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Permit (41) CITY OF TIGARD MASTER PERMIT 31.:' COMMUNITY DEVELOPMENT Permit#: MST2015-00299 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439a Date Issued: 08/04/2016 'TIGARD y� �a Parcel: 2S110BA10800 `; Jurisdiction: TIGARD AO Site address: 14076 SW 118TH CT I Subdivision: MEDALLION MEADOWS Lot: 1 Project: Medallion Meadows, Lot 1 Project Description: New SF. 3/20/2017: REPRINTED permit to show deck addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1320 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 1542 sf Garage: 637 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 2862 sf Value: $354,144.48 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: 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: 4 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 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 Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2862 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: $24,351.43 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 orth in OAR 952-001-0010 through OAR 952-001-0090. You may o• -in a copy• •- rules or direct questions to OUNC by calling 503. . •87 or 1.800.332.2344. ^ Issued By411111...-Ar...,-. .c._,. _ i_.....�.r Permittee Signature: —1 I 3.639.4175 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 •ject. Approved plans are required on the job site at the time of each inspection. MIIMIN 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 P _ Transmittal Letter I c \f;t) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ./041 DATE RECE ' D: DEPT: BUILDING DIVISION ,r : I ' ' FROM: 7171 dPISc -462MAR '2 ° '�fi1 f D-7.7: ) 0 V , 5 „ Act COMPANY: ô-tliid J € e-Jiln ,r 1 PHONE: -, � 1' tI'i► / �/ ,. By. RE: e/si c i/ei Ge''finnblr1.5*-- s2z9(Site Address / /� *;P191 1.E i /L'W I ill' (Project name or subdivision name . a lo D, Der) ATTACHED ARE THE FOLLOWIN; P E S: I Copies: Description: Copies:/ Description: Additional set(s) \, (�iki Revisions: /?77. Cross section(s) . 6 d-t. isWall bracing and/or lateral analysis. Floor/roof framing. (22Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: 3S 3 AddCd Dec 1C • FOR OFFICE USE ONLY Routed to P it Technician: Date: 3 - Q,© - I 7 Initials: -J-1' Fees Due: pi Yes J No Fee Description: Amount Due: PJ col rati A, .y( 14f` $ 44 AAtre $ ►4t ,.- lia $ Sit. & . - F,5'3 IiiierateLAZ. S ecial4iTyrsi....' Special Instructions: _i'� -'— 1.7' /3 Reprint Permit(per PE): ►, ,i�-_r": Done �' Applicant Notified: sate: Initials: I:\Building\Forms\TransmittalLetter-Revisions_061316.doc CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00299 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2016 Parcel: 2S 110BA10800 Site address: 14076 SW 118TH CT Jurisdiction: TIGARD Subdivision: MEDALLION MEADOWS Lot: 1 Project: Medallion Meadows, Lot 1 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1320 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 1542 sf Garage: 637 sf Front 20 Dwelling Units: 1Smoke Third: 0 sf Right: 5 Detectors: Yes Total: 2862 sf Value: $353,386.03 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 0 Y Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 Tubs/Showers: 3SF Rain Storm Sewer: 100 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Footing Drain: 0 Ice Maker: 1 Bckflw Prevntr: 0 Catch Basins: 0 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 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: 4 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 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 SecurityAlarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2862 Owner: Contractor: JT ROTH CONSTRUCTION INC J TROTH CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $24,253.60 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. A `,: 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 throug' OAR.' -001 +090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. �� _ �/ Issued Permittee Signature: '� w� /`•, 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 proj-• . Approved plans are required on the job site at the time of each inspection. Building Permit Application , VE ' iz(z Residential „. , via .-., '� '1► FOR OFFICE ISE ()NEICity of Tigard `1'' Received y�� _ 1a! DateB : f, (/CI ,1� Permit No.: .