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Permit CITY OF TIGARD MASTER PERMIT : ' COMMUNITY DEVELOPMENT Permit#: MST2015-00302 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016 T i i;A II C� 9 Parcel: 2S110BA12100 Jurisdiction: TIGARD Site address: 14177 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 14 Project: Medallion Meadows, Lot 14 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1925 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 3 Second: 873 sf Garage: 738 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2798 sf Value: $352,069.66 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 0 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Tvaes 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 Temo Srvc!Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add9 500 sf: 0 201-400 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2798 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: $24,223.39 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. ose rules are set forth in OAR 95::; r0u095010tahe 010 rules or direct questionsto OUNC by calling50987 or0332:// p Permittee Signature: e 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 a project. Approved plans are required on the job site at the time of each inspection. ' Building Permit Application ti Residential RECEIVED FOR OFFICE. I st;()NIA City of Tigard Received Date g 015 B ,. 1/ Permit No../ 13125 SW Hall Blvd.,Tigard,OR 1AL 3 O 2Plan Re (. 3, /s c�/S���� Phone: 503.718.2439 Fax: 503.598.1 ��'t;GA'�D Date/By: )� Other Permit: 5��1� T I G A R[) Inspection Line: 503.639.41750 f ' t+4 Date Ready/By: j Juris: BI See Page 2 for Internet: www.tigard-or.govpt 11.011\,1 1 `�''' Notified/Method: is IP Supplemental Information TYPE OF WORK (�P REQUIRED DATA:1-AND 2-FAMILY DWELLING 'New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated o his application. C RI 1-and 2-family dwelling 0 Commercial/industrialValuation: $ t© Ij 0 Accessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms JOB SITE INFORMATION AND LOCATION Total number of floors: 2., Job site address: j Lig 7 7 .S",vv, // S -714 C r. New dwelling area: 2_7 9 g square feet 3 City/State/ZIP: 'j'' (o l.Rc• l o . 9-722 r7/ Garage/carport area: 7 3 2/ square feet v Suite/bldg./apt.no.: Project name:Alma,/, 1 ���/ ,�i Covered porch area--,N, �4 square feet g /7 1 Cross street/directions to job site: , 1 97 ..t-N 2., G A Y-i,z )t✓ Deck area: D...a.b IR square feet] 9 D. S Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: M c D INL (0 0 f7 /A D w� Lot no.: 1 y Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. /l%�W -5,'A/CELE 1=1aM 1‘...ycZE S /DE-A.)1-e: Valuation: $ Existing building area square feet j New building area: square feet R PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: 5 5„bivke As B (( w Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: b ,APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: r p, r cow.Tac..ri o I.)t Structural plan review fee(or deposit): Contact name: I:3 F v 10 De Hp, ? Po 9'--c � j� FLS plan review fee(if applicable): Address: I `°, , Jinx i 5--/ 7 Total fees due upon application: City/State/ZIP: 2,epYC-R_-o 1,3 C)g... Cf 7 07 s7�pd (5, ) 59 0 O B O 5 Fax::(3 3) s90 (-7 5 Amount received: Phone: u3 E-mail: l7‘..t. fl C-6 S-r^ (G M S t w � PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: r Submit two(2)sets of roof plan with connection details J L and fire department access,along with the 2010 Oregon Address: �c ��" Solar Installation Specialty Code checklist. City/State/ZIP: "v s Permit Fee(includes planreview $180.00 s and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: `7 g 0 3.7 Total fee due upon application: $201.60 Authorized signature: 1) ,' .,,XL.. 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 Print name:D p v l0 A1,,___ a ,,,-±Date: /2,-21 /5 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Electrical Permit Application FOR OF Fl( I: I St: OSI.\ City of TigardReceived � � RECEIVED Date/B : _ Permit#: .