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Permit (64) 1 PCITY OF TIGARD MASTER PERMIT N.. . COMMUNITY DEVELOPMENT °' s >' "!i,1 , Permit#: MST2016-00518 TIG13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439MIIMP Date Issued: 03/15/2017 ''� �' 4 •n Parcel: 2S110BA12900 Jurisdiction: Tigard Site address: 14031 SW 118TH CT Subdivision: MEDALLION MEADOWS Lot: 22 Project: Medallion Meadows, Lot 22 Project Description: New SF. 8/30/17: REPRINTED to add NC unit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1624 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1291 sf Garage: 684 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2915 sf Value: $396,676.71 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: 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 1 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: 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 2915 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: $31,178.06 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification e er. ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c the rules or direct questions to OUNC by calling 503.23 :87•• .800,x '3 ,/ .• Issued Bye Permittee Signature: _ � ��L��- 503.639.4175 by 7:00 a.m.for the next available inspection date. X This permit card shall be kept in a conspicuous place on the job site until completi• of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application ..' ', , ' FOR OFFICE USE ONLY Cityof Tigard Received g Date/By: PermitNo.:nit-20// -1:219 5/1' • 13125 SW Hall Blvd.,Tigard,OR 97223 I 42016 Pian Review11111 ° {O Phone: 503.7182439 Fax: 503.598.1960 Other Permit: Date/By: TI GA R D Inspection Line: 503.639.4175 Date Ready/By: iarie: I H See Page 2 for Internet: www.tigard-or.gov , Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST �,New constructionMechanical permit fees"are based on the value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES" Cia/1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning / 46.75 Job site address: /4,/03/ .5�4 yt/. J/e 7`14.. Gr Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: -1- F-...i&412-D , C.-., 9'7 (2.:7-$,' Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 • Suite/bldg./apt.no.: I Project name: Duct work 2332 Cross street/directions to job site: ' 1 13 . N G(A-Rf4-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: /1/44 CDA 1....c( d N 1ti"I t=p00.4. S I Lot no.: 2,2,-, Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 �j Flue vent for water heater or gas AC=-6') 6/l•-)(so C- '1M i�L7 P.-as/ {�'C,(uGC fireplace 23.32 a Q /r. �/� / Log lighter(gas) 23.32 e?,,)//2 GC G( Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent _ 23.32 ,�/ Other: 23.32 Lpy�PROPERTY OWNER ❑,TENANT Environmental exhaust and ventilation: Name: Range hood/other kitchen 6:-: equipment 33.39 Address: ,5''p.ttill C- AS B 'C Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 ___--Phone4--- ) - %APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: 11::CX-42 D CC)A.)ST Cyt I e1 $14.15 for first four;$4.03 for each additional Contact name: A.1 c 12)e. - rypdepovr Furnace,etc. Address: ./ Gas heat pump P 0, lam/` ,'S 7 � Wall/suspended/unitheater City/State/ZIP: ,a E.F,V&_12,7-.0 o.3 / CV._ 9 )0 7 5 Water heater Phone:633) 590 0 9 o s Fax::(5..3) „_S-C7d i 7 5 i Fireplace Range E-mail: P©tl!2-D CO iv ST(7". 0415/0r C0NA_ Barbecue CONTRACTOR Clothes dryer(gas) Business name: :ltiOther: i �' t r MECHANICAL PERMIT FEES" Address: P.O ,B4)( L 3 3Subtotal �,c City/State/ZIP: Minimum permit fee($90.00) Phone:(.5d-3 6 SV.- 0 I'Fax:(S53) '5 O .-3(2)51K Plan review(25%of permit fee) Statteosurcharge(12%of permit fee) CCB lie.: 17 5 &'Z Li _ TOTAL PERMIT FEE c 3 f This permit application expires if a permit is not obtained 2i within AO days after it has been accepted as complete. Authorized signature:..44// �1111V- * Fee methodology set by Tri-County Building Industry Service Board Print name: DPI/ IC) s • t► -',Ili-Date: i'2,:S'/40 1:I Building\Permits1MEC_PermitApp_040!13.dm 440-4617T(I1/02/COM/WEB) CITY OF TIGARD MASTER PERMIT 7` COMMUNITY DEVELOPMENT Permit#: MST2016-00518 TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2017 Parcel: 2S 110BA 12900 Site address: 14031 SW 118TH CT Jurisdiction: Tigard Subdivision: MEDALLION MEADOWS Lot: 22 Project: Medallion Meadows, Lot 22 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1624 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1291 sf Garage: 684 sf Front: 20 Smoke Dwelling Units. 