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Permit (56) f1111ak CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016 00539 • T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2017 Parcel: 2S 110BA 13000 Jurisdiction: Tigard Site address: 14015 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 23 Project: Medallion Meadows, Lot 23 Project Description: New SF. 5/31/17, REPRINTED to add 94sf of covered porch. 8/30/17: REPRINTED permit to include A/C. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right 5 Detectors: Yes Total: 2621 sf Value: $332,456.81 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 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 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: 5 201-400 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 2621 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: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,197.50 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C-• - . e rules are set orth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. . •. . :60.332. . Issued By: /' ,..--,' �, Permittee Signature: � . Call 50 6' 75 by 7:00 a.m.for the next available inspection date. —.> This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. °` Mechanics! Permit A plicati r � ' FOR OFFICE USE ONLY City of Tigard Received peewit NoiLIST • 13125 SW Hall Blvd.,Tigard,OR 97223 1 Date/By: A/6- S-39 Ilk Other Permit: Phone: 503.7182439 Fax: 503.598.1960 �} pian Review Date/By: T I G A R D Inspection Line: 503.639.4175 y /f( F'j`��i Date Ready/By: loris: f See Page 2 for Internet: www.tigard-or.gov i t `�' Notified/Method: L Supplemental Information illlLD1NG DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST Mechanical permit fees*are based on the value of the work ONew construction 0 Addition/alteration/replacement performed..Indicate the value(rounded to the nearest dollar)of all 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1Z1-and 2-family dwelling 0 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: ` sr, ,,,/ • Air conditioning 1 46.75 /4/°15 Job site address: YY iJ9 7rif 61-- Furnace 100,000 BTU(ducts/vents) 46.75 Cit /State/ZIP: r Furnace 100,000+BTU(ducts/vents) 54.91 y '7"�(�i�12--7 c...�C� �T 7 �Z-�j/ Heat pump 61.06 Suite/bldg./apt.no.: I Project name: Duet work 2332 Cross street/directions to job site: j 1 13 *+•}A -,• G A.Ps V--1) Hydronic hot water system 23.32 1 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: t4 C I A Lc i a N /tt=A Do LA;5 I Lot no.: Z 3 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 AIGL,-) 6/tit Co c-E piatin I Ly ,.P--im,,/ Pte/1X6 fireplace 23.32 / j-3 // Log lighter(gas) 23.32 (. l 7 e Lt}kt`LA 4( C"` Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 la PROPERTY OWNER 1 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen iequipment 33.39 Address: ,�j'�M\ I=- A BE---1-0--): Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) • F- k as L - tlut..i;iil paCLAdrts 2332 = ( APPLICANT 0 CONTACT PERSON Other: 23.32 � ` Fuel piping: Business name: 17.2( „I.. t'� c- D 6,....)_strati et/t?L..) $14.15 for first four;54.03 for each additional Contact name: ')Ay I t) lbe.N Ne2T' Furnace,etc. Address: P 0 . caX L1 Gas heat pump Wal!/suspended/unithester City/State/ZIP: .i=f.V ..To 0J1 CV._ W' 7 07 S Water heater Phone:(5:3) 590 „ 0 9 0 s Fax::(5Q3) .547e) .- /-7 S i Fireplace Range E-mail: ppLI.(2. D CO /,-.)S re,MS KJ, c0i,"\_ Barbecue CONTRACTOR Clothes dryer(gas) Business name: '"- Other: � �� L. v ' '� ME CHANICAL PERMIT FEES* Address: r.o, J34)(' Lj,33 Subtotal City/State/ZIP: L�t ' h/1 l S Minimum permit fee($90.00) - Phone:(563 (�S r J,` V fS /Fax:(.s3) bS a -,3 d vs- t State surchargeu rev ( of permit fee) (12%of permit fee) ,5,, (.„ CCB lic.: i 7.0. b Z ti TOTAL PERMIT FEE j/`,. 