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Permit (43) CITY OF TIGARD MASTER PERMIT 1 ' COMMUNITY DEVELOPMENT 1111 Permit#: MST2017-00355 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2017 T[C.r1]i D Parcel: 1 S 134 DC 13400 Jurisdiction: Tigard Site address: 11414 SW SUZANNE AVE Subdivision: MISSION MEADOWS Lot: 6 Project: Mission Meadows, Lot 6 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 Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 3154 sf Value: $391,887.09 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 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: 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 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 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: $32,597.84 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 1-0090. You/ obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ^/1/ permittee Signature: /f/L6-1 Z--1--------- 0.3( 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 FoR OFFICI: l SE O\I.1 Received �"� _ City of Tigard C� g x K; j ate/By: /( /� I PermitNo.ifAg�6)17 /J1 II II 13125 SW Hall Blvd.,Tigard,OR 97223 # janReview ��'� CSLPhone: 503.718.2439 Fax: 503.598.1960RF �� a,:r1 a DateBy: 9"a7• )7 Other Pennity ?6/7-1e1:474( 1 WARD ARD Inspection Line: 503.639.4175 Date Ready/By: /(..2,t - � lir s: See Page 2 for Internet: www.tigard-or.gov otified/Method: /(� Supplemental Information SEP 1 4 201 TYPE OF WORK CITY'OF. t�,p gp y� REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction 0 Dem-Milton N .., lei Permit fees*are based on the value of the work performed.� � R �'t ` � Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 O equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: 089f) 39�J ElAccessory building 0 Multi-family Number of bedrooms: 4 ID builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 27(► D Job site address: 1 i-4`y S(ik) ‘,.,2,..,,,,,,„,,„ j2 b- New 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: w11S.. 76 square feet gaL Cross street/directions to job site: Springwood ST to 115th AVE cover 16 7 N square feet j*�1© Other structure area: square feet �G REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Mission Meadows I Lot no.: 6 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 ® 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: g." APPLICANT APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name:Mission Homes NW (Please refer tofee schedule) Structural plan review fee(or deposit): Contact name:Ben Dalbey FLS plan review fee(if applicable): Address:PO BOX 1689 Total fees due upon application: City/State/ZIP:Lake Oswego Or 97035 Amount received: Phone:(503)5935324 Fax: :(503)2148524 E-mail:benldalbey@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 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 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained ,signature —, within 180 days after it has been accepted as complete. Print name:Ben Dalbey Date:8-8-17 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR 01:,:1(1, l SF 0yI.1 City of Tigard Received Permit No;(../tie , o +11 13125 SW Hall Blvd.,Tigard,OR 97223 Kfici,'I'-0,:,; , ,i't, ;y . ePhone: 503.718.2439 Fax: 503.598.1960 eview ' bate/By: Other Permit: Inspection Line: 503.639.4175I Ic.AtI Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information SPP 14 ?r TYPE OF WORK CITY f>,VTIC,ARD COMMERCIAL'FEE* SCHEDULE USE CHECKLIST ®7 Mechanical permit fees*are based on the value of the work ®New construction 0 Addition/alteration/ I i r. a^ ' gi }x"'�, performed.Indicate the value(rounded to the nearest dollar)of all ,lit ?Wr i Aa 0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: DescriptionIQn. Ea. Total JOB SITE INFORMATION AND LOCATION Heating cooling: Air conditioning 1 46.75 Job site address: //9/4( s ,5".1, f1- 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 F 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.: ,6' 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 4 PROPERTY OWNEROther: 23.32 0 TENANT 