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Permit (240) t 71 CITY OF TIGARDiffilMASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016-00505 T[GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2016 Parcel: 2S110BA13200 Jurisdiction: Tigard Site address: 14068 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 25 Project: Medallion Meadows, Lot 25 Project Description: New SF. 6/21/17, REPRINTED to add a/c. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1267 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 3 Second: 1500 sf Garage: 572 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2767 sf Value: $349,685.47 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Drains: 0 gWater Lines: 100 Catch Basins: 0 Footing 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: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add9 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 2767 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,527.88 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don- ' ce with approved plans, This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 d• . ATTENTION: • -gon law requires you to follow the rules adopted by the Oregon Utility Notification e. ose rules are s. forth in OAR :52-001-0010 through OA" •. -w •091. You may obtain a copy of the rules or direct questions to OUNC by calling 50319T.8 2 4. ssued By: A. ,de •_ �/ Z / Permittee Signature: a. Call 503.639.4175 by 7:00 a.m.for the next available inspec ion date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application Cl of Tigard r 1 rF i1 � Received I Permit hI /( ���` a 13125rS W Hall Blvd.,Tigard,Oa '" c'-. ... PDateB : J_ S Phone: 503.718.2439 Fax: 503.598.19.1 Dat Review I Other Permit: 1 Date/By: T 1 G A R D Inspection Line: 503.639.4175 NOV t/ tj o� 1 7(\�� Date Ready/By: Judo: 1 9J See Page 2 for Internet: www.tigard-or.gov ll V ' 7 Notified/Method: (I Supplemental Information TYPE _ '' R l COMMERCIAL FEE* SCHEDULE— USE CHECKLIST ( /t11*- Mechanical permit fees*are based on the value of the work EgNew construction 0 Addit t'ai 1.t4 1.14' performed:Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 5a/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 JOB SITE INFORMATION AND LOCATION Heating/cooling: /� Q .,5; W. U Air conditioning 46.75 Job site address: /I' '8 /�`j 71.4 C.T T. Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: '-'--i('►4\2-'JC,t2, 9-7 c2-77- Furnace 100,000+BTU(ducts/vents) 54.91 i Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: ' i 0 1-1A Cv A-I:\PD 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: fy'j CDA Lc( ar� .l iia L P D tA,5 Lot no.: Other: 23.32 2� Other fuel appliances: Tax map/parcel no.: Water heater i 23.32 DESCRIPTION OF WORK Gas fireplace/insert 3339 Flue vent for water heater or gas d _ fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 • Et PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment ' 33.39 Address: S'p•M\ L-- P*S B `- —) Clothes dryer exhaust 3339 City/State/ZIP:— Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) • Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: �(AA �Oo5 j 12 1 0110 t") $14.15 for first four;$4.03 for each additional Contact name: 12) tiw 1 D !)(4._-:1.4 po(LT- Furnace,etc. Gas heatpump Address: P. o .BeiX is--2-7 I V Wall/suspended/unit heater City/State/ZIP: tj v&:42 i sem] 1 a� t '?0.7 . _Waterheater Phone:(5',3) 5'7o (:1 905 Fax::(543) X90 -- (7 S f Fireplace .� ange E-mail: 7p0LI.ft e• CO II.)SrCt, MSbJ, CO,.,GU _ Barbecue . CONTRACTOR Clothes dryer(gas) Business name: Other: Ct7�� �^ 'N�— MECHANICAL PERMIT FEES* Address: Po. B4 x• (433 Subtotal City/State/ZIP: G Lp+C-i MUS j 0'c-- Cf'7 0 i S Minimum permit fee($90.00) �j Plan review(25%of permit fee) Phone:(5036 6.— t(-70g [ Fax:6t 3) (05 C-) .