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Permit CITY OF TIGARD MASTER PERMIT PE! II. COMMUNITY DEVELOPMENT Permit#: MST2017 00384 T t OAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2017 Parcel: 1 S 134 DC 13600 Jurisdiction: Tigard Site address: 11452 SW SUZANNE AVE Subdivision: MISSION MEADOWS Lot: 8 Project: Mission Meadows, Lot 8 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 DwellingUnits: 1 Yes Third: 0 sf Right: 5 Detectors: Total: 3154 sf Value: $391,593.94 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: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Bckflw Prevntr: 0 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 F urn>=100 K: 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: $32,598.49 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: g.,`ii(,V6.� ' Permittee Signature: tjC� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Residential RECEVED hOR of ii is t sI: 0y1.1 City of Tigard Received Il OCT 9 2 017 Date/By: f 0 /�, Permit No.:�j 7-7,� y' 13125 SW Hall Blvd.,Tigard,OR 97223 / " S/). 1,2 T�C��y� Plan Review 7/03/ INI . Phone: 503.718.2439 Fax: 503.598.19.�.� Date/By: �©..��.� -1 r Other Permit•.6/444207 y � �',.��:-r..f,, J J I I('n R U Inspection Line: 503.639.4175 1 AFib Date Ready/By: Juris: See Page 2 for Internet: www.tigard-or.gov BUIL[IH\IG DIVISION Notified Method: `(7•04?pSupplemegtal lnformalion•• • TYPE OF WORK RE UIRED DAT&I AND 2-FAj131L'l DWELLTP d:%I, ®New construction 12 Demolition Permit fees*are base$on thevalue of[he work performed.� Indicate the value(rgltft�eti•to the nearest'dollar)of all • ,• ❑Addition/alteration/replacement 0 Other: equipment,materials,?atom overheajliann a profit for the work indicated on they kcation. ••,31� •1 ••••••• CATEGORY OF CONSTRUCTION • J ••••• ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: ••••• .••• I.••... • �''(�1 • 0 Accessory building 0 Multi-family Number of bedrootrts:• ••••• • 0 Master builder 0 Other: Number of bathrioms•.•;13 ••••• ••••• •a,. • • JOB SITE INFORMATION AND LOCATION Total number of floors: 2 ••• •3'7 CO • ' a •••••• Job site address: 11452 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 area: '2t8I 7 Q square feet f$ac Cross street/directions to job site:Springwood ST to 115th AVE _ -•D.,.,k an.a:CQ� t f Q square feet J1$ Other structure area: l e' square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Mission Meadows I Lot no.:8 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: e? APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name:Mission Homes NW (Please refer toleeschedule) Structural plan review fee(or deposit): Contact name:Ben Dalbey FLS plan review fee(if applicable): Address:PO BOX 1689 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 PHOTOVOLTAICSOLAR 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 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 lic.:186849 Total fee due upon application: $201.60 Authorized signature: Zvi,.--- i ---- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name:Ben Dalbey Date:8-8-17 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR O l lc I: I S1:()NI City of Tigard figi "° ,E Received p9Date/By: Permit No.` . A 11,1 . 13125 SW Hall Blvd.,Tigard,OR _ w � T Plan ReviewePhone: 503.718.2439 Fax: 503.598.166 T9 2017 Date/By: Other Permit: Inspection Line: 503.639.4175ICA :I Date Ready/By: Juris H See Page 2 for Internet: www.tigard-or.gov Notified/Method: (t7� CITY OF )1�../FSSiSr-'ii+iDSupplemental Information ni V PS1ON TYPE OF WORK COMMERCIAL FEF•§CII)iDULE •14HECKLI 3'••• Mechanical permit fees*are based on the value of® the work••••New construction ❑Addition/alteration/replacement • dt�fl performed.Indicate the value(rounded tq RtC flearest dollarj : El Demolition 0 Other: mechanical materials,equtpnTelti labor,overhead and profit. • 441411e:$ • •••••• CATEGORY OF CONSTRUCTION RESIDENTIAL F4IIVILENT/ViSTBAIS FEES* •• ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessorybuilding •�" ••••• For spechd thJ6•mation us•e checklist. • • ❑Multi-family 0 Master builder •••! � Vys, • Ea. •Total 0 Other: Description t • Heating/cooling: ••;••• • •• •• JOB SITE INFORMATION AND LOCATION _ Air conditioning •• ••• 1 46.75 ••••• Job site address: 11452 SW Suzanne PL • Furnace 100,000 BTU:tctig