= t '(.3, 4 'I 13125 SW Hall Blvd.,Tigard,OR 97223 �p 4 2.. Plan Review Phone: 503.718.2439 Fax: 503.598.19b1Q1 6+ Date/B : L, ' Other Permit: s' # , — Inspection Line: 503.639.4175 . TIC A 1Z U j Date Ready/By �� BI See Page 2 for Internet: www.tigard-or.gov k � ��ri, Vii" Notified/Method:` Zi (( , `a�, l� Supplemental Information '',-E G/1/-}/L 97// . Bryn of ,, '• " ' ' ',-- = / - ,RBOORATAti•vAND 24FANOtirrIVFEALINO ®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 vcn workindicatedonthis C�" (�O�t'r�:0 Ct ' �.,� application. Valuation: J\- S350U > v - J3�® 1-and 2-familydwelling 0 Commercial/industrial al ElAccessory building 0 Multi-family Number of bedrooms: 4 ❑Master builder 0 Other: Number of bathroom: jou` !ITtR1ki i of LOCATION Total number of floors: 2 Job site address:14076 SW 118th Court New dwelling area: 2862 square feet 4,'i City/State/ZIP:Tigard,OR 97223 Garage/carport area: 637 square feet Suite/bldg./apt.no.: Project name:'l 4_d/t-641i4e ,i s_e-7:1... Covered porch area: \8Q square feet J 3 el Cross street/directions to job site:Gaarde Road to 118th Court Deck area: S C., " square feet . .4_0 Other structure area: square feet DEfiDIDEDDATArCOWIEACIittELIST 1 I� I Subdivision:Medallion Meadows Lot no.:1 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 0RIPTIO(W WORKwork indicated on this application. III Construction of new single family residence Valuation: $ Existing building area: square feet New building area: square feet C4 Pg*MtIV OWNER f) T mo. Number of stories: Name:J.T.Roth Construction Inc. Type of construction: Address:12600 SW 72°a Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(503)6392639 Fax:('503)6240239 New: a 0 APPLICANT' b , oro ,COI+T CT ft'I N' I OC% ER .FRES'. Business name:J.T.Roth Construction Inc. (i!I fetrifeesci ` Structural plan review fee(or deposit): Contact name:David Jensen na FLS plan review fee(if applicable): Address:12600 SW 72 Ave City/State/ZIP: fees due upon application: ity/State/ZIP:Tigard,OR 97223 Phone:(503)8060602 Fax::(503)6240239 Amount received: E-mail:davidj@jtrothinc.com PI OT 'OIE TAIc P`AIVF YSTFAI " y' Commercial and residential prescriptive installation of Coivir**C1' roof-top mounted PhotoVoltaic Solar Panel System. Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details °a 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 lie.:31700 Total fee due upon application: $201.60 Authorized signature: ` This permit application expires if a permit is not obtained I' >!i4.! _ - 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-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) ' Electrical Permit Application �` .`' �����,a y FOR OFFI('E ISE()NEI Cityis Of Tigard �I�`R.' "`) Received Date/B Permit#: • v 13125 SW Hall Blvd.,Tigard,OR 97123 �� r� (� •M � �"� Plan Review Phone: 503.718.2439 Fax: 503.598.1960 ,;t� Date/B : Related Permit#: T 1 G A K D Inspection Line: 503.639.4175 ,i 4 Ready Date/By: luris: ® See Page 2 for Internet: www.tigard-ocgov r -^ Notified/Method: ? g Supplemental Information V TY ,WEI�� l° ( 1 1` ` M ,,,.Ply REVIEW ' ®New construction 0 Additiori/alteratioii( I$$ edt Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 am s or more g 0 Demolition 0 Other ;, p ❑Builain over three stories. where the available fault current 0 Marinas and boatyards. €AO `� ,M4STAUCUOSV.'' exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or .JOB SITEINFORMATIONN,II LOC NIION .• 0 Emergency system. larger separately derived Job#: Job site address: 14076 SW 118th Court ❑Addition of new motor 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 raze 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 118th Court FEE UED : , Description 1 Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision:Medallion Meadows Lot 4: 1 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 Ea.add'1500 sq.ft.or portion -11Is33.92 1 ° 00eRyIpTION WOR Limited energy,residential 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.) ►,®® PSR DR Renewable Energy ❑ See Page 2 , �0. . - s. . 