� - 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / i ��� --eV"`y Phone: 503.718.2439 Fax: 503.598.19 C 3 0 2 015 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Luria: I I 6„1 R D Internet: www.ti and or. ov ® See Page 2 for g g CITY OF TIGARD Notified/Method: Supplemental Information New construction TYPE ` 'IfING DIVISION PLAN REVIEW ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards. exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building ❑Commercial-use agricultural less to ground,or exceeds 14,000 ❑Multi-familyamps for all other installations. buildings. 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: I Job site address: 0 Addition of new motor load of system. 100HP or more. ❑"A","E","l-2","1-3", City/State/ZIP: -J—��,� �� ©1`n CZ Z z 9 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 1 1 (e) t. to Coc AR.OG FEE SCHEDULE DescriptioI QtyI Each Total i New residential single-or multi-family dwelling unit. • Subdivision: j,L D A L t_to i._ ,E--p W S I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less J 168.54 4 DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential tk/EL.J S'1 t•-161-4_---- P-PM I Ly P- 3 i pe-y(„6 (with above sq.(t.) ) 75.00 2 / Limited energy,multi-family residential(with above sq.ft.) 75.00 2 fig PROPERTY OWNER I 0 TENANT Renewable Energy 0 See Page 2 Name: Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 1/E --Lo201 amps to 400 amps 133.56 2 Address: s A t^fle p S City/State/ZIP: t3 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 am1 Ps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 12 APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel A.Fee for branch circuits with Business name: FV u I) c s 5 above service or feeder fee, T�L�CLv1U 7.42 2 Contact name: 0each branch circuit .n E PCs R Pf32T" B.Fee for branch circuits without serce o Address: P,_‹) .2_,X IS 7 7 branch circuitt feeder fee,first 56.18 2 branch City/State/ZIP: B .---,P1le—A2TDdJ O9-. Q.7().,7 .S Each add'I branch circuit 7.42 2 Phone: o cy I Miscellaneous(service or feeder not included) 3) S /0 — (E O$ I Fax: :(D3) J�90 17 S I Each manufactured or modular Email: Fou Ct- D .,0,-1..s-t--. e Ms/`j C . dwelling,service and/or feeder 67.84 2 ' _ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 6-L&7 EGEc wk._ &la j p Sign or outline lighting 67.84 2 Address: (p I S.1/4 , / 9 --ii Signal circuit(s)or limited-energy /�t E , i"10 p R. /0 y panel,alteration,or extension. 0 See Page 2 2 OR._ pt zZ Each additional inspection over allowable in any of the above City/State/ZIP: po�i-Ll�� � 1 Additional inspection(1 hr min) 66.25/hr Phone:(< 3) Z 7 3 7 3 e. I Fax:(g ) w ' , 7 p7 (7 Investigation(1 hr min) 66.25/hr Email: t=L E lr'EEL E t_Ti2t`,6 RvtlP L G�,A u.... , Gt::M1 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 1 9 1 2_7' I Electrical Lic.: C (03 9 I Suprv.Lic.: 5762 s specifically listed(%:hr min) 90.00/hr Suprv.Electrician signature,required:;fes /J H,^ ELECTRICAL PERMIT FEES Li Subtotal: Print name: Roa +.. Qil eNpg lamC, I Date: /Z —29 3� ❑Plan Review Required(25%of permit fee): �J State surcharge(12%of permit fee): Authorized signature: i%/�,�/�// TOTAL PERMIT FEE: Print name: This permit application expires if a permit is not obtained within 180 Da l ,0 rJ ,_ �� - , I'Date: /Z —c9.-_30 I days after it has been accepted as complete. • Number of inspections allowed per permit. I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 4404615T(11/05/COM/WEB J ' Mechanical Permit Application FOR OFFICE I SE ON I.1 City of Tigard Received a / Permit No.: . IIII s r 13125 SW Hall Blvd.,Tigard,OR Date/By: 30 /j / S ea Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: r i G n R D Inspection Line: 503.639.4175 DEC 3 0 2015 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGARD TYPE iliiyG DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work IgNew construction ❑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:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* Dial1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning / 46.75 Job site address: 1 Li 1 .7.7 Si Iii/ 1/6 T kt T- Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: •-f—1&49-1D OF. 9--7 -Z'5/ Furnace 100,000+BTU(ducts/vents) 54.91 t jj Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: 1 1 E3 .. H G APk v4-p 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: 1 C p A LL t a N `ADo t.)S Lot no.: /17/ Other: 23.32 /•11 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 i--) SI locoi-E PAM I LP---csI p j�.0 fireplace 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 MPROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: SAS AS g eZ...11 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 C%APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: uel piping: �' (�t.lr2 COt�S j �2(I C* 0 1_� $14.15 for first four;$4.03 for each additional Contact name: 'D Av 1 D t' 4 - -j- Furnace,etc. Address: r O -sax IS -7 Gas heat --- Wall//sususpended/unit heater City/State/ZIP: 'a a V p r o t ./ Ox)-. 9 )07 s Water heater Phone:Kg) 570 7d () 9 0 S Fax::(-i43) ..59'ei -? s j Fireplace Range E-mail: Cal g to CO asi ST-C; altS N , C 0 NA_ Barbecue CONTRACTOR Clothes dryer(gas) y� Other: Business name: � 'rY-`A L` t y R 2,ivt MECHANICAL PERMIT FEES* Address: p Q, ,i34-x' '433 3 Subtotal City/State/ZIP: L CjpC,K.._ia MA'S 0 g 7 o i s Minimum permit fee($90.00) Q f• Ci (Fax: O .- U Plan review(25%of permit fee) Phone: 3 6� V g ( 3j �5 3 n! C� State surcharge(12%of permit fee) CCB lic.: 1 7 0 IV-2-Li 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: ,1]Ar// -1--DeDate: / Z_al -/S L ,n--- -:..-- ,,.,..,,.1-- • Plumbing Permit Application Building Fixtures roll OFF1CI. l'SE O\l.\ City of Tigard RECEIVED Received ��/ `� City Date/By: 4:94/11 ( Permit No.: r 5 �/j�,, III13125 SW HaII Blvd.,Tigard,OR 97223 Plan Review ✓'� Phone: 503.718.2439 Fax: 503.5r 603 U 2015 Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE I is y 1 ';e, DIVISION FEE* SCHEDULE 'New construction 0 Demolition For special information use checklist Description I Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 tg 1-and 2-family dwellingSFR(2)bath 437.78 0 CommerciaUindustrial 0 Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: I 1._I 17 7 5 ► % 11 O r H G Catch basin or area drain 18.76 „�--I&KA) Q t� 912. 2 , J FDooting drain line,ore trench drain 18.76 2 City/State/ZIP: 7 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 • -t-Nk 1,1 (2 Li e e Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: L1/410A.) , 'j S I Lot no.: , / Wateruasonce (no.linear ft.: ) Page 2 fyi��� tv Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 ME-1,0 ,c1")1.,L t_ (is4 l t l/ c$/ L C Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 lig PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: S'P/1k p S Se-Lf Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ( APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: snzactto Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: .D AU 10 D 4?-1-- Roof drain(commercial) 12.51 Address: }PL(,. J70 1S7 - Sink/basin/lavatory ■ 25.02 City/State/ZIP: C i , *tJ 0 0-7 Solar units(potable water) 62.54 Phone:(5.,i-3) 590 d-8 p S Fax::(5.•3) 5'ci0 1-7 5 I Tub/shower/shower pan 12.51 E-mail: F'oU.lit D Co NS'f' c ILA SN, CO Art Urinal 25.02 CONTRACTOR Water closet 25.02 + Water heater 37.52 � pi Business name: "-r14 'uLL IJ OMeAN y Water piping/DWV 56.29 Address: 1607 I t S. E . ► I UL--12. 'RA - Other: 25.02 City/State/ZIP: E L LS Bc12-0 t 0 i Ct ) I 2-3 Subtotal Phone:(563) fn 440 --C9 i t 3 Fax:( ) Minimum permit fee: $72.50 q p p Plan review (25%of permit fee) CCB Lic.: !2_ 1 Plumbing Lie.no.:31-/-26 0 pg State surcharge(12%of permit fee) Authorized signature: : 14111 TOTAL PERMIT FEE Print name: mm-,B7. '. This permit application expires if a permit is not obtained within 180 days Jr�y�p V&J p Date:f Z�ZC,_/s after it has been accepted as complete. .17v ,o /O -�;f /)% 9J4L..f- *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLM1J-PermitApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB) City of Tigard 74 COMMUNITY DEVELOPMENT DEPARTMENT T F G A R D Building Permit Review — Residential Building Permit #: M i�pt5-D0 5,02- Site D2- Site Address: I t- i 7 7 s,c.