-3 !!" State surcharge(12%of permit fee) ' CCB lie.: 1- G7(02-Li TOTAL PERMIT FEE 50R. . This permit application expires ifs permit is not obtained within_in days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: DA, /b eol1\p s-- Date: //_28- I:\Building4Permits\MEC_PermitApp_040113.doc 440-4617r(I1/02/COM/WEB) 1StCITY OF TIGARD MASTER PERMIT . COMMUNITY DEVELOPMENT Permit#: MST2016-00505 Tr A.R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2016 Parcel: 2S110BA13200 Site address: 14068 SW 118TH CT Jurisdiction: Tigard Subdivision: MEDALLION MEADOWS Lot: 25 Project: Medallion Meadows, Lot 25 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1267 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 3 Second: 1500 sf Garage: 572 sf Front: 20 Dwelling Units: 1 Smoke Third: 0 sf Right: 5 Detectors: Yes Total: 2767 sf Value: $349,685.47 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 1 Y Rain Drain: 1 Urinals: 0 Lavatories: 5 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: 0 Bckflw Prevntr: p Footing Drain: 0 Ice Maker: 1 Catch Basins: 0 Hose Bib: 2 Backwater Value: 1 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 add9 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 Y Garage Opener N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: NEW P y Square Feet: SF VB R-3 2767 Owner: Contractor: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION Required Items and Reports(Conditions) FOUR D CONSTRUCTION CO PO BOX 1577 1 Ersn Cntrl 503-639-4175 12600 SW 72ND AVE#200 BEAVERTON,OR 97075 TIGARD,OR 97223 PHONE: 503-720-7445 PHONE: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,430.52 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 acrnrdan a 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. NTION: Ore•.n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1-0010 through OAR• -4 4'-�. You may obtain a copy of the rules or direct questions to OUNC by calling 503. . .87 0 .800.3 .23.4. I 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. I uilding Permit Application Residential � �F ,� ;1` r City of Tigard il � 13125 SW Hall Blvd.,Tigard,OR 97223 Plate/By:Receved ([ I Ip ' Permit No.:1' Tai)1�—60 566- Phone: 503.718.2439 Fax: 503. 1h n Review W� 7,„�1�F7 Da DateBIy: �-7-) C, -# Other Permit: go2„90/6��Cl/a,a, TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ) orris: ® See Page 2 for Internet: ww.tigard-or.gov ().Y J n 4 4`1. wj Notified/Method: ' ,y-/� Supplemental Information REQUIRED DATA:1-AND 2-FAMILY DWELLING y "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 ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1-and 2-family dwelling ❑Commercial/industrial Valuation: $34 1 �Q�, y7 Aft- ❑Accessory building ❑Multi-family Number of bedrooms: 1 El Master builder El Other: �[Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: -2_,,¢ , 3 1 Job site address: /V063 S,VI/ 1/8 .r Cr: New dwelling area: , 767 square feet City/State/ZIP: 1"i(.0A RD t Okt. , c1 2.2.y Garage/carport area: 5/Z square feet Suite/bldg./apt.no.: Project name: v%Covered porch area square feet j�B Cross street/directions to job site: 1 'i 70 -/-1,1/2 (Deck area: )G�Q J `y �-��'(3'�(�E. r square feet v 7 Oer structure area % , square feet REQUIRED DATA. MERCIAL-USE CHECKLIST Subdivision: b t L 1/4.1 0 0 M Lot no.: * e... D V t.tJ rj. �,� 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 DESCRIPTION OF WORK work indicated on this application. Nts-LS/ s, ivt LE v--pdM'►iLy c -ES IOL74.)(-C Valuation: $ Existing building area square feet New building area: square feet PROPERTY OWNER ".TENANT Number of stories: Name: Type of construction: Address: ,.o'C ASA pi L:�� Occupancy groups: City/State/ZIP: Existing: Phone:( ) . Fax:( ) New: p�qq APPLICANTBUILDING PERMIT FEES* trF^ 0CONTACT PERSON '' Business name: lr (Please refer to fee schedule) - �p?,!�/ '1 C� IO Structural plan review fee(or deposit): Contact name: 'b fww 1 D o,c H p aF'po p.- FLS plan review fee(if applicable): Address: F•0. ,L. c >< 15"7.7 City/State/ZIP: 2 t,Y .��ti 0� 97 07 e Total fees due upon application: 4 Phone:(5o3) 590 _ O 3 o S Fax::(.�3) 5�}0.,. `-7 5 , Amount received: ��� E-mail: 04 1z i, 0 ,S ri AA S A�1 CO PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-tor mounted Photo Voltaic Solar Panel System. Business name: t ,� Submit t (2)sets of roof plan with connection det aAse Address: 1_n P 9)-6,, L. and fire dep. r.