vepts) • •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 23.32 Subdivision:Mission Meadows Lot no.:8 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 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 23.32 121 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 diyer(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: CS —_ * Fee methodology set by Tri-County Building Industry Service Board Print name:Ben Dalbe Date: /6,,-61"-Th I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Famil Fee Schedule: ,, $0.00 to$500.00 Minimum fee$69.06 ••••• ..: Elgctrieal Permit ApplieatioUI.nEcEVED 1 i of oii is l: l sl clNl.N City of Tigard I� Received 13125 SW Hall Blvd.,Tigard,OR 97223 2017 DateB : f,(� �r0 Mill Plan Review Phone: 503.718.2439 Fax: 503.598.1960 OCTO T Date/B : Related Permit#: Inspection Line: 503.639.4175 CITY `' OF T I G/•"RD Ready Date/By: Juris: 0 See Page 2 for Internet: www.ti and-or. ov g g BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW• ••a ,,VIEW. ®New construction 0 Addition/alteration/replacement Please check all that apply(salib hits is of platy�llttIntsthecked)•••• ••• 0 Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three std•• where the available fault • •••• • CATEGORY OF CONSTRUCTION �4ir l•• 0 Fltrinas anildings. . •• • exceeds 10,000 amps at 150 volts a 0 Floalttlgbsildings. • ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 140/4 0 Comme•cial-use agrieult°11t•• 0 Multi-familamps for all other installetipys. •• bindings• •• y 0 Master builder 0 Other: 0 Fire pump. 0 h`sttlfalldhbf 150 KYA ob•• ••••• JOB SITE INFORMATION AND LOCATION ❑Emergency system. • • largyer separately deriy�d•• • ❑Addition of new motor Ioed%f• sl�.sfeyi. • •' Job#: Job site address:11452 SW Suzanne PL 1oo11P or more. •••••• ❑`A",°P'1"1-2",°`1-3' • City/State/ZIP:Tigard Or 97223 ❑Six or more residential•ttits• • •• occupapcy. • . ❑Health-care facilities. •••••• ❑]jecreatiYnal vehiclop•arYcs.Y• Suite/bldg./apt.#: Project name:Mission Meadows ❑Hazardous locations. • • 0 pm,*oiiage for mei-et-Mho •••• 600volts El Service or feeder 600 amps or more. nominal. • ••• • • Cross street/directions to job site:Springwood ST t oll5th AVE FEE SCHEDULE • + Description I Qty. I Each I Ai&•1• New residential single-or multi-family dwelling unit. Subdivision:Mission Meadows Lot#:8 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 1 75.00 2 New Single Fmaily Construction (with above sq.fr.) Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 =� PROPERTY OWNER 0 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, 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 56.18 2 branch circuit City/State/ZIP:Lake Oswego Or 97035 Each add'I 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 ❑ 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 CCB Lie.: 65444 Electrical Lic.: 24-248C Suprv.Lic.:ff /�s specifically listed(Y2 hr min) 90.00/hr �/� `"��''�� ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: G'/tel/%le 10 j7/7 Subtotal: Print name: Marvin Bergevin Date:/5-6-7'7 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: �, 6----- ----- TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Ben DAIb Date:76—6 77 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: itES DENT. i°" .� ti al t • v iIHI ra riA Fee for all residential systems combined: $75.00 Renewable electrical energy sys ems: ••••• 5 kva or less •••• '.1Q0 Check Type of Work Involved: 5.O l to 15 kva ••••1111 139.56 '••Ii ❑ Audio and Stereo Systems* 15.01 to 25 kva • • ••➢0024 ••• Wind•eneration s stems•n excess of kva: •. • ❑ Burglar Alarm 25.01 to 50 kva •• • -: SQ1.0e4 _El 50.01 to 100 kva •. •• 5•2 26 ••.11 ❑ Garage Door Opener* >100 kva(fee in accordarl.e.•• with OAR 918-309-0b,1 ■: .5436 ❑ Heating,Ventilation and Air ConditioningSolar generation systems in excess oft •itva:• • . . System* Each additional kva over 25 0742 • U ❑ Vacuum Systems* >100 kva—no additional charge - 0.0 _© Each additional ins,ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr char•ed at an hourl 1 hr min) Inspections for which no fee is ■ 90.00/hr —. s•ecificall listed('/z hr min an }iCUMME . u 4,y - _ of Fee for each commercial system: $75.00 snot al(Enter on Page 1 . * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ 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 Plumbing Permit Application Building Fixtures E /Q rc)l2 ()Hsi( l: t sl: cl,l.l City of Tigard Received Permit No 74 i• 13125 SW Hall Blvd.,Tigard,OR 97223 OCT 201 DateB y .