Permit (169) CITY OF TIGARD MASTER PERMIT
.14--- 1
21 '' COMMUNITY DEVELOPMENT Permit#: MST2017-00383
T(;GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2017
Parcel: 1 S 134DC 13700
Jurisdiction: Tigard
Site address: 11480 SW SUZANNE AVE
Subdivision: MISSION MEADOWS Lot: 9
Project: Mission Meadows, Lot 9
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 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: $391,368.44 Rear: 5
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: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 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'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 NORTHWEST LLC 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: $32,581.22
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 2-001-0090. You ma obtainbtaa copy of the rules or direct questions to OUNC by calling 503.23 .1987 or 1.800.332.2344.
Issued By: 4.- jZ(/fr/r/-f—e.,-4."'-F--'ermittee Permittee Signature: 7"/ *'1-
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 RECEIVED
City of Tigard Received
11 • /g Date/By: iesfrdl/7 Permit No otD/ ...//�?F.3ll 13125 SW Hall Blvd.,Tigard,OR 97243r �7
Phone: 503.718.2439 Fax: 503.598.1960 2 17 Plan Revie I
I i c;,�it Inspection Line: 4 503.639.4175Fax: ,4 - Date/By: f V -•`� IN Other Permit:StNR-,Cc,I,7- J 7
CITY O� T IGARD DateReadyBy: ,' // Juris: ® See Paget for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Me o : i Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on his application.
® 1-and 2-family dwelling 0 Commercial/industrial Valuation: 34:31l a
O
El Accessory building 0 Multi-family Number of bedrooms: c-
❑Master builder El Other:
Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 37 C,0
Job site address: 11480 SW Suzanne PL 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 area60''21$4 square feet)sa.6
Cross street/directions to job site:Springwood ST to 1156 AVE �- meek area: r 0 square feet l $
w 11.7 r strut re W '' 1d square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Mission Meadows I Lot no.:9 Permit fees*are based on the value of the work performed.
Tax reap/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
1 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:
ae APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mission Homes NW
(Please refer to fee schedule)
Contact name:Ben Dalbey
Structural plan review fee(or deposit):
Address:PO BOX 1689 FLS plan review fee(if applicable):
City/State/ZIP:Lake Oswego Or 97035 Total fees due upon application:
Phone:(503)5935324 Fax: :(503)2148524 Amount received:
E-mail:benldalbey@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:Missiom Homes NW Submit two(2)sets of roof plan with connection details
Address:PO BOX 1689 and fire department access,along with the 2010 Oregon
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 lit.:186849
Total fee due upon application: $201.60
Authorized signature: Z This permit application expires if a permit is not obtained
l/� within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name:Ben Dalbey Date:8-8-17
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application , t„t OI,:,t ,. , S, ()NI.)
City of Tigard Received
9 Date/By: Permit No t•AvERF,Enr,
13125 SW Hall Blvd.,Tigard,OR 97223 OCT 2017
' s Phone: 503.718.2439 Fax: 503.598.1960 DaPlan Review
I I c.n 1:I Inspection Line: 503.639.4175Date Re Other Permit:
CITY OF Ti( AD
t r, Date Ready/By: Juris: B See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
o Multi-family 0 Master builder
❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 11480 SW Suzanne PL
Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP:Tigard Or 97223 Furnace 100,000+BTU(ducts/vents) 54.91
•
Suite/bldg./apt.no.: Project name:Mission Meadows Heat pump 61.06
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 R 23.32
Subdivision:Mission Meadows Lot no.:9 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 Other: 23.32
❑ TENANT
Environmental exhaust and ventilation:
Name:Mission Homes NW Range hood/other kitchen
Address:PO BOX 1689 equipment 1 33.39
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
E 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)
Phone:(503)3935315 Fax ( ) Plan review(25%of permit fee)
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:
l�/���_ Fee methodology set by Tri-County Building Industry Service Board
Print name:Ben Dalbey Date: /Vier
I:\Building\PermitsWEC_PermitApp_040113.doe 440-4617T(1V1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi Family Fee Schedule:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Electrical Permit Application �` i of of ric I. 1 S►:O\1.1
City of Tigard RECEIReceived
1221= MMESI
13125 SW Hall Blvd.,Tigard,OR 97223 OCTn Review
( T 9 2017 DateB : �
Phone: 503.718.2439 Fax: 503.598.1960 l•
Date/B Related Permit#:
Inspection Line: 503.639.4175
CITY c"
:. TIGARD Ready Date/By:
Juris ® See Page 2 for www.tigard-or.gov BUILDING DIVISION Notified/Method:
Supplemental Information
TYPE OF WORK PLAN REVIEW
►iii New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0Building over three stories.