-lit access,along with th• i Oregon SSolar Installation ialty Co•, ecklist. City/State/ZIP: /3 tIV aiPermit Fee(in lanreview $180.00 r admmrstrah', ees ): Phone:( ) Fax:( ) States rcharge(12%of permit fee): $21.60 CCB lic.: 7 i 0 37 Total fee due upon application: $201.60 Authorized signature: '� /, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:,`pv 1 o z D1T, -f-Date: 1/.- , /� *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application 1 FOR OFFICE USE ONLY City of Tigard 1 • Received /� �}��/ 13125 SW Hall Blvd.,Tigard,OR 'x-� .,l n ' Date/By:1. 1} /49-0 go Calb Permit No.:h0-51—c9 'C 6��5-6S- 11 Pl Phone: 503.718.2439 Fax: 503.598.1960 Dan Review Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 NOVDate Ready/By: H y: Juris: See Page 2 for Internet: www.tigard-or.govV �� 3 Notified/Method: Supplemental Information 116" R TYPE tr'w R � Try COMMERCIAL FEE* SCHEDULE — USE CHECKLIST q� J'" '� ¢� � t`" Mechanical ;New construction 0 Additiclrfatc»/Y� a emenl^ permit fees are based on the value of the work p performed:Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* r0l-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 JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: /V4068 .St (A/ //8 Cr' Furnace 100,000 BTU(ducts/vents) j 46.75 City/State/ZIP: 'T—i 149---D . OF, Furnace 100,000+BTU(ducts/vents) 54.91 r Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: i I 0 -HA ky G A-Pt v2-1) 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: pS Lot no.: Other: 23.32 L + 1t j�C��' � Other fuel appliances: Tax tnap/parcel no.: Water heater J 23.32 DESCRIPTION OF WORK Gas fireplace/insert f 33.39 Flue vent for water heater or gas / i"-) 6/1J b t.c-: PAIS 1 L..1/ i / j� _dUt fireplace 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Et PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Sp.f4/1 -&--- P.5 B-- `--- Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: cup__ Fuel piping: �{� t I CT j� $14.15 for first four;$4.03 for each additional Contact name: 1:2) AY I D ,.,,De..- H , epo�-j--- Furnace,etc. Address: gC) c;>( LS 7--2 Gas heat pump Wall/suspended/unit heater City/State/ZIP: � �� LT1� t 9 .707 s.S. Water heater Phone:(<43) 5 7io 0 3 0 S Fax::(5,;.):3) cIO 1—1 s i Fireplace E-mail ©(l ft_D CO S T' ''C �) RangeM"s ` COC O 1 L Barbecue CONTRACTOR Clothes dryer(gas) Business name: '' „, .�.72A i..... Other: D.'t MECHANICAL PERMIT FEES* Address: x 4,3Subtotal City/State/ZIP: c, L L444\ 0 9-__ ( -7 o l s Minimum permit fee($90.00) 5/S/ Plan review(25%of permit fee) Phone:(5(53) ,S 4 og [Fax:(St 3) (05 Cj .--3S) !j S/ — State surcharge(12%of permit fee) CCB lie.: 17."b t--/ TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 /-/ days after it has been accepted as complete. ,Z) Authorized signature: Fee methodology set by Tri-County Building Industry Service Board Print name: Act, !D et) J4 p ate: //._.Z I:\Building\Permits\MEC_PermitApp_040113.doc 440-46171'(11/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY City of Tigard - 11 ,'p. Received ® permit#: )57.---90t le-605--Os- III _ 13125 SW Hall Blvd.,Tigard,�'e 9 , Plan Review Phone: 503.718.2439 Fax: 51 . :19 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: .Auris: ® See Page 2 for T 1 G A R D Internet: www.tigard-or.gov Nov f 2 Z015, Notified/Method: Supplemental Information LIL TYPE OF WORK PLAN REVIEW "" g h, �i 9 s i Please check all that apply(submit 2 sets of plans w/items checked): 5(New construction ❑Additionll feta it> leptatl hi ' 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition El1$�T Other:. 71 , V' `�.1+0�`` �^( where the available fault current 0 Marinas and boatyards. CATEGORY CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. l,1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address:/4/0 6 9 s-, VV' /1 8 1 .f 100HP or more. ❑"A","E","I-2","1-3", ❑Six or more residential units. occupancy. City/State/ZIP: TA 0 p`(Ll7 OR 9 -7 L Z z71 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 1 1 3 - t il-AP-OE, FEE SCHEDULE Description I Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision: 1't=1)A L LA0 N tk/7C`� S Lot#: 2.5. Includes attached garage. 1,000 sq.ft.or less J 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 ��yy ..