�ST/�/?-vvgEy Plan Review e Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: Inspection Line: 503.639.4175 CITU C, a iGARDDateBy: IRc�A It 1> r to Read B : Juris 63 See Pae 2 for ••••• Internet: www.tigard-or.gov BUIL[� ta }1V1�9t y y g otified/Method: Supplp•J erielnformaton • a TYPE OF WORK FEE* SCIIEDULE 00001110••.. ••.• ®New construction 0 Demolition For special NI rpt r rn use Phecklisb • • Description • Qty. a. •TQM•• ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(initQislkj.00 ft.for each utility connection CATEGORY OF CONSTRUCTION SFR(1)bath a• • :• .M .70 ••••o• ••..• ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath •••....• •• 37.78 ••••••• • SFR(3)bath .�(6.32 • 0 Accessory building ❑Multi-family ••.••• • 1• ❑Master builder Each additional bath/kitcheis••••a • 25.02 .•••• ❑Other: Fire sprinkler( sq.ft.:••••• •• •Page 2 •••••• JOB SITE INFORMATION AND LOCATION; Site utilities: •••• a Job site address: 11452 SW Suzanne PL Catch basin or area drain god,• :8/6 •a..a o 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.:8 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 0 PROPERTY OWNER I 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 ti 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: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: (7143,47 ,/i�7i /-�v l 4� 7h/ii, Plan review (25%of permit fee) Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature:� ___- -.. TOTAL PERMIT FEE Print name: A"'1!/v /�ei',�[ Date: /� 6..7^7 This permit application expires if a permit is not obtained within 180 days t" /7 l/La` / 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/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su s i ression Systems: Footingdrain-ls`100' $121.90 '•• 50.03 0 to 2,000 • ••••O• • • 2,001 to 3,600 $P69%,•• • •••• Footing drain-each additional 100' 37.52 • • ••.•• 3,601 to 7,200 $33.20 • Sewer-1st 100' • 62.54 7,201 and greater $�2r11•• ••�••• •• Sewer-each additional 100' 37.52 • •••••• •••• • Water Service-1st 100' 62.54 • • • • • ••• Medical Gas Systems: •• • •,•• h Water Service-each additional 100' 37.52 !.••• Storm&Rain Drain-1st 100' 62.54 "� '• � M f*,•. $1.00 to$5,000.00 Minimum ee 572.50 • • •• • Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 Fol ZItE'fst$5,000.00 and$1.52 for • '° " Fee ea11W0 each adURioRai$100.00 or friction thereof!te••• °� m and inoiuling4610,000.0••••• ••••• Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.5ae'grjliptrst$10,000.00 and$1.54 for • which no fee is specifically indicated 90.00/hr ■ each additional$100.00roriractipn 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$125,t •• 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!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*. i ati fixture y �� dons, Fix a fore r i r _; >'r WQr lierforined: cad, Added R 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 El New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918 780 0040. Dishwasher -Commercial El 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 3' 1 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 TIGARD Building Permit Review — Residential Building Permit #: j' S � %/ J<'),T; � Site Address: I 1115 = Lw S. ,4d /F- Project Name: /;.sleet /Newt% 4!S Lot #: $ (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: AIG ❑ Verify site address/suite#exists and active in permit system. ❑ River Terrace Neighborhood: 0 No 0 Yes,See River Terrace Review Addendum Attached Site Plan Elements: 12r ree(3)copies of site plan B tirti atrmPares on site PSI;plan must be on 8-1/2"x 11"or 11 x 17"paper Pfloprint of new structure(including decks)with finished 'yawn to scale(standard architect or engineer scale) floor elevations rth arrow aatrtflity locations&easements(required for new and additions) ae address,project or subdivision name and lot number idewalk/driveway approach ,d': •p licant information(name and phone number) eglimortienr rkwells/septic systems rAnt dimensions and building setback dimensions •8sttng trees fete retained with drip line,and tree lgtcfeetogix of buildings to be