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Permit (52)
CITY OF TIGARD MASTER PERMIT a .. . ,._ COMMUNITY DEVELOPMENT Permit#: MST2017-00414 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2017 Parcel: 1S134DC12900 Jurisdiction: Tigard Site address: 11493 SW SUZANNE AVE Subdivision: MISSION MEADOWS Lot: 1 Project: Mission Meadows, Lot 1 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1257 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1635 sf Garage: 465 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2892 sf Value: $356,241.90 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 0 Tubs/Showers: 3 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: 5 201-400 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 2892 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: PHONE: 503-381-3753 FAX: 503-214-8524 Total Fees: $31,911.14 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. T ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 .83411. Issued By: - -vo--/--N_ —C Permittee Signature: Call 5033959 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. City of Tigard iii iliP 111 COMMUNITY DEVELOPMENT DEPARTMENT I T 1 c A R D Building Permit Review — Residential Building Permit #: p% a)j 7 1401 Site Address: it.1613 SW lJ Z-C4 r1 r'€ IR— Project Name: M i S 5't O rl, M&01 cLO(RJ,S Lot #: 1 (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N SFR . dvel ., 4,ii 0 , ,hi "6-f ig 4/2-eilgii—/crr - 7 Verify site address/suite# exists and active in permit system. �'1 River Terrace Neighborhood: X No El Yes,See River Terrace Review Addendum Attached Site Plan Elements: /Three(3)copies of site plan n,,__:. s es on site Site plan must be on 8-1/2"x 11"or 11 x 17"paper ) Footprint of new structure(including decks)with finished fDrawn to scale(standard architect or engineer scale) floor elevations orth arrow [Jtility locations&easements(required for new and additions) ato address,project or subdivision name and lot number Sidewalk/driveway approach Applicant information(name and phone number) ems /eLot dimensions and building setback dimensions grreerte-be retained with drip line,and tree L+Squacc4sotage-of buildings to be demolished •rotection measures Lir^'area h,,,1.d,ng coverage area,percentage of coverage and ,�!treet tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) ,treet names Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? IN e i oS 4 foot differential) If yes,is a storm water quality facility shown? i es o Ci� 4 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: O Yes,applicant was notified ee No Received: ❑ Yes ❑ No /Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake (%Land Use Case#: S 0 a 2-0IG - 00001 eZ' Zoning: 12-1 5 A Required Setbacks: Front '2 0 Rear I S Side 5 Street Side 1 S Garage 7 0 X'Landscape Requirement: �f A 0/0 Lot Coverage Maximum: OV % e BuildingHeight:lg Maximum Height SO Actual Height Li" Visual Clearance -getnsiiiti^e Lands. El Yes ❑ No Type Urban Forestry Plan )21'Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: ( � r Date: I 0/2..5 / 11 Revisions (after Bu' •ing Submittal only) Revi- . - Dat Revision 1: 1/,' Approved ❑ Not Approved7 Revision 2: El Approved ❑ Not Approved Revision 3: El Approved El Not Approved I:\Building\Forms\BldgPernutRvw RES 061417.docx Building Permit Submittal Original Submittal Date: id iA Ii 7 Site Plans: # 3 Building Plans: # 3 Building Permit#: Ei--rieiter building permit#above. Workflow Routing: Tanning El•— gineering Permit Coordinator ig-11't lding Workflow Sign-off: U--‘3'161-off for Planning(include notes from planning review) Route Application Documents: engineering: (1) copy of permit application, (1) site plan, (1) building plan and on nal 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: Date: ,'.)