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 23.32 121 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: * Fee methodology set by Tri-County Building Industry Service Board Print name:Ben Dalbey Date: c_.....7.../7 I:\Building\Permits\MEC_PermitApp_040113.doe 440-4617T(1 I/02/COM/WEB) Electrical Permit Application roiz 01:11(11 l SE 0y1.) , City of Tigard ki,' .;IF s ceived 13125 SW Hall Blvd.,Tigard,OR 97223 4(> �t . ate/B : Iffilli PlanReview Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 r, y 4 1 l�i Ready Date/By: Juris: Ea See Page 2 for Internet: www.tigard-or.gov yrS EE P I A�y�NNotified/Method: Supplemental Information TYPE OF WORKC 1 T Ot'TIGARJ PLAN REVIEW ®New construction ❑Addition/alteration/re I r t` �, Please check all that apply(submit 2 sets of plans w/items checked): Bu <t o 5 J. �' /_ `'� { , 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑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 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural 0 Multi-family ❑Master builder amps for all other installations. buildings. ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived / /J ❑Addition of new motor load of system. Job#: Job site address: 6/ !/t iv f-,,..,4,...177 I00HP or more. ❑°°A",°E",°'1-2",°°1-3", City/State/ZIP:Tigard Or 97223 0 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 0 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. l Each I Total I * New residential single-or multi-family dwelling unit. Subdivision:Mission Meadows Lot#: e2 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 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.) 1 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) � PROPERTY OWNER Renewable Energy 0 See Page 2 � ❑ TENANT 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 APPLICANT ❑ CONTACT PERSON Branch circuits—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 Address:PO Box 1689 service or feeder fee,first 56.18 2 branch circuit 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 Signal circuit(s)or limited-energy Address:5287 Portland RD NE panel,alteration,or extension. 0 See Page 2 2 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.Lie.:342 g specifically listed(V2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 1047/1 Subtotal: Print name: Marvin Bergevin Date: G'7a7 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Ben DAlbey Date: f?�7days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_Permi1App_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB 1 Electrical Permit Application—City of Tigard . Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: E "16': Olt,, �l Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 1. 100.70 _© 5.01 to 15 kva 133.56 _© n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 Wind •eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva - 301.04 _© 50.01 to 100 kva I. 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040 ■ 552.26 —© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 _© El Vacuum Systems* >100 kva—no additional charge 0.0 _© Each additional ins•ection over allowable in an of the above: El Other: Each additional inspection is ■ 66.25/hr —� char•ed at an hourl (I hr min) Inspections for which no fee is 1.190.00/hr —. secificall listed r/z hr min Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: El Audio and Stereo Systems El B• oiler Controls El Clock Systems El D• ata Telecommunication Installation El F• ire Alarm Installation ❑ H• VAC El Instrumentation El Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical El Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 I Plumbing Permit Application � �1 FOR UI l I( II I I. ON I.1 BuildingFixtures City of Tigard Received d 4 Date/By: Permit No.:�57�U 7.