1 Third: 0 sf Yes Right 5 Detectors: Total: 2915 sf Value: $396,676.71 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 1 Y 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: Bckflw Prevntr: 0 1 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<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 P W/Svc or Fdr: 0 Ea add l 500 sf: 6 201-400 amp: 0 201-400 amp: 0 P 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: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: NEW SF VB p SquareFeet: R-332915 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: $31,080.70 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 -,er. se rules are et 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 503.23.:19;7 00.332.-. 4 Issued By: ,k1..C(2:5; )/ 4�'/�� Permittee Signature: . . 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; project. Approved plans are required on the job site at the time of each inspection. c Building Permit Application c Q 7 -2 Residential ' l " " FOR OFFICE USE ONLI' City of Tigard G i:1,' ;) 2.0 6 Received permit No 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ��/�/� }�fSZ- �(� ��s'�i�+ Phone: 503.718.2439 Fax: 5031981is960 �'. patty e`" Q �'1A-) Other Penn lie„'f0/6--Q e 93/ TI G n R I) Inspection Line: 503.639.4175 .q Date Read/B Juris: Internet: www.ti and-or. ov Ready/By: s Supplemental See Page 2 for g g Notified/Method:dit:� �� /CI: Supplemental Information ,1/4- „/p TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING (` New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. wi 1-and 2-family dwelling ElCommercial/industrial Valuation: $ 3'96 / , 6 �-�J ❑Accessory building 0 Multi-family Number of bedrooms: / b ,/ ❑Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 9 a 7 \) Job site address: /Yo31 c-.kg i/Or Gr New dwelling area: 32.5/3 squarefeet City/State/ZIP: rJ i to i2.-13 1 Oki--., 9-72Z 5/ Garage/carport area: &g 7L/ square feet Suite/bldg./apt.no.: Project name: Covered porch area: 3-1 square feet)a ) ) Cross street/directions to job site: 1 ! ,e T 1, ���Yui'$Z.CJ E.- P o-ol;"Dr'dcar �...._ea ,2„.,3,-- ci. square feet 1 1 OtheiEsiP4Aquare feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: M,....:_-^p A L l 10 ] fy7 tF- ,DC w$ I Lot no.: f,,.� Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. ,A./4-.-W -5,i\/t,ua lJ.=Par-l►Il.t/ Valuation: $ 'C�-�S iU�7l��iC. Existing building area square feet New building area: square feet g PROPERTY OWNER I 0 TENANT Number of stories: Name: Type of construction: Address: Sb i 'C AS r3 t Lu tJ Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) 6,APPLICANT ` 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: r®u ü J�/s.rp_Gt crl®l.:t (Please refer to fee schedule) Contact name: Structural plan review fee(or deposit): T�1�Y to H> �P1' s�-c” — Address: 'F'° x. FLS plan review fee(if applicable) �Y ,gc-o tJ OF_ 9 7 07 Total fees due upon application: City/State/ZIP: = Phone:(5073) 59 0 M ©B O S Fax::(s‘13) s9 0 17 S i Amount received: E-mail: `y P Co S,�- /1/44 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: f Submit two(2)sets of roof plan with connection details Address: r v t=' and fire department access,along with the 2010 Oregon S Solar Installation Specially Code checklist. City/State/ZIP: V Permit Fee(includes plan review $180.00 Phone:( ) Fax:( ) and administrative fees): State surcharge(12%of permit fee): $21.60 CCB lic.: '7 i 0 37 — _ Total fee due upon application: $201.60 Authorized signature: /..0.02, This permit application expires if a permit is not obtained /1,,eiewithin 180 days after it has been accepted as complete. Print name:,1=7 V to z i e) 2 t) i r--Date:/Z-s../� *Fee methodology set by Tri-County Building Industry Service Board. I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) I Mechanical Permit Applicata ,,„ , ; I FOR OFFICE USE ONLY City of Tigard Received ,y - " Date/By: Permit No.:i/JT �/ -tn SIP 13125 SW Hall Blvd.,Tigard,OR 97223 is.,- , E) 2016 Plan Review {C+ V Phone: 503.718.2439 Fax: 503.598.1960 Date/13y: Other Permit: T I GA R D Inspection Line: 503.639.4175Date Ready/By: Sufis. Ht See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ,New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,e.ui.ment,labor,overhead,and .rofit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* CZ1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description p Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: / AP ,5 ,e r..f#- GT Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: •T-1&14`2 D 9.' -i_$' Furnace 100,000+BTU ducts/vents 54.91 r Heat pump 61.06 Suite/bldg./apt.no.: I Project name: Duet work ■ 23.32 Cross street/directions to job site: f 1 :3 . H (,1' 'A'(z-i) 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: C L 6 Lot no.: Z.