/)j7i ) Engineering Review ❑lope at building pad: ?'jD NA1�Conditions "Met"prior to issuance of building permit Easements (encroachments)per engineering conditions of approval and plat ©/Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: /_,_ i, Date: fa/ii/// Revisions (after Building Submitt, 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: L.46 C Fees Entered: Wash Co Trans Dev Tax: 'Yes El N/A Tigard Trans SDC: rYes ❑ N/A Parks SDC: ; 1° Yes ❑ N/A LIDA ❑ Yes );1...N/A OK to Issue Permit ?P /44----Approved by Permit Coordinator: Date: / / I:\Building\Forms\BldgPermitRvw_RES_061417.docx Building Permit Application Resiiential I:012 OFFI( F I sI:tlNl.v 4 City Of Tigard .,‘„, € ew' 14 gl PermitNo.: /7, . , 13125 SWHall BlvdTigardOR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Inspection Line: 503.639.4175 DateB : J'O"' i Other Permit:�/ 1 7' , l I G A It ll p Date Re See Pagefor ' Internet: www.tigard-or.gov OCT 2'5 2017 Notified/Method: IMIE d: Supplemental Information TYPE OF WORItiTy OF TIGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING I i 0 New construction D a.i. .11'DING DIV' ON Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 •ther: equipment,materials,labor,overhead,and thprofit for the CATEGORY OF CONSTRUCTION ' work indicated on this application.3 +S' ,a..111 ® 1-and 2-family dwelling 0 Commercial/industrial Valuation: 00 a El Accessory building 0 Multi-family Number of be ooms: 4` 3596 ❑Master builder 0 Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 33 J 7 Job site address: 11493 SW SUZANNE PL New dwelling area: 2892 square feet City/State/ZIP:Tigard Or 97223 Garage/carport area: 465 square feet Suite/bldg./apt.no.: Project name:Mission Meadows Covered porch area: 130 square feet 16341" Cross street/directions to job site:Springwood ST to 115th AVE tea: square feet P. ;b G.eve.v � 3'7 Jds� Other structure area: square feet REQUIRED DATACOMMERCIAL-USE CHECKLIST Subdivision:Mission Meadows Lot no.:1 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 ❑ 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 tofee srhedufr� 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: T5?i —�' 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 PhotoVoltaic 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 lic.:186849 Total fee due upon application: $201.60 Authorized signature�6„......e.„„,..4__ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Print name:Ben Dalbey Date:8-8-17 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOIR OFFICI: 1 SI: ON II City of Tigard Received "1 Date/By: Permit No.: .� , 13125 SW Hall Blvd.,Tigard,OR 97• ' Ai �(,, 11111 . Phone: 503.718.2439 Fax: 503.598.;,',t, 0+. J . 1 Plan Review I I,i,\1,f, Inspection Line: 503.639.4175 Date/By: Other Permit: Internet: www.tigard-or.gov Date Ready/By: Juris See Page 2 for OCT il: ry t}1:� Notified/Method: Supplemental Information TYPE OF r r3ll.� iOF TILGU RD COMMERCIAL FEE* SCHEDULE – USE CHECKLIST ®New construction ❑Addition/ ,li i �5 Mechanical permit fees*are based on the value of the work ISAO� performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® l-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating cooling: Job site address: 11493 SW SUZANNE PL Air conditioning 1 46.75 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.: I Project name:Mission Meadows Heat pump 61.06 Duct work 23.32 Cross street/directions to job site:Springwood St to 1156 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 I Lot no.: 1 Other: 23.32 Tax map/parcel no.: Other fuel appliances: Water heater 1 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 New Single Family Construction Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 .e PROPERTY OWNER I 0 TENANT Other: 23.32 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, Phone:(503)5935324 toilet compartments,utility rooms) 4 23.32 Fax:(503)2148524 APPLICANTAttic/crawlspace fans 23.32 0al 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 City/State/ZIP:Lake Oswego Or 970335 Wall/suspended/unit heater Water heater 1 Phone:(503)5935324 I Fax::(503)2148524 Fireplace 1 E-mail:benldalbey@gmail.com Range Barbecue 1 CONTRACTOR Clothes dryer(gas) Business name:Advantage Heating LLC Other: Address:2355 Hyacinth ST NE MECHANICAL PERMIT FEES* Subtotal City/State/ZIP:Salem Or Minimum permit fee($90.00) Phone:(503)3935315 I Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lie.: 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 IPrint name:Ben Dalbey I Date:,2r—/V I I:\Building\Permits\ivtEC_PermitApp_040113.doc 440-4617T(11/02/CO]M/6B) Electrical Permit Application F01z0141( Ltsr. 0\1.1 City of Tigard RECEIVE.