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Permit (43) //�rrn I. CITY OF TIGARD ?MAI MASTER PERMIT `"! `` COMMUNITY DEVELOPMENT Permit#: MST2015-00292 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/12/2016 Parcel: 2S 110 BA10900 Jurisdiction: TIGARD Site address: 14080 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 1 Project: Medallion Meadows, Lot 2 Project Description: New SF. 9/26/16, REPRINTED to correct the number of tub/showers actually permitted. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 7 First: 1243 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1529 sf Garage: 701 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2772 sf Value: $348,989.44 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 Drains: 0 Water Lines: 100 Catch Basins: 0 ooting Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 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 addi 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 2772 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 2 Home not prescriptive see TIGARD,OR 97223 engineering PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $24,102.85 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. AT a • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0 -0010 through• R 952---0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5, . :2.1987 or 1.800.332.2344. Issue 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 completion of the project. Approved plans are required on the job site at the time of each inspection. iipi ,...., CITY OF TIGARD MASTER PERMIT .', COMMUNITY DEVELOPMENT Permit#: MST2015-00292 TEGA.RI) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/12/2016 Parcel: 2S110BA10900 Jurisdiction: TIGARD Site address: 14080 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 1 Project: Medallion Meadows, Lot 2 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 7 First: 1243 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1529 sf Garage: 701 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2772 sf Value: $348,989.44 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 0 Tubs/Showers: 3 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 Fu rn>=100 K: 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 2772 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 2 Home not prescriptive see TIGARD,OR 97223 engineering PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $24,102.85 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT 6 .6,• •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-00 6010 through OA 1-0090./00` You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issu:d By: k iCX rl A._/1-1-s-41 Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of th roject. Approved plans are required on the job site at the time of each inspection Buildin2 Permit ApplicationLC sidential �-'y 78 S City of Tigard ce\ ! e2iJi> -w �S ' �is—_. s �t� Inspection Line: 503.639.4175 ��C ill Pe Date/By /a 1 Other Permit: s age 2 r T 1 Ci A R D p U �! Date Ready/By ��' JJJ 1`�✓t'' Internet: www.tigard-or.gov .y�r tR��� y y / Juris: Supplemental See Page 2 for IN OC \• VtS Notified/Method: t.„--/A u, / Information • ;II AND 2jP �Y 1 ®New construction ■ Demolition Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement — Indicate the value(rounded to the nearest dollar)of all ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTIONwork indicated on this application. 9 39 ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $3 t. � ❑Accessory building 0 Multi-family Number of bedrooms: 4 ❑Master builder ❑Other: Number of bathrooms: 3 JOBSITE:INFO DMATION AND LOCATION ="� Total number of floors: 2 Job site address:14080 SW 118th Court New dwelling area: 2772 square feet39. City/State/ZIP:Tigard,OR 97223 Garage/carport area: 701 square feet Suite/bldg./apt.no.: Project name: Cnri rent n� _ 1 Covered porch area: `55k square feet K al Cross street/directions to job site:Gaarde Road to 118'"Court / 1 Deck area:�9 6 . square feet'�d.. Other structure area: 91 square feet 1'� Subdivision:Medallion Meadows REQUIRED DATA;C'O RC ..USE CHECKl iST" I Lot no.:2 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 work indicated on this application. Construction of new single family residence Valuation: $ Existing building area: square feet New building area: square feet C.,1'PROPERTY q ' �:�� �����' 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 Phone:(503)6392639 Existing: Fax:C503)6240239 New: 0 APPLICANT 'Z''caNyter PERSON;; Business name:J.T.Roth Construction Inc. t` r `I of Contact name:David Jensen Structural plan review fee(or deposit): Address:12600 SW 72°d Ave FLS plan review fee(if applicable): City/State/ZIP:Tigard,OR 97223 Total fees due upon application: Phone:(503)8060602 I Fax::(503)6240239 Amount received: E-mail:davidj@jtrothinc.com PHOTOVOLTAIC501,44 PANEL SYSTEM FEES* CONTRACTORCommercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details Address:12600 SW 72°d Ave and fire department access,along with the 2010 Oregon Solar Installation Specialty Code checklist. City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review Phone:(503)6392639 and administrative fees): $180.00 I Fax:(503)6240239 CCB lie.:31700 State surcharge(12%of permit fee): $21.60 Total fee due upon application: $201.60 Authorized signatur:-s-- This permit application expires if a permit is not obtained c.