demolished protection measures Piset.stek-imililino.roverage area,percentage of coverage and eet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) treet names wipleeptriW corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? i❑No 4 footfodifferential) If yes,is a storm water quality facility shown? ❑Yes t ,y.k clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995): �Required: ❑ Yes,applicant was notified �o Received: ❑ Yes 0 No off Public Facilities Improvement(PH)Permit: Required: 0 Yes,applicant was notified 0 No Applied For: 0 Yes 0 No,stop intake ,Land Use Case#: s OR9Of d 044 5,;--Zoning: p-tl s- @'Required Setbacks: Front a0 Rear is Side S Street Side •t//4 Garage vett Er-Landscape Requirement: ..---• % kr- .-- - kr- . Coverage Maximum: rr% `ti Building Height: Maximum Height Actual Height 77 ii Visual Clearance ensitive Lands: 0 Yes &No Type Yrban Forestry Plan 'Conditions"Met" .rior to issua ce of buildin, permi Notes: . a ' ;� , G �. Approved By P . ning: �f +ate: 47/4:A7 Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved l:\Building\Fonns\BldgPermitRvw RES 061417.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: ❑ Enter building permit#above. Workflow Routing 0 Planning 0 Engineering 0 Permit Coordinator 0 Building Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review) Route Application Documents: 0 Engineering: (1)copy of permit application,(1)site plan, (1)building plan and original plan review routing form. 0 Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: E eering Review a Lid pe at building pad: 3, G/a [ ditions"Met"prior to issuance of building permit Ea sements (encroachments)per engineering conditions of approval and plat Dir Water Quality/Quantity Facility: (.341- c'445/To. Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: 0 Yes ❑ No LIDA Facility on lot ❑ Yes 0 No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: /bf o/ '7 Revisions(after Building Submittal nly) 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 7 C Fees Entered: Wash Co Trans Dev Tax: ►/A Tigard Trans SDC: 17.1' es !��/A Parks SDC: .1!.. Yes i /A LIDA El Yes N/A 7,••K to Issue Permit /i - 1:\Building\Forms\BldgPermitRvw_RES_061417.dOCx pproved by Permit Coordinator: Niate: Jp/l/ FOR OFFICE USE ONLY—SITE ADDRESS: 4l�j� 2 <-5Gr 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 III Transmittal Letter 1 ,(,1\1i n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov / TO: DATE RECEIVED: DEPT: BUILDING DIVISION FROM: DECr° -ev) 60./ 1 : 2017 COMPANY: 44 /55/v- 1(10(1'5 ` 4G fiGARDN PHONE: co3--,��? 3—r3'2 Y3UU _ I 1^a 1!!iS (� By: RE: l� �/s, 9 rte • .tress i �� (P AN bei•) a00J F21 LOT t 1)5 L'---/c..- �f , k � 4 ____--__,.__ 'rolect name or su ri ivision name an. of m e••���-- L� ry ATTACHED ARE THE FOLLOWING ITEM,• ► Copies: .I Description: 1 ;copies: , Description: I Additional set(s) of plans. Q ' Revisions: R cs 6 (---4 Cross section(s) and details. 1 Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. ( u\ Q,l" Engineer's calculations. Other(explain): l REMARKS: C c cc On 6 FOR OFFICE USE ONLY Routed to Permit Tec . 'cian: Date: 1 ,. Fees Due: Yes 9 - I � Initials: 11 J J ❑No Fee Description: Amount Due: . S Nr PIcw, rcvi ev $ 4c- $ $ Special $ Instru ons: I 'kt. nt Permit(per PE): [] Yes e.? I 13 ° I ❑DoneApplicant Notified: ' Date: //,2,p././f Initials: 44.--- a —a nicieti4t 6' ,),L t7dcc I:\Building\Forms\Transmittal er-Revisions.doc 05/25/2012 Plumbing Permit Application Building Fixtures roi orrlc t. ISI: otil.l City of Tigard � ����;,��. �-ceived 11 41 13125 S W Hall Blvd.,Tigard,OR 97223 Date/By: I e0 // , Permit No. I Phone: 503.718.2439 Fax: 503.598.1960 3 �r PlanReview �t 57:11.1.)J7(b? Inspection Line: 503.639.4175 ! $ 1 018 )' DateBy: Other Permit No.: 1 1(1A1:1) p Date Ready/By: Juris: ®See Page 2 for Internet: www.tigard-or.gov l e i l r . t 1 l IotiSed/Method: Supplemental Information ,. TYPE OF woRX6UILD NG DIVISION : ' FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist escription l Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: ^° w 1-2-family dwellings(includes 100 ft.for each utility connection)_ •CATS ORI' OF C4 NS; 1HiCTION . ., , .�.