75- - j- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: 1142 * Fee methodology set by Tri CountyBuilding Indus twice Iloar3 Print name: w ,j_QE 6 it -- Date: /2 7-..5"-/6 ' L\Buildineermits\MEC_PennitApp_040113.doc 440-4617r ill/02/COM/WEB) CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT P . ' 'ri 4Permit#: MST2016-00539 Date Issued: 03/15/2017 T t GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ®4/ 7 67.3-7, Parcel: 2S110BA13000 Jurisdiction: Tigard Site address: 14015 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 23 Project: Medallion Meadows, Lot 23 Project Description: New SF. 5/31/17, REPRINTED to add 94sf of covered porch. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2621 sf Value: $332,456.81 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: 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'I 500 sf: 5 201-400 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 2621 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: 503-720-7445 i FAX: 503-590-1751 Total Fees: $30,145.14 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 issua - , or ' work is susp= d-.• for more - 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification 4e i e Th•s- ule a'- se • in OAR 952-001-0010 throu h OAR 952-001-0090. You may obtai of the rules or direct questions to OUNC by calling 503.2 9; •r 1.:•.F.2.2 i,if F r Issued By: , -3--,•--e--%----------- -- Permittee Signature: / all 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 e project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit#: MST2016-00539 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2017 Parcel: 2S 110BA13000 Site address: 14015 SW 118TH CT Jurisdiction: Tigard Subdivision: MEDALLION MEADOWS Lot: 23 Project: Medallion Meadows, Lot 23 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1206 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 28 Bathrooms: 3 Second: 1415 sf Garage: 628 sf Front: 20 Dwelling Units: 1 Smoke Third: 0 sf Right 5 Detectors: Yes Total: 2621 sf Value: $330,358.73 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays:Y 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 0 Water Lines: 100 Drains: Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 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<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 p W/Svc or Fdr: 0 Ea add'I 500 sf: 5 201-400 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 SecurityAlarm: N Vaccuum System: N Garage Opener: N All Other N Other Description Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2621 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: 503-720-7445 FAX: 503-590-1751 Total Fees: $30,084.49 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 OUNC by calling 503 .1987 .800.33 . 44. _. Issued By: / _... / / Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. s This permit card shall be kept in a conspicuous place on the job site until completion he project. Approved plans are required on the job site at the time of each inspection. • BUildin Pei'Iillt App]1CatlOn' �' j' Residential , FIVE') i '`Q e i ' FOR OFFICE USE ONLY City of Tigard DECReceived 4 13125 SW Hall Blvd.,Tigard,OR 97223 �`Z Date/B R Permit Ng/�� -� � t��C�c Phone: 503.718.2439 Fax 503.59ill8. J OF Plan Review lJ 7 T 1 G A R D Inspection Line: 503.639.4175 " TGA[� Date/ : - ,� ---111 Other Permit: � y �j Internet: www.tig 3.63 41 T DateReady/By. for i�UILDIh,(' DIVISION ! ]oris: ® SeePene2fnr 1J 1!l F+� l��:6 6'i 1 Notified/Method: ,�r /� •1) Supplemental Information TYPE OF WORK ~ fJ�uiy1' i' New construction REQUIRED DATA:1-,AND 2-FAMILY DWELLING 0 Demolition Permit fees*are based on the value of the work performed. ID Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. fil 1-and 2-family dwelling Valuation: ❑Commercial/industrial $ 330 .2 --.s. 0 Accessory building IDMulti-familyNumber of bedrooms: ❑Master builder ❑Other: Numb `3 er of bathrooms: JOB SITE INFORMATION AND LOCATIONTotal number2..