Permit (78) CITY OF TIGARD MASTER PERMIT
11 .11
COMMUNITY DEVELOPMENT Permit#: MST2015-00298
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2016
Parcel: 2S 110BA12800
Jurisdiction: TIGARD
Site address: 14075 SW 118TH CT
Subdivision: MEDALLION MEADOWS Lot: 21
Project: Medallion Meadows, Lot 21
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1346 sf Basement: 0 sf Left: 10 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1904 sf Garage: 724 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 10
Detectors:
Total: 3250 sf Value: $402,900.92 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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 Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 500 sf: 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&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 3250
Owner: Contractor:
JT ROTH CONSTRUCTION INC J TROTH CONSTRUCTION Required Items and Reports(Conditions)
FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 1 Ersn Cntrl 503-639-4175
12600 SW 72ND AVE#200 TIGARD,OR 97223
TIGARD,OR 97223
PHONE: PHONE: 503-639-2639
FAX: 503-624-0239
Total Fees: $25,252.10
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OU NC by calling 503.232.1987 or 1.:00.332.2344.
Issued By: v��% Permittee Signature: �� t� i,
503.639.4175 by 7:00 a.m.for the next available in-,•'•n date.
This permit card shall be kept in a conspicuous place on the job site until completion of the • .sect.
Approved plans are required on the job site at the time of each inspection.
, Building Permit Application /_5 /: /s—
Residential FOR OFFICE l SE ON l.v
' City of Tigard Received Permit No.: M i_,
`J g �/��� Date/By: 9 i t7 / ")SMO 1 5"Ck-�jg r
;� ■ w 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review 19 s, ,/7 1
Phone: 503.718.2439 Fax: 503.598.1�� O� DateBy: ] C Other Permit: doda,7
• A 1Z€� Inspection Line: 503.639.4175 q 0, Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �C, B r ��® tified/Method 0 d"---- __c Supplemental Information
eta 1; ,°.?,1,..!:,9,1!,_ � i. �
New construction 0 D-�01. Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
ti � VOW work indicated on this_app�plliccaatiion_- ...)/
Valuation: �371 '�J }�
).1 1-and 2-family dwelling ❑Commercial/industrial f
Number of bedrooms: 5
❑Accessory building 0 Multi-family
❑Master builder 0 Other: Number of bathrooms: 3
401., I1*414FORIOtiON.�lF�'iCiOR ,N
Total number of floors: 2
Job site address:14075 SW 1186 Court New dwelling area: 3250 square feet 39-7 el'
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 724 square feet
Suite/bldg./apt.no.: Project name: eelekw:iCovered porch area: 53 square feet )9 o I-
Cross street/directions to job site:Gaarde Road to 118th Court Deck area: 1 .97 12I6, square feet 13 4
mQ.y„a j Tip.rc t,./y I , �v:5 1'A) Other structure area: square feet
CAlaVt V� C;), C4(C\, 1, i * Iti f l 1 a a !`i” S `_
Subdivision:Medallion Meadows i)/ t S Lot no.:21 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
" work indicated on this application.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
iii";PR1* `'f(WI `:. g. % Number of stories:
Name:J.T.Roth Construction Inc. Type of construction:
Address:12600 SW 72°d Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)6392639 Fax:('503)6240239 New:
x. z
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
Total fees due upon application:
City/State/ZIP:Tigard,OR 97223
Amount received:
Phone:(503)8060602 Fax::(503)6240239
E-mail:davidj@jtrothinc.com
,,,,:,;,,:, „,,,:,-!-,,,,,,,,-;;;,,,,;:•,•:,x:::,:::,':,,,,,',:-.''':-.-,,;:,',-'-',:-:;:f'.:',-,,,, Commercial and residential prescriptive installation of
-� "�; �" .; , ", .': „ Ii8 roof-top mounted Photovoltaic Solar Panel System.
Business name:J.T.Roth Construction Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:12600 SW 72"Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Tigard,OR 97223 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)6392639 Fax:(503)6240239 State surcharge(12%of permit fee): $21.60
CCB lic.:31700 Total fee due upon application: $201.60
Authorized signa -,-.. /' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
_ dir, *Fee methodology set by Tri-County Building Industry
Print name:Da, • Jensen Date:12/22/2015 Service Board.
