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Permit CITY OF TIGARD MASTER PERMIT Permit#: MST2016-00365 ` 2 '- COMMUNITY DEVELOPMENT r �°'�� Date Issued: 05/04/2017 T f(-ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 � , if ,A Parcel: 2S 1700 Jurisdiction: Tigard Site address: 14248 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 10 Project: Medallion Meadows, Lot 10 Project Description: New SF.7/10/17: REPRINTED permit to show reduction of hose bibs from(2)to(1). 3/21/18: REPRINT to add A/C unit, backflow preventer.4/5/18: REPRINT to add 399 SF of stairs to deck. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1289 sf Basement: 818 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 4 Second: 1404 sf Garage: 852 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 3511 sf Value: $442,712.43 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 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: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 7 201-400 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 3511 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 Geotechnical Inspection TIGARD,OR 97223 Required before foundation PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $32,611.04 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo�ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. -75 Issued By: �%., ., Al .[ i-- Permittee Signature: l� e�� - �GC� �I T 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. City of Tigard ■ COMMUNITY DEVELOPMENT DEPARTMENT TIGAD Building Permit Review — Residential Building Permit #: 7-Xi& 365— Site Address: j L 4 S 6 J ) 5 ` (►-I Project Name: M cd i i 0n Mew-laws Lot #: ) 0 1 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N" F cle-I-aci,t.A- 1-e.s-, denCiL, /91� S'Z.j%'S 7b rev/- v.7c- /SF L l Verify site address/suite#exists and active in permit system. River Terrace Neighborhood: ikrNo 0 Yes,See River Te►race Review Addendum Attached Site Plan Elements: ilt ree(3)copies of site planxisting structures on site ert-tte plan must]x on 8-1/2"x 11"or 11 x 17"paperFootprint of new structure(including decks)with finished I'f.rawn to scale(standard architect or engineer scale) "floor elevations M. orth arrow ) t tility locations(required for new,may apply for additions) Lite address,project or subdivision name and lot number J27,cation of wells/septic systems n pplicant information(name and phone number) sting trees to be retained with drip line,and tree t dimensions and building setback dimensions protection measures ...21iot area,building coverage area,percentage of coverage and ,treet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) Iet names 1roperty corner elevations(2 foot contour lines if more than r) 4 foot differential) {Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified J5rNo Received: 0 Yes 0 No NiPublic Facilities Improvement(PH)Permit: Required: 0 Yes,applicant was notified 0 No Applied For: 7'Yes 0 No,stop intake l-Land Use Case#: 6 L oD.U 1 aj -- 0000 L oiling. R._4 -5 Required Setbacks: Front €90 Rear ) S Side 5 Street Side Garage J o 1 Landscape Requirement: Vo of Coverage Maximum: % \'Building Height: Maximum Height '30 Actual Height A 7 Visual Clearance Easements arRensitive Lands: 0 Yes ri'No Type Urban Forestry Plan Conditions"Met"prior to issuance of building permit tes: Approved By Planning: ' �_044„,,..,,✓ Date: q -- is, (9-/co Revisions(after B 'ding Submittal only) ` R4yie ate Revision 2: 0 Approved 0 Not Approved 4 t- , Revision 3: 0 Approved 0 Not Approved IABuildingTorms\BidgPennitRvw_RES_091216.docx Building Permit Submittal Original Submittal Date: q�l9/1G Site Plans: # —3 Building Plans: # Z...._7 - Building Permit#: nt building permit#above. Workflow Routing: E I.V.—Planning I ngil�P neering ern it Coordinator L g Workflow Sign-off [3 -off for Planning(include notes from planning review) Route Application Documents: Engineering: (1)copy of permit application,(1) site plan,(1)building plan and original plan review routing form. iding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: _,,�.,� �� - Date: �L�/i(� 1 Engineering Review Slope at building pad: if !.: l Conditions"Met"prior to issuance of building permit • /6 Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes No Assess Water Quantity Fee in-lieu: 0 Yes No LIDA Facility on lot 0 Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: _ Date: • ly) Reviewer Date Revisions(after Bum ubmittal o Not Approvad' 11., . Kj 4 fit 3-2- -/P3 Revision 2: 0 Approved 0 Not Approved .r. Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review ❑ Conditions"Met"prior to issuance of building permit ,\ 0 Approved,NOT Released: Date: Notes: Revisions(after Building Submittal only) e��1 A, Ng**I: 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 0 N/A ( — Tigard Trans SDC: .- es 0 N/A Parks SDC: PA-Yes 0 N/A K to Issue Permit, APP Y roved b Permit Coordinator: Date: 40.11k I:\Building\Fonns\BldgPermitRvw RES_091216.docx 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 NI Transmittal Letter r i t i A R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: krY1 DATE RECEIVED: 14 q DEPT: BUILDING DIVISION w/ MAR 2 9 N18 FROM: `%i'/9Gr,U �J C7'/SC-'/f/ COMPANY: 7 X ;for/ /m/s� ��, ILDPNG PHONE: i(061-(96 /2 z, By:/57, , (Site Address) (Permit Number) "iz . 0/1/ /l%e 7wf lor/0 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. 2— Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMAR : N c lc 9"(= m FOR OFFICE USE ONLY Routed to Permit Tec • Ian: Date: - 2-- J ' Initials: Fees Due: g]Y4si�J No Fee Description: Amount Due: $ 4 Special Instructions: Reprint Permit(per PE): / El No ❑ Done Applicant Notified: Xed__ )1:es 47'/S I:\Building\Forms\TransmittalLetter-Revisions 061316.doc CITY OF TIGARD MASTER PERMIT III a. '' COMMUNITY DEVELOPMENTPermit#: MST2016-00365 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i!.. .;,.P. t ; Date Issued: 05/04/2017 TE �t1 R. 9 ' ` pp Parcel: 2S110BA11700 inTJr /I ear. Jurisdiction: Tigard Site address: 14248 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 10 Project: Medallion Meadows, Lot 10 Project Description: New SF. 7/10/17: REPRINTED permit to show reduction of hose bibs from (2)to(1). 3/21/18: REPRINTED permit to add A/C unit and backflow preventer. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1289 sf Basement: 818 sf Left 5 Parking Spaces: 0 Height: 27 Bathrooms: 4 Second: 1404 sf Garage: 852 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3511 sf Value: $442,712.43 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 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: 1 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 500 sf: 7 201-400 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 3511 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 Geotechnical Inspection TIGARD,OR 97223 Required before foundation PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $32,566.04 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the opted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through R 952-001-0090. Y a cop of the rules orN1irect questions to OUNC by calling 50 .1987 or 1.800.332 2344. Issued B �� - • ee Signature: wi''' T ' L''a� Cal 0 .9.4175 by 7:00 a.m.for the next available inspection date. ". This permit card shall be kept in a conspicuous place on the job site until completion •f the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application ,(,. I. POR OFFICE ESE OV'1.1' City of Tigard it Received �° Date/By: -r/ �� Permit No.: 13125 SW Hall Blvd.,Tigard,OR 972 , I Phone: 503.718.2439 Fax: 503.598.1 Plan Review Date/By: Other Permit: 7 I G A R D Inspection Line: 503.639.4175 \.\\$ Internet: Line:g rd-or.gov t� * - + Date R11ffl See Page 2 for t F r ;A e Ready/By: eadNotified/Method: Supplemental Information lii TYPE OF WOR :\ IL A-At COMMERCIAL FEE* SCHEDULE- USE CHECKLIST :44/ y New construction ❑ •Addition/alteratiJ Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all El Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ t RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling 0 Commercial/industrial 0 A , •-,, r; g For special information use checklist ❑Multi-family 0 Master builde ✓ 0 Ot Description �. ,.. Qty. Ea. Total JOB SITE INFO TION D LOCATIO Heating/cooling: Job site address: `t1 u.► Air conditioning ' 46.75 '� I $� /r v Furnace 100,000 BTU(ducts/vents) 46.75 - City/State/ZIP: rt y/1' 9 Furnace 100,000+BTU(ducts/vents) 54.91 - Suite/bldg./apt.no.: 1 3 yk.► Project name: Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: 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: Lot no.: /d Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 x, PEST,R.IPTJOlki OF WORKGas fireplace/insert 33.39 Flue vent for water heater or gas . (4- ! ' /9atti fireplace 23.32 /� _ Log lighter(gas) 23.32 &jam.y t e 51,V/ r C��.