--of floors: 3^�I j Job site address: y 0 I S et`„ Zt ,r }µ oL 7 et J VY eT New dwelling area: 26Z/ square feet City/State/ZIP. '1"-t(0R 12...E) CAL _ Garage/carport area: 6Z / square feet Suite/bldg./apt.no.: Project name: AL, 1 ‘ Cross street/directions to job site: 1 'A AL ./1„,:„ ,, Covered porch areal &qs square feet) l� T 13 2,7 GZ Q Deck area: \ �Z0 square feet jao,6 Other structure area: square feet Subdivision: ma-b.LL1/4. MLS W Z3 Lot no.: REQUIRED DATA:COMMERCIAL-USE CHECKLIST 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 DESCRIPTION OF,WORK equipment,materials,labor,overhead,and the profit for the work indicated on this application. —Af �! S'�I�/CSL i=A1-s►It. E'S f t EJIiLC Valuation: $ Existing building area square feet New building area: square feet R PROPERTY OWNER 0 TENANT Number of stories: Name: Address: Type of construction: �'p ( e ASL LG"..l Occu anc City/State/ZIP: P Y groups: Phone:( ) Existing: Fax:( ) �r..,�.v i1—` 0 CONTACT PERSON Business name: BUILDING PERMIT FEES* C9lA i 7 [ J�/ T. CT 1tJ 0 , ° (Please refer to,feeschedule) Contact name: AY 1 o De N Fi�P PO ex. Structural plan review fee(or deposit): Address: F'0,S l), X 5 -� FLS plan review fee(if applicable): City/State/ZIP: �—P-ve 1�-p t,..) 0 , C .7 0-7 Total fees due upon application: pplication: Phone:(603) 5.90 _ O23 0 S I Fax::(...S.;3) S'9 0— 17 5 i Amount received: E-mail: l� l c L3 J.1 S,r AA h i co . PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of Business name: roof-top mounted PhotoVoltaic Solar Panel System. Submit two(2)sets of roof plan with connection details Address: _ 114 f31 `� and fire department access,along with the 2010 Oregon City/State/ZIP: L Solar Installation Specialty Code checklist. Permit Fee(includes plan review Phone:( ) I Fax:( ) and administrative fees): $180.00 CCB lic.: 7 `7 State surcharge(12%of permit fee): $21.60 Authorized signature: ( Total fee due upon application: $201.60 oti, .do(/L70e__ This permit application expires if a permit is not obtained I Print name: * within 180 days after it has been accepted as complete. v t �= ^(- Date: Z /� Fee methodology set by Tri-County Building Industry Service Board I:1Building\Petmits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l I/02/COM/WEB) 7 Mechanical Permit ApplicataErFIVEI/ FOR OFFICE. USG ONLY City of Tigard Received II °EriI 13125 SW Hall Blvd.,Tigard,OR 97223 r0 Received Permit No �j /6 �' q Phone: 503.718.2439 Fax. 503.598.1960 "? �' 1 Plan Review T I G A R D Inspection Line: 503.639.4175 p I {�y Date/By: Other Permit: Internet: www.tigard-or..41 [, ,r \r F.'1IC:Axa fj DateReady/By: furls: 0 SeePage2for ^ _I Notified/Method: BUILDING n A Supplemental Information TYPE OF WORKfb7tIP1* 1 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ;New construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work 0 Demolitionperformed.Indicate the value(rounded to the nearest dollar)of all 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ R11-and 2-family dwelling 0 Commercial/industrialRESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0 Accessory building Fors j pedal information use checklist. ❑Multi-family 0 Master builder 0 Other: Description JOB SITE INFORMATION AND LOCATION g/coolin I Qty. Ea. I Total Heatin g: Job site address: 7°/5 r �Y.�d� Air conditionin' 46.75 �/9 7W 6r' Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: �-�•—i L 412-D ■ '�'"� Ly�'"Z' .`/r Furnace 100,000+BTU ducts/vents 54.91 Suite/bldg./apt.no.: r / Heat pump I Project name: 61.06 Cross street/directionst':3 to job site: Lk Duct work ■ 23 32 l l •-i H G fi>, t CZD Hydronic hot water system 23.32 Residential boiler(radiator or ' h dronic 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: /y)C 0 A Li,( a 1� cS 1 Lot no.: 2 3 Other: jUZL AI�GiAJ 23.32 Tax map/parcel no.: Other fuel appliances: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Aleat•-) Flue vent for water heater or gas X i til U L,6 Ram 1 1 , p---e-„�.' t P Jl.3C.6 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 J 0 TENANT • Other: 23.32 Name: Environmental exhaust and ventilation: Range hood/other