I:\Building\Permits\BUP-RESPermi ,sp.doc 02/24/2011 440-4613T(11/02/COM/WEB) -
Electrical Permit Application FOR OFFICE 1 SF.Oyl.v
Received
City of Tigard ® r DateB : Permit#: '+�,- ; „- , el
114 r" a 13125 SW Hall Blvd.,Tigard,OR 97223 !1 Plan Review
Phone: 503.718.2439 Fax: 503 ':IV r 1 DateB : Related Permit#:
10
Inspection Line: 503.639.4175n Ic '3 Ready Date/By: Juns: Ed See Page 2 for
T I G A R D Internet www.tigard-or.gov c 14�1 Notified/Method: Supplemental Information
i ,. „- /oro 1 ¢ y 1 F}
®New construction ❑Addition/altera t�Qi�p Please check all that apply(submit 2 sets of plans w/items checked):
Vim'' `,R`\'���777��� ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: itia4O where the available fault current 0 Marinas and~ boatyards.
'IO[ '` ,< ){� , K h. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-familydwelling0 Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
.404';';$.�1 .W 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 14075 SW 118"Court 100HP or more. ❑"A "E","1-z","1-3",
City/State/ZIP: ar
TI d,OR 97223 ❑Six or more residential units. occupancy.
Tigard, ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Pro Project name: 0 Hazardous locations. 0 Supply voltage for more than
J 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site:Gaarde Road to 118"Court ' Y EE D
Description I Qty. I Each I Total 1
New residential single-or multi-family dwelling unit.
Subdivision:Medallion Meadows Lot#:21 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 6 33.92 1
D RIP ON f F" � ,x ^, . ,, , i" ` Limited energy,residential
�� 1 75.00 2
(with above sq.ft.)
Wiring for new single family residence
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
td PROI"�1°HERR a.„.„..,,,,,..,.,„..„:„.„,,,,„,,„,„,,,,..,„AND'
Renewable Energy 0 See Page 2
... - Services or feeders installation,alteration,and/or relocation
Name:J.T.Roth Construction Inc. 200 amps or less 100.70 2
Address: 12600 SW 72nd 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)63926389 Fax:(503)6240239 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less i 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 rcuits—nw,alteration,or extension,per panel
, .:' - ®,4 A.Fee for cibranch 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 72nd Ave branch ciorcuder fee,first 56.18 2
City/State/ZIP:Tigard,OR 97223 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)8060602 Fax: :(503)6240239 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:davidj@jtrothinc.com
Reconnect only 67.84 2
. 0 ,. . _ Ppmp or irrigation circle 67.84 2
Business name:Grizzly Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:8002 NE Hwy 99#248 panel,alteration,or extension.
City/State/ZIP:Vancouver,WA 986645 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)9094080 Fax:(360)6948939 Investigation(1 hr min) 90.00/hr
Email:grizzlyelectricinc@msn.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 186218 Electrical Lic.: 3-7//%,:_ Suprv.Lic.: 37446k.. 24+1 .-speclfical listed(%hrmm)
Suprv.Electrician signature,required: Subtotal:
Print name: Ron Nelson Date: 12/22/2015 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: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(I 1/05/COM/WEB
Mechanical Permit Application EOR OFFR E t SE ONE 1
•
City Tigard TI and ON Received
Date/By: Permit No.:
= 13125 SW Hall Blvd.,Tigard,0 I.' 1,% Plan Review
• Phone: 503.718.2439 Fax: 503:1.. 60 C A (� ,,,,kDaBy, Other Permit:
T i G A R D Inspection Line: 503.639.4175 O�G Y `e,I4 O\4 Date Ready/By: Jas: 0 See Page 2 for
Internet: www.tigard-or.gov ®�� e�®� Notified/Method: Supplemental Information
''l"; ' .1? , _ ,., f 1<, * : EiR 1
1, "`"''''''''''''''''"?"-'•` ' ` ' Mechanical permit fees*are based on the value of the work
/4 New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
TE(4, if o t1 Value:$
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
, ,c Heating/cooling:
v ., . �,.,.. r Air conditioning 46.75
Job site address:14075 SW 118thCourt Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site:Gaarde Road to 118th Court Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision:Medallion Meadows Lot no.:21 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
4 EA'
Gas fireplace/insert 33.39
Flue vent for water heater or gas
HVAC installation for 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
Other: 23.32
' ��'° � ; � °1,Ig *** n Environmental exhaust and ventilation:
Name:J.T.Roth Construction Inc. Range hood/other kitchen
°d equipment 33.39
Address:12600 SW 72 Ave Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)6392639 Fax:(503)6240239 Attic/crawlspace fans 23.32
C : x ,40,0 k f Other: 23.32
... r. 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)8060602 Fax::(503)6240239 Fireplace
Range
E-mail:davidj@jtrothinc.com Barbecue
x, ;;:':0 �;,, i `. Clothes dryer(gas)
Business name:All Time Heating LLC Other:
Address:PO Box 1341 Subtotal
City/State/ZIP:Lake Oswego,OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)2082276 Fax:(503)2082276 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: 7 * Fee methodology set by Tri-County Building Industry Service Board
Print name:Aaron Svobova J Date:12/22/2015
I:\BuildinglPermits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Plumbing Permit Application
Building s Fixtures
' FOR OFFICE t SE ONI.)