� Received 13125 SW Hall Blvd.,Tigard,OR 97223 Dan R : `_ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Inspection Line: 503.639.4175 OCT2,5 Date/B : Related Permit#: ! Ready DJuris. ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information op wary OF TIGARD ®New construction 0 Addition/alte y II ISI PLAN REVIEW 0 Demolition kO Please check all that apply(submit 2 sets of plans w/items checked): ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 01-and 2-family dwelling 0 Commercial/industrial 0 Accessorybuildingless to ground,or exceeds 14,000 0 Commercial-use agricultural 0 Multi-family 0 Master builder 0 Other: amps for all other installations. buildings. JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑Installation of 150 KVA or 0 Emergency system. larger separately derived Job#: I Job site address:11493 SW SUZANNE PL ❑Addition of new motor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard Or 97223 0 Six or more residential units. occupancy. Suite/bldg./apt.#: ❑Health-care facilities. 0 Recreational vehicle parks. I Project name:Mission Meadows 0 Hazardous locations. 0 Supply voltage for more than Cross street/directions to job site:Springwood ST t 0115th AVE ❑Service or feeder 600 amps or more. 600 volts nominal. FEE SCHEDULE Description 1 Qty. I Each I Total Subdivision:Mission Meadows New residential single-or multi-family dwelling unit. I Lot#: 1 Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4 DESCRIPTION OF WORK Ea add'1500 sq.ft.or portion 4 33.92 1 Limited energy,residential New Single Finaily Construction (with above sq.ft.) 1 75.00 2 Limegy,mmily residential(with aboveulti-fasq.fr.) 75.00 2 ®'PROPERTY OWNER i; TENANT Renewable Energy 0 See Page 2 Name:Mission HOmes NW Services or feeders installation,alteration,and/or relocation 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 I Fax:(503)2148524 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocatin Owner installation:This installation is being made on property that I own which is not 200 amps or less intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 59.36 1 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 '' APPLICANT 1 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel Business name:Mission HOmes NW A.Fee for branch circuits with above service or feeder fee, Contact name:Ben DAlbey each branch circuit 7.42 2 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 Miscellaneous(service or feeder not included) Phone:(503)5935324 I Fax: :(503)2148524 Each manufactured or modular Email:benldalbey@gmail.Com dwelling,service and/or feeder 67.84 2 CONTRACTOR Reconnect only 67.84 2 Business name:Connections Electric Pump or irrigation circle 67.84 2 Sign or outline lighting .-x 67.84 2 Address:5287 Portland RD NE Signal circuit(s)or limited-energy panel,alteration,or extension. See Page 2 2 City/State/ZIP:Salem Or 97305 Each additional inspection over allowable in any of the above Phone:(503)3907914 Additional inspection(1 hr mm) 66.25/hr Fax:( ) Investigation(1 hr min) 90.00/hr Email:connectionselectric@hotmail.com Industrial plant(1 hr min) 78.18/hr CCB Lic.: 65444 Inspections for which no fee is Electrical Lic.: 24-248C I Suprv.Lic.; //C specifically listed(%hr min) 90.00/hr Suprv.Electrician signature,required: LDI/`�J/1 u ELECTRICAL PERMIT FEES Subtotal: Print name: Marvin Bergevin I f �V /� Date: .� �- ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: 6------------- TOTAL PERMIT FEE: IPrint name: Ben DAlbey / ^ This permit application expires if a permit is not obtained within 180 I Date: 4-76),`// days after it has been accepted as complete. * Number of inspections allowed per permit. I:1BuildinglPermitslELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 !! 