kitchen Address: U _-�O equipment 33.39 City/State/ZIP: Clothes dryer exhaust 33.39 Single-duct exhaust(bathrooms, Phone:( ) • toilet compartments,utility rooms) 23.32 y _ t APPLICANT �Sh'at,c farts- _ 23.32 0 CONTACT PERSON Other: 23.32 Business name: * t Fuel piping: p" DCc%1N ST gi,i Cr 1 01J _ Contact name: $14.15 for first four;54.03 for each additional t`Jw 1 D -�� �A Nal-- Furnace,etc. Address: 0, ��( is---i--7 Gas heat pump City/State/ZIP: Wall/suspended/unit heater Ep,VE- L• 1 cry- 9 -207 Water heater Phone: C Jr f0 c^'U L j IFax::(553) -cie3 /7 S I Fireplace E-mail: ®AIi2--0 CO v Range i �1 Barbecue CONTRACTOR Clothes dryer rY (gas) Other: Business name: E r A i? mac.. Address: t� : MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal C 0.,C,i‘= r + 0 7 �-- / l Minimum permit fee($90.00) Phone:(jL' Plan review 25%of permit fee ( 5G...-. t(708 Fax:(S:13) tb50 —324�> ( P ) CCB lie.: ! State surcharge(12%of permit fee) TOTAL PERMIT FEE / This permit application expires if a permit is not obtained within 180 Authorized signature: - days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board Print name: 2:),tlwt J-1)z-,, ',"opu— Date: / 2:S-/G I:\Building\Permits\MEC_Permi tApp_040113.doe 440-4617T(I1/02/COM/WEB) Rf3 Electrical Permit Application �. a FOR OFFICE USE ONLY - City of Tigard 1, Received 13125 SW Hall Blvd.,Tigard,OR 97223 LH:_1,.- " ' '� Date/By: Permit 5 vg,--05-37 Phone: 503.718.2439 Fax: 503.598.1960 / +- tan Review K 3 (WTI I,DRate/By: Related Permit#: TI G A K D Inspection Line: 503.639.4175 Y Date/By: Juris: Internet: www.tigard-or.gov I See Page 2 for l T 5 ;�, r ed/Method: Supplemental Information TYPE OF WORK PLAN REVIEW #New construction ❑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. 12(1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: JOB SITE INFORMATION AND LOCATION 0 Fire pump. 0 larger Installation of 150 KVA or ❑Emergency system. larger separately derived Job#: I Job site address: /yQ is s' ❑Addition of new motor load of system. i a )Jg r'� (tet 100HP or more. ❑"A»`°E» `1_2» "1.3» City/State/ZIP: l l �g...0C ! / ❑Six or more residential units. occupanty. R l Z Z 'L 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal. 1 `t'' 6r`�3'si1izoE; FEE SCHEDULE Description I Qty. 1 Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: (✓o fl L.L.44.::t -L---hi70,-S I Lot#: 2,3 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less ) 168.54 4 DESCRIPTION OF'WORK Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,}_ residential ..— with above s..ft. 75.00 2 1L./. 4..." Si tJ&t..L F'F iv i I )04-iC ; Limited energy,multi-family 75.00 2 residential(with above sq.ft.) PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: p� �O 201 amps to 400 amps - 133.56 _© City/State/ZIP: YJ 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 snips or less 59.36 I 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 `CONTACT PERSON Branch circuits-new,alteration,or extension, •er panel I APPLICANT 0 Business name: r f^ y-� A.Fee for branch circuits with o(. D 'o?cis 24,t lit;ice] above service or feeder tee, each branch circuit 7.42 2 Contact name: 0 ,ice V 1 0 i; 3 t 1 �IQ,IZT t F B.Fee for branch circ, MENIMIIIMIIIMINNINIMMI__ service or uit er fee,first „ i 56.18 branch circuit City/State/ZIP: '•C.p, -o •JJ >r 02. ` � ' 7.S Each add'I branch circuit 7.42 Phone:( � ) � � .�� Fax: : ° ) _ Miscellaneous(service or feeder not included) 3 69 I<7 S I Each manufactured or modular dwelling,service and/or feeder Email: 67.84 2 D (3,a.�"r , ivt,5 A.i ' c..A3iv-v Reconnect only 67.84 2 6 i i,{-e CONTRACTOR Pump or irrigation circle 67.84 Business name: Ir GSC Sign or outline lighting ' Lr2Lvlp li 67.84 -® Address: .u r Signal circuits)or limited-energy It E • 9 .Z.A/D UR. - /0 V sand alteration or extension. 