why.1 l T Received
City of Tigard ! Date/By: Permit No.: M
= 4 13125 SW Hall Blvd.,Tigard,OR 97 " JTa �� c
Phone: 503.718.2439 Fax: 503.598. •.1 p 1� Plan Review
J O Date/By: Other Permit No.:
Inspection Line: 503.639.4175 C
l 1 C A K I� �� (n� .;: ReadyBy Juns ® See Page 2 for
Internet www hgard or gov 1� r �fiedllvlethod Supplemental Information
@ New construction 0 D1 For special information use checklist.
Description Qty. I Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
y. q . ,. +': i' .`s ... .�� ..... SFR(1)bath 312.70
11 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath x 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
tE'O 1Ol4- LOC ,.. '. j . . Site utilities:
Job site address:14075 SW 118th Court Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: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 ( Lot no.:21 Fixture or item:
Tax map/parcel no.: Backflow preventer x 31.27
D� flOI ', Backwater valve 12.51
.. ., Clothes washer 25.02
Plumbing installation at new single family residence Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
rt kitor Y3 i g4 ( 1 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.d Ave.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223
Hose bib 25.02
Phone:(503)6392639 Fax:(503)6240239 Ice maker 12.51
( otticOr ra t 0 I! ° Interceptor/grease trap 25.02
Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:David Jensen
Roof drain(commercial) 12.51
Address:12600 SW 72m1 Ave. Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)8060602 Fax::(503)6240239 Tub/shower/shower pan 12.51
E-mail:davidj@jtrothinc.com Urinal 25.02
+I Water closet 25.02
,.-. Water heater 37.52
Business name:A.L.L.Plumbing LLC Water piping/DWV 56.29
Address:9312 NW Skyline Blvd Other: 25.02
City/State/ZIP:Portland,OR 97231 Subtotal
Phone:(503)5200313 Fax:(503)7067764 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:194089 Plumbing Lic.no.:PB1022
State surcharge(12%of permit fee)
Authorized signature:. TOTAL PERMIT FEE
Print name:Gary Luchs Date:12/22/2015 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
/
ill
71COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: /iS F(1bi s--..a-,241g
Site Address: C 1 n---1 5 sw ( V 5Th C---
Project Name: viedal l i 01l lyke;c0aj 3 Lot #: 2
(New dwelling= subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: ne N S --
ciVerify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ Yes 12C No
Sit Plan Elements:
ree(3) copies of site plan 2 sting structures on site
tx
o plan must be on 8-1/2" 11"or 11 x 17"paper IC Footprint of new structure(including decks)with finished
awn to scale(standard architect or engineer scale) oor elevations
Orth arrow Utility locations(required for new,may apply for additions)
i.te address,project or subdivision name and lot number r. •cation of wells/septic systems
information(name and phone number)2L1)
r Erosion control(including drainage-way protection,silt fence
ot dimensions and building setback dimensions design,location of catch basin,etc.)
^g•Lot area,building coverage area,percentage of coverage and Street names
/impervious area(applicable if R-7,R-12,R-25&R-40) -BS eet tree size,type and location
NJ Property corner elevations (2 foot contour lines if more than xisting trees to be retained with drip line,and tree
4 foot differential) protection measures
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
/Required: ❑ Yes,applicant was notified X.No Received: ❑ Yes ❑ No
LI Public Facilities Improvement (PFI) Permit:
equired: ❑ Yes,applicant was notified ❑ No Applied For: ['Yes E No,stop intake
2 Land Use Case#: J U S3 2.0\S`00006Voning: R— IA , S
Setbacks: Front 201 Rear \ 5' Side gi1 o' Street Side Garage '0'
-E3'Landscape Requirement:
$ of Coverage Maximum: % ,
• Building Height: Maximum Height 3'0
Actual Height 214
I
• Visual Clearance
- Easements
EAensitive Lands: Yes ❑ No Type (OW --\f(�,�\Il V ,S\ I(( . �}tCr T
• Urban Forestry Plan
IA Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: , -rj fyl LeArl rb()lc,1 Date: v2`2 c
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_0709I 5.docx
Building Permit Submittal
Original Submittal Date: 0/2-4/1 5—
Site Plans: # 7
Building Plans: #
Building Permit#: tenter building permit#above. _ �
Workflow Routing: [t]-Manning eering eLc� rm--Coordinator 1E-Buil
Workflow Sign-off: -off for Planning(include notes from planning review)
Route Application Documents: Bring: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
g--Iluti1 ing: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: 71;554-2,3
d.
By Permit Technician: Date: /,�/ i3--
Engineering Review
[r Slope at building pad: p 7,
1 Conditions "Met"prior to issuance of building permit
yrEasements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: iifi'L 27 Date: (2-34:1—/G
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
DC Fees Entered: Wash Co Trans Dev Tax: ( Yes ❑ N/A
Tigard Trans SDC: ❑ Yes 'N/A
j Parks SDC: Yes CI N/A
l�OK to Issue Permit
Approved by Permit Coordinator: f----- Date:1 , I
I:\Building\Fonns\BIdgPennitRvw RES 070915.docx
City of Tigard ' COMMUNITY DEVELOPMENT DEPARTMENT r
EEIVED
111 Request for Permit A '1�«�'
q ctlon
LIG A i l) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 tigardo g 2 2016
BUILDING DIVISION
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: X❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: J.T. Roth Construction Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 12600 SW 72nd Ave ��(• '
City/State/Zip: Tigard, OR 97223
Phone No.: (503)639-2639
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR • RMIT (do not cancel permit).
Permit#: MST 2015-00298 ..,5441A1.7,2-015-'Qo a2 a 7
Site Address or Parcel#: 14075 SW 118th Court
Project Name:
Subdivision Name: Medallion Meadows Lot#: 21
EXPLANATION: After applying for the building permit it was discovered that the plan
submitted for permits did not conform well to the site.
The applicant has elected to construct a different house plan that will work better with the site
Signature: - —� J Date: 08/19/2016
Print Name: David Jensen
Refund Policy
1. The city's Community Develop ent 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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date at�. (P l Route to Records: Date ID 7 /k _ By
Refund Processed: Date/p/7//' 1 Invoice Processed: Date By
Permit Canceled: Date09 By .r'" ' Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_ 2314.doc
III
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TIGARD
City of Tigard
September 23,2016
J.T. Roth Construction
Atm: David Jensen
12600 SW 72"d Ave., #200
Tigard, OR 97223
Re: Permit No ST2015-00298 c SWR2015-00227
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14075 SW 118th Ct.
Project Name: Medallion Meadows,Lot 21
Job No.: N/A
Refund Method: ® Check#222422 in the amount of$28,786.68.
❑ Credit card "return" receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$ .
Comment(s): Per applicant's request as building plans did not fit on lot and plans were
resubmitted under MST2016-00306/SWR2016-00269. Refund 100% of permit fees except
for plan review that was already completed when request to cancel permit was received.
If you have any questions please contact me at 503.718.2430.
Sincerely,
"woo
4 , - 4r / "
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: J.T. Roth Construction DATE: 8/18/2016
Attn: David Jensen
12600 SW 72nd Ave., #200 REQUESTED BY: Dianna Howse
Tigard, OR 97223
TRANSACTION INFORMATION:
Receipt#: 404637&404638 Case#: MST2015-00298&
SWR2015-00227
Date: 6/23/2016 Address/Parcel: 14075 SW 118th Ct
Pay Method: Credit Card Project Name: Medallion Meadows,Lot 21
EXPLANATION: Building plans were not a good fit for this lot and new plans were submitted under
�
MS
T2016-0030`$6/SWRa2016-.�002�`69�. Refund
100,%w`(otp�f�permit fees
exce
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lan review.
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Building Permit 230-0000-43104 $2,206.80 v
Mechanical Permit 230-0000-43102 300.99 ✓
Electrical Permit 220-0000-43103 447.06 ✓
Plumbing Permit 230-0000-43101 500.32
12%State Surcharge 100-0000-24001 414.63 ✓
Erosion Control 100-0000-43134 461.40 ✓
Metro Construction Excise Tax 230-0000-24010 483.48
Tig-Tual School CET 230-0000-24102 3,900.00 ✓
Washington County TDT 405-0000-43320 8,113.00
Parks SDC Improvement 425-0000-43300 4,248.00
Parks SDC Reimbursement 425-0000-43301 1,001.00
Parks SDC Neighborhood 425-0000-43300 1,575.00
Sewer Connection Fee 500-0000-25500 5,100.00
Sewer Inspection 230-0000-43118 35.00
TOTAL REFUND: $28,786.68
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager tOtl410
If under$25,500 Department Manager n^
If under$50,000 City Manager \ /I/ ' I LZi g
If over$50,000 Local Contract Review Board
,:.