- Other: 23.32 r"�� �� Z 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 A/01,J SeI,..)6C.6 i � Pf4m ` (-7 i PET6_ fire.lace . 23.32 / Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 a PROPERTY OWNER I 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen e•ui t ment 33.39 '`� Address: i`/1�► C P.5 B e-bo`,--� Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, ....•: toilet compartments,utility rooms) 23.32 (y1,APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: �C.Y tt2' )iN S go Lr I�� $14.15 for first four;$4.03 for each additional Contact name: I-) !v 1 D t ) r7 0_, - Furnace,etc. Address: g © z)X j S Gas heat pump Wall/suspended/unit heater City/State/ZIP: .EpVr 2x0,1,..D Cyt' 9 )0 7 Water heater Phone:('�3) $90 _ 0 305 Fax::($ 3) 9O .- 17 S I Fireplace Range E-mail: 10 u D Co j`}Sr Cf, MS&). C 0 i•-•*t Barbecue CONTRACTOR Clothes dryer(gas) Business name: �--�V`t12,A ` A.f-t3,1\,(..._ Other: ) MECHANICAL PERMIT FEES* Address: P,0 ,�z, 1433 Subtotal City/State/ZIP: C L c m,AS 0 c 7 o iS Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( 131 ( S V r 1,clo ' (Fax:643) S o ._3 !r�S State surcharge(12%of permit fee) CCB lac.: 1 7 62-Li / TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. .44 * Fee methodology set by Tri-County Building Industry Service Board Print name: DAV Ip s • ir -rel ate: i 2.7.6-...44, 1:1Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/WEB) Electrical Permit Applicatio> -i ''„i. FOR OFFICE USE ONLY City of Tigard Received - Permit#: 13125 SW Hall Blvd.,Tigard,OR 97223 C 1 Date/B : iolfrc `�i .� ,�,-%e- /U�L Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 1 Read Date/By: Juris: TIGARD Y Y ® SeePage2for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW p►! New construction 0 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 stones. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 1-and 2-family dwelling El Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder El Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: I Job site address: /y0,3/ S, w 1)9 ?y e/�+ 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: 1 � � OR �-p-7 L/ > ❑Six or more residential units. occupancy. 1 2.Z' 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 t (611+ 10 C;f YA R-J FEE SCHEDULE Description I Qty. I Each I Total I " New residential single-or multi-family dwelling unit. Subdivision: ,C.p A L L./c,IQ ME ice-+5 I Lot#: Z 7, Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or lessL 168.54 4 Ea.add'1500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential �% � S I NCstPt`+'1 I (with above sq.ft.) 75.00 2 / i(� �.,t., Limited energy,multi-family residential(with above sq.ft.) 75.00 2 PROPERTY OWNERRenewable Energy . 0 See Page 2 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 3 A ,- P S REEL-0 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 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 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 I APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: IoLl) .D Ce 1':)ST`124.t(:rrut\i above service or feeder fee, 7.42 2 each branch circuit Contact name: – i ` Address: v i D . � t, �i2p( 4Z-A-- B.Fee for branch circuits without - scrvu aur tbedet Ike,first- - a ..-,/ LS 7 7 branch circuit 56.18 2 City/State/ZIP: BE- y 0 9'70 7 s Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(5-43) s70 -- 05 OS Fax: :(5.)-3) 590,_, –1 S I Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Biu it., 0 ,,y r,sT-- , , ci3M 'L Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 6.L&To �Lec ri2 l. &Rac Sign or outline lighting 67.84 2 �1 D Ci Z AiL) �i . 41 /01/ Signalel,alteration, or limited-energyxesi0 See Page 2 2 Address: t� ., panel,alteration,or extension. City/State/ZIP: 2 Each additional inspection over allowable in any of the above Po L111�0 i OP, 9 2.1_0 Additional inspection(1 hr min) 66.25/hr Phone:( jai Z-7 7 .3 /8e, Fax:(16'/:)3) 70 j — ' / V Investigation(1 hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr L L ti ree.LE L flZJ IJ LLF'(..t; /Wt A 1� , e. i ' Inspections for which no fee is •CCB Lic.: 1 9 j Z7'/ Electrical Lic.: G 4,3 O Suprv.Lic.: �,7.,z S specifically listed(%z hr min) 90.00/hr t / ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: ' -. �, /4,,,j,...,„___, vcr ZSubtotal: Print name: RO e ✓- ,Riv,4 eiv.1� ?12.....