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Permit 111111 qCITY OF TIGARD MASTER PERMIT I . COMMUNITY DEVELOPMENT I , ,. .1 Permit#: MST2015-00058 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ®�.fOT, Date Issued: 06/17/2015 Parcel: 2S110BA11300 Jurisdiction: TIGARD Site address: 14160 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 6 Project: Medallion Meadows, Lot 6 Project Description: New SF. 11/5/15, REPRINTED to add a/c. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1453 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1483 sf Garage: 648 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2936 sf Value: $367,442.90 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 Drains: 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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: 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/500 sf: 6 201-400 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 8 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 2936 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: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $24,033.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTEN Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 0 through R 952-801-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued A Permittee Signature: - . /r Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection. Mechanical Permit Applicil4CEIVEI P FOR OFFICE USE ONLY City of Tigard Received / — Permit No.: '- ! �a5-._0516�/ 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ` �J `� [Z(�QC// Plan Review ' B Phone: 503.718.2439 Fax: 503.598.196e i 5 ?O 1 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Read/B lur s: la See Page 2 for Internet: www.tigard-or.gov kill'OF 116A1(1) Notified Method: Supplemental Information -Fij TYPE O COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value or the stork 4 New construction ❑ Addition alteration/replacement pet-fonned.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY O RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist. Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning t/ 46.75 Job site address: I 1 l j (- L- S (� L t 1 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 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: 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.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: _ Name: Range hood/other kitchen equipment 33.39 Address: 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 ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:(5C-3) 0 ,.7 Y y s Fax::( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: Other: MECHANICAL PERMIT FIIIIIMIL Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fay: I I State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE 0.1 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: Date: l Building'PermitsMEC_PermitApp_0401I3.doc 440-4617T(11/02/COMIWEB) 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:A Building\Permits\M EC_PermitApp_0401 13.doc 2 711 III CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2015-00058 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/17/2015 Parcel: 2S110BA11300 Jurisdiction: TIGARD Site address: 14160 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 6 Project: Medallion Meadows, Lot 6 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1453 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1483 sf Garage: 648 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2936 sf Value: $367,442.90 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 Drains. 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 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 SrvclFeeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add,500 sf: 6 201-400 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 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: Y Other: N Other Description: 9 BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2936 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: PHONE: 503-590-0805 FAX: 503-590-1751 Total Fees: $23,932.20 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 952-001-001 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. - 1.800.332.2344. Issued By: Permittee Signature: -.