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 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 `❑.4porr >s'CONTACT-r: Bnch circuits—new,alteration,or extension,per panel � A.Fee for branch circuits with Business name:J.T.Roth Construction Inc. service or feeder fee, :1:c317ranch circuit 7.42 2 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'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)8060602 Fax: :(503)6240239 Each manufactured or modular Email:davidj@jtrothinc.com dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR . Pump or irrigation circle 67.84 2 Business name:Grizzly Electric Sign or outline lighting 67.84 2 Address:8002 NE Hwy 99#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 CCB Lic.: 186218 Electrical Lic.: Suprv.Lic.: 37446 specifically listed(14 hr min) 90.00/hr ..EL EC;I#C "PERM.IT F"'4, Suprv.Electrician signature,required: Subtotal: Print name: Ron Nelson 0 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: tit has been accepted as complete. * Number of inspectidaysafoerns 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 Ol F ICE ( SE()NEN City of Tigard Received ,1444 INPermitNo.:. #..,, # •o 13125 SW Hall Blvd.,Tigard,OR 97223 w� •! Date/By: — i Phone: 503.718.2439 Fax: 503.598.1960E)it.+ Plan eB Review Other Permit: �` v.; Y T I G A K D Inspection Line: 503.639.4175 \.\ Date Ready/By: Jur s: ® See Page 2 for Internet: www.tigard-or.gov - G`- .:tilfied/Method: Supplemental Information TYPE OF W v `�` <- 4. iL F * VLE=1J$E C'EIE 1` f k .,,,,f1-,,,, Mechanical permit fees*are based on the value of the work ®New construction D Addition/alteration/replaceinpa performed.Indicate the value(rounded to the nearest dollar)of all a�' t. Value:$ ` L EC)rIPIPlt 1:1 T'/SYSIZM$ ' . ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory buildingn l Fors special information use checklist. 0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total ' 1sI ' 0 -/ LOCA`01 Heating/cooling: Air conditioning 1 46.75 Job site address:14076 SW 118thCourt 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.:01 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater I 23.32 ;i" i 't F , "itiGas fireplace/insert J 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 �` `PROPERTY own* 0 ,� ' �”�� 0 Environmental exhaust and ventilation: Name:J.T.Roth Construction Inc. Range hood/other kitchen 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 APrucitNNT" r;,4OO 'A�I' OIV 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. I 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)6240239Fireplace Range E-mail:davidj@jtrothinc.com Barbecue CO1ACTO ,. 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: / /t ' Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svobova Date: 12/22/2015 I:\Building\Permits\MEC_PernritApp_040113.doc 440-4617T(11/02/COM/WEB) ' Plumbing Permit Application , '-- Building Fixtures , ' �` �, gFOR OFFICE CSE O\L1 Cityof Tigard . Received Permit No.: III 13125 SW Hall Blvd.,Tigard,OR 91223 sl r Date/By: �5j r 5 )�Gtq m Phone: 503.718.2439 Fax: 503.598.1960,.,, '. § 1 Plan Review I Date/By: Other Permit No.: Inspection Line: 503.639.4175 e 1!t A R D 1,), pate Ready/By: Juris H See Page 2 for Internet: www.tigazd or gov a,,; 'Notified/Method:s� Supplemental Intorma5on T4 . ®New construction WO0 D k pn For special information use checklist Description Qty. Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY"O O1 IS'n J TjO14' SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath x 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITEINFORSIAMItt"D L A' ON, Site utilities: Job site address:14076 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 I Lot no.:01 Fixture or item: Tax map/parcel no.: Backflow preventer x 31.27 VDRL£ 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 y >®+`1 o1?Rilt 084,N R 0 ' Expansion tank 12.51 Name:J.T.Roth Construction Inc. Fixture/sewer cap 25.02 Address:12600 SW 72"d Ave. Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP:Tigard,OR 97223 Hose bib 25.02 Phone:(503)6392639 Fax:(503)6240239 Ice maker 12.51 a'APPLLCOIT" sde.CONTACt.PMON Interceptor/grease trap 25.02 Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2 Contact name:David Jensen Primer 12.51 • 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) Authorized signature: State surcharge(12%of permit fee) P� TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Gary Luchs Date:12/22/2015 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 II 1,11 COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential Building Permit #: 3r t _o, 9Zge1 Site Address: {Li 07 an, i 19 h Project Name: P\ al j i oln Meadows Lot #: (New dwelling= subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: ()pJ� S F 'Verify site address/suite# exists and active in permit system. �. River Terrace Neighborhood: ❑ Yes Z( No Sits Plan