Permit (104) CITY OF TIGARD , _ MASTER PERMIT
�r 7/ 4+'� Permit#: 00381
COMMUNITY DEVELOPMENT MST2017-
Date Issued: ST2017-
/27/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134DC13100
Jurisdiction: Tigard
Site address: 11445 SW SUZANNE AVE
Subdivision: MISSION MEADOWS Lot: 3
Project: Mission Meadows, Lot 3
Project Description: New SF. 1/12/2018: REPRINT permit to remove laundry tray.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1513 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 26 Bathrooms: 3 Second: 1505 sf Garage: 406 sf Front: 20 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors:
Total: 3018 sf Value: $366,821.74 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains. 0
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvoes Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<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: 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 3015
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: 503-593-3524 PHONE: 503-381-3753
FAX: 503-214-6524
Total Fees: $32,202.85
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 QR 95 - 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ Permittee Signature: 0,1/ /4 787%oz.,/ nOk
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.
FOR OFFICE USE ONLY—SITE ADDRESS:
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
1111 =. Transmittal Letter
T I G A RD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: p-vi DATE RECEIVED::
DEPT: BUILDING DIVISION RECEIVED
� JAN 8 2018
FROM: !>C"t/ d;i/ CITY OF TIGARD
/� 3UILDING DIVISION
/
COMPANY: ' /l SS/UN /Y1z-j
PHONE: 6.0
RE: yy (site c SU 7-4(vAte_ (Permit TNum-oi)/ 7—CSC):-X/
( rP ojectt eliname orr subdivisi' on name of t nummit)�cr.
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: irt/A)',UVc-I (C) la4_4 rc.Pyi ✓Lt i P/anif
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: J — J 7 Initials: II
Fees Due: Yes ❑No Fee Description: Amount Die:
• s— ► )r P/ 4 V e $
$
$
Special
Instructions:
Reprint Permit(per PE): 2 Yes ❑No ❑ Done
Applicant Notified: Date: Initials:
L\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD MASTER PERMIT
1110/ A
Permit#: MST2017-00381
COMMUNITY DEVELOPMENT Date Issued: 11/27/2017
itG .RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134DC13100
Jurisdiction: Tigard
Site address: 11445 SW SUZANNE AVE
Subdivision: MISSION MEADOWS Lot: 3
Project: Mission Meadows, Lot 3
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1513 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height 26 Bathrooms: 3 Second: 1505 sf Garage: 406 sf Front: 20 Smoke Yes
Ri ht: 5 Detectors:
Dwelling Units: 1 Third: 0 sf 9
Total: 3018 sf Value: $366,821.74 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain
0 Catch Basins: 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 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
Ecompasing: Y
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 3018
Owner: Contractor:
Required Items and Reports(Conditions)
MISSION HOMES NORTHWEST LLC MISSION HOMES NORTHWEST LLC
PO BOX 1689 PO BOX 1689 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035
PHONE: 503-593-3524 PHONE: 503-381-3753
FAX: 503-214-8524
Total Fees: $32,202.85
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 fo.. OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7 or 1.800.332.2344.
Issued By: �` < Permittee Signature:
�'"Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion the pr.ject.
Approved plans are required on the job site at the time of each inspect'
Building Permit Application
Residentiali-
R �° 1 s' