Permit (32) CITY OF TIGARD MASTER PERMIT
an . COMMUNITY DEVELOPMENT Permit#: MST2017-00354
Date Issued: 10/17/2017
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S134DC13300
Jurisdiction: Tigard
Site address: 11409 SW SUZANNE AVE
Subdivision: MISSION MEADOWS Lot: 5
Project: Mission Meadows, Lot 5
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1328 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1826 sf Garage: 606 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 3154 sf Value: $394,345.04 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 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
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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3154
Owner: Contractor:
MISSION HOMES NW MISSION HOMES NORTHWEST LLC Required Items and Reports(Conditions)
PO BOX 1689 PO BOX 1689 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-593-5324 PHONE: 503-381-3753
FAX: 503-214-8524
Total Fees: $32,625.26
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 ol&taitioy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� �-�w''
Issued By: e✓• 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 the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
` • Residential
City of Tigard tPermit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 t` 5n` eview 54/k),07,'".004.1.13
s Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 9 —o1s 'I'� Other Permit:
l C n�Z Inspection Line: 503.639.4175 SE(? 4 �}9 Date Ready/By: �� Jurie: 0 See Page 2 for
Internet: www.tigard-or.gov r ' I f Noti led/Method' 60 /7 Supplemental Information
CII O � MGA J
TYPE OF'WORK��ii REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Den 1L rJiY,.TT-Jr. 717),,„,:,,,„, Permit fees*are based on the value of the work performed.
t,t t'.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on thi a plication.
CATEGORY OF CONSTRUCTION 39(!y
J 3
1+El.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: $350
❑Accessory building 0 Multi-family Number of bedrooms: 4
0 Master builder 0 Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 3760
7L 0
Job site address: I I(j Q, C G1J fne,- P 1New dwelling area: 3154 square feet
City/State/ZIP:Tigard Or 97223 Garage/carport area: 606 square feet
Suite/bldg./apt.no.: Project name:Mission Meadows Covered porch area: �2t8` 76 square feet)Sa6
Cross street/directions to job site:Springwood ST to 115th AVE � ! coo/ ,.1 7 6 square feet j3ag
other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Mission Meadows I Lot no.:_7 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.
Valuation: $
New Single Family Residential Construciton Existing building area: square feet
New building area: square feet
►o PROPERTY OWNER 0 TENANT Number of stories:
Name:Mission Homes NW Type of construction:
Address:PO BOX 1689 Occupancy groups:
City/State/ZIP:Lake Oswego OR 97035 Existing:
Phone:(503)5935324 Fax:(503)2148524 New:
k.+ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mission Homes NW (Please refer tofee seheda!e.)
Structural plan review fee(or deposit):
Contact name:Ben Dalbey
Address:PO BOX 1689 FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP:Lake Oswego Or 97035
Phone:(503)5935324 Fax: :(503)2148524 Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:benldalbey@gmail.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Missiom Homes NW Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:PO BOX 1689 Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)5935324 Fax:(503)2148524 State surcharge(12%of permit fee): $21.60
CCB lie.: 186849
.... J Total fee due upon application: $201.60
Authorized signature: / ` ---- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ben Dalbey Date:8-8-17 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application FoR orr►ci: t SI: O'\►.v
City of Tigard ec'i; `! p . -ived
` Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 ' t ' ." * y
11111
■ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit:
� �t;A R l� Inspection Line: 503.639.4175 r U p g ) } r Date ReadyBy: loris: H See Page 2 for
Internet: www.tigard-or.gov D F I 1 4 f D i/ Notified/Method: Supplemental Information
Cal' 0,1; iltAiti)
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
rTT7T P 17,7TITI T bT Mechanical permit fees*are based on the value of the work
0New construction 0 Addition/alteration r"etiladerlt -' ` ``''' performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder
0 Other: Description I Qty. Ea. Total
JOB SITE INFORMATION'AND LOCATION Heating/cooling:
/ 5Air conditioning 1 46.75
f
Job site address: l'4 L,/,1 U✓�1ti�GyIV C ,i___ Furnace 100,000 BTU(ducts/vents) 1 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:Mission Meadows
Duct work 23.32
Cross street/directions to job site:Springwood St to 115th AVE 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:Mission Meadows Lot no.:S Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
New Single Family Construction 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 9 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Mission Homes NW Range hood/other kitchen
equipment 1 33.39
Address:PO BOX 1689
Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego Or 97035 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32
Phone:(503)5935324 Fax:(503)2148524 Attic/crawlspace fans 23.32
=4 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Mission Homes NW Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Ben Dalbey Furnace,etc. 1
Address:PO BOX 1689 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Lake Oswego Or 970335 Water heater 1
Phone:(503)5935324 Fax: :(503)2148524 Fireplace 1
Range
E-mail:benldalbey@gmail.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Advantage Heating LLC Other:
MECHANICAL PERMIT FEES*
Address:2355 Hyacinth ST NE Subtotal
City/State/ZIP:Salem Or Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)3935315 Fax:( )
State surcharge(12%of permit fee)
CCB lic.: 174260 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: /...*1- * Fee methodology set by Tri-County Building Industry Service Board
Print name:Ben Dalbey Date: (,--7 '7
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB)
Electrical Permit Application rt�iz t1FFlcl: lsi,0\1.1
City Of Tigard ' el 0 t'eceived
Date/By: Permit 4:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960Date/By: Related Permit 4:
�
Inspection Line: 503.639.4175 `1 C!p 4 )1 L('�' Ready Date/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov aa g Notified/Method: Supplemental Information
TYPE OF WOR 1 O ' a�� PLAN REVIEW
®New construction ❑Addrtion/altera> 11 , lQ.etlt ilt , "_�,,:'� Please check all that apply(submit 2 sets of plans w/items checked):
.
0 Demolition El Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder El Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
P1/ 0� / ❑Addition of new motor load of system.
Job#: Job site address:
[ w J 1"2.4,17 1.c-/PL.- 1001-IP or more. ❑«A>, «E„ «1 2„ «l 3„
City/State/ZIP:Tigard Or 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Mission Meadows 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:Springwood ST t o115th AVE FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Mission Meadows Lot#: 5 Includes attached garage.
1,000 sq.ft or less I 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 4 33.92 1
DESCRIPTION OF WORK Limited energy,residential
New Single Fmaily Construction (with above sq.ft.) I 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
CI PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Mission HOmes NW 200 amps or less 1 100.70 2
Address:PO BOX 1689 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Lake Oswego Or 97035 601 amps to 1,000 amps 301.04 2
Phone:(503)5935324 Fax:(503)2148524 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
1:1 APPLICANT 0 CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Mission HOmes NW above service or feeder fee,
7.42 2
each branch circuit
Contact name:Ben DAlbey B.Fee for branch circuits without
service or feeder fee,first
Address:PO Box 1689 branch circuit 56.18 2
City/State/ZIP:Lake Oswego Or 97035 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)5935324 Fax: :(503)2148524 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:benldalbey@gmail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Connections Electric Sign or outline lighting 67.84 2
Address:5287 Portland RD NE Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Salem Or 97305 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)3907914 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:connectionselectric@hotmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 65444 Electrical Lic.: 24-248C Suprv.Lic.:36 / specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: !v /41
Subtotal:
Print name: Marvin Bergevin Date: /,-----7.-77 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Ze'lAuthorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Ben DAlbey Date: fr2<-7 7 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemmitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing Permit Application
. ` Building Fixtures .4 `„ � ,k
City of Tigard Received
4 �ateB Permit No.:
4 13125 SW Hall Blvd.,Tigard,OR 97223 s Fp 1 4 20 I' y'
s Phone: 503.718.2439 Fax: 503.598.1960 Date/By:ew Other Permit No.:
Inspection Line: 503.639.4175 0 "1, aa, "b
I i c A R t) l x i>: 'tj adyBy: Juris: 63 See Page 2 for
Internet: www.tigard-or.gov p�� Notified/Method: Supplemental Information
TYPE OF WORK BUILDING iIV1S1o1:1 FEE* SCHEDULE
For special information use checklist
®New construction 0 Demolition
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
0 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: ///(e..)
