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Permit (71) CITY OF TIGARD MASTER PERMIT ., , ',,.' 4 '''N .-1 14 .'" ' COMMUNITY DEVELOPMENT p Permit#: MST2017-00256 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 s/`� '/� Date Issued: 11/28/2017 Parcel: 2S 110BA13300 Jurisdiction: Tigard Site address: 14026 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 26 Project: Medallion Meadows, Lot 26 Project Description: New SF. 2/5/2018: REPRINT permit to remove(1)laundry tray and correct number of tub/showers to(3). BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1879 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 628 sf Garage: 455 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Detectors: Yes Right: 5 Total: 2507 sf Value: $405,014.56 Rear: 12 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 0 Y Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: 1 Catch Basins: 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: 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 add'I 500 sf: 4 201-400 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: Square Feet NEW SF VB R-3 2507 Owner: Contractor: JT ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION Required Items and Reports(Conditions) 12600 SW 72ND AVE#200 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 503-639-2639 PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $30,798.74 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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '''Sc;7 Issued By -- Permittee Signature: L�/l/ ,9",".:./ -J?e^il 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 MASTER PERMIT ,Fli¢'' Permit#: MST2017-00256 COMMUNITY DEVELOPMENT Date Issued: 11/28/2017 T I CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S110BA13300 Jurisdiction: Tigard Site address: 14026 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 26 Project: Medallion Meadows, Lot 26 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 1879 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 628 sf Garage: 455 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 2507 sf Value: $405,014.56 Rear: 12 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: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<10OK: 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: 4 201-400 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 2507 Owner: Contractor: JT ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION Required Items and Reports(Conditions) 12600 SW 72ND AVE#200 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175 TIGARD,OR 97223 TIGARD,OR 97223 PHONE: 503-639-2639 PHONE: 503-639-2639 FAX: 503-624-0239 Total Fees: $30,798.74 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 enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1 00.332.23 / Issued By�� ° -A ._.c----' Rarmittee Signature: f `...iiL Ca 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. Building Permit Applicatio il Residential EcEi�P l FOR UI F x( 1: 1 SI.ON Ll Cityof Tigard Received/By: te10 , PermitNo.: '' a 131SW Hall Blvd.,Tigard,OR 97223 J U N 2 9 2017 PlaDatn Reviewi17 rl�� ��as ■ ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: - ,g`� )- - Other Permit:5,0Lo,c'l�Cn�i-- T I c,A!t t, Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: / J Q)' Jig El See Page 2 for ` ^ Internet: www.tigard-or.gov N tified/Method: 7`' I Supplemental Information BUILDING DIVISION , . ' ' , . ... ,rf .., ,.,":�-:�. �.s_. ., r. ,.�s .' . ,,,.., :- ;` . r x's• .M * a. „t`* ►'11 New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEORYt 114 t work indicated on this application. ® 1-and 2-family dwelling Valuation: 9Q 1 o i`r 0 Commercial/industriai El Accessory building 0 Multi-family Number of bedroo 3 ❑Master builder 0 Other: Number of bathrooms: 2. 3 q , MA .' Total number of floors: 2 D49 C Job site address:14026 SW 118th Court New dwelling area: 2507 square feet City/State/ZIP:Tigard,OR Garage/carport area: 455 square feet Suite/bldg./apt.no.: Project name: Covered porch area: 132 square feet /'a$ Cross street/directions to job site:Gaarde Road to 118`h Court Deck area: 174 square feet) 8-1 9 Ca.lw, Vcr Other structure area: 1 � square are feet -.iki7 $'W'0i� 1! i' .. tA fad ." Subdivision:Medallion Meadows Lot no.:26 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 tl work indicated on this application. Construction of new single family residence Valuation: $ Existing building area: square feet , New building area: square feet i 1 `11" � '$° Number of stories: Name:J.T.Roth Construction Inc. Type of construction: Address:12600 SW 72nd Ave Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:(503)639-2639 Fax:(503)624-0239 New: 0 : TAC - �� ,, a ,. ,. . r. , s.. . f �" � t Business name:J.T.Roth Construction Inc Structural plan review fee(or deposit): Contact name:David Jensen FLS plan review