-C6SS13125 SW Hall Blvd.,Tigard,OR 97223 SrraC I /1; 'Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: I I l,A I;I Inspection Line: 503.639.4175 ,a ;it 4' RI,' , 4 1�eadyBy: Juris: See Page 2 for Internet: www.tigard-or.gov �(j,$1`; Nr kn B, tlffed/Method: Supplemental Information TYPE OF WORK BUILDING DI SIGN FEE* SCHEDULE CI New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total 0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwellingSFR(2)bath 437.78 ❑Commercial/industrial 0 Accessory building ❑Multi-family SFR(3)bath 1 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: J/57 �f s4/" �v` 1e9/ Catch basin or area drain 18.76 ����� reDrywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard Or 97223 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:Mission Meadows Manufactured home utilities 50.03 Cross street/directions to job site:SPringwood St to 115th AVE Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Missiom Meadwos I Lot no.: t ' Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 New Single Family Construction Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER ` 0 TENANT ' Expansion tank 12.51 Name:Mission Homes NW Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:PO BOX 1689 Garbage disposal 1 25.02 City/State/ZIP:Lake Oswgo Or 97035 Hose bib 1 25.02 Phone:(503)5035324 Fax:(503)2148524 Ice maker 1 12.51 is APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Mission Homes NW Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Ben Dalbey 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 Water closet 3 25.02 CONTRACTOR Water heater 1 37.52 Business name:Pipe It Plumbing LLC Water piping/DWV 56.29 Address: p, ? s c,k /. Other: 25.02 City/State/ZIP: EaV1`gi (De 7c.) I Subtotal Phone:0'03) .�C(C� '� `7- 7 `-C) cFax:(cc-93)96�-dd (J Minimum permit fee: $72.50 ( Plan r J 3s--( j �c, Plan review (25%of permit fee) CCB Lic.: ! -1Plumbing Lic.no.: / - State surcharge(12%of permit fee) Authorized signature:A�/��. ,��_ � TOTAL PERMIT FEE Print name: IC)..c,A. /170,74, Date: f.--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 lndustry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: bs' t . 't i i c " Footing drain-1' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for � E" � i t � f. each additional$100.00 or fraction thereof,to • and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated ■ 90.00/hr ■ each additional$100.00 or fraction thereof,to minimum char_e-1/2 hour and including$25,000.00. Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours minimum char_e-2 hours each additional$100.00 or fraction thereof,to Reinspection Fees _ 90.00/hr and including$50,000.00. Additional plan review for revisions - 90.00/hr - $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for minimum charle-1/2 hour each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. tatty by Fixture `" ' r±; ' .•7• ;`,17" tureIffor �r,. R $c Plan review is required for anyof the following.ed Capp Baptistry/Font Please check all that apply. Bath Tub/Shower 0 Any new commercial building with water service 2"and Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" Car Wash Drain Garbage Domestic-non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: /Users/benldalbey/Downloads/PLMF_PermitApp.doc 2 City of Tigard g COMMUNITY DEVELOPMENT DEPARTMENT : IGARD Building Permit Review — Residential Building Permit #: A5.� /7-003s—s_ Site Address: ##2-1/ cz1,() Qry A-e__.- Project Name: ' )f Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: ,y II< Verify site address/suite# exists and act�io permit system. la Iver Terrace Neighborhood: V No ❑ Yes,See River Terrace Review Addendum Attached Sits Plan Elements: PE/Three(3)copies of site plan 10 rk,sting structures on site Ll to plan must be on 8-1/2"x 11"or 11 x 17"paper TA Footprint of new structure(including decks)with finished EJ P awn to scale(standard architect or engineer scale) ;.or elevations !!I brth arrow riylity locations&easements(required for new and additions) IrrSe address,project or subdivision name and lot number 0 S dewalk/driveway approach plicant information(name and phone number) tO; cation of wells/septic systems rE .t dimensions and building setback dimensions r xisting trees to be retained with drip line,and tree II l uare footage of buildings to be demolished otection measures pi 