�'' //'e / 01- Project Name: /W rde-,;(( cc, 6Wec(4r_)r Lot #: /4( (New dwelling= subdivision name;.Addition or,Alteration=last name of owner) Planning Review Proposal: K' F-l) 7-A2---1 fd'Verify site address/suite# exists and active in permit system. ❑ River Terrace Neighborhood: ❑ Yes ' No Site lan Elements: Three(3)copies of site plan it/AEI-Existing structures on site ,ESite plan must be on 8-1/2"x 11"or 11 x 17"paper 'Footprint of new structure(including decks)with finished awn to scale(standard architect or engineer scale) floor elevations Aii North arrow (SUtility locations (required for new,may apply for additions) -Site address,project or subdivision name and lot number 1v Location of wells/septic systems ,s. pplicant information (name and phone number) Erosion control (including drainage-way protection, silt fence ,arof dimensions and building setback dimensions design,location of catch basin,etc.) ❑Lot area,building coverage area,percentage of coverage and .-QStreet names 1 impervious area (applicable if R-7,R-12,R-25&R-40)i<•el 5 J ireet tree size,type and location .roperty corner elevations(2 foot contour lines if more than iv isting trees to be retained with drip line,and tree 4 foot differential) protection measures l/ 'Clean Water Services-Service Provider Letter (lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Public Facilities Improvement (PFI) Permit: Required: Vl Yes,applicant was notified ❑ No Applied For: N‹Yes ❑ No,stop intake .0-Land Use Case #: S ii&Ze=2/3 -15 706' Q Zoning: R-Li' 5 Setbacks: Front 2_0 Rear i j Side 5 Street Side /.S Garage ze) 12'Landscape Requirement: iv it p Lot Coverage Maximum: ✓V/'r 0/0 ,Building Height: Maximum Height 3 0 Actual Height 23 Visual Clearance _--Easements et; f V/Sensitive Lands: ❑ Yes ❑ No Type Urban Forestry Plan D-Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: (6_693*-- Date: /a2.• 3 b '- (S- Revisions S- Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved i:\Building\Forms\BldgPennitRvw_RES_070915.docx I Building Permit Submittal Original Submittal Date: /1,/05,0/5 Site Plans: # -; Building Plans: # Building Permit#: ['Enter building permit#above. Workflow Routing: Z Planning ifErEngineering ermit Coordinator wilding Workflow Sign-off: El Sign-off for Planning(include notes from planning review) Route Application Documents: Er Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Zr Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: /0 �,,/� ��614-1 & Date: 74P--44--- Engineering 4P-- / --- Engineering Review Slope at building pad: 5 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 I ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: 4` Z7 Date: li d -5 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved E 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 Taxes ❑ N/A Tigard Trans SDC: ❑ Yes (FPN/A Parks SDC: /I Yes ❑ N/A OK to Issue Permit Approved by Permit Coordinator: /Or-Date: i� �D /S I:ABuilding\Fonns\BldgPennitRvw_RES_0709I5.docx 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14177 SW 118TH CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: PASS Comments: Corrections from previous inspection complete. Violation Summary: Tel: 503.718.2439 Inspection Date: December 6, 2016 at 8:38:51 AM Record ID: MST2015-00302 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14177 SW 118TH CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 699 Mechanical final Result: PASS Comments: Correction from previous inspection complete. Violation Summary: Tel: 503.718.2439 Inspection Date: December 6, 2016 at 8:58:01 AM Record ID: MST2015-00302 Inspector: David Young Inspector Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14177 SW 118TH CT, TIGARD, OR, 97224 Record Type: Residential - Master Permit Inspection Type: 299 Final inspection Result: PASS -CofO Comments: Final erosion control approved. Moisture content form received. Street tree certification received. High efficiency lighting form received. Duct seal test report received. Insulation certification checked. C of O left on site with contractor. Tel: 503.718.2439 Inspection Date: December 6, 2016 at 9:06:43 AM Record ID: MST2015-00302 Inspector: David Young Note: contractor to provide permit for lawn irrigation Backflow devise, test report received. Schedule Backflow devise final for approval after permit is obtained. Violation Summary: Inspector Contractor