440-4 615 T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2,-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: ' ®v � Fee for all residential systems combined: $75.00 Renewable ble electrical energy systems: Check Type of Work Involved: 5 kva or less III 100.70 _© 5.01 to 15 kva 133.56 _© 12 Audio and Stereo Systems* 15.01 to 25 kva - 200.34 _© ElWind •eneration s stems in excess of 25 kva: Burglar Alarm 25.01 to 50 kva - 301.04 _© Garage Door Opener* 50.01 to 100 kva 552.26„ta _© >10with0 kva OAR(fee in accordance ■ _� AK] 552.26 �UxJ Heating, Ventilation and Air Conditioning * Solar generation systems in excess of 25 kva: System Each additional kva over 25 IN 7.42 _© al Vacuum Systems* >100 kva-no additional charge - 0.0 _© ElOther: additional ins°ection over allowable in an of the above: Other: Each additional inspection is 11166.25/hr —� chaz ed at an hourl (1 hr min Inspections for which no fee is s.ecificall listed(%hr min) III 90.00/hr 1 e1 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: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* El Medical ❑ 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 I.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application Building Fixtures 1/ECEIVE City of Tigard Received 711 13125 SW Hall Blvd.,Tigard,OR 97223DateBy: Plan Review Permit No.:/, -7-2.0 1 7" Jii1 I Phone: 503.718.2439 Fax: 503.598.1960p T 2017 iOther Permit No.:, Inspection Line: 503.639.4175 Date/By: I IGARI) TJG R DateRead B Internet: www.tigard-or.gov 1 ��II y y' Juris See Page 2 for Notified/Method: Supplemental Information TYPE OF WORpjIjLDG DIVISION FEE* SCHEDULE ®New construction 0 Demolition For special information use checklist DescriptionII Total ❑Addition/alteration/replacement 0 Other: Qty. Ea. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 1 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 Site utilities: JOB SITE INFORMATION AND LOCATION Job site address: 11493 SW SUZANNe PL Catch basin or area drain 18.76 City/State/ZIP:Tigard Or 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Mission Meadows Manufactured home utilities 50.03 Cross street/directions to job site:SPringwood St to 115th AVE Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision:Missiom Meadwos I Lot no.: 1 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 New Single Family Construction Clothes washer 1 25.02 Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 =4 PROPERTY OWNER I 0 TENANT : Expansion tank 12.51 Name:Mission Homes NW Fixture/sewer cap 25.02 Address:PO BOX 1689 Floor drain floor sink/hub 25.02 Garbage disposal 1 25.02 City/State/ZIP:Lake Oswgo Or 97035 Hose bib 1 25.02 Phone:(503)5035324 Fax:(503)2148524 Ice maker 1 12.51 =4 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 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 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:2229 NE BURNSIDE ST#81 Other: 25.02 City/State/ZIP:Gresham OR 97030 Subtotal Phone:(503)5440477 Fax:( ) Minimum permit fee: $72.50 CCB Lic.:174351 Plumbing Lic.no.:6 744 Plan review (25%of permit fee) / l 7 State surcharge(12%of permit fee) Authorized signature:�_� OW TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Ben Dalbey Date:10/6/17 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 Building Fixtures r01z ()Hi( 1] I sr Oy1.1 City of Tigard ,.4 %,..,I, +.,,_f. f Received `/) i Date/By: / /a {�/1\ Permit No.: ) III 13125 SW Hall Blvd.,Tigard,OR 97223L 3 / x cTI o�) _1--//LI s Phone: 503.718.2439 Fax: 503.598.19 3 Plan Review 1 h � R_ �! DateBy: Other Permit No.: l i c n It I) Inspection Line: 503.639.4175 Date Read B Internet: www.tigard-or.govt Ready/By: Turis: Ea See Page 2 for La 1'y �,^ r A-,!;14 iyi:) � Notified/Method: Supplemental Information TYPE OF DN DIVISION ' ,,FEE* SCHEDIT ;R. , ®New construction 0 Demolition For special information use checklist or rk - ,.c i ti n a . Ea. Total ❑Addition/alteration/replacement 0 Other: - -family dwellings(includes 100 ft.for each utility connection) - CATEGORY OIl CONSTRUCTION 0 , R(1)bath 312.70 ® 1-and 2-family dwelling 0 Commercial/industrialII SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 1 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB,SITE+ INFORMATION AND LOCATION. ,; Site utilities: Job site address: //(I f3 SW Suzanne PL Catch basin or area drain 18.76 City/State/ZIP:Tigard Or 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:Mission