'FOR TIDEMARK; SYSTEM ADMINISTRATION USE ON "Yz'
Case Refund Processed: Date: 1 /0/7//0 By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
4
Dianna Howse
From: Dianna Howse
Sent: Thursday, August 18, 2016 5:28 PM
To: davidj@jtrothinc.com
Cc: #Building Permit Technicians; Mark VanDomelen
Subject: RE: Medallion Meadows Lot 21: MST2016-00306, SWR2016-00269 & MST2015-00298,
SWR2015-00227
Attachments: Req PermitAction_082014.doc
Hello David,
Due to the differences in the building permit plans, and the fact that the fees cross two fee schedule increases (1/1/2016
and 7/1/2016), I am unable to just"credit" the permit fees from one permit to another on the building and sewer
permits for lot 21 of Medallion Meadows.
You will need to submit a request to void the first permit and process a refund for MST2015-00298. I have attached the
request form for you to complete and return to us. We will refund all permit and SDC fees paid on this permit,with the
exception of plan review and archiving fees as plan review was already completed on this permit prior to cancellation.
Please allow 3-4 weeks for processing the refund check which will be mailed to you.
Thank you and please let me know if you have any questions.
Dianna Howse
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2430
From: Branden Taggart
Sent: Thursday, August 18, 2016 2:45 PM
To: davidjOjtrothinc.com
Cc: #Building Permit Technicians
Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269
David,
Dianna is working on the credit/refund details. This process is complicated with the changes in SDC fees between the
two permits,so it will take a little more time. We will get back to you as soon as we know more. In the meantime, if you
can submit the form to get the process started,that would be great.
Thank you,
Branden Taggart
iIICity of Tigard
Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent tgard-orgov
.
From: Branden Taggart . ._ .e . .�
Sent: Thursday, August 18, 2016 2:24 PM
To: 'David Jensen'
Cc: #Building Permit Technicians
Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269
Hi David,
If you submit a Request for Permit Action form to us requesting to void permit MST2015-00298,we will credit MST2016-
00306. You can follow the link below to complete the Request for Permit Action:
http://www.tigard-or.gov/document center/Building/ReqPermitAction.pdf
Once we receive the completed form from you,we will let you know what the balance due is. Let us know if you have
any questions.
Thanks,
Branden Taggart
4 City of Tigard
e. .4 Permit Technician
Community Development
1,100,0
13125 SW Hall Blvd
Tigard, OR 97223
(503)71 -2449
brandenttigarcl-or.gov
From: David Jensen [mailto:davidj(qtrothinc.com]
Sent: Thursday, August 18, 2016 1:22 PM
To: Branden Taggart
Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269
Branden:
Thanks for the notification. However, I am wondering about the fees due. As you can see in your records I have already
purchased permits for this house. As we began the formwork on the plans submitted we realized that the plans we
originally submitted would not work on the lot. We then resubmitted a new plan that better fit the site conditions. I
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understand that we have incurred costs for the additional plan review but all other fees that have been previously paid
for should be credited to the new plan.
Please let me know what the revised amount due is for Medallion Meadows lot 21.
Thank you
DAVID JENSEN
J.T. ROTH CONSTRUCTION,INC.
503.639.2639
davidj@jtrothinc.com
www.jtrothinc.com
From: Branden Taggart [mailto:brandent@tigard-or.gov]
Sent: Wednesday, August 17, 2016 9:32 AM
To: davidj@jtrothinc.com
Cc: #Building Permit Technicians
Subject: Medallion Meadows Permit: MST2016-00306, SWR2016-00269
Hi David,
Your permit for lot 21 of Medallion Meadows is ready to issue. The balance due is$34,615.06, and you can pay the
permit fees online at https://aca.accela.com/tieard/or in person when you pick up the permit between the hours of
8:00 a.m. and 4:30 p.m., Monday through Thursday. We are closed on Fridays. If you have any questions, please let me
know.
Thanks,
Brandon Taggart _ .
City of Tigard
Permit Technician
Community Development
13125 SW Hall Blvd
Tigard. OR 97223
(5033 718-2449
brndenttigard-or.gov
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may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
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