fee(if applicable): Address:12600 SW 72"Ave, City/State/ZIP:Tigard,OR 97223 Total fees due upon application: Amount received: Phone:(503)806-0602 Fax::(503)624-0239 7x7) E-mail:davidj@jtrothinc.com �� x. Commercial and residential prescriptive installation of .. . a fill X' , r. a ,. roof-top mounted PhotoVoltaic Solar Panel System. Business name:J.T.Roth Construction Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:12600 SW 72nd 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: $201.60 Authorized signature: - This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ' Print name:David Jensen Date:06/26/2017 Fee methodology set by Tri County Building Industry ervice Board. I:\BuildingTermits\BUP-RESPermi •pp.doc 02/24/2011 440-4613T(11/02/CO Mechanical Permit A t Ili ,:y.,.. I OR 01 I,,( 1� I. I O.1.1 City of Tigard Ei'QEp Datteived /By Permit NoJ)k-/ (7-0D 4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' ■ Phone: 503.718.2439 Fax: 503.598.19 N q ( 2017 DaBy. Other Permit: T t G n R t) Inspection Line: 503.639.4175 �i Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.govCITY OF TIGARD Notified/Method: Supplemental Information x ,' 1 ; . .ht c --00.0,;,- „,,,, ,,--,-.,,r �, Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ ® 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 3 :-t �.' ,Il A lc .„,. , Heating/cooling: ` s Air conditioning x 46.75 Job site address:14026 SW 118th Court Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) x 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.:26 Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 O Gas fireplace/insert 33.39 ,, „, .;, _,v�, ,,,,.' ,,. ., . ,. ,� ,. ., . �,, ., Flue vent for water heater or gas HVAC installation 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 ':► �OP 'b. ., e - "$ t `„ Other: 23.32 Environmental exhaust and ventilation: Name:J.T.Roth Construction Inc. Range hood/other kitchen equipment 33.39 Address:12600 SW 72°d 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 rir p e Other: 23.32 Fuel piping: Business name:J.T.Roth Construction Inc. $14.15 for first four;$4.03 for each additional Contact name:David Jensen Furnace,etc. 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 Clothes dryer(gas) Business name:All Time Heating LLC Other . ? X alvt, Ott _1.. w . . Address:PO Box 1541 Subtotal 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: � * Fee methodology set by Tri-County Building Industry Service Board Print name:Aaron Svoboda Date:06/26/2017 I:\Building\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Electrical Permit A licatio ECEIVEP i OR t,,:r I( l. 1 ti 1; 0\1 1 City of Ti and Received g Date/B : Permit#: i �/ .AI 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 'lig Phone: 503.718.2439 Fax: 503.598.1960 U N Z 1l Date/B Related Permit#: T 1 t A R n Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for Internet: www.ttgard-or.gov Notified/Method: Supplemental Information CITY 0 IVARik. ..i.„,1-'...,_'1::.,,t i t � � m. t .A ®New construction 0 Addition/a 17 a e Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more ❑Building over three stories. 0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards. t.': t° ` exceeds 10,000 amps at 150 volts or ❑Floating buildings. ®"i-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural amps for all other installations. buildings. E. Multi family ❑Master builder 0 Other: El_ um . p p ❑Installation of 150 KVA or t �)� ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 14026 SW 118th Court l OOHP or more. 0"A","E","1-2","I-3", City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:Gaarde Road to 118th Court Description I Qty,Each I Total 1 New residential single-or multi-family dwelling unit. Subdivision:Medallion Meadows ) Lot#:26 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 168.54 4 Ea.add'l 500 sq.ft.or portion 3 33.92 101.76 1 - ' .. r ;, , Limited energy,residential with above s ft. 1 75.00 75.00 2 Wiring of new single family residence ( q ) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) r4 Renewable Energy ❑ See Page 2 ry R*P,' ' t :' :X 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 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 Branch circuits—new,alteration,or extension,eer Panel " ' "�`` * 1 ' . ti ,' ' A.Fee for branch circuits with Business name:J.T.Roth Construction Inc. above service or feeder fee, 7.42 2 each branch circuit Contact name:David Jensen B.Fee for branch circuits without Address: 12600 SW 72°d Ave. service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:Tigard,OR 97223 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)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 . y � o , Pump or irrigation circle 67.842 Business name:Dreamhouse Electric LLC Sign or outline lighting 67.84 2 Signal circuits)or limited-energy Address: 13075 SW Canyon Road panel,alteration,or extension. 