1 t area,building coverage area,percentage of coverage and E reet tree size,type and location s pervious area(applicable if R-7,R-12,R-25&R-40) Street names it Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? Yes ❑I foot4� S,d differential) If yes,is a storm water quali facility shown? ❑Yes No 11' lean Water Services—Service Provider Lett (lot platted prior to 9/10/1995): 4 i W '! & / , i `,C /Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No lUi Public Faciliti Improvement(PFI)Permit: PF/..2®V Q _66.07 y Required: Yes,applicant was notified ❑ No Applied For: PP� pP Yes ❑ No,stop intake Land Use Case#: 0/:(46-20/ --(9 ) oning: Required Setbacks: Front ) Rear lc Side Street Side A. 4Garage 2O 0 landscape Requirement: 0/0 Iti i1 of Coverage Maximum: % / ! /Buildin Height: Maximum Height � Actual Height ��tp t ITPcJisual Clearance IF j.ensitive Lands: ❑ Yes ❑ No Type R. Urban Forestry Plan ❑ Conditions "Me 'prir to issuance ofb 4. g pf rmit Notes: iOZt ��A3/I . .-e' 1''1 Pi /Cri^}r- / // /&.z6-2/7c--(__ Approved By Planning: 1i Date: !`y Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPen nitRvw_RES_061417.docx Building Permit Submittal Original Submittal Date: L Site Plans: # Building Plans: # Building Permit#: `nter buildin permit# above. Workflow Routing: PlanningEngineering C rmit Coordinator 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: By Permit Technician: ��L, i/ j ,.��� � Date: 77(7%> En ineering Review gi G Slope at building pad: 2. S/v ❑ onditions "Met"prior to issuance of building permit 0)A/0/Timis tin T Al E r 14-,27 Li' asements (encroachments)per engineering conditions of approval and plat Water Quality/Quantity Facility: OA 76.11 &Li-Ah L I rte( (A-c/t 17'y 0 A./-SI re- -Assess Water Quality Fee in-lieu: ❑ Yes n No Assess Water Quantity Fee in-lieu: ❑ Yes 11 No LIDA Facility on lot: ❑ Yes li No 12/ Approved b NOT Engineering: Da Date: 5t/2o/7 Y i� Notes: PG Z. 4/EL-1?s TO 6, i1 freo AA. --5 Aiv 0 /NSPA-LG. 4 C.4)6R-6126 577- 6-r Gic"fuS • Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: 7 SDC Fees Entered: Wash Co Trans Dev Tax: eYes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA ❑ Yes ON/A FOK to Issue Permit �j� Approved by Permit Coordinator: 44ate: 9/ i 7 I:\Building\Fonns\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 FOR OFFICE USE ONLY—SITE ADDRESS: L L Z 44 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 ill Transmittal Letter 1 ;( n It r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or,Q'ov TO: raY-i DATE RECE IED: DEPT: BUILDING DIVISION FROM: ri ! op,\AnDEC 18 2017 TTY OSRD COMPANY: 44/')/ /4/17e f BUILDING DrMi ION PHONE: cO 3— f '3— S3 z--(/ By: RE: Wlddress) -* e35 —4177ç(7 44/5pf„,,, Ai. 4,..) )/v/- ‘ (Project name or subdivision name and lot numb ) (--,--1 s. ATTACHED ARE THE FOLLOWING IT . S: Copies: Description: Copies: Description: Additional set(s) of plans. \ 4K Revisions: Aso 19t.-..( Cross section(s) and details Wall bracing and/or lateral analysis. Floor/roof framing. k \ 1 Basement and retaining walls. Beam calculations. \� Engineer's calculations. Other(explain): Il� REMARKS: FOR OFFICE USE ONLY Routed to Permit 'echnician: Date: la.— j q - j -7 Initials: Fees Due: ,'Y-s ❑No Fee Description: Amount Eiue: -S t1 r fp)o.ln rAv; cw $ y.s $ $ Spec. $ In ctions: Reprint Permit(per PE): 0 Yes J]No ❑ Done Applicant Notified: Date: Initials: 1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012 Plumbing Permit Application Building Fixtures FOR OFFICE l SE ON1.1 City of Tigard '..�.,.° I " g V tom.rt, Received 13125 S W Hall Blvd.,Tigard,OR 97223 „ ''" Date/By: i ?�/ti I Permit No. 5701_6)/2^..06 7,3 S'3` III Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Inspection Line: 503.639.4175 IAN 3 0 `�0 1 S7 Date/By: Outer Permit No.: I 1 t 1 R 1) c Date Read B Internet: www.tigard-or.gov y y: Juris. I 0 See Page 2 for Notified/Method: Supplemental Information ' TYPE OF W i I Off" $1GAH .1. 