q aWSGf �� 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:Mission Meadows
Manufactured home utilities 50.03
Cross street/directions to job site:SPringwood St to 115th AVE 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:Missiom Meadwos I Lot no.: C Fixture or item:
Tax map/parcel no.: �J Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New Single Family Construction Clothes washer 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
`. PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Mission Homes NW Fixture/sewer cap 25.02
Address:PO BOX 1689 Floor drain/floor sink/hub 25.02
Garbage disposal 1 25.02
City/State/ZIP:Lake Oswgo Or 97035 Hose bib
1 25.02
Phone:(503)5035324 Fax:(503)2148524 Ice maker 1 12.51
ra APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Mission Homes NW Medical gas(value:$ ) Page 2
Contact name:Ben Dalbey Primer 12.51
Roof drain(commercial) 12.51
Address:PO BOX 1689
Sink/basin/lavatory 5 25.02
City/State/ZIP:Lake Oswego OR 97035 Solar units(potable water) 62.54
Phone:(503)5935324 Fax: :(503)2148524 Tub/shower/shower pan 3 12.51
E-mail:benldalbey@gmail.com Urinal 25.02
CONTRACTOR Water closet 3 25.02
Water heater 1 37.52
Business name:Pipe It Plumbing LLC
Water piping/DWV 56.29
Address: p Lc j 'l�A,, r3 g-cf Other: 25.02
City/State/ZIP: -Scre',it�/ l o61, c' ?cc c9 Subtotal
Phone:( -e) )S� --047 7 Fax: �"9bin:NS Minimum permit fee: $72.50
CCB Lic.: I7'y Icy/��1 Plumbing Lich.no.:(`TPR�C'�/`7 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: /3-t..1 a_Ji.... Date: 47,-,1117,7
7 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\PermitswLMU-PermitApp.don 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
I
D Building Permit Review — Residential
TIGAR
+moi.�_.....,w.�.. _.� __ t.. _ ,.,� >s`� ._ .,.._ _..__ v.-....F�, _���._ i�i_a_. _ .-�..._ .. _. in i,_ � .-.� .✓.... .�,t>_,_, __
Building Permit #: S 772_0/7—003 47
/
Site Address: //qq 9 cS'Z(J �tz /9v-e____
Project Name: PiSibrt nzof Lot #: ,S----
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: / 1e-_.
IV(
Verify site address/suite#exists and actr�v permit system.
Iver Terrace Neighborhood: Lid No ❑ Yes,See River Terrace Review Addendum Attached
Sit'Plan Elements:
/Three(3)copies of site plan VD II sting structures on site
�e plan must be on 8-1/2"x 11"or 11 x 17"paper VA Footprint of new structure(including decks)with finished
O P awn to scale(standard architect or engineer scale) ;•or elevations
? rth arrow Vfility locations&easements(required for new and additions)
1 Si address,project or subdivision name and lot number VS dewalk/driveway approach
IV plicant information(name and phone number) 0 A cation of wells/septic systems
rg •t dimensions and building setback dimensions IT xisting trees to be retained with drip line,and tree
If uare footage of buildings to be demolished otection measures
t area,building coverage area,percentage of coverage and r eet tree size,type and location
;impervious area(applicable if R-7,R-12,R-25&R-40)
Street names
Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? 6a Yes ❑E
4 foot differential) If yes,is a storm water .uality facility shown? ❑Yes •No
11 i Clean Water Services—Service Provider Lett platted prior to 9/10/1995): 4carp/242-PP/ t&) / 16
equired: 1:1 Yes,applicant was notified No Received: ❑ Yes ❑ No
Public Faciliti Improvement(PFI) Permit: 7F/�
, ®/(e - 1,0
-- -z-/
Required: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
,X�and Use Case#: 0G� j( , --(�0'
IJ oning:
Required Setbacks: Front 2£ Rear lc- Side Street Side A) Garage C)
0 landscape Requirement:
it of Coverage Maximum: 0/0
Building Height: Maximum Height Actual Heighti (e
ktiPc.,Tisual Clearance
16' j►ensitive Lands: ❑ Yes ❑ No Type
►1. Urban Forestry Plan
❑ Conditions "Ms.c prigr to issuance of b'ilp g rmit
Notes: %0dig ��/ 2// ni C/ ,p/-2'6 f /?I c/04— /&.zt-waC%(__.eh .