0 Page 2 2 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:dreamhouseelectric@gmail.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr lrt-690 5' spectficall�y listed /z hr mm) CCB Lic.: 196726 Electrical Lic.: C-848 Suprv.Lic.: L Suprv.Electrician signature,required: Subtotal Print name: Chris Mahoney I Date: 06/26/2017 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: G,% TOTAL PERMIT FEE: L../ This permit application expires if a permit is not obtained within 180 Print name: —, Date: days after it has been accepted as complete- , omplete. • Number of inspections allowed per permit. I:1Building\Permits\ELC PennitApp_ELR_ERE.doc Rev 06/17/2015 44o-4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures RECEIVEP rO►.& Orr►( ►: l sl: 0v►.1 City14of Tigard Received Permit No.Jk-T4T�/7 � 13125 SW Hall Blvd.,Tigard,Ot 'i 21� �'17 plan Review Phone: 503.718.2439 Fax: 5! . ': 6 Date/By: Other Permit No.: Inspection Line: 503.639.4175 t I t ARD y �� Date ReadyBy: huffs 61I See Page 2 for Internet: www.tigard or.goCITY OF { � Notified/Method: Supplemental Information . . a w . , :,'„,..<.- w Vii , "I New construction 0 Demolition For special information use checklist Description Qty. 1 Ea. 1 Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) C l Rv OF Cold .IJil of SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory building 0 Multi-family SFR(3)bath 1 500.32 0 Master builder 0 Other: Each additional bath/kitchen 25.02 Fire sprinkler( sq.ft.) Page 2 +I+ : `illi , f ATI) '., Site utilities: Job site address:14026 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.: 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.:26 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 s ; jf . ..-;,---,,i,...,,,,-- OWD Backwater valve 12.51 r1S� STF R Clothes washer 25.02 Plumbing of new single family residence Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 l o R'l ,,; ' itOk '# ,: Expansion tank 12.51 Name:J.T.Roth Construction Inc Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:12600 SW 72"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 1E" , c.,.-, ri, p Q* 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 E-mail:davidj@jtrothinc.com Urinal 25.02 � Water closet 25.02 '? . - .. . << Water heater 37.52 Business name:ALL Plumbing LLC WaterPip 1 m WV 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 Luch Date:06-26-2017 This permit application expires if a permit is not obtained within 180 days "``` ��/��/�t 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) plumbing Permit Applic,l i ,,cEivEp p Building Fixtures FOR OFFICE USE ONI.I' City Of Tigard Received 1 '.7 /7 �5 - 2 9 ���f Date/By: Permit No.:M � 13125 SW Hall Blvd.,Tigard,OR AB Plan Review • Phone: 503.718.2439 Fax: 5 9604_9 OF tI VA M D Date/By: Other Permit No.: Inspection Line: 503.639.4175 TIGARD Date Ready/ y. )oris: See Page 2 for Internet: www.tlgard-or.goiT 3ILDING DIVISION Notified/Method: Supplemental Information TYPE FU WORK ll FEE* SCHEDULE New construction 0 Demolition For special information use checklist. Description Qty. Ea. Total 0 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 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 0 Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: /170,46 ‘-t1,/ f/91 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 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: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 /rte Water service(no.linear ft.:_) Page 2 /�/f,?7vi Subdivision: GGJN'/ ✓v/ Ij'^v�j Lot no.: 2_1' Fixture or item: Tax map/parcel no.: Backflow preventer ` 31.27 PFSC 1°N# F VORI _ ,� 4 Backwater valve 12.51 �` �,+ �>`� Clothes washer 25.02 ,J/"" `'-4r � • ✓�7`lflL,i4.-2 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY O fl Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone ( ) i Fax ( ) Ice maker 12.51 ; - AP C :0 NTACT PE } N `! Interceptor/grease trap 25.02 Business name: /0 ., ` _ Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: ,ej9/,/fe J�,u1e Roof drain(commercial) 12.51 Address: /2l (.S"GiJ 92 '7 Sink/basin/lavatory 25.02 City/State/ZIP: eds►�g Solar units(potable water) 62.54 Phone:. ('J3) O ---06 ,2___( Fax:: �) �� -��.3 (, Tub/shower/shower pan 12.51 E-mail: ��-- / Urinal 25.02 „" ,err J�- f '' ' C�t?f V, Water closet 25.02 Water heater 37.52 Business name: 52,4"4/3-y hh9.2$Cg10 Water piping/DWV 56.29 Address: / 7 3 V 7 Other: 25.02 City/State/ZIP: .-z/eJ� .,,,,, J/�3 Subtotal Phone:�`O3) 3$l7 2 j Q Fax:( )/ Minimum permit fee: $72.50 v Plan review (25%of permit fee) S'-x•: y/ (7 Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: ///� TOTAL PERMIT FEE Print name: /: --�� Date: This permit application expires if a permit is not obtained within 180 days k. S 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) Plumbing Permit Application - City of Tigard . Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty• Fee(ea) Total Square Footage: Permit Fee: Footing drain-1'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 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 Valuation: Permit Fee: 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 Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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 (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. 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*. :T1aIIiiteview.for Plumbing Installations Quantity by Fixture Type , Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed; Capped, Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water 0 Medical gas and vacuum systems for health care facilities. CAspiratorW C -Commercial ❑ Any multipurpose fire sprinkler system. Dishwasher: -Domestic 0 Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" �_ 3" Iso O 1C 4.s �ser�nag m t. 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 Ice Mach./Refrig.Drains Comments regarding fixture work: 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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard Li COMMUNITY DEVELOPMENT DEPARTMENT IN 0 T I G A R D Building Permit Review — Residential Building Permit #: /17y _ C, OcQ Site Address: /4/(1242 iJ /7i ___our'f Project Name: ✓11./a61//bYI rvdOtr,.J 1 Lot #: cc(to (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Pro osal: AJe) s.)- AP Verify site address/suite#exists and activ in permit system. ver Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached Si Plan Elements: ree(3)copies of site plan ■".,;,ting structures on site 8i'te plan must be on 8-1/2"x 11"or 11 x 17"paper iri Footprint of new structure(including decks)with finished Vawn to scale(standard architect or engineer scale) P.or elevations orth arrow II tility locations&easements(required for new and additions) ate address,project or subdivision name and lot number i.ewalk/driveway approach pplicant information(name and phone number) ! I . •tion of wells/septic systems 4 Lot dimensions and building setback dimensions °,sting trees to be retained with drip line,and tree PI uare footage of buildings to be demolished otection measures • t area,building coverage area,percentage of coverage and treet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Street names 1 roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? [E es ❑ 4 foot differential) If yes,is a storm water quality facility shown? ❑, es IJl1 o 4 °len Water Services—Service Provider Lette of platted prior to 9/10/1995): w--,10./', quired: ❑ Ye applicant was notified IA No Received: �d( LI Yes ❑ No Public Faciliti Improvement(PFI) Permit: equired: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake Iand Use Case#: ie‘Qe ,3-- 0o6D0 ( / tcl-A7- v -2OOT oning: Required Setbacks: R-2-/-s- Front — .-ront tQ 0 Rear l� Side Street Side is Garage c 2.6 1 Oandscape Requirement: toiof Coverage Maximum: 0/0 v(Tii?Ci uildin Hei ht: I i g g Maximum Height Actual Height c1 .-_1 isual Clearance /Sensitive Lands: IllJ Yes ❑ No TYPe crban Forestry Plan Le�u tea�it,� f x��' onditions "Met" rior to issuance of building ding permit Notes: Approved By Planning: -- ~ 4fAZ Date: / /NT Revisions (after Building Submittal only) Reviewer Revision 1: ❑ Approved GI Not Approved Date Revision 2: El Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\BuildingTorms\BldgPermitRvw RES 061417.docx Building Permit Submittal Original Submittal Date: / Site Plans: # — Building Plans: # Building Permit#: ZEnter building permit#above. �' �/ �) 1'11 eerin Drmit Coordinator t3uilding Workflow Routing: 'Planning gm g Workflow Sign-off: 12—Sign-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. rr'Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: , J,___ (ty1 Date: fo 8./ /J Engineering Review lope at building pad: I ° 4 Conditions "Met"prior to issuance of building permit Er Easements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: Cl Yes Er No Assess Water Quantity Fee in-lieu: ❑ Yes Er-No LIDA Facility on lot: ❑ Yes No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: .,_4, , Date: 1 / /i 7 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved El 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: C Fees Entered: Wash Co Trans Dev Tax: 7""""es El N/A Tigard Trans SDC: s ❑ N/A Parks SDC: ares ❑ N/A LIDA ❑ Yes '[3N/A K to Issue Permit /� � Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_RES_061417.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 10, 2018 at 10:57:07 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Cancelled per contractors request, ac to be added to permit prior to final inspection. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 10, 2018 at 10:59:27 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Fireplace not complete Impact protection Ballard in garage not filled with concrete. ORSC Figure M1307.1 Provide 1 " clearance to combustible at water heater B vent. Seal penetrations at HVAC equipment. R302 Not ready for Inspection, Work not complete. No further inspection done. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 10, 2018 at 11 :00:12 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Rain drain and down spout not finished left side garage. Gutter and downspout not done at front of porch. Not ready for Inspection, Work not complete. No further inspection done. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 31 , 2018 at 12:47:05 PM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Work not complete, not ready for Inspection. Ac electrical not connected. Penetrations at HVAC equipment in garage ceiling not sealed. R302 No further inspection done. Investigative fee for re inspections applied for scheduling 5 re inspections with work not complete. R109.4 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 31 , 2018 at 12:46:00 PM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Microwave/warming oven outlet removed from wall, not secured. OESC 334.30 Romex not protected laying in cabinet. Ac electrical connection not done, approximately 40' to disconnect from ac placement. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 July 31 , 2018 at 12:34:36 PM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Not ready for Inspection, Work not complete. Backflow devise for landscape irrigation not installed or tested. Devise on mst permit not separate permit. Cleanouts not to grade, no thread sealant on caps. Master tub not sealed to tub deck. No further inspection done. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 August 28, 2018 at 11 :27:22 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Provide approved Backflow devise test report for landscape irrigation Backflow devise. Drain for landscape wall to terminate at approved location, at sidewalk not approved location. OPSC 309, 1101 .1 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 August 28, 2018 at 11 :28:48 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: Corrections from previous inspection complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 399 Plumbing 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: 14026 SW 118TH CT, TIGARD, OR, 97224 September 18, 2018 at 10:50:30 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Previous corrections appear to have been completed. A/C installed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14026 SW 118TH CT, TIGARD, OR, 97224 October 11 , 2018 at 10:43:55 AM Record Type: Record ID: Residential - Master Permit MST2017-00256 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - CofO Comments: Previous corrections completed Final erosion control passed Street tree certificate received Moisture content form received High efficiency lighting form received Insulation certification verified Blower door and/or duct seal test certificate received C of 0 left on counter. Violation Summary: Inspector Contractor II Ill TIGARD City of Tigard March 1,2018 J T Roth Construction Attn: Austin Roth 12600 SW 72nd Ave., Suite 200 Portland, OR 97223 Re:Permit No. MST2017-00256 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 14026 SW 118th Ct Project Name: Medallion Meadows,Lot 26 Job No.: N/A Refund: ® Check#227711 in the amount of$28.02. E Credit card "return"receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: A change in the scope of work to remove laundry tray resulted in overpayment of permit fees;refund difference. If you have any questions please contact me at 503.718.2430. Sincerely, 4" ' 'Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefundsgalsW0AitAe 'de?paTaiga4egon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT /API 3 r) 2.0;3 Request for Permit Action #„! TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ® Owner Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) ; � � ( �� Mailing Address: 2(, 4t e City/State/Zip: etsr Ok Phone No.: LS°3) 3 - )1 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CAN .uiVOID PERMIT APPLICATION. REFUN13 ERMIT FEES (attach copy of original receipt and provide explanation below). \ ❑ CE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 1)\k-C. : 3 t - b©4-S -17 Site Address or Parcel#: LID '. 1 (.4...."/4- Project Name: \J l� r Kk .4-S Ul �� Subdivision Name: Lot#: EX ATION: (J ) _ cue.t4-•__ (15) 41,-10 'l ( 3) Signature: - Date: /,- 3 D � ' Print Name: Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. ! / L(7e) 3 0 V �M, 3, 01) 'r2tr�i-iJ FOR OFFICE LSE ONLY Route to Sys Admin: Date By Route to Records: Date r , ,a /9 By Refund Processed: Date a3/472// — By40y Invoice Processed: Date By Permit Canceled: Date/f/ – B ,.r, Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_692314.doc