Permit (20) CITY OF TIGARDIN MASTER PERMIT
�-- 44
1r COMMUNITY DEVELOPMENT Permit#: MST2016 00306
Date Issued: 08/31/2016
TLC. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BA12800
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: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: 2621 sf Value: $327,903.53 Rear: 20
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 RainStorm Sewer: 100
0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
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'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 Y
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2621
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: $30,030.06
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 t - ules 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-copy of the .es or direct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344.
Issued By: .,-_,A,....____<_-- tea'' Perrftittee Signature: 1 ,.)g-. 1.----
03.639.4175 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 pr.*.,'-.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
H ( z�
"�'`"
Residential
IA, City of Tigard AUG i 2016 Receives ���/
4 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �� t(v PermitNo �/ rP��p�
■ ' Phone: 503.718.2439 Fax 503 598, Dat Review
( R ' rs c;_ Date/By: ` j Other Perm /6r f7G}
J,,, ,i,, Inspection Line: 503.639.4175 0 ,,,'''"":[',..t l
s
. Date Ready/By: y
Internet: www tigard or govoQ(/7 /(g Juris: I S See Page 2 for Information
Nohfied/Methoc( !!
Supplemental mental
4
a.. < 1 It +V s..,.r 9. _, z � , � ; . Wr W4 rw. ,a= � �,... 4,,.;/� w®New construction ❑Demolition
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other:
equipment,materials,labor,overhead,and the profit for the
_�: . 4U1-
' t,��. `a
nWwork indicated on this application.
►tel 1-and 2-family dwellingValuation: S p_,0v . a.7 9 fj'
0 Commercial/industrial - J
❑Accessory building ❑Multi-family Number of bedrooms: 5
❑Master builder
0 Other: Number of bathrooms: 3
i, , ..tib rn.. x � � 4t
~ Total number of floors: 2 %•34;)/..13
41
Job site address:14075 SW 11816 Court
New dwelling area: 2621 square feet
City/State/ZIP:Tigard OR,97224
Garage/carport area: 628 square feet
Suite/bldg./apt.no.: 1 Project name:/t1
d,L f CAI f"1 E-,94. e t t i S Covered porch area: 63 square feet 17 u
l s'
Cross street/directions to job site:Gaarde Street to 1186 Court
Beeirdrea:P i0 na square feet)a C'O
Other �e area:1!'n j\04square feet
ite rt 1 Z 9 9 1 fir# ffid:s
Subdivision:Medallion Meadows ������- �u° � .,,,w ,,�:„,�ti,
I Lot no.:21 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
"�' *�� l ,:w• ); work indicated on this application.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
ww i.�:. r`....5 .,,. , ` r,, '�` e'.*'m” a' d•, ,,� Number of stories:
Name:J.T.Roth Construction Inc.
Type of construction:
Address:12600 SW 72n Ave.
Occupancy groups:
City/State/ZIP:Tigard OR,97223
Phone:(503)639-2639 Existing:
Fax (503)6244/239
g' ` ; New:
a Ia a /
u +,w =, ..;. 4 a s i ',,.
Business name:J.T.Roth Construction Inc. ;
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)806-0602 l Fax::(503)624-0239 Amount received:
davidj@jtrothinc.com
t r
$ t f i h s r `S.° i f t
E-mail:
�, x ,' t 4 q t 4 °0 x�,< Commercial 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)639-02639 and administrative fees): $180.00
/ Fax:(503)624-0239
CCB lic.:31700 ; / 7 State surcharge(12%of permit fee): $21.60
` Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
/
`"- "w�'Pe it within 180 days after it has been accepted as complete.
nt name: I Date:08/01/2016 I "Fee methodology set by Tri-County Building Industry
1 Service Board.
.ng\Permits\BUP-RESPe pp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
.% Mechanical Permit Aaplicat». ,c 1.OR(Il l l( I. 1 Sh ( �►.)
City of Tigard s Received
Permit Nge/S-
1,1 � 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �Q���(�
g Phone: 503.718.2439 Fax: 503.598.1961 U r 1 2016 Plan Review
T t G n R 1l Inspection Line: 503.639.4175 Date/BY: Other Permit:
Interna. Line:www.tigard-or.gov 4 , Date Ready/By: Juris: ® See Pae 2 for
e 1 F Notified/Method: B
3 + Supplemental Information
Mechanical permit fees*are based on the value of the work
®New construction
0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
r ' s t k Value:$
k
,kH*,e a .. ;.,y .x: 7 k �'' ti Y1
® 1-and 2-family dwelling 0 Commercial/industrial '