��i '6 -a�' "� Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROP TX.OWNER Other: 23.32 „( TPNANT Environmental exhaust and ventilation: Name: �i� a>�, (i(<k/f>' Range hood/other kitchen Address: i�e0 )l/ 9 z � equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Til-A4 il- , Single-duct exhaust(bathrooms, j/'q - toilet compartments,utility rooms) 23.32 Phone: (93 )C,) /-26- c Fax:( ) Attic/crawlspace fans 23.32 0.APPLICANT ;. lam'comAcT.PERSON Other: 23.32 Business name: "r` j�J�j � Fuel piping: ��"� / $14.15 for first four;$4.03 for each additional Contact name: rO )tjf A. t/ Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:c77, ) r ,1(07_, Fax::( ) Fireplace E-mail: Range Barbecue CONTRACTOR Clothes dryer(gas) Business name: J-7.-- �j�,,N coin >K , Other: Address: /2-- a) 7 / 1 `S- /l�jT�I MECHANICAL PERMIT FEES* `ZL✓ / Subtotal t ,` .5 City/State/ZIP: 77?"-i7)1-11 Minimum permit fee($90.00) Phone: Plan review(25%of permit fee) ( ) Fax:( ) State surcharge(12%of permit fee) 5'; (�i CCB lic.: `yiy you TOTAL PERMIT FEE 5) // This permit application expires if a permit is not obtained within8 0 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: e ij,/,0 ,7 - tit Date: //Z./AO, I:\Building\Permits\MEC_PermitApp_040113.doc (11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Plumbing Permit Application Building Fixtures t o ,4t i�, FOR OFFICE USE ONEI' City of Tigard ,. . _ Received Ill 13125 SW Hall Blvd.,Tigard,OR 97223T\\\''''''' Date/By: 3 f��I � � Permit No.:/v07-71)i Phone: 503.718.2439 Fax: 503.598.1960 Plan Review TIC A x U Inspection Line: 503.639.4175 Q i 'i Date/By: Other Permit No.: Internet www.tigard-or.gov a8 .tReady/By: Jens: See Page 2 for .,, •.1llotified/Mcthod Supplemental upplemental Information �a r TYPE.OF-WORK ‘,1 't Y. s FEE* SrrLIEDULE= ■ ew construction 0 Iibl11i6n For special information use checklist cription❑Addition/alteration/replacement ElOther • QtY• Ea. Total IDes New 1-2-family dwellings(includes 100 ft.for each utility connection) _.. •(ATEGORy:O� coNSTRUcTION SFR(1)bath 312.70 llil 1-and 2-family dwelling ❑Commercial/ind " ,i SFR(2)bath 437.78 ElAccessory building 0 Multi-family SFR(3)bath 500.32 El Master builder Each additional bath/kitchen 25.02 0 Other Fire sprinkler( sq.ft.) Page 2 ,# f` -,=+, 400 SJTE,'INFOR IATTI•N:,AND LOCATION t'_ i „n, Site utilities: Job site address: / / 5 51 nom //(,J) j7 Catch basin or area drain 18.76 City/State/ZIP: T� [ 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: 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer ./r31.27 27 '3 f y7 ,,.. ' Backwater valve � C ION (�F'"�'� lil�" � � 12.51 ,,f/ / e I � / Clothes washer 25.02 WDishwasher 25.02Wadded 7i t'' 1 SX hrr9 evevN 01-//15) )0/- (,--Cti 9 r ) • • g fountain 25.02 Ejectors/sump 25.02 ■ � �0 �. :., -� � w• �; � '� r�ANT v, � , *•;. Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker ft x1 12.51 i •f ' 4,k ' cor TACT:I'ERSs`Nu -, Interceptor/grease trap 25.02 Business name: T' /f 0,9) / yt/s/ Medical gas(value:$ ) Page 2 Contact name: /spa 5;./ 2 Primer 12.51 Address: Roof drain(commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:1)3 ) '-G'0l'•Of," -z..., Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 > , t10NTR. .,,, .--. Water closet ` � - ,: � 25.02 W _. ,,, ., ,. . Water heater Business name: 37.52 MM/t - ela Ltd:- Water piping/DWV 56.29 Address: 00 Other: 25.02 City/State/ZIP: -7-1-6„,„,,,,e,, Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) CCB Lic.: ell 1,-.7 Plumbing Lic.no.: Plan review (25%of permit fee) Authorized signature: State surcharge(12%of permit fee) M. �" � TOTAL PERMIT FEE g'ggim rot Date: 7 e4, This permit application expires if a permit is not obtained within 180 days IRMIMSPafter it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46161(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty• Fee(ea) y Total •Square Footage: , Permi .:. ee: " r Footing drain-1't 100' 50.03 0 to 2,000 $121.90 37.52 2,001 to 3,600 $169.69 Footing drain-each additional 100' 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 ua 0i1 ''; Perm it Fie ` ,` ' = Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 • $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for bil ? each additional$100.00 or fraction thereof,to ler Inspections or Fees F � 0 and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. : ', l n 