--- (with above sq.ft.) /•-/ '1-,..) S I ;,: P-Pm J ) PI t-/ 124 i 0 1•.iC..tr5 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy . 0 See Page 2 aPROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 _ 201 amps to 400 amps 133.56 2 Address: A i`ft PS -.7-1_-0 L3 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) 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 APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: Fo`„t t.2. D C. ,K3 stalk c `4 r,.3 above service or feeder fee, 7.42 2 each branch circuit Contact name: ) 7J Vi D G ,141A,32pp 2 .B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: h�,c) , Pv./ LS 7 -7 branch circuit City/State/ZIP: B� ✓e- 0 of , 9 70`7 s Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(.‹,,,3) 5-70 L'3; 'Os Fax: :(533) .9c'- r S 1 Each manufactured or modular 67.84 2 D dwelling,service and/or feeder Email: Fou. Z. J� 6 NSA , dos Ai , c_cl 6/1_ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: L&re �I-ec r lc_ &R J p Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address: CO I S'� M E , 9 L A/f p ., 4 1 /0 Vpanel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/Z1P: Pp RT 1--.04.3 D OP,. !Q� 7 2..2--0 Additional inspection(1 hr min) 66.25/hr ij Phone:(� y3) '1-7 7 --3 78e, Fax:(i6-120 '?o j — 7 9 �7 / Investigation(1 hr min) 66.25/hr Email: 1� �� Industrial plant(1 hr min) 78.18/hr t5.1..C�'eeL e�-T� �-6('zar C G M,1'� I Inspections for which no fee is � specifically listed(%Z hr min) 90.00/hr CCB Lic.: 1 9 i "-z-7,-/ C/Electrical Lie.: C t,3 Suprv.Lie.: 5762, w�2 ELECTRICAL PERMIT FEES r/�'Gr Suprv.Electrician signature,required: Subtotal: Print name: licit) 1'4'x?rn�ivpAgI Date: dt/_Zfie: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: /, 941.11." TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ,�i Print name: o O/ „1--., ,6_-_-,44,1,11 4-—Date: d 1 z g.../.6, days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Pernits\ELC_PernitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB Plumbin2 Permit Application Building Fixtures 5 44'�J FOR OFFICE USE ONLY Cityof Tigard Received ^ Permit No.: ) { / g Date/By: I� t Sj i t l5l /f( 625 IIII r 13125 SW Hall Blvd.,Tigard,OR 972 ig t Plan Review - Phone: 503.718.2439 Fax: 503.598''1 tl " 1 L'I`-: Date/By: Other Permit No.: _ T I G A KD Inspection Line: 503.639.4175 4.,;.,-,1; �.. 1 _ Date ReadyBy: Saris: ® See Page 2 for Internet: www.tigard-or.gov + ,.c i' t t kx" ,ii, i" Notified/Method: Supplemental Information sal' `v r �' FEE'�'SCHEDULE TYPE 0����;�a; )) '/I�4�� i"= J'New construction 0 Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 igf 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath J 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 r,.1Q b SI 4: ii 8 Ila Catch basin or area drain 18.76 C 7- Drywell,leach line,or trench drain 18.76 City/State/ZIP: T-(('FWD 0 I' 9 ' Z Li 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: l i B - g 6,14,412.0e-,- 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: iyi rgD A Lt i t j a,,,cs, I Lot no.: 2s Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK _ Clothes washer 25.02 i`ii -(>J 51/1/4.)1_,I.CZ EF M 1 c y 1�-c: i e tY Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 1 I'PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: Floor drain/floor sink/hub 25.02 Address: Pi'1Lt: P.5 BE 1. fit,-> Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 [ ,APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: rh Medical gas(value:$ ) Page 2 `-� s 't t"rta, Primer 12.51 Contact name: G)F' O I 0 De . (� ����1'-t+`y `'� Roof drain(commercial) 12.51 V'"� Address: C 74 /' 7 7 Sink/basin/lavatory 25.02 City/State/ZIP: Y t.-) 0 e'- 9"7®y2,.S Solar units(potable water) 62.54 Phone:(5;3) 3cio 0 S 0 S Fax: : 3) 5-90 - t- S 1 Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: uL 11- D 63 N S'r ek.ii.Sly t co All 25.02 Water closet CONTRACTOR Water heater 37.52 Business name: `-r-µ )U L L* .IJ c.c.)