„ Date:i z_s',�(_ ❑Plan Review Required(25%ofpetmit 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: f.��0 L7-� L �L_ Date: 2�C,.�� days after it has been accepted as complete. «� * Number of inspections allowed per pennit. I:\Building\PermitstELC_P€rmitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB Plumbing Permit Application Building Fixtures 1 :'` " ' FOR OFFICE USE ONLY City of Tigard 1 2 l a c Received Permit No.',t G - 'I 13125 SW Hall Blvd.,Tigard,OR 97223 U!�; Date/By: /�f� I�'" �S�tJ Plan Review Phone: 503.718.2439 Fax: 503.598.1960DateBy: Other Permit No.: Inspection Line: 503.639.4175 Date Read/B Juris: ® See Page 2 for TIGARD r Ready/By: Internet: www.tigard-or.gov , :L Notitied/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE New 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 ig 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 0 Multi-family 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: / y()3 I ✓, VV, 118 r14 Gr. Catch basin or area drain 18.76 ,/ Drywell,leach line,or trench drain 18.76 City/State/ZIP: `1'--1(A-D O '`. CJ 1 Z � L / 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: It ,r'R g >IA fl'I~✓E 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.: ) 1 Page 2 Subdivision: iy/t ED A L`Iwo ,,. A, I Lot no.: 2 2 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 //t="(/.) iNLt_L ppm i<y 1 S, tt, Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Er PROPERTY OWNER I 0 TENANT - Expansion tank 12.51 Name: -Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: J' Nt p. BC-710U-, G arbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone-(_ ) Fax:( ) Ice-maker-_ 12.5.1 as APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: F D .Sr aci� Medical gas(value:$ ) Page 2 Contact name: i Primer 12.51 F U ,1,--) s��F- I2: Roof drain(commercial) 12.51 Address: P f) £3r 15-7 "7 Sink/basin/lavatory 25.02 City/State/ZIP: j3 4.,�+-rye 6 9"7 O 7 S Solar units(potable water) 62.54 Phone:(<-3) 5'c/4.-..) - 0 S p S Fax::(5:,3) 5'90 _ it-7 S 1 Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: --c$0,;1L. D C',O 0-.-r +�Hi s/)` Co 1 Water closet 25.02 1 CONTRACTOR Water heater 37.52 Business name: `-r---i4 E r i IA L L J CC:%/'/1 e A N y Water piping/DW V 56.29 Address: I 0+ A S. . A ‘V&tZ_ Other: 25.02 City/State/ZIP: 14 i L.L5 j . 1 0 k`'_ GI `) 1 Z-3 Subtotal Phone:( 03) (p 7 V --moi' i(3 Fax:( ) Minimum permit fee: $72.50 - CCB Lie.: !Z(,9 (7 Plumbing Lic.no.:31-/-Z 6 0 e Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signatures TOTAL PERMIT FEE Print name: 7,dVZA S. �p pd�.._ Date:) 2�c/� This permit application expires if a permit is not obtained within 180 days vim- after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. L1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard NI COMMUNITY DEVELOPMENT DEPARTMENT :1111 II T I G A R D Building Permit Review — Residential Building Permit #: f j c-,--er/ — /9 _5 Site Address: j-0'1 SW 11 F0 ettg+ Project Name: M-CM t Urn tAi a ttA S Lot #: i2 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N S Verify site address/suite# exists and active in permit system. .bir River Terrace Neighborhood: ❑ No X Yes,See River Terrace Review Addendum Attached Site Plan Elements: ; Three(3)copies of site plan 'xisting structures on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper Drawn to scale(standard architect or engineer scale) ootprint of new structure(including decks)with finished floor elevations North arrow ►-1 tility locations(required for new,may apply for additions) €ite address,project or subdivision name and lot number W II, .cation of wells/septic systems ,Applicant information(name and phone number) Wei xisting trees to be retained with drip line,and tree likrof dimensions and building setback dimensions protection measures fjfitn of area,building coverage area,percentage of coverage and 4 "treet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Xtreet names Property corner elevations(2 foot contour lines if more than 4 foot differential) X Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified A No Received: ❑ Yes ❑ No :Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified X No Applied For: PP ❑ Yes ❑ No,stop intake "q.Land Use Case#: 9 f j f3 to -dboD(p Zoning: __ - - --- '! Required Setbacks: Front q 0 Rear I Side 5 Street Side Garage "Landscape Requirement: WA. Lot Coverage Maximum: (J Building Height: Maximum Height g Actual Height t-21 Visual Clearance Easements Sensitive Lands: XYes ❑ No Type WW V A\u/e, V vit19 MI- X_ Urban Forestry Plan . Conditions "Met"prior to issuance of building permit Notes: C�i k o ttiond i i iqGraar?yiUY 1 I S&-ux4nA t . Approved By Planning: AI /Ai 1 A k O. A i Date: 1215110 Revisions (after Building Submittal on,) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\B1dgPermitRvw RES 091216.docx Building Permit Submittal Original Submittal Date: / '�p. Site Plans: # 3 Building Plans: # ..3 Building Permit#: [ Enter building permit#above. Workflow Routing: Planning (Engineering El-Permit Coordinator E--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. Lrl3uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: %,/,-.5/./C., Engineering Review y Slope at building pad: //j®. Conditions"Met"prior to issuance of building permit pEasements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 7 No Assess Water Quantity Fee in-lieu: ❑ Yes /1 No LIDA Facility on lot: ❑ Yes Z No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: jrZ I, Date: -7.-,4 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 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 Parks SDC: 51 Yes ❑ N/A E. i K to Issue Permit /' A ,roved by Permit Coordinator: Date: h2/7/`' I:\Building\Forms\B1dgPernutRvw_RES_091216.docx FOR OFFICE USE ONLY–SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter I 1 t i. n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: ) 8 M DATE DEPT: BUILDING DIVISION ��/L MAY 222017 FROM: D 0.0 VD D140?_reat2T CITY BUILD OF D V SION D COMPANY: Cet 5 C-1-1 o iU / PHONE: 5-v` –723--'7 y S By:� RE: 1 C�� 1 S CU, J 1 S�1' c t^ Le -605/ (Site Address) (?ermit Number) M4DIALL <1 J9 D itD-r Z (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEM Copies: I Description: I Copies: I Description: Additional set(s) of plans. �1 Revisions: Cross section(s) and d ail•. ( Wall bracing and/or lateral analysis. Floor/roof framing. G t r– Basement and retaining walls. Beam calculations. �—Engineer's calculations. Other(explain): REMARKS: vtSc gaA Cc-L-Arm 9 * (A 7- - W1N )• - /k MikcTE\2_ Bt bl� FOR OFFICE USE ONLY Rout- to P- it Technician: Date:3 – r-2 Initials: 4-') Fees Due• 411I Yes 0 No Fee Description: _. • pew, r�., Special Instructions: — Reprint Permit(per PE): ❑ Yes t No Done Applicant Notified: Date: 6/5///7 ..-% , ,�, tial •� \BuildingTormsgransmittalLetter-Revisions 061316.doc City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14031 SW 118TH CT, TIGARD, OR, 97224 August 29, 2017 at 12:36:30 PM Record Type: Record ID: Residential - Master Permit MST2016-00518 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Provide impact protection for appliances in garage. Figure M 1307.2 Provide permit for ac installed, not on permit. Remove debris on range for inspection. Not ready for inspection, work not complete. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14031 SW 118TH CT, TIGARD, OR, 97224 August 29, 2017 at 1 :31 :50 PM Record Type: Record ID: Residential - Master Permit MST2016-00518 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Provide permit for ac not on permit. 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: 14031 SW 118TH CT, TIGARD, OR, 97224 August 29, 2017 at 1 :25:24 PM Record Type: Record ID: Residential - Master Permit MST2016-00518 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Remove white cap in lower level shower drain. Seal base of shower to floor in upper level main bath. 407.2 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: 14031 SW 118TH CT, TIGARD, OR, 97224 October 12, 2017 at 10:04:06 AM Record Type: Record ID: Residential - Master Permit MST2016-00518 Inspection Type: Inspector: 299 Final inspection Aaron Cillo-Gobel Result: PASS - CofO Comments: Previous corrections completed Final erosion control passed Street tree certificate received Moisture content form received High efficiency lighting form received Insulation certification verified Blower door and/or duct seal test certificate received C of 0 left on counter. Note: sidewalk and approach previously approved prior to construction of building. Violation Summary: Inspector Contractor