0 Accessory building �� For spectral information use checklist.
❑Multi family 0 Master builder
0 Other: Description Qty. Ea. Total
Heating/cooling:
Job site address:14075 SW 118th Court Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) ) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:Gaarde Road to 118th Ct. 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 I Lot no.:21 Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 23.32
.ArMWZ. ,.,�.�Z V N- ,. i. t x �..a, '' : • . ,ter „ Gas fireplace/insert 33.39
�__ Flue vent for water heater or gas
Mechanical installation at new single family residence fireplace p 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
a t
I....x.:$ `' Other: 23.32
Environmental exhaust and ventilation:
Name:J.T.Roth Construction Inc. Range hood/other kitchen
Address:12600 SW 72.d Ave. equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
Phone:(503)639-2639 toilet compartments,utility rooms) 23.32
Fax (503)624-0239 Attic/crawlspace fans 23.32
a". ,> .rk *b . .`; t 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"Ave. Gas heat pump
City/State/ZIP:Tigard,OR 972223 Wall/suspended/unit heater
Water heater
Phone:(503)806-0602 j Fax::(503)624-0239 Fireplace
E-mail:davidj@jtrothinc.com Range
k Barbecue
.,... -�.:..,u z...F , '� .�z? ,>,k,, n,-�. -t ,v Ix.. . 1 n# .. , o Clothes dlyer(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)
Phone:(503)208-2276 I Fax:(503)208-2276 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.:}8-745 / TKA 75-- t l /17// 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: a Fee methodology set by Tri County Building Industry Service Board
Print name: ' r -'�---� I Date:08/01/2016 J
`'
I:Building\Permits\MEC_PemtitApp_o40113.doc 440-4617T(11/02/COM/WEB)
Electrical Permit Application ► �` tom:
City of Tigard AUG1 2016 Date/B : Permit#: /1--C70,/6-0 0 30
' - w 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19610 C. . , Date/B : Related Permit#:
Inspection Line: 503.639.4175 e heady Date/By: Juris: El See Page 2 for
T 1 G A R D Internet: www.tigard-or.gov "Notified /Method: Supplemental Information
.k
4 n L s6ak r } F g q � ' F
8 .
E New construction 0 Addition/alteration/replacement Please check all apply(submit 2 sets of
plans w/items checked):
DemolitionOther:
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ 0 where the available fault current 0 Marinas and boatyards.
t t ii*f 46 t t f 3 o g exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® m
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
, " '6 "r : O `SO" 1.1 L,„::!..:10,414.04- :'a.t ,. ,
` 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 10011P or more. ❑°`A'°,"E","1-2",°`1-3",
City/State/ZIP:14075 SW 118th Court ❑Six or more residential units. 0Recreational vehicle arks.
❑Health-care facilities. P
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 Ct. '" Mw
Description�, f'Qty 1 Each f Total .-I `�
New residential single-or multi-family dwelling unit.
Subdivision:Medallion Meadows Lot#:21 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4
z
Ea.add'l 500 sq.ft.or portion 33.92 1
... ,.,�*.�.r,..s � k � .<..�,,i�,. t 3 .=I,t' 't;., r_. . , a*a CUs....e�-g .� Limited energy,residential 1 75.00 2
Wiring of new single family residence to include low voltage (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2 ,
laN . -1' �-:*R�t, i r. MOi - . t V. 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"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)639-2639 Fax:(503)624-0239 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 I
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
g r E Branch circuits-new,alteration,or extension, r panel
r, . _n .... . ,� nti �.',. �. e*., ..*. . ,.., ,�, �w >.w 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"Ave. service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Tigard,OR 97223 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)806-0602 Fax: :(503)624-0239 Each manufactured or modular 67.84 2
Email:davidj@jtrothinc.com dwelling,service and/or feeder
Reconnect only 67.84 2
. t .. (f . ti . .. ;;, .. . .. . _ a ,a Pump or irrigation circle 67.84 2
Business name:Dreamhouse Electric LLC Sign or outline lighting 67.84 2
Address: 13075 SW Canyon Road Signal circuit(s)or limited energy ❑ See Page 2 22
y panel,alteration,or extension.
City/State/ZIP:Beaverton,OR 97005 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-5144 Fax:(503)648-9723 Investigation(1 hr min) 90.00/hr
Email:dfreamhouseelectric@gmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 196726 Electrical Lie.: C-848 Suprv.Lie.: specifically listed(%Z hr mm
/11 Suprv.Electrician signature,required: Subtotal:
Print name: Chris Mahoney I Date: 08/01/2016 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
4 Authorized signature: TOTAL PERMIT FEE:
/ This permit application expires if a permit is not obtained within 180
Print name 4�` J 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/OS/COM/WEB
1
. ' Plumbing Permit Applicat>l0 : w , x::. ,.