2eyiev'.1.10 Plu mban I *aU i o S k~ Quantity by Fixture Type; n Plan review is required for any of the following. Fixture Type for - Replace/ ' Please check all that apply. Capped Work Performed: 0 Any new Added ReIotate new commercial buildingwith water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain sink: -2" o 11eji a or ,oi.r ' . ry 4 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 .1,1 CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016-00365 17 f+Ca al ft D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2017 FR{ �� ,�� Parcel: 2S1106A11700 M Jurisdiction: Tigard Site address: 14248 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 10 Project: Medallion Meadows, Lot 10 Project Description: New SF. 7/10/17: REPRINTED permit to show reduction of hose bibs from (2)to(1). BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1289 sf Basement: 818 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 4 Second: 1404 sf Garage: 852 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3511 sf Value: $442,712.43 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 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 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 7 201-400 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 3511 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 Geotechnical Inspection TIGARD,OR 97223 Required before foundation PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $32,478.65 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y. ... obtain copy oft - es or direct questions to OUNC by calling 503.232.19: or 1.800.332.2344. - 6 Issued By: lar.-_ _..........i.02.:..._ Permitteecalling 50AL l` 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 e project. Approved plans are required on the job site at the time of each insp on. CITY OF TIGARD MASTER PERMIT 2..' COMMUNITY DEVELOPMENT PermitIN #: MST2016 00365 T f aA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2017 Parcel: 2S110BA11700 Jurisdiction: Tigard Site address: 14248 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 10 Project: Medallion Meadows, Lot 10 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 1289 sf Basement: 818 sf Left: 5 Parking Spaces: 0 Height 27 Bathrooms: 4 Second: 1404 sf Garage: 852 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3511 sf Value: $442,712.43 Rear: 15 PLUMBING Sinks: 2 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 500 sf: 7 201-400 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 3511 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 Geotechnical Inspection TIGARD,OR 97223 Required before foundation PHONE: PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $32,388.65 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throu AR 952-001-0090. -- -: -- -in a c•• • .- rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344 Illialb- Issued By• _ Permittee Signature: :....01....4111111.4111 . . ' 3.639.4176 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 •. project. Approved plans are required on the job site at the time of each inspect'• . • Building Permit Application 6' ,�. / 6 Residential 10k 0111( 1. 1 'l 0y►.l G City of Tigard Received y j Date/By: Ci tel/l 4377- Permit No.:/4157,7,h /0 /�5 !Pli II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review L6 Phone: 503.718.2439 Fax: 503.598.1 0 Date/By: ` - ^' ) C T �"�Fermi: J 'l ie'-1 ,j l r I c;n at t� Inspection Line: 503.639.4175 t 1° Date ReadyBy: II �w>¢, ® See rage 2l for Internet: www.tigard-or.gov -t", (N;-, ^, -, Notified/Methods: r (ri L;,L-t,, Supplemental Information �, ▪.,;.'(314,,Rr Permit fees*are based on the value of the work performed. ®New construction [ nibll r J !kr.r� ,-1 i q 1 )i 5 1 Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement �] equipment,materials,labor,overhead,and the profit for the 4 -� work indicated on this application. . _ .,�� ▪ �� ,, _ Valuation: $500;D0999- `j 11c, ® 1-and 2-family dwelling 0 Commerciallindustrial ❑Accessory building 0 Multi-family Number of bedrooms: 4 ❑Master builder 0 Other: Number of bathrooms: 4 S� Total number of floors: 3 �.3 Job site address:14248 SW 118th Court New dwelling area: 3511 square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: 852 square feet Suite/bldg./apt.no.: I Project name: f �jjL, p') / y /e f-,�y Covered porch area: 25 square feet14 Q 4— Cross street/directions to job site:Gaarde Road