Approved By Planning: P4;4- Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPennitRvw RES_061417.docx
Building Permit Submittal
Original Submittal Date: I/ '//Q
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 'Engineering E -Permit Coordinator wilding
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.
rzr Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /
By Permit Technician � '�'/` Date: ,//7//)
Engineering Review
�_
Slope at building pad: 4 '7
❑ conditions "Met"prior to issuance of building permit,1fON PI TihNS 'vU r 716-7- 755;7
�/ sements (encroachments)per engineering conditions of approval and plat
LJ Water Quality/Quantity Facility: L) A T& &AkL l r y -e Glu A.A.) 7 t Ty (4-c IL 17 y
Assess Water Quality Fee in-lieu: El Yes 11 No
Assess Water Quantity Fee in-lieu: ❑ Yes II No
/...
IDA Facility on lot: ❑ Yes 1I No
TA roved byEngineering: „girl:
/%I' Date: ct�20 / 7
PP g
Notes: P6 4, 6r/L G /16 C-PS To E,vE 2 G/ZE tIoN16.5 AR) 0 l.'/S7vi-a_ -P
.v6126126 ST/ZEET CI Chi TS
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: Cl Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
El 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: es 01 N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: 'Yes El N/A
LIDA El Yes N/A ',A /e 11)1- �
'tOK to Issue Permit
1 912
Approved by Permit Coordinator: Dater /"y
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Albert Shields
From: Albert Shields
Sent: Wednesday, September 20, 2017 5:45 PM
To: benldalbey@gmail.com
Cc: Monica Bilodeau;Jonny Gish
Subject: MST2017-00353, 354, & 355 Mission Meadows
Ben, on reviewing your plans and applications for these three permits Engineering has noted that the homes need to be
energized and streetlights installed and energized before we can release and issue the permits. Accordingly, I have put
these permits on hold as Approved but Not Released. Plan Review will proceed and we will release the permits when
the above actions are complete. Please let me know if you have any questions.
Albert Shields
1
Plumbing Permit Application
Building Fixtures ,.