Building Fixtures I OR OFF l( F l SF ONE)
City of Tigard i''U u U 1 Received
: Permit Norfj/ `4,-4`O.. 6('
III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5Q>)1Q60w, -3, i DateBy: Other Permit No.:
r I c A u 11 Inspection Line: 503.639.4175 s i ri ° Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
®New construction 0 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)
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
i.!,,1't I 94 Site utilities:
..x - -
Job site address:14075 SW 118th Court Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Gaarde Road to 118th Ct. 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.:21 Fixture or item:
Tax map/parcel no.: Backflow preventer :OKIL/ ) 31.27
i _ .. r
� w. Backwater valve 12.51
`�s Clothes washer 25.02
Plumbing installation of new single family residence Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Fixture/sewer cap 25.02
Name:J.T.Roth Construction Inc.
Floor drain/floor sink/hub 25.02
Address:12600 SW 72nd Ave. Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)639-2639 L Fax (503)624-0239 Ice maker 12.51
wiii m to "' pj 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 72nd Ave. Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)806-0602 Fax::(503)624-0239 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:davidj@jtrothinc.com
..
Water closet
25.02
, J ,:01,. ,i . ,,l...4 , � f b -:-WIt .
Water heater 37.52
Business name:ALL Plumbing LLC Water piping/DWV 56.29
Address:9312 NW Skyline Blvd Other: 25.02
City/State/ZIP:Portland,OR 97231 Subtotal
Phone:(503)520-0313 Fax:(503)469-1470 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:194089 Plumbing Lic.no.:PB-1022 0
State surcharge(12%of permit fee)
Authorized signature: --- TOTAL PERMIT FEE
l This permit application expires if a permit is not obtained within 180 days
Print name:Gary Luchs Date:08/01/2016 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)
IIICity of Tigard
u COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
Building Permit #: "1--C-7-.20 /6 — 0030
Site Address: I (1-0 "7 5 S u .1 l l S ` a
Project Name: N/lc-dl al l i cry lAtc--.1 cit.(' S Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: NI e.c,J SES
.'Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: N No E Yes,See River Terrace Review Addendum Attached
Site Plan Elements: NFK
Arniree(3)copies of site plan „ Existing structures on site
lite plan must be on 8-1/2”x 11"or 11 x 17"paper 12.Footprint of new structure(including decks)with finished
,5rawn to scale(standard architect or engineer scale) floor elevations
forth arrow 'Utility locations(required for new,may apply for additions)
laSite address,project or subdivision name and lot number „I2tocation of wells/septic systems
1pplicant information(name and phone number) xisting trees to be retained with drip line,and tree
Ant dimensions and building setback dimensions Pc-protection measures
OILot area,building coverage area,percentage of coverage and 14Street tree size,type and location
un ervious area(applicable if R-7,R-12,R-25&R-40) 'Street names
Property corner elevations(2 foot contour lines if more than
4 foot differential)
Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified .V.No Received: ❑ Yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: Yes,applicant was notified ❑ No Applied For: CR—Yes ❑ No,stop intake
la-Land Use Case#: S l.k.a. a-U l a O 0 o d
Or-Zoning: R— 4 -5
N.-Setbacks: Front a-J Rear l S Side 1 p Street Side — Garage .7-0
---
l Landscape Requirement:
Lot Coverage Maximum: %
.A'Building Height: Maximum HeightActual Height c -3 7"
`J(Qc,12rVisual Clearance
Easements
Sensitive Lands: ❑ Yes ii---‘No Type
.Urban Forestry Plan
Ail---conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: X.X. (°(,`'`^ Date: 'r( - l S.,
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\BldgPermitRvw_RES_060116.docx 1
Building Permit Submittal
Original Submittal Date: r//1/44,
Site Plans: # /3
Building Plans: # 3
Building Permit#: 42'"Enter building permit#above.
Workflow Routing: ' Planning 'Engineering R Permit Coordinator —Building
Workflow Sign-off: .[.- Sign-off for Planning(include notes from planning review)
Route Application Documents: .D-.Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
yriginal plan review routing form.
Wr Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc. 1
Notes:
By Permit Technician: / C `r i - Date: P//j
Engineering Review
7Slope at building pad: 1
476
XConditions "Met"prior to issuance of building permit
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 ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: dG .0 Date: g:z./4
-/6
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 [11 N/A
L Tigard Trans SDC: Yes ❑ N/A
Parks SDC: es ❑ N/A
'OK to Issue Permit
Approved by Permit Coordinator: isOW--
Date: 5A/` '
I:\Building\Forms\BldgPermitRvw_RES 060116.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14075 SW 118TH CT, TIGARD, OR, 97224 April 6, 2017 at 10:52:19 AM
Record Type: Record ID:
Residential - Master Permit MST2016-00306
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No AC installed at this time.
Violation Summary:
Inspector Contractor