to 118t`Court Deck area: 336 square feet J a 2 9 Other structure area: na square feet 2 ' 8 tt13 �� „I',jl, i § t, 4 't Subdivision:Medallion Meadows I Lot no.:10 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 D -� work indicated on this application. Construction of new single family residence Valuation: $ Existing building area: square feet New building area: square feet I. A �l+i'll' Number of stories: Name:J.T.Roth Construction Inc. Type of construction: Address:12600 SW 72°d Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(503)639-2639 Fax:(503)624-0239 New: ' ” ,. r r.., 3,.,. ,max ., ! , '' PEP ON ` ti Business name:J.T.Roth Construction Inc. " ` rvm -. Structural plan review fee(or deposit): Contact name:David Jensen FLS plan review fee(if applicable): Address:12600 SW 72°d Ave. Total fees due upon application: City/State/ZIP:Tigard,OR 97223 7S l' Amount received: Phone:(503)806-0602 Fax::(503)624-0239 ", E-mail:davidj@jtrothinc.com t Commercial and residential prescriptive installation of -i .4 „ ,_ 7-taf- x. „ ; , , z t P, ,: , f ,, N.-- roof-top mounted PhotoVoltaic Solar Panel System. Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:12600 SW 72"Ave Solar Installation Specialty Code checklist. City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review $180.00 and administrative fees): Phone:(503)639-2639 Fax:(503)624-0239 State surcharge(12%of permit fee): $21.60 CCB lic.:31700 Total fee due upon application: $201.60 -- Authorized signature. / This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name:D< Jensen Date:09-16-2016 *Fee methodology set by Tri-County Building Industry Service Board. I kBuilding\Permits\BUP-RESPermi 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application [(4z 01,1.1( I 1 SF O'l.l City of Tigard Received Permit No.: S77/�f(--+ „,,'' -S 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review It Phone: 503.718.2439 Fax: 503, 8.496 Date/By: Other Permit: T I(;\RI) Inspection Line: 503.639.417 n,- a ,l0\Cj Date Ready/By: Juris: Fd See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information 44 " 4 "„ ' " Mechanical permit fees*are based on the value of the work ®New construction 0 Additio 'tot v: y replacement performed.Indicate the value(rounded to the nearest dollar)of all Demolition 0 Other: mechanical materials,equipment,ent,labor,overhead,and profit. Value:$ I ® 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 * -, Heating/cooling: Air conditioning 46.75 Job site address:14248 SW 118th Court Furnace 100,000 BTU(ducts/vents) J 46.75 City/State/ZIP:Tigard,OR 97224 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.:10 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 t,.' t ;o x I > - Gas fireplace/insert 33.39 .. .. . . , , .. . • .., .. ,") - .. Flue vent for water heater or gas HVAC installatioin at 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 ' 23.32 � . � 3l * " Other: -. t . . ,t,,. a � � F :4 3 , uf=. 2„, ,, - . _ 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)639-2639 Fax:(503)624-0239 Attic/crawlspace fans 23.32 i .% . .. * V . tJi 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°d Ave. Gas heat pump Wall/suspended/unit heater , City/State/ZIP:Tigard,OR 97223 Water heater Phone:(503)806-0602 Fax::(503)624-0239 Fireplace Range E-mail:davidj@jtrothinc.com Barbecue . ._ .,. fi ag . , f . _ . Clothes dryer(gas) Business name:All Time Heating LLC Other: Address:PO Box 1341 Subtotal I City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)208-2276 Fax:(503)208-2276 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: s Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svoboda t` Date:09-16-2016 I1Building\Pennits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Electrical Permit Application IOR 0141( I: l SE Oyl City ofTigard r, 3 Received Permit#: `J g ? DateBy: P1,57;90��: t:)()i��5 II N` 13125 SW Hall Blvd.,Tigard,OR 97223 ": t; , ,,,.,, plan Review 3 Phone: 503.718.2439 Fax: 503.598.19 ', ° Related Permit 4:F Date/By: Inspection Line: 503.639.4175 @: Ready Date/By: Juris: 63 See Page 2 for T I G A R D Internet www.tigard-or.gov A g �3 1 u Notified/Method: Supplemental Information ®New construction 0 Addition/alteratlon/rpt1 TI1�1 f"°t‘N It, Please check all that apply(submit 2 sets of plans w/items checked): �„I ` x ° 0 Service or feeder 400 amps or more 0 Building over three stories. where ❑Demolition ❑Other where the available fault current 0 Marinas and boatyards. iv 17°1l A exceeds 10,000 amps at 150 volts or ❑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 t t " 4 �,l 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 14248 SW 118th Court 100HP or more. ❑"A","E","l-2","1-3 City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. 