- a�_ 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. a Building Permit Application Residential RECEIVED 1011 OF I.it I. l til: U\1. ' Cl of Tigard 1 Daceived �8" /�- , )65 fs.��n g Dateiv Permit Na.:r] [S . 13125 SW Hall Blvd.,Tigard,OR 9722R 2 8 2015 Plan Revie 't\ ,/ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ` t/ 5.�/s Other Permit: je��3 [�juris Inspection Line: 503.639.4175 Date Rea. / 63 See Page for T I G R D CITY OF TIGA S Notifed/Me tho d;�� :l/Internet: www.tigard-or.gov supplemental Information rmation BUILDING DIVISION e� /�9r/i.t. TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 1New construction Cl 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. Valuations 1 1-and 2-family dwelling ❑Commercial/industrial ■� ( are d• Q . 0 _AIL El Accessory building El Multi-family Number of be r rooms: 14 El builder ❑Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: IL.,I 60 5,� . 11 8.114 ei-- New dwelling area: 2 r36, square feet City/State/ZIP: 'i(e,to RD l ovi__ 9.722.y Garage/carport area: 6 Y S square feet Suite/bldg./apt.no.: Project name: _ Covered porch area: square feet[44 Cross street/directions to job site: 1 ',3 T H 9. (,p' 3Z.p a- r►!' (q6,-) y(- � 45-- ` .`.`.,�� e;; square feet l�'-�`. Other structure area: J square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST i. Subdivision: ,`b A L.I O 1j Melk D w5 Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rowded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIP'T'ION OF WORK work indicated on this application. Valuation: $ /`/'GW S'/A/OLE r-P0.11 lky 9--E'S a De—ULC Existing building area square feet New building area: square feet k PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: ,51::,roe AS 13 el-4-11.J Occu Panc groups: s:P City/State/Z1P: Existing: Phone:( ) Fax:( ) New: Cit,APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: %0u12 D 1)N5TP-U.cTION Structural plan review fee(or deposit): Contact name: TD F4 y I p D c H 9.....e Po cz F'0. FLS plan review fee(if applicable): Address: , I S 7 7 Total fees due upon application: City/State/ZIP: >tPYt RTO t.] Ow- f 7 07 S -,, or Amount received: 7� e Phone:(6 V3) 59 O O a O 5 I Fax::(S,..;3) 59 0 17 5 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: t7,.4. 12- flC60-1.S-i- E. MSN t co W Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel Syste .. Business name: Submit two(2)sets of roof plan with connecti retails J(: and f i r e depart -I t access,along with th- 110 Oregon Address: �� Solar Installation 5,: laity Code c - ist. City/State/ZIP: v Permit Fee(inclur. .1•• eview $180.00 Phone:( ) J p � Fax: -- and admin. . .: e fees): ( ) State surcharge Vo of permit • : $21.60 CCB lic.: '7, l� s7 r 7 I ` Total 'ee due mpon application: , $201.60 Authorized signature: This permit application expires if a permit I not obtained !� within 180 days after it has been accepted -complete. p v t o z D G RP(p 7 Z 7/� *Service Board set by Tn-County Building Industry Print name: Date: 1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) • 'Electrical Permit Applica IRECEIVED ► (ill ()l•►.I( I: I tit; O.I., City of Tigard Received =DM Permit#:)-//r�1 J- J''Q 14 • 13125 SW Hall Blvd.,Tigard,OR 9721 R 2 8 2015 Dates U� Phone: 503.718.2439 Fax: 503.598.1 60 Plan Review �.�` Date/B d�: Related Permit#: t ,u 6- TI A R I Inspection Line: 503.639.4175 CITY O F TIGAR D Ready Date/By: funs: Internet: www.tigard-or.gov la See Page 2 for BUIl DING DIVISION Notified/Methnd: Supplemental Information TYPE OF WORK PLAN REVIEW KNew construction ❑Addition/alteration/replacement Please check all that apply(submit Is sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: CATEGORY OF CONSTRUCTION where the available fault current ❑Marinas and boatyards. exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural El Multi-family ❑Master builder ❑Other: amps for all other installations. buildings. CI Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: I Job site address: I Li 160 Se W, //U(� G1 ❑Addition of new motor load of system. I00HP or more. ❑`•A^,•`E„ °l_2„ "l-3„ City/State/ZIP: 1 0 A�� 02 ei 7 Z z `i ❑Six or more residential units. occupancy. t ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. ❑Supply voltage for more than Cross street/directions to job site: C� p ❑Service or feeder 600 amps or more. 600 street/directions l i t fit t G OVA R-D FEE SCHEDULE volts nominal. Descriptio I Qty I Each I Total I • New residential single-or multi-family dwelling unit. Subdivision: &'6C:D A L LZ5 N M,E.