0 See Page 2 III City/State/ZIP: 'F0 izzr L 0 O pi 2,2_ Each additional inspection over allowable in any of the above t / _ Additional inspection(1 hr min) 66.25/hr Phone: 3' z 7 7 3-28 Fax:4'6)3) J', i — 7%/ 477 Investigation(1 hr min) 66.25/hr Email: tr L l E G fi2 tr / 14— i /,-e‘ Inspections plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: 1 9 j 27' I Electrical Lie.: C 4,3 9 I Suprv.Lie.: 5762 5 specifically listed(Y2 hr min) 90.00/hr Suprv.Electrician signature,required: 1 ELECTRICAL-PERMIT`FEES b' ' � Zi2-- Subtotal: Print name: 12s0B_ , t ,ipi4gi- Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: A. / I TOTAL PERMIT FEE: Print name: :� , "'"...../6, This permit application expires if a permit is not obtained within 180 VID X17 j .0.17,1}4,400.0.17,1}4,400/21--Date ,, � days after it has been accepted as complete. * Number of inspections allowed per permit. I:1BuildinitTermits1ELC_P€rmitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB Plumbing Permit ApplicationEC, Building Fixtures FOR OFFICE USE ONLY City of Tigard DEC fi" 8 2016 Received _ - d Date/By: Permit No/1-7Q-A,./6)f v�t'�� j�`�L' 13125 SW Hall Blvd.,Tigard, 97223 f Phone: 503.718.2439 Fax: 503.598 I p Plan Review x ask Date/By: Other Permit No.: Inspection Line: 503.639.4175 ,, , Date Ready/By. TIGARll Juris: ® See Page 2 forInternet: www.tigard-or.gov � LDi ;DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE aNew construction 0 Demolition For special information use checklist Description Qty. Ea. 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 0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 1 500.32 ❑Master builderEach additional bath/kitchen { 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: / / )j3 .5.6u. ng 114 Cr' Catch basin or area drain I 18.76 City/State/ZIP: / - Drywell,leach line,or trench drain 18.76 �I r) 0 r1 9 '7 • �/ `2 ! Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/diredions to job site: 1 i B Nk g (,jq R 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: fy1 EL)A C1 I )& p`, I Lot no.: 4. Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 ,`/CL^-s ,5)t L)L.,- pM 1 t 1/ PC?Si t t'- Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Ei PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Sir:W V P 5 Q ECS Floor drain/floor sink/hub 25.02 i-/ Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 f � . Ic Phone:( ) Fax:( emaker 17 51 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: f=^ D 5 zactio Medical gas(value:$ ) Page 2 C `'"` Primer 12.51 Contact name: ,.D Au 1 0 /D€/P X /�� _ Roof drain(commercial) 12.51 Address: (L C S xJ J Sinklbasitt/lavatory 25.02 City/State/ZIP: 43Y i, r..1 0 izs 9 7 c. 7 1S Solar units(potable water) 62.54 Phone:(,5)-3) 5.9G-S 0 S Fax::(_5.3) 5-90 - i-7 S i Tub/shower/shower pan 12.51 E-mail: �t'iR- D Co&31"" Crc /4')I.S")r CO Ain Urinal 25.02 ^ e. CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: --- tA L t...�Y.1�,1 /�/1 e F1ls.3 /� Water piping/DW V 56.29 Address: t9(� ( A S" te-g_ , - Other: 25.02 City/State/ZIP: 1.1 L j S B 0 / 0 Ci' `) i,2-3 Subtotal Phone:(S03) ,YO co ,1 3 Fax:( ) Minimum permit fee: $72.50 Pl CCB Lic.: l' e. umbi3_! F� Plan review (25%of permit fee) Plumbing Lic.no.: Z 6 0 P State surcharge(12%of permit fee) Authorized signature: - TOTAL PERMIT FEE Print name:D/3)4 o -DE A ,j- Date:/x 6-46 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.doc 10/01/09 440-46I6T(10/02/COM/WEB) IllCity of Tigard COMMUNITY DEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: /-7.5' 0/ 0® 13 j Site Address: ItAOIS SW I`y C e Project Name: MCdntA 1(.311 Mia OWS (New dwelling=subdivision name;Addition or Alteration=last name of owner) Lot #: '2_ Planning Review Proposal: NCvJ 52- Verify site address/suite#exists and active in permit system. River Terrace Neighborhood: ZNo ❑ Yes,See River Terrace Review Addendum Attached Site Plan Elements: 1``Three(3)copies of site plan M• /Mg Site plan must be on 8-1/2"x 11"or 11 x 17"paper t41° xisting structures on site rawn to scale(standard architect or engineer scale) floore levationsw structure(including decks)with finished X /North arrow Si e