--' ._ r' within 180 days after it has been accepted as complete. I Print name:David Jensen I Date:12/22/2015 I *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP- SPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application FOR OFFICE LSE ()N1.1 City of Tigard ECEINIReceived 14 Dan II 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review Phone: 503.718.2439 Fax: 503.598.1960Q Date : Related Permit#: Inspection Line: 503.639.4175 DEC 4 u ` rJ B Ready Date/By: Juris: ® See Page 2 for T I G A R D Internet: www.tigard-or.gov itop*BID Notified/Method: Supplemental Information A- ),VVIS',0,',:i"-: : ';:".'''..-' '' ,: '':',2-, '-":7':"'''':::: :'-',4:**, 'iowy-,0,i,,.—:,:::,„, , , _-.- , , E New construction 0 Addition/a1tea%G cement Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition 0 Other: ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. C4TEGO* '< ' (�I O _ exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural ngs. 0 Multi-family ❑Master builder 0 Other: ampsireform all other installations. but 0 Fire pump. Installation❑ of 150 KVA or SI= [tMAti°7 1 A1 ❑Emergency system. larger separately derived Job#: Job site address: 14080 SW 1185h Court ❑A 01-113 o of newremotor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal. Cross street/directions to job site:Gaarde Road to 1185h Court Description I Qty. I Each 1 Total I ' New residential single-or multi-family dwelling unit. Subdivision:Medallion Meadows Lot#:2 Includes attached garage. 1,000 sq.ft.or less 1 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion r\ 33.92 1 :' DSCtON 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.) Renewable Energy 0 See Page 2 0-,P P lY*OWNER • - L '� :,'S.','.i, 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 i6; Branch circuits—new,alteration,or extension,per panel� 3AN 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 Ave service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:Tigard,OR 97223 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)8060602 Fax: :(503)6240239 Each manufactured or modular 67.84 2 Email:davidj@jtrothinc.com dwelling,service and/or feeder Reconnect only 67.84 2 fl #"f Pump or irrigation circle 67.84 2 Business name:Grizzly Electric Sign or outline lighting 67.84 2 Address:8002 NE Hwy99#248 Signal circuit(s)or limited energy 0 See Page 2 2 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(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 186218 Electrical Lie.: ,37s'`., Suprv.Lie.:3-?dd6-A[,vs; ,,specifically listed(%hr min) Suprv.Electrician signature,required: 1 ) �ALr PEi kT',, Subtotal: Print name: Ron Nelson Date: 12/22/2015 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 7-",74.- -") TOTAL PERMIT FEE: Authorized signature: �2....�------ -' 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\Pemuts\ELC_PemutApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Mechanical Permit Application FOR OFFICE 1 SE ONEI Cityof Tigard Received _ g ` Date/By: Permit No.: S a 14 g 13125 SW Hall Blvd.,Tigard,OR 97' y C ►.: 1 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.598. Q ��` Date/By: TIG A R D Inspection Line: 503.639.4175 ac C D �TO Date Ready/By: Juris: El See Page 2 for Internet: www.tigard-or.gov w� ~®� ,Ge.ti® otified/Method: Supplemental Information . °• 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: CA O "Y''CE ONSTR 5 7AI A YSi 1S El * °%' ►1 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 J#1It SIM IWOR l k` ON AP L ?+l A'l tS'. eating/cooling: H Air conditioning 46.75 Job site address:14080 SW 1186 CourtFurnace 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 1185h 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.:02 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater ,) 23.32 CRI O1l W f W„ • 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 ' - ►2 PRI OW'1 I2 ' Al .. andenttlah 23.32 Other: ,fl- Environmental exhaust ion: Name:J.T.Roth Construction Inc. Range hood/other kitchenj 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) S 23.32 Phone:(503)6392639 Fax:(503)6240239 Attic/crawlspace fans 23.32 0 API'LiCAT, , p.-, CAl'9`74'ACT pgisoN,, ,, ,, Other: 23.32 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. J Address:12600 SW 72"d Ave. Gas heat pump Wall/suspended/unit heater City/State/ZIP:Tigard,OR 97223 Water heater 1 Phone:(503)8060602 Fax::(503)6240239 Fireplace J Range E-mail:davidj@jtrothinc.com Barbecue cOrokrwc,TORClothes dryer(gas) Business name:All Time Heating LLC Other: .614 CAL!ERirn " . ... 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: j * Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svobova _.....