Elements: hree (3)copies of site plan xisting structures on site �' to plan must bes on 8-1/2"x 11"or 11 x 17"paper 7Footprint of new structure(including decks)with finished raven to scale(standard architect or engineer scale) floor elevations [lvorth arrow dUtility locations (required for new,may apply for additions) to address,project or subdivision name and lot number $ ocation of wells/septic systems Applicant information(name and phone number) 1'Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions design,location of catch basin,etc.) -Q-Lot area,building coverage area,percentage of coverage and -8-Street names impervious area(applicable if R-7,R-12,R-25&R-40) street tree size,type and location 'Property corner elevations (2 foot contour lines if more than B'Existing trees to be retained with drip line,and tree 4 foot differential) 1 �- protection measures Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): /Required: ❑ Yes,applicant was notified >r No Received: ❑ Yes ❑ No LxJ Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: L1 1'es ❑ No,stop intake Li/Land Use Case#: 5 U B 20 i 3-00CCA Zoning: R LA,S Yr Setbacks: Front 2 O t Rear 15 Side 5 ' Street Side -- Garage 2 d �- Landscape Requirement: 0/0 -Lot Coverage Maximum: 0/0 .Building Height: Maximum Height 3 0' Actual Height 2,,L1 10i/Visual Clearance ®' Easements ensitive Lands: CI Yes No Type Urban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: /_ ----j M - back) Date: ( 2, Z i 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\B1dgPennitRvw REs o70915.docx Building Permit Submittal Original Submittal Date: /4014/I s-" Site Plans: # 3 Building Plans: # �_ Building Permit#: nter building��p,,errm�mitt--#above. Workflow Routing: arming I�r nglneering mit Coordinator uilding Workflow Sign off: off for Planning(include notes fromplanning review) Route Application Documents: �7ineering: (1) copyofpermitapplicat:n, (1) siteplan1) building lan, (1) building plan and inal plan review routing form. ding: originalitlitiitlbildilidm calculations and trust details,if applicable, etc. Notes: By Permit Technician: Date: Engineering Review Slope at building pad: Conditions "Met"prior to issuance of building permit /4r.Easements (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 I No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: "2 Date: f,,1 .-1 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: , Yes ❑ N/A Tigard Trans SDC: ❑ Yes jrN/A Parks SDC: p. Yes ❑ N/A `rOK to Issue Permit Approved by Permit Coordinator: Date: 1.V > S I:\Building\Forms\B1dgPennitRvw_RES 070915.docx 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14076 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: MST2015-00299 Inspector: Jeff Grove Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14076 SW 118TH CT, TIGARD, OR, 97224 March 14, 2017 at 7:03:24 AM Record Type: Record ID: Residential - Master Permit MST2015-00299 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved final erosion control prior to scheduling building final inspection. No final inspection done at this time. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14076 SW 118TH CT, TIGARD, OR, 97224 March 14, 2017 at 10:46:32 AM Record Type: Record ID: Residential - Master Permit MST2015-00299 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Seal line-set penetration at garage ceiling. R302.5 Protect copper tubing from contact with sheet metal collar. M1309.2 Note: for building final, provide permit for approximately 100 sq ft of deck over 30" above grade with 5 risers not on approved plans. Plans show patio at grade. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14076 SW 118TH CT, TIGARD, OR, 97224 March 22, 2017 at 9:45:58 AM Record Type: Record ID: Residential - Master Permit MST2015-00299 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Corrections complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14076 SW 118TH CT, TIGARD, OR, 97224 March 22, 2017 at 9:48:21 AM Record Type: Record ID: Residential - Master Permit MST2015-00299 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Final erosion control approved. Street tree certification received. Moisture content form received. High efficiency lighting form received. Insulation certification checked. Duct seal test report received. Fall prevention devices installed. C of 0 left on site with builder. Violation Summary: Inspector Contractor