Meadows Manufactured home utilities 50.03 Cross street/directions to job site: 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:Mission Meadows Lot no.: 4., Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 I}FSCRIPTION 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 0 l ROPER' ;OWN'ER 1 31`Eh1ANT Expansion tank 12.51 Name:Mission Homes NW Fixture/sewer cap 25.02 Address:PO BOX 1689 Floor drain floor sink/hub 25.02 Garbage disposal 1 25.02 City/State/ZIP:Lake Oswego OR 97035 Hose bib 1 25.02 Phone:(503)5935324 Fax:(503)2148524 Ice maker 1 12.51 <•'APPL1CANT 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:The Mullen Company Water piping/DWV 56.29 Address: 1601A SE River RD Other: 25.02 City/State/ZIP:Hillsboro OR 97123 Subtotal Phone:(503)6400113 Fax:( ) 77//Z- Minimum permit fee: $72.50 CCB Lic.:92689 Plumbing Lic.no.: ` .6 Plan review (25%of permit fee) /��- State surcharge(1T L PEf PERMIT fee) EE Authorized signature:`//` TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Ben Dalbey Date: 1-24-18 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-Pe,mitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard • c O>MMUN►l'Y I)I \'I LOPMJ NT DEPARTMENT 2 Request for Permit Action t`1t;ARt) 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: ic Ownerliej (:heck(✓)one Applicant El Contractor 0 City Staff REFUND OR Name: IA 1 INVOICE TO• (Business or Individual) /if f 1 i-*1 0" j t,/LA" Mailing Address: I too & y City/State/Zip: Z-r-) 2' OS L-vef o O jf 7 d 3 5' Phone No.: cc) 3-5'73 -1 ? 2-- (1 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. 0 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). 0 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#: 1_,c) Project Name: M /55A) /I9le c,040og`/ rr�� Subdivision Name: /14/5.5.4" Me•„,1 o`er„ Lot#: EXPLANATION: f1 ( - IA.01 P4.Z,.,t ti Signature: Print Name: Date: Refund Policy E/ I. The city's Community Development Director,Building Official or City lingineer 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 800.4 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. FOR OFFICE 1JSI3 ON .V" Route to Sys Admin: Date By Route to Records: Date Refund Processed: Date By Permit Canceled: Date By Invoice Processed: Date By By Parcel Tag Added: Date By l:\Building\Farms\Regl'ennitAcrion_092 14.doc City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11493 SW SUZANNE AVE, TIGARD, OR, 97223 June 11 , 2018 at 9:38:50 AM Record Type: Record ID: Residential - Master Permit MST2017-00414 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS Comments: 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: 11493 SW SUZANNE AVE, TIGARD, OR, 97223 June 11 , 2018 at 9:37:36 AM Record Type: Record ID: Residential - Master Permit MST2017-00414 Inspection Type: Inspector: 399 Plumbing final David Young Result: FA I L Comments: Finish sealing corners master shower walls. Finish sealing base of upper main bath tub/shower. 407.2 Provide permit for landscape irrigation installed without permit. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11493 SW SUZANNE AVE, TIGARD, OR, 97223 June 11 , 2018 at 9:38:15 AM Record Type: Record ID: Residential - Master Permit MST2017-00414 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS Comments: 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: 11493 SW SUZANNE AVE, TIGARD, OR, 97223 June 21 , 2018 at 10:31 :39 AM Record Type: Record ID: Residential - Master Permit MST2017-00414 Inspection Type: Inspector: 299 Final inspection David Young Result: FA I L Comments: Provide approved approach and sidewalk inspection prior to building final inspection. Finish back filling and provide access to area drain backwater devise in rear yard. No ac installed. All else appears ok. Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11493 SW SUZANNE AVE, TIGARD, OR, 97223 June 22, 2018 at 10:22:54 AM Record Type: Record ID: Residential - Master Permit MST2017-00414 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Corrections complete. 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 checked. C of 0 left on site with approved plans. Violation Summary: Inspector Contractor