0 oc ccvehicle arks. 13Health-carefacilities. p 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:Gaarde Road to 118th Courtz Description 1 ,Q )ty..L.., Each. ,,I r .Total f New residential single-or multi-family dwelling unit. Subdivision:Medallion Meadows Lot#:10 Includes attached garage. 1,000 sq.ft.or less 1 168.544 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 7 33.92 1 R, , r h D. (W WORK. ,x., .. , ., z ,.,. , Limited energy,residential Wiring of new single family residence (with above sq.ft.) 1 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 ,.. ,.F 't r_,,y.. *T°,.. . f` .. t . ..,�..a z �5`. . ... . .. 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)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 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 f al Branch circuits—new,alteration,or extension,per panel L . . E. yr a r:F�.., . a,. ,, 1'i, ,. , �,,. 0 �,. ,.. 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: service or feeder fee,first 12600 SW 72nd Ave. 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)806-0602 Fax::(503)624-0239 Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:davidj@jtrothinc.com Reconnect only 67.84 2 Vii` .,, . , . .. . . s .., Pump or irrigation circle 67.84 2 Business name:Grizzly Electric Sign or outline lighting 67.84 2 Address:8002 NE Hwy99 Suite#248 Signal alteration,t(s)or limited-energy 0 See Page 2 2 panel, or extension. City/State/ZIP:Vancouver,WA 98665 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(360)909-4080 Fax:(360)694-8939 Investigation(1 hr min) 90.00/lir Email:grizzlyelectricinc@msn.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 186218 Electrical Lic.: 37446 Suprv.Lic.: specifically fisted(14 hr mm Suprv.Electrician signature,required: Subtotal: Print name: Ron Nelson Date: 09-16-2016 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signatureA. '�-- TOTAL PERMIT FEE: / This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building'Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures 14 OR 011 IR E l til. 0v1.1 City of Tigard t,. Received teBy: Permit No.:/')i57 v/ i 11111 I ■ 13125 SW Hall Blvd.,Tigard,OR 97223i-.1.*;„t s.4,, 4. y' �� Phone: 503.718.2439 Fax: 503.598. , f' Plan Review Other Permit No.: I i c A l�t Inspection Line: 503 639 4175 s, `�Q�� Date Ready/By: inns 61 See Page 2 for Internet: www tigard oT gov (,c Notified/Method Supplemental Information : 4"` .�,�'..W, ,„.`., .-M .•-,a v, r, .�..,r"`i o-, ., f of � O s ,'.�`�.".. ,w r .,, �.. ,.,;.: �. .<,.. .. , ® ,. . r ❑Dei 1l '`�° ,l t � For special information use checklist New construction ,,, �e 1 �) Description I Qty. Ea. Total ❑Addition/alteration/replacement 0 O� " New 1-2-family dwellings(includes 100 ft.for each utility connection) t t� SFR(1)bath 312.70 ® 1-and 2-family dwelling LL 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath /x 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 1 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 z s a i b ,, -. S"' r Site utilities: Job site address:14248 SW 11816 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.: 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.:10 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 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 . . . t* ,` ` 's ad�' Expansion tank 12.51 Name:J.T.Roth Construction Inc. y Fixture/sewer cap 25.02 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 Fax:(503)624-0239 Ice maker 12.51 [ * �i Interceptor/grease trap 25.02 Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:David Jensen Roof drain(commercial) 12.51 Address:12600 SW 72e1 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 E-mail:davidj@jtrothinc.com Urinal 25.02 Water closet 25.02 .i .a;w ''''''"'-'""'"'"''''r ,: ' , . , . . ,�.� . � .