address,project or subdivision name and lot number Ill, locations(required for new,may apply for additions) 'cation of wells/septic systems xisting ees to be �,*�i pplicant information(name and phone number)��' it dimensions and building setback dimensions n.rote coon me suresretained with drip line,and tree NalLot area,building coverage area,percentage of coverage and Xtreet tree size,type and location it N impervious area(applicable if R-7,R-12,R-25&R-40 roperty corner elevations (2 foot contour lines if more than ,,Street names foot differential) Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified No Received: ❑ yeS ❑ No -0 Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified No Applied For: ❑ yeS ❑ No,stop intake Land Use Case#: 51.4f -Dii -CCCVLP Jnr I oning: Q --- J A I 'ear Side 5Street Side Garage Landscape Requirement: zi of Coverage Maximum: /� FA Building Height: axlmum Height ipt Eisual Clearance Actual Height I/ asements Sensitive Lands: X Yes ❑ No rban Forestry Plan Type � �a-� ( IOW IA tUG �f 14 - 7 Conditions "Met"prior to issuance of buildinge permit Notes: Approved By Planning: = - �_ Date: _R./cake_ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 1:\BuildingTonns\B1dgPernvtRvw RES_091216.docx Building Permit Submittal Original Submittal Date: /a2- //." Site Plans: # 3 Building Plans: # 2 Building Permit#: C3--Enter building permit#above. Building Workflow Sign-off: [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. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: , _ Date://d k By Permit Technician: arffillial Engineering Review zr Slope at building pad: /J,, li\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: D Yes No Assess Water Quantity Fee in-lieu: ❑ Yes No LIDA Facility on lot: ❑ Yes No Date: CINOT Approved by Engineering: Notes: Date:Approved by Engineering: J'7 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review 0 Conditions"Met"prior to issuance of building permit Date: 0 Approved,NOT Released: 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: WI D C Fees Entered: Wash Co Trans Dev Tax: <l�oYes 0 N/A Tigard Trans SDC: Yes 0 N/A Parks SDC: Yes 0 N/A rOK to Issue Permit / % �`� Approved by Permit Coordinator: Date: I:\Building\Forms\B1dgPemutRvw_RES_091216.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 9, 2017 at 10:55:52 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Seal hood vent to wall penetration. N1104.8.2, M1601 .4.1 Seal condensate penetration in foundation vent, back patio area. R408.2 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 9, 2017 at 10:50:53 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Remove white cap from main floor shower drain. Fix leaking shower head same bath. Fix leaking shower head in master bath. Fix leaking shower head upper level main bath. Glue cleanout riser body in place right side. unable to find sanitary sewer cleanout. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 9, 2017 at 10:57:40 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Provide single recepical marked non gfci protected at second fridge location in mudroom, And laundry room. 210.8 A Note: space 22, 28 in panel not labeled. All else appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 12, 2017 at 9:30:13 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 12, 2017 at 9:28:48 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 199 Electrical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 12, 2017 at 9:29:31 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: Corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14015 SW 118TH CT, TIGARD, OR, 97224 October 12, 2017 at 9:50:51 AM Record Type: Record ID: Residential - Master Permit MST2016-00539 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - CofO Comments: 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. Note: sidewalk and approach previously approved prior to construction of building. Violation Summary: Inspector Contractor