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 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:11480 SW Suzanne PL ❑Addition of new motor load of system.
City/State/ZIP:Tigard Or 97223 100HP or more.
❑ ❑ p`E°' `1-2 `1-3
Six or more residential units. occu ancy
❑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 oll5th AVE FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Mission Meadows Lot#:9 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4
DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 4 33.92 1
Limited energy,residential
New Single FmailyConstruction 1 75.00 2
g (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
e' PROPERTY OWNER ❑'TENANT Renewable Energy ❑ 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
City/State/ZIP:Lake Oswego Or 97035 401 amps to 600 amps 200.34 2
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
Branch circuits—new,alteration,or extension,pier panel
® APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name:Mission HOmes NW above service or feeder fee,
each branch circuit 7.42 2
Contact name:Ben DAlbey B.Fee for branch circuits without
Address:PO Box 1689 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:Lake Oswego Or 97035 Each add'l branch circuit 7.42 2
Phone:(503)5935324Miscellaneous(service or feeder not included)
Fax: :(503)2148524 Each manufactured or modular
Email:benldalbey@gmail.com
dwelling,service and/or feeder 67.84 2
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
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
CCB Lic.: 65444 Electrical Lic.: 24-248C Suprv.Lic.36,6g specifically listed(%2 hr min) 90.00/hr
Suprv.Electrician signature,required: / %1 ELECTRICAL PERMIT FEES
I04%1 Subtotal:
Print name: Marvin Bergevin Date: 'T-6-7,2 0 Plan Review Required(25%of permit fee):
/� State surcharge(12%of permit fee):
Authorized signature: /� Com'`. TOTAL PERMIT FEE:
�f This permit application expires if a permit is not obtained within 180
`'d'_6-� /
Print name: Ben DAlbey Date: .._ ) days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615TO 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
• '7! !: i .., _ X11 : jr
Fee for all residential systems combined: $75.00 Description Q . Each I Tota fix•
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15 01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
B• urglar Alarm 25.01 to 50 kva
301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating, Ventilation and Air Conditioning
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is
s ecificall�listed(%z hr mm) 90.00/hr
�4 1 ` r? :
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit Application NED
Building Fixtures OCTroiz orrlcl: 1 S► oyl.l
City of Tigard 1 9 �o�� Received
Date/By: Permit No.'
II
13125 SW Hall Blvd.,Tigard,OR 97223 OF TIG
�L�� � ��.J
• S g CITY !!af� D Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Other Permit No.:
Inspection Line: 503.639.4175 �U3�-���� DIVISION Date/By:I 1 1 A 1:I) Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®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
g 0Commercial/industrial
0 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 SITE INFORMATION AND LOCATION Site utilities:
Job site address:11480 SW Suzanne PL Catch basin or area drain 18.76
Drywell,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.:9 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 I ❑ 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
Pore APPLICANT ❑ 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
CONTRACTOR Water closet 3 25.02
Water heater 1 37.52
Business name:Pipe It Plumbing LLC Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
/7K3 37 ,q/f5-/�� Plumbing p$712,,7 Plan review (25%of permit fee)
CCB Lic.: ! Lic.no.:
/„..."-\_.