>") Date:12/22/2015 I:\Building\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB) • Plumbing Permit Application Building Fixtures � IFOR OFFICE ISE O\L1 r Cl of Tigard Received `J g (�1 Date/By: Permit No..y)ST + j COSIA IIIa 13125 SW Hall Blvd.,Tigard,OR 97223 nC c g Ztt Plan Review S Phone: 503.718.2439 Fax: 503.598.1960 C- �j� DateBy: Other Permit No.: Inspection Line: 503.639.4175 1` Ail TIC ARD a� ate ReadyB Juns H See Page 2 for p� `t{ Y Internet: www tigard or gov ` M V 1St otified/Method Supplemental Information ®New construction ❑Demolition For special information use checklist Description I Qty. I Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) C 0 , 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 JOB; U L YI FORMAUON AND LOCATE , Site utilities: Job site address:14080 SW 118th Court Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 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 I Lot no.:02 Fixture or item: Tax map/parcel no.: Backflow preventer x 31.27 Backwater valve 12.51 ► I I N OF WORK'', Clothes washer 25.02 Plumbing installation at new single family residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 CC,pttopimt* us T 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 72m1 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 T3 APP K)fl', , - , 0 toloAcr P $ 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 7201 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 Urinal 25.02 E-mail:davidj@jtrothinc.com �.,: Water closet 25.02 C€NTRACrOR 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 Lie.no.:PB1022 State surcharge(12%of permit fee) Authorized signature: _�"" TOTAL PERMIT FEE Print name:GaryLuchs 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.doc 10/01/09 440-4616T(10/02/COM/WEB) V City of Tigard INa q COMMUNITY DEVELOPMENT DEPARTMENT T I G n K D Building Permit Review — Residential Building Permit #: rYiS T 1 S—C)a2qt, Site Address: J2/0S')G3 //e37l Project Name: i' / /4' dkeeocl'WS Lot #: CZ;? (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: /Ve&L) S?,‘ r% Verify site address/suite# exists and active in permit syste hiver Terrace Neighborhood: ❑ Yes No Si)6 Plan Elements: hree (3) copies of site plan 4 'xisting structures on site ite plan must be on 8-1/2"x 11"or 11 x 17"paper Il!�`ootprint of new structure (including decks)with finished shed to scale(standard architect or engineer scale) oor elevations i1 orth arrow Utility locations (required for new,may apply for additions) VJ tte address,project or subdivision name and lot number 5ocation of wells/septic systems II(pplicant information(name and phone number) !i Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions esign,location of catch basin,etc.) 1pot area,building coverage area,percentage of coverage and treet 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 *sting trees to be retained with drip line,and tree 4 foot differential) protection measures lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): equired: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No It Public FacilitiImprovement (PFI) Permit: Required: Yes,applicant was notified ❑ No Applied For: Yes E No,stop intake and Use Case#:L 'L& O/S- 006) .2 oning: IC_ Li, c etbacks: Front d)© Rear /s Side 5 Street Side /S Garage ,‘=„2O I!' Landscape Requirement: 0/0 Lk o of Coverage Maximum: 0/0 V Building Height: Maximum Height 0 o?( 1 Actual Height �(17'/ Ill Visual Clearance 71 Easements f!f " ensitive Lands: ❑ Yes V<To Type VA rban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: r Approved By Planning: - Date: 4„/„--- Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1 I:\Building\Fonns\B1dgPermitRvw—RES—070915.docx Building Permit Submittal Original Submittal Date: 104/11/1 Site Plans: # 3 Building Plans: # �_ Building Permit#: nter building permit# above. Workflow Routing: lanning EgmeeringB--P-615-it Coordinator uilding Workflow Sign-off: -off for Planning(include notes from planning review) Route Application Documents: 1 - rigineering: (1) copy of permit application, (1) site plan, (1) building plan and oral plan review routing form. L�f'�u�ldtng: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: _ Date: /0/./0/S Engineering Review Slope at building pad: 4,7 Conditions "Met"prior to issuance of building permit ,,Easements (encroachments)per engineering conditions of approval and plat 15 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: 4� Date: 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: SDC Fees Entered: Wash Co Trans Dev Tax: cZDYes ❑ N/A Tigard Trans SDC: ❑ Yes X'N/A Parks SDC: r Yes ❑ N/A KD OK to Issue Permit ��j �/i Approved by Permit Coordinator: ��ll/1' v Date: J.42/14 , 1:\Building\Fonns\B1dgPennitRvw_RES_070915.docx 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14080 SW 118TH CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: PASS Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: MST2015-00292 Inspector: Jeff Grove Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14080 SW 118TH CT, TIGARD, OR, 97224 March 14, 2017 at 10:41 :33 AM Record Type: Record ID: Residential - Master Permit MST2015-00292 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide fall prevention devise at upper level bonus room Windows with 24" or less to finished floor and greater than 72" to grade. R613.2 All else appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14080 SW 118TH CT, TIGARD, OR, 97224 March 14, 2017 at 10:29:33 AM Record Type: Record ID: Residential - Master Permit MST2015-00292 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Corrections from previous inspection complete. Note: no AC installed at this time, permits and inspections required at time of installation. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14080 SW 118TH CT, TIGARD, OR, 97224 March 21 , 2017 at 1 :09:41 PM Record Type: Record ID: Residential - Master Permit MST2015-00292 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - CofO Comments: Previous correction 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 0 left on counter. Violation Summary: Inspector Contractor