-p00v I Lot#: ( Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less t 168.54 4 DESCRIPTION OF WORK Ea.add 1 500 sq.ft.or portion 33.92 1 Limited energy,residential ( /UE 4./ �.j/ (with above sq.ft.) ( 75.00 2 S'/NG PPMI / J2.L-3lpc�.iC� Limited ener gy,multi-family 75.00 2 residential(with above sq.ft.) kg PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Page 2 Name: Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 ' 2 Address: SA MC p S n�ZO 201 amps to 400 amps 133.56 2 City/State/ZIP: ;7 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) I Fax:( ) 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 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 Ps P 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 I5i APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel Business name: q� A.Fee for branch circuits with rout 12, , C0 pQST-g2.a( Zi;1\J above service or feeder fee, each branch circuit 7.42 2 Contact name: p,V i 0 �l(�J` L pp�2..r- B.Fee for branch circuits without Address: �7� service or feeder fee,first ` `'X 'S 7 branch circuit 56.18 2 City/State/ZIP: -BC P•yt•-3 OR 9 70 7 S Each add'l branch circuit 7.42 2 Phone:(S�3) s� _ Ors Os Fax: : �,_ Miscellaneous(service or feeder not included) I (S3) , 9 17 S I Each manufactured or modular Email: N nh dwelling,service and/or feeder 67.84 2 �u IZ D C,o NSr '� ' C:. 3 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 6.L d7 ELEC i K, � 1y1 p Sign or outline lighting 67.84 2 Address: (0 I S' a /t e r q Z ND D Z. # /0 L/ Signal circuit(s)ere or limited-energy t�/ I kJ 7 panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: P��T-L,A�O �� pu z Z Vy Each additional inspection over allowable in any of the above Phone:( �j ? �j , 1 Additional inspection(I hr min) 66.25/hr Z 7 7 —3 71 J Fax:cs-e.g) 9°I _ ---) 7/ y Investigation(1 hr min) 66.25/hr Email: C L t�T•EEL E er p-i 6124:LL P t�C itov A t✓ , <-0,ila■ Industrial plant(I hr min) 78.18/hr Inspections for which no fee is CCB Lic.: I 9 7�,/ I Electrical Lic.: (p� • Suprv.Lic.: C-7 C specifically listed(%:hr min) 90.00/hr y J /�L J ELECTRICAL PERMIT FEES Suprv.Electrician i at ,requir t: ok _ / �`> /0////40 'r` _ / Subtotal: Print name: 12,02ckit.) I IZMEALI,/ l Date: y_27_1 5 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: �� TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: 1. - .te: ,,,, it t/ ; t: — .2 t days after it has been accepted as complete. Number of inspections allowed per permit. 1:1Bui ldinglPermits\ELC_PermitApp_ELR ERE.doc Rev 04/21/2014 440.46151(11/05/COM/WEB • Mechanical Permit Applicati DECEIVED F (►�1 OR(lrrl( l: t St: .) Received Q City of Tigard Dateive Permit No.: ,, i —Mn _ J IIII 13125 SW Hall Blvd.,Tigard,OR 97223 APR 2 8 2015 !/LC/ I Plan Review �y h_ Phone: 503.718.2439 Fax: 503.598.19yp Date/By: Other Permit: IL, f �1/jdlN T I'.A R D Inspection Line: 503.639.4175 IrITY OF TIGARD Date Ready/By• Sufis: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work KNew construction El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 01-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: Air conditioning 46.75 y 1 LI 0 51(Ai. 1� 8 ?R e fi Furnace 100,000 BTU(ducts/vents) I 46.75 City/State/ZIP: •T—1&49--D OF. 9-7 --Z Furnace 100,000+BTU(ducts/vents) 54.91 l Heat pump 61.06 Suite/bldgJapt.no.: Project name: Duct work 23.32 Cross street/diredions to job site: I 1 g -r-14 G A R\z-D 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: M C D A LL 1 a t J /A L P Dow,s Lot no.: '^ Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater I 23.32 DESCRIPTION OF WORK Gas fireplace/insert . 