�,_v � _ ,... � . ,� 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 CCB Lic.:194089 Plumbing Lic.no.:PB-1022 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:Aaron Luchs Date:09-16-2016 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-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard vit. iti III COMMUNITY DEVELOPMENT DEPARTMENT ■ T I G A R D Building Permit Review — Residential c Building Permit #: /157 J/ ---dL :3 :;c- Site Address: 1 t-1 ,4 Y) 6 t/ ) j ) (l-( , Project Name: Mcci all r0,- foci 6,,,JS Lot #: ) O (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N.(/ t i SF cyi 2l-ack t-c S o d e n ciL. EX Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: "No ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: 0 ree(3)copies of site planxisting structures on site `mite plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished di rawn to scale(standard architect or engineer scale) "floor elevations orth arrowJtility locations (required for new,may apply for additions) [Site address,project or subdivision name and lot number cation of wells/septic systems Lpplicant information(name and phone number) , xtsting trees to be retained with drip line,and tree L,`^'t dimensions and building setback dimensions protection measures ,Lot 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) (`treet names 1 roperty corner elevations(2 foot contour lines if more than 4 foot differential) Vr-Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified At-No Received: ❑ Yes ❑ No Public Facilities Improvement(PFI) Permit: Required: El Yes,applicant was notified ❑ No Applied For: ,'�YYes ❑ No,stop intake Land Use Case#: 6 LLB ()I. aj 0 U 0 0 co roning: IX 4 •5 equired Setbacks: Front ap Rear 1 S Side 5 Street Side Garage p ,j=j-"Iandscape Requirement: -- Jfot Coverage Maximum: 'Building Height: Maximum Height '�jO Actual Height A 7 Visual Clearance Easements ensitive Lands: ❑ Yes V'No Type . f Urban Forestry Plan Conditions "Met"prior to issuance of building permit tes: Approved By Planning: awl., a. 0,„ Date: R fb. 19-150 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw_RES_091216.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: nt r building permit#above. ,� �,��---�� Workflow Routing: �Pla-nning I ngineering Li""Permit Coordinator L�B'ii ding Workflow Sign off: LSi -off for Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. ding: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: --ore" Date: �� , l Engineering Review Slope 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 No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 4L 13 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: Les ❑ N/A Tigard Trans SDC: ►" es ❑ N/A Parks SDC: ►i'Yes ❑ N/A ►��K to Issue Permit Q Approved by Permit Coordinator: Date: % 7)14 I:\Building\Forms\B1dgPermitRvw_RES_091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 March 21 , 2018 at 11 :55:06 AM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Provide approved thread sealant on cleanout caps. 707.3 Locate storm cleanout for inspection. Secure main level powder bath Lay. 407 Provide missing strainer in master shower. 404.1 Provide permit for landscape irrigation Backflow devise, irrigation installed without permit. Note: front storm catch basin covered with bark dust. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 March 23, 2018 at 12:10:41 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Corrections complete. Backflow test report received. 1 " Wilkins model 350, serial # A566163 located left front. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 March 23, 2018 at 12:10:41 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 399 Plumbing final David Young Result: PASS Comments: Corrections complete. Backflow test report received. 1 " Wilkins model 350, serial # A566163 located left front. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 March 23, 2018 at 12:13:05 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Ac installed. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 April 13, 2018 at 12:53:29 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 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. Duct seal test report received. Insulation certification checked. C of 0 left on site with contractor. Deck framing ok per approved revision. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 April 13, 2018 at 12:50:46 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14248 SW 118TH CT, TIGARD, OR, 97224 April 13, 2018 at 12:50:46 PM Record Type: Record ID: Residential - Master Permit MST2016-00365 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: Violation Summary: Inspector Contractor