� � State surcharge(12%of permit fee)
Authorized signature: !s'\_ l t:741
"--t7 ` TOTAL PERMIT FEE
Print name. ig-t ad, Date: ZBC7 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-PemritApp.d°c 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 , Supplemental Information
Fee Schedule: Residential Fire Suppression
Systems:
Footing drain-I'100' .. .z,_ 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 Systems:
Water Service-each additional 100' 37.52 "
Storm&Rain Drain-1st 100' 62.54 L 4 �� �' a
$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
" '- each additional$100.00 or fraction thereof,to
1.6;4:°:1‘0, ° ° � � 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 char l e-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*.
a �; Qu *t ` ix Type ' *
Fixture'Typefor ?'R- p
i'orl Perform N �� Rddcate�� Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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 o° i+,o �.:,° :r
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
11111 COMMUNITY DEVELOPMENT DEPARTMENT
s
T 1 G A R D Building Permit Review — Residential
Building Permit #: /1/ - 7 ,�,,'' g , — ','7') - 5-i--;
Site Address: 1111 ' SGV soz.v7ne P1
Project Name: /IN?SS:a►p` /N ea Lot #: 9
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: / )
e Verify site address/suite#exists and active in permit system.
4ET River Terrace Neighborhood: ofe;}-No 0 Yes,See River Terrace Review Addendum Attached
Si Plan Elements:
Three(3)copies of site plan
$,,,,��ESctsttng structures on site
'te plan must lx on 8-1/2"x 11"or 11 x 17"paper +C�laootpriat of new structure(including decks)with finished
Drawn to scale(standard architect or engineer scale) floor elevations
.LlNorth arrow lUtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number Sidewalk/driveway approach
Applicant information(name and phone number) .BLeextieiref•wells/septic systems
''Lot dimensions and building setback dimensions to be retained`with drip line,and tree
.;1S4.....Cf.,urage of buildings to be demolished protection measures
DLet—.a,L.eld4 coverage area,percentage of coverage and &Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) , Street names--
Vroperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? oCTiPes ❑No
4 foot differential) If yes,is a storm water quality facility shown? r.:1Yes.,WICro
J'Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: 0 Yes,applicant was notified I 1 io Received: 0 Yes 0 No
Public Facilities Improvement(PFI)Permit
Required: 0 Yes,applicant was notified 0 No Applied For. 0 Yes 0 No,stop intake
jd'Land Use Case#: sot' ,;,?tv4 -t,?/ vQ l
J:J-zoning: IR-11.5 —
P-Required Setbacks: Front .at) Rear I S Side 5 Street Side 4)/A Garage . e...)oeiLoan��dscape Requirement d— % /
,� t Coverage Maximum: em.--
1,-/HBuilding Height Maximum Height ' ) Actual Height o?7
Visual Clearance
,dr-Sensitive Lands: 0 Yes 12—No Type
J Urban Forestry Plan
P onditions "Met"prior to issuance� of buil g permit
Notes: . 1`.1. Ar . ' .. - -r .. O _____ r. Cit
Approved By ' arming: ���'. _ Date: f9��—
ti 7
Revisions(after Building Submi a only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
1:1Building\Forms\BldgPemiitRvw_RES 061417.docx
•
Building Permit Submittal
Original Submittal Date: `(J f (/7
Site Plans: #
Building Plans:
Building Permit#: /, nter building permit#above.
Workflow Routing: ► Planning f Engineeringermit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include nota 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: . Lam � L' Date: O
Engineering Review
pe at building pad: 3.6 90
fc6nditions"Met"prior to issuance of building permit
igyarements (encroachments)per engineering conditions of approval and plat
Water Quality/Quantity Facility: (n/(2 F d.4/5/7b
Assess Water Quality Fee in-lieu: 0 Yes 0 No
Assess Water Quantity Fee in-lieu: 0 Yes 0 No
LIDA Facility on lot: 0 Yes 0 No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: /oho 7
Revisions(after Building Submitta only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
❑ 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
rDC Fees Entered: Wash Co Trans Dev Tax: es r- /A
Tigard Trans SDC: es N/A
Parks SDC: J2CYes /A
LIDA ❑ Yes S /A
C OK to Issue Permit ,/
ApprovedPermit Coordinator: 1 j J�' Date: i°//
PP by
I:\Building\Forms\BldgPermitRvw RES 061417.docx
Plumbing Permit Application
Building Fixtures 1.()Rorr►ct:I "sI: ()N IA
City of Tigard ' �'ivea
1,1
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: / ?i)f 11-j, Permit N SJ `�iyl�y?