1 33.39 Flue vent for water heater or gas NE=6*-) 6 1•-?C0i-e F-PM I Ly `�/ ®C/ucC fireplace 23.32 / Log lighter(gas) _ 23.32 Wood/pellet stove _ 33.39 Wood fireplace/insert _ 23.32 Chimney/liner/flue/vent _ 23.32 la PROPERTY OWNER ❑ TENANT Other: _ 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 1 33.39 Address: St=4841 t- A5 Be-11.1 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 ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: C`�—1. — 3) COiQ ST 12(.1 a 101 -) $14.15 for first four;$4.03 for each additional Contact name: 't twit) Ze< N 1pi-P Porcr Furnace,etc. Address: Q g c.X IS 7-7 Gas/sus pump 9 Wall/suspended/unit heater City/State/ZIP: ,B Env 2TD l Q� -f' 7 07 S Water heater i Phone:(5-43) 590 9° .� c 9 0 S Fax::(5 3) s'qd I—1 5 i Fireplace Range E-mail: r o ae... p Co 0 Sr e., M1S N r C O, Barbecue CONTRACTOR Clothes dryer(gas) Business name: C �`r�--A L. Other: y R �'N� MECHANICAL PERMIT FEES* Address: pA f3a7(' 433 Subtotal Minimum permit fee($90.00) City/State/ZIP: C L,p,L,�i�S (�� q'7 Q j C� Plan review(25%of permit fee) Phone:C5 ty3 (0 S c.,._. I c'o g I Fax:6,13) (05 0 ,-3 n?G 15 State surcharge(12%of permit fee) CCB Sic.: I 7 0 tj q 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: DA / , 1)e itj - Date: '/—Z 7-1 S • Plumbing Permit Application Building Fixtures FOR OFFICE 1 SE ONLY City of Tigard RECEIVED Received ,/ Date/By: Li i ' 14 7 Permit No.:04)179QI g ■14 . 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.5941IW 2 8 2015 Other Permit No.: ,11 6--1941/4// Date/By: TIGARD Inspection Line: 503.639.4175 Date Ready/By: luny: ® See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE ofiidhi®ING DIVISION FEE* SCHEDULE 'New construction ❑Demolition For special information use checklist Description I Qty. [ Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 NI 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) 1 Page 2 JOB SITE INFORMATION AND LOCATION _Site utilities: Job site address: 1 i f 1('O s`()._ i I S,*.44 6-/- Catch basin or area drain 18.76 �/ Drywell,leach line,or trench drain 18.76 City/State/ZIP: 'F 1(�f D 0�1 9 '1 2.Z / 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: i Ilk G` * Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Pagc 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: /yel Er)A L`10A) ,mow S Lot no.: Fixture or item: k Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 /k/E /0 S l N L'L tL F#/ icy f�C'5I7 JL t Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 (r PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink./hub 25.02 Address: SPkikE AS Se-0t,., Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 (a APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: � , rr� Medical gas(value:$ ) Page 2 C `"l-t `) slam to Primer 12.51 Contact name: „D AV i n £))1 p,� _ t"'�'`t�"�� Roof drain(commercial) 12.51 Address: (0 &74 iS 7 '7 Sink/basin/lavatory 25.02 City/State/ZIP: ,BarSV d4y,1•-) Or-- 9"7 0-TS Solar units(potable water) 62.54 Phone:63) 590 O S 0 S Fax::(S:3) .S-90 I-75 I Tub/shower/shower pan 12.51 E-mail: r-0u(L- D CO NiA- a. .5".) '1 r CO N Urinal 25.02 kJ 4ONTRACTO,r``>;t L 6.r- Water closet 25.02 Q 1� 1 Water heater 37.52 Business name: °T'-14 e /A u L LA--1,i [,c,M P Al tu y Water piping/DW V 56.29 Address: I (00 I A S.& . R 1�Vt:9Z RA - Other: 25.02 City/State/ZIP: 14 I L!S B v ! 0 t_ R ') 1 Z 3 Subtotal Phone:(513) (D Liv - (V1(3 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: !Z�D Plumbing Lic.no.:3��G Go Ile, Plan review (25%of permit fee) T State surcharge(12%of permit fee) Authorized signature. ._ TOTAL PERMIT FEE Print name: J,�jbll� �� . Date:t../.....2,2_ This permit application expires if a permit is not obtained within 180 days ar � 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) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT Ir` Building Permit Review — Residential I I ( , 11: I) Building Permit #: ti5T 9016-666 og Site Address: f 4 16 0 SW 11'6- C* . Project Name: Meclail ion Vte011ckW S Lot #: 6 