11143(; 11 j ;1 � 1 * 3 H71>ruI.lc ®New construction ❑Demolition For special information use checklist El ,� Description Addition/alteration/replacement 0 Other: n ; -�, I QIY� � Ea. � Total -, New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OUCONSTRUCTION. � iiiiiip SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/irtlttstrial SFR(2)bath 437.78 ❑Accessory building11 SFR 3 bath 0 Multi-family ( ) 1 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other Fire sprinkler( sq.ft.) Page 2 JOB SITE 1NFORIVJATION AND LOCATION Site utilities: Job site address: (Ill/ 1 SW Suzanne PL Catch basin or area drain 18.76 City/State/ZIP:Tigard Or 97223 Drywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: I Project name:Mission Meadows Footing drain(no.linear ft.: ) Page 2 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision:Mission Meadows Water service(no.linear ft.: ) Page 2 I Lot no.: 6 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 New Single Family Home Constriction Clothes washer 1 25.02 Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 6 PROPERTY.OWNER- ' TEN ] ANT Expansion tank � ;�, 12.51 Name:Mission Homes NW Fixture/sewer cap 25.02 Address:PO BOX 1689 Floor drain/floor sink/hub 25.02 City/State/ZIP:Lake Oswego OR 97035 Garbage disposal 1 25.02 Hose bib 1 25.02 Phone:(503)5935324 Fax:(503)2148524 Ice maker 1 12.51 ,. sat AP1 L1t ANT , CONTAcT PERSf}N Interceptor/grease trap 25.02 Business name:Mission Homes NW Medical gas(value:$ ) Page 2 Contact name:Ben Dalbey Primer 12.51 Address:PO BOX 1689 Roof drain(commercial) 12.51 City/State/ZIP:Lake Oswego OR 97035 Sink/basin/lavatory 5 25.02 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: 160IA SE River RD Other: 25.02 City/State/ZIP:Hillsboro OR 97123 Subtotal Phone:(503)6400113 Fax:( ) 7 ll/A0 Minimum permit fee: $72.50 CCB Lic.:92689 Plumbing Lia no.: 3z<o,2,&O_ rDe Plan review (25%of permit fee) Authorized signature: State surcharge(12%of permit fee) TOTAL PERMIT FEE I 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-PermitApp.doc 10/01/09 440-4616T(10/02/C OM/W EB) l'Ai City of Tigard • COMMUNITY ulsVla..OPMS N`I DliPAR'l'Ml NT i iii 4 Request for or Fermat Action 7 i c„A I:o 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tig or ov 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 Check(1')one Applicant ❑ Contractor ❑ City Staff REFUND OR Name: /�� INVOICE TO: (Business or Individual) /r�/ff 1 f=A H�f'�,"7 A/W Mailing Address: { Q & 6j f Z .44 City/State/Zip: f/'Y�2 Oft.-v jo C L- k f7d3s' Phone No.: So 3.-J 7 3 -1 ?y c1 PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. ❑❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ) REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: Site Address or Parcel#: /---• 7 Project Name: i4 /55/v' _Me c,dto61/4.•5 Subdivision Name: ,i 1 /SS4.. / M,,,L o✓IS Lot#: EXPLANATION: 3 K17-v/ 1A-rAj " 4A Signature: A4.--e...---c..--- Print Name: e Date: 30.-/ kawimicx 1. The city's Community Development Director,Building Official or City Isngineer 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 fcc'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: DateBy By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By l:\Building\Forms\acyYcnnitAction J192314.doc City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11414 SW SUZANNE AVE, TIGARD, OR, 97223 March 16, 2018 at 9:54:36 AM Record Type: Record ID: Residential - Master Permit MST2017-00355 Inspection Type: Inspector: 199 Electrical final Aaron Cillo-Gobel Result: PASS Comments: A/C installed. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11414 SW SUZANNE AVE, TIGARD, OR, 97223 March 16, 2018 at 9:57:16 AM Record Type: Record ID: Residential - Master Permit MST2017-00355 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. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11414 SW SUZANNE AVE, TIGARD, OR, 97223 March 16, 2018 at 9:49:41 AM Record Type: Record ID: Residential - Master Permit MST2017-00355 Inspection Type: Inspector: 699 Mechanical final Aaron Cillo-Gobel Result: PASS Comments: A/C installed. Note: cooktop not installed at this time. Violation Summary: Inspector Contractor