016 Attn: David Jensen 12600 SW 72nd Ave., #200 REQUESTED BY: Dianna Howse Tigard, OR 97223 TRANSACTION INFORMATION: Receipt#: 404637&404638 Case#: MST2015-00298& SWR2015-00227 Date: 6/23/2016 Address/Parcel: 14075 SW 118th Ct Pay Method: Credit Card Project Name: Medallion Meadows,Lot 21 EXPLANATION: Building plans were not a good fit for this lot and new plans were submitted under � MS T2016-0030`$6/SWRa2016-.�002�`69�. Refund 100,%w`(otp�f�permit fees exce 4�p„y,t fE plan lan review. W'44tW,� AraSr y ;:;f irrZP , ,:4Q� �� ' R :4r+ Description���*� �F� eK pigt���rCYri1t k«.Y„ � , }? ; �r��.. a�. � '� a �.�YJ�*r',��� ,r.w Building Permit 230-0000-43104 $2,206.80 v Mechanical Permit 230-0000-43102 300.99 ✓ Electrical Permit 220-0000-43103 447.06 ✓ Plumbing Permit 230-0000-43101 500.32 12%State Surcharge 100-0000-24001 414.63 ✓ Erosion Control 100-0000-43134 461.40 ✓ Metro Construction Excise Tax 230-0000-24010 483.48 Tig-Tual School CET 230-0000-24102 3,900.00 ✓ Washington County TDT 405-0000-43320 8,113.00 Parks SDC Improvement 425-0000-43300 4,248.00 Parks SDC Reimbursement 425-0000-43301 1,001.00 Parks SDC Neighborhood 425-0000-43300 1,575.00 Sewer Connection Fee 500-0000-25500 5,100.00 Sewer Inspection 230-0000-43118 35.00 TOTAL REFUND: $28,786.68 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager tOtl410 If under$25,500 Department Manager n^ If under$50,000 City Manager \ /I/ ' I LZi g If over$50,000 Local Contract Review Board ,:. 'FOR TIDEMARK; SYSTEM ADMINISTRATION USE ON "Yz' Case Refund Processed: Date: 1 /0/7//0 By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 4 Dianna Howse From: Dianna Howse Sent: Thursday, August 18, 2016 5:28 PM To: davidj@jtrothinc.com Cc: #Building Permit Technicians; Mark VanDomelen Subject: RE: Medallion Meadows Lot 21: MST2016-00306, SWR2016-00269 & MST2015-00298, SWR2015-00227 Attachments: Req PermitAction_082014.doc Hello David, Due to the differences in the building permit plans, and the fact that the fees cross two fee schedule increases (1/1/2016 and 7/1/2016), I am unable to just"credit" the permit fees from one permit to another on the building and sewer permits for lot 21 of Medallion Meadows. You will need to submit a request to void the first permit and process a refund for MST2015-00298. I have attached the request form for you to complete and return to us. We will refund all permit and SDC fees paid on this permit,with the exception of plan review and archiving fees as plan review was already completed on this permit prior to cancellation. Please allow 3-4 weeks for processing the refund check which will be mailed to you. Thank you and please let me know if you have any questions. Dianna Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2430 From: Branden Taggart Sent: Thursday, August 18, 2016 2:45 PM To: davidjOjtrothinc.com Cc: #Building Permit Technicians Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 David, Dianna is working on the credit/refund details. This process is complicated with the changes in SDC fees between the two permits,so it will take a little more time. We will get back to you as soon as we know more. In the meantime, if you can submit the form to get the process started,that would be great. Thank you, Branden Taggart iIICity of Tigard Permit Technician Community Development 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent tgard-orgov . From: Branden Taggart . ._ .e . .� Sent: Thursday, August 18, 2016 2:24 PM To: 'David Jensen' Cc: #Building Permit Technicians Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Hi David, If you submit a Request for Permit Action form to us requesting to void permit MST2015-00298,we will credit MST2016- 00306. You can follow the link below to complete the Request for Permit Action: http://www.tigard-or.gov/document center/Building/ReqPermitAction.pdf Once we receive the completed form from you,we will let you know what the balance due is. Let us know if you have any questions. Thanks, Branden Taggart 4 City of Tigard e. .4 Permit Technician Community Development 1,100,0 13125 SW Hall Blvd Tigard, OR 97223 (503)71 -2449 brandenttigarcl-or.gov From: David Jensen [mailto:davidj(qtrothinc.com] Sent: Thursday, August 18, 2016 1:22 PM To: Branden Taggart Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Branden: Thanks for the notification. However, I am wondering about the fees due. As you can see in your records I have already purchased permits for this house. As we began the formwork on the plans submitted we realized that the plans we originally submitted would not work on the lot. We then resubmitted a new plan that better fit the site conditions. I 2 understand that we have incurred costs for the additional plan review but all other fees that have been previously paid for should be credited to the new plan. Please let me know what the revised amount due is for Medallion Meadows lot 21. Thank you DAVID JENSEN J.T. ROTH CONSTRUCTION,INC. 503.639.2639 davidj@jtrothinc.com www.jtrothinc.com From: Branden Taggart [mailto:brandent@tigard-or.gov] Sent: Wednesday, August 17, 2016 9:32 AM To: davidj@jtrothinc.com Cc: #Building Permit Technicians Subject: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Hi David, Your permit for lot 21 of Medallion Meadows is ready to issue. The balance due is$34,615.06, and you can pay the permit fees online at https://aca.accela.com/tieard/or in person when you pick up the permit between the hours of 8:00 a.m. and 4:30 p.m., Monday through Thursday. We are closed on Fridays. If you have any questions, please let me know. Thanks, Brandon Taggart _ . City of Tigard Permit Technician Community Development 13125 SW Hall Blvd Tigard. OR 97223 (5033 718-2449 brndenttigard-or.gov DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 3