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: nel SF 1 erify site address/suite#exists and active in permit systee.. Cpl River Terrace Plan District: ❑ Yes Lr7 No Siv Plan Elements: g ree(3)copies of site plan structures on site e plan must be on 8-1/2"x 11"or 11 x 17"paper Z(ii Footprint of new structure(including decks)with finished yawn to scale(standard architect or engineer scale) or elevations orth arrow Utility locations(required for new,may apply for additions) //Si Site address,project or subdivision name and lot number a' 'cation of wells/septic systems 12r pplicant information(name and phone number) i Erosion control(including drainage-way protection,silt fence Lot dimensions and building setback dimensions sign,location of catch basin,etc.) t area,building coverage area,percentage of coverage and reet names 21/Property area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location 21Property corner elevations(2 foot contour lines if more than existing trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services—Service Provider Letter of platted prior to 9/10/1995): /Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No ICY Public Facili�tie mprovement(PFI)Permit: Required: IV Yes,applicant was notified ❑ No Applied For: Lq Yes ❑ No,stop intake Land Use Case#: Sv B201 3-00006 Lid Zoning: R,-t( ,S Setbacks: f _ 4. ) Front 4(26)Rear 15(22) Side 5(S) Street Side -7-- Garage 2.0 (21) $L dscape Requirement: % -e- of Coverage Maximum: i _/Building Height: Maximum Height 30' Actual Height 26 L� isual Clearance V./Visual NZ/Easements Lands: ❑ Yes IN No Type TM Urban Forestry Plan ❑ Conditions "Met"prior to issuance of building permit ctiec a • f1 WI q2.-- Notes: Approved By Planning: I II _- a a.g., .• Date: 14 12 a kS Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_031015.docx Building Permit Submittal`7`/ Original Submittal Date: Nf (C Site Plans: # 3 Building Plans: Building Permit#: , /Enter building permit#above. Workflow Routing: E1 Planning ('Engineering Permit Coordinator 2.-Building Workflow Sign-off: Er Sign-off for Planning(include notes from planning review) Route Application Documents: 1 Engineering. (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: « Date: /��j C_. Engineering Review ❑ Slope at building pad: /11/t.% ❑ Conditions "Met"prior to issuance of building permit E---h cements (encroachments) per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 'rn�6+'��' Assess Water Quantity Fee in-lieu: ❑ Yes IIYNo LIDA Facility on lot: ❑ Yes ,1A,L NOT Approved by Engineering: Date: itl�' , Notes: ‘211 ,41fJ/2 Approved by Engineering: &i 2) , /Ya(,cea/✓Date: S / 4� 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 'pproved,NOT Released: / Da te:�/7�/J5- 4', Notes: ,�c�tGZ �ay,� ‘ 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: OK to Issue Permit Approved by Permit Coordinator: W/i/i-5Z' Date: I:\Building\Forms\B1dgPermitRvw_RES_031015.docx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14160 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2015-00058 David Young Wall repair required at outlet right side of kitchen sink. 312.4 Single outlet in garage to be labeled not gfci protected. 210.8 Outlet by left sink in upper main bath shows open neutral, as does both master bath outlets. Fix loose outlet upper front bedroom by closet, left side. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14160 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2015-00058 David Young Note: provide approved thread sealant on clean out caps. 316.1 Will check at ﬁnal building inspection. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14160 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2015-00058 David Young Note: provide 1" clearance at B vent in garage to return air duct, will check at building ﬁnal inspection. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14160 SW 118TH CT, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - C of O MST2015-00058 Jeff Grove Street tree Moisture content Lighting efﬁciency Duct leak test All reports recieved Violation Summary: Inspector Contractor