� x�
City of Tigard
Received /
i'h s 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: G 30 �� Permit No. STA /�00S5-/
Phone: 503.718.2439 Fax: 503.598.1960 N3 0 2018 Plan Review
Inspection Line: 503.639.4175 Date/By: Other Permit No.:
I I .,ARI) p , t4,7,-,1,-A!a'�I t t Date Read B Juris: I B See Page 2 for
Internet: www.tigard-or.gov a"�I T 1j , y `;,., y y
TYPE OF Wliail ti�]ING D1ViSiO lNohfiedMethod: Supplemental Information
FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
❑Addition/alteration/re lacement17: Description
Addition/alteration/replacement Qty. I Ea. Total
0 Other: �,r ? ¢ '�::- New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY'OF CONSTRUCTION 'IE�r (( SFR(1)bath 312.70
®1-and 2-family dwelling 0 Commercial qtr:,: 1 SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITEINFORMATION AND LOCATION Site utilities:
Job site address: 11(4 Q 1 SW Suzanne PL Catch basin or area drain 18.76
City/State/ZIP:Tigard Or 97223 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: I Project name:Mission Meadows Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision:Mission Meadows Water service(no.linear ft.: ) Page 2
Lot no.: 5 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New Single Family Home Constriction Clothes washer 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r< PROPERTY OWNER 1 0 TENANT Expansion tank
12.51
Name:Mission Homes NW Fixture/sewer cap 25.02
Address:PO BOX 1689 Floor drain/floor sink/hub 25.02
City/State/ZIP:Lake Oswego OR 97035 Garbage disposal 1 25.02
Hose bib 1 25.02
Phone:(503)5935324 Fax:(503)2148524
Ice maker 1 12.51
' APPLICANT
' Q
CONTACT PERSON Interceptor/grease trap 25.02
Business name:Mission Homes NW Medical gas(value:$ ) Page 2
Contact name:Ben Dalbey Primer 12.51
Address:PO BOX 1689 Roof drain(commercial) 12.51
Sink/basin/lavatory 5 25.02
City/State/ZIP:Lake Oswego OR 97035
Solar units(potable water) 62.54
Phone:(503)5935324 I Fax::(503)2148524 Tub/shower/shower pan 3 12.51
E-mail:benldalbey@gmail.com Urinal 25.02
CONTRACTOR Water closet 3 25.02
Business name:The Mullen Company Water heater 1 37.52
Water piping/DWV 56.29
Address:1601A SE River RD
Other: 25.02
City/State/ZIP:Hillsboro OR 97123
Subtotal
Phone:(503)6400113 Fax:( ) 7/(7)0
Minimum permit fee: $72.50
CCB Lic.:92689 Plumbin Lic.no.:3`-'426,63-pe Plan review (25%of permit fee)
Authorized signature: A /� State surcharge(12%of permit fee)
C� I TOTAL PERMIT FEE
Print name:Ben Dalbey I Date: 1-24-18 I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitAppdce 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT NT DEPARTMENT
III
Re quest t for
q Permit Action
l I c i,A t;I) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or..gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or:gov
FROM: Owner A
Check(I)one l� Applicant ❑ Contractor 0City Staff
REFUND OR Name:
I INVOICE TO: (Business or individual) ,�,ff,i-m ,e f ,,-,
Mailing Address: 1190 & y /6'
City/State/Zip: 4-ire. Olt-vej 0 dR I'7d3.5-
Phone No.:
PhoneNo.: [ 3^$i73 S ?2l/
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
0❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
J REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#:
Site Address or Parcel#: 1--, 7
Project Name: M /.S5A o/t' Mlle AAo L, C
Subdivision Name: .44 Iss4" Me,,.,1a✓1 W
Lot#:
EXPLANATION: 01--ck pl (yv- Y PJ-r e1
Signature: Av--
Print Name: (8e� 0.—A*, Date: �jc�.—/
Refund Policy
I. The city's Community Development 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.
Route to Sys Admin: Date By Route to Records: Date
Refund Processed: Date By
BY Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date
I:\Building\Forms\RegIennitAction_o92114.doe BY
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11409 SW SUZANNE AVE, TIGARD, OR, 97223 March 16, 2018 at
10:25:08 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00354
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Water pressure = 45psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11409 SW SUZANNE AVE, TIGARD, OR, 97223 March 26, 2018 at
12:06:53 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00354
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
No ac installed at this time.
Separate permit and inspection required at time of installation.
Note: add laundry tray installed without permit to permit prior to building final inspection.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11409 SW SUZANNE AVE, TIGARD, OR, 97223 March 26, 2018 at
12:06:08 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00354
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed at this time, separate permit and approved inspection required at time of
installation.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11409 SW SUZANNE AVE, TIGARD, OR, 97223 April 25, 2018 at 10:59:46 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00354
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Final erosion control approved.
Street tree certification received, trees installed per city approved site plan.
Moisture content form received.
High efficiency lighting form received.
Grading to be fixed by patio, landscaper working on site.
Insulation certification checked.
Duct seal test report checked.
Violation Summary:
Inspector Contractor