• Phone: 503.718.2439 Fax: 503.598.1960 11-4'‘.N 3 0 r(Y SF�lan Review (•!J
Inspection Line: 503.639.4175 ateBy: Other Permit No.:
IIc 1t.0 p T, t Ready/
By:www.tigard-or.gov 1 .x' i y o 1rr;3 Su SeePage
2 lInr
t�1.,r�� �1` �t � 4 �"�� t>tified/Method: Supplemental Information
TSPE OF WORK
13U111)1NG JVISit XV ' ' FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description
❑Addition/alteration/replacement ❑Other: 1 Qty. I Ea. ( Total
44eI
d * 2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ` . I I 312.70 I
® 1-and 2-family dwelling ❑Commercial/industrial tt.te •uY.., •1, P'.ath 437.78
❑Accessory building 0 Multi-family R" )bath 1 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
SOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:It titQ 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.: J 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 7 Water service(no.linear ft.: ) Page 2
I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTIO1 OF WORK Backwater valve 12.51
� Clothes washer
New Single Family Home Constriction 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PRo*►ERTY WLV
.� . O � �
e ,_. laTE1gAN`l' < 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
r 1_APPLICANT j [Q CONTACTPER SON 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 1 Fax:( ) ? /( l2 0 Minimum permit fee: $72.50
1-4,2.(e.0-. gPlan review (25%of permit fee)
CCB Lic.:92689 Plumbing Lic.no.:3
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-PetmitApp.doc 10/01/09
440.4676T(10/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Reuest for P
qPermit Action
, ,,;A,,,„ 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 Applicant ❑ Contractor 0City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual) Miff 1 ixI gam .7 /(/LA✓
Mailing Address: ro & X /6 7 1,4
City/State/Zip: 1- 2' Of L-vej 0 0R 1'7 T 3 s
Phone No.: so 3.-,c?3 -7 ?2--(/
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED(1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
0 INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below).
REMOVE/REPLACE CON TRACTOR ON PERMIT(do not cancel permit).
Permit#:
Site Address or Parcel#: 1--- 7
Project Name: /�/1 /55/o, n /4e o1.,
Subdivision Name: 44/554 /rZ ,ja✓5
Lot#:
EXPLANATION: ;awin( i (:)-"k
Signature: Date: 3v.-/
Print Name:
Refund Policy
I. The city's Community Development Director,Building Official or City Iingincer 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
l:\Building\Forms\ReyPermitAction 092314.doc By
i
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223 May 11 , 2018 at 10:36:42 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223 May 11 , 2018 at 10:35:03 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS
Comments:
No ac installed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223 May 11 , 2018 at 10:43:19 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
No ac installed.
Final erosion control approved.
Street tree certification received.
Moisture content form received.
Moisture barrier form received.
High efficiency lighting form received.
Insulation certification checked.
Blower door test report received.
C of 0 left on site with approved plans.
Note: condensate left side above bare ground, do not bury with ground cover not
installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223 May 7, 2018 at 2:36:34 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Provide protection Ballard that protects water heater from impact per figure M1307.1
No ac installed at this time.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
overflow fixtures in both upstair bathroom tub/shower not complete.
Tub and shower at backwall not sealed in upstairs master bathroom.
OPSC 407.2
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Upper level light fixture in bathroom not installed.
No a/c installed at this time
Gfci in upper level master not working(no power won't reset)
No power in other bathroom outlets
R109.3
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11480 SW SUZANNE AVE, TIGARD, OR, 97223 May 9, 2018 at 1 :00:20 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00383
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS
Comments:
No a/c installed
Violation Summary:
Inspector Contractor