(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrsal�':;s;.''l"- (j it (2)bath 437.78 ❑Accessory building 0 Multi-family " SFR(3)bath 1 500.32 Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address://45.address://45. L 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.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRTPTIO111 OF WORifiBackwater 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 ®;PROPEROWNER ,U TENANT n.. , 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 i°±4:''APPLICANT NT 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/D W V 56.29 Address: 1601A SE River RD Other: 25.02 City/State/ZIP:Hillsboro OR 97123 Subtotal Phone:(503)6400113Fax:( ) ' Minimum permit fee: $72.50 CCB Lie.:92689 I 7Plumbing Lic.no.:3' ' ' !iOs� '1'l'�(/ Plan review (25%of permit fee) J � � Authorized signature: C �----- State surcharge(12%of permit fee) TOTAL PERMIT FEE Print name:Ben Dalbey Date: 1-24-18 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. 1:\BuildingWermits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard • COMMUNITY Dli\'I 1,OPMl NT DEPAR'T'MENT _ "III Requestfor Permit Action I 1 t.A€.0 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •mww.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 Check(v")one +' ` 0 Contractor 0 City Staff REFUND OR Name: At ' INVOICE TO (Business or Individual) /sf, -zj a^4.f A/LA/ Mailing Address: lb & X /6 I 4.'y4 City/State/Zip: L-.ir 2'' at't/ei 0 OR F7 e'l3 5"' Phone No.: fc 3-5'73 -5- ?2—(/ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(1): 0 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). E REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: Site Address or Parcel#: Z-�J 7 / 7 Project Name: iil %SSIo ," \ /44ee oLa J Subdivision Name: frJ /5S//w- / en.,I 0 viii' Lot#: EXPLANATION: 01-{k. a ( - ,, Ph,4A Signature: GLJG-^--"" Print Name: �e f 0��� Date: 3v.-/ Refund Policy 1. The city's Community Development Director,Building Official or City I,ngineer 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 refimd 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\ItcgPennitAction 092314.doc BY City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 11 , 2018 at 10:52:20 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved plumbing final inspection for PLM 2018-00216 prior to building final. No Backflow test report with City required documents. Provide test report and schedule above plumbing final with building final. All else for building final appears ok at this time. 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: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 1 , 2018 at 10:08:15 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Seal base of tub /shower at main level bath. 407.2 Hot and cold reversed at upper level main bath/shower. Seal around back side of master tub. 407.2 Stopper not sealing at right side Lay in master, unable to test overflow. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 1 , 2018 at 9:48:35 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 699 Mechanical final David Young Result: FA I L Comments: Hood vent above gas range not working or connected at this time, no cord visible for connection. All other permitted mechanical appears ok. Note: 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: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 1 , 2018 at 9:29:36 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: No power to sink left side kitchen outlets and dining plug. Outlet above fireplace not secured. 406.5 Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 3, 2018 at 9:15:10 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 199 Electrical final Chip Barnett Result: PASS Comments: Previous corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 3, 2018 at 9:15:24 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 699 Mechanical final Chip Barnett Result: PASS Comments: Previous corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 3, 2018 at 9:15:58 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 Inspection Type: Inspector: 399 Plumbing final Chip Barnett Result: PASS Comments: Previous corrections completed Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11452 SW SUZANNE AVE, TIGARD, OR, 97223 May 15, 2018 at 8:32:26 AM Record Type: Record ID: Residential - Master Permit MST2017-00384 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