`" i e AN 7 Water piping/DW V 56.29 Address: 16C,)1 A S, C . p. ‘ / %Z... Other: 25.02 City/State/ZIP: IL_ . LS Bc -0 i 0 9' ) I.1 3 Subtotal Phone:(5'03) 6,'4V --0 t 13 Fax:( ) Minimum permit fee: $72.50 �2_65,S 3q 2G O Pb Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: ,4011° .' TOTAL PERMIT FEE i Print name: / Date: l z /� This permit application expires if a permit is not obtained within 180 days �/�(//� �� hJw �/- after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\BuildingWermits\PLMU'PermitApp.doc 10/01/09 440-46I6T(10/02/COM/WEB) City of Tigard :11111 111 N COMMUNITY DEVELOPMENT DEPARTMENT c A R D Building Permit Review — Residential Building Permit #: H 5T a.C I to — O b 5p 5--- Site Site Address: 140(p ii SCJ df El-ti Li Project Name: 146dalV( (Iv, Mead J A)_1 Lot #: . S (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: .J .e ;,,y i c. e tk A SF I `Verify site address/suite#exists and active in permit system. W.-River Terrace Neighborhood: W No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: Three(3)copies of site plan .OExisting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations ..EINorth arrow f Dtility locations(required for new,may apply for additions) VSite address,project or subdivision name and lot number cation of wells/septic systems Applicant information(name and phone number) hxisting trees to be retained with drip line,and tree Lot dimensions and building setback dimensions protection measures ....pt t area,building coverage area,percentage of coverage and street tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) k treet 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 "No Received: ❑ Yes ❑ No kr Public Facilities Improvement(PFI) Permit: Required: L '-'"Yes,applicant was notified ❑ No ApFor:plied PPlid X Yes ❑ No,stop intake (-Land Use Case#: S U 3,U — i iu v( Zoning: R- 4 .5 ad'Required Setbacks: Front cao Rear 15 Side 5 Street Side to j5 Garage d 0 Landscape Requirement: -ErLot Coverage Maximum: 0/0 .0'Building Height: Maximum Height ) Actual Height 41,.,)7 :V.Visual Clearance IR'Easements Sensitive Lands: ❑ Yes No Type .R'Urban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: r,tuLti,..., 0 Oak:� E� Date: 1 I -a€i - i b Revisions (after Building Submittal only) Reviewer Revision 1: ❑ Approved 0 Not Approved Date Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved ❑ Not Approved l:\Building\Forms\B1dgPerniitRvw RES 091216.docx Building Permit Submittal Original Submittal Date: /flag /ii Site Plans: # 3 Building Plans: # Building Permit#: 2'Enter building permit#above. la-Building Routing: CJ'Planning -Engineering Permit Coordinator Workflow Sign-off: Er Sign-off for Planning(include notes from planning review) Route Application Documents: 0 Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan reviewl routing forcatim. Buding: originapermit applion,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: \ / By Permit Technician: ( 1) C Date: /f/A f!l i,6 11‘.. AMININ Engineering Review (76Slope at building pad: ❑ Conditions "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 .if' No Assess Water Quantity Fee in-lieu: ❑ Yes ,-Er No LIDA Facility on lot: ❑ Yes —No ❑ NOT Approved by Engineering: Date: Notes: / Approved byEngineering: lvcdLi L� • Date: to Z I1 PP � � 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: :.' es ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: / Yes ❑ N/A 1?4:1 OK to Issue Permit /14-P4'Approved by Permit Coordinator: /����'11�ate: I:\Building\Forms\BldgPermitRvw_RES_091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14068 SW 118TH CT, TIGARD, OR, 97224 June 20, 2017 at 1 :27:11 PM Record Type: Record ID: Residential - Master Permit MST2016-00505 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Provide permit for AC installed without permit. Protect copper line set tubing from concrete contact, appears to be buried in concrete without protection. M1309.2 Seal all mechanical penetrations in garage. R302.5.3 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14068 SW 118TH CT, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2016-00505 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14068 SW 118TH CT, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2016-00505 Inspection Type: Inspector: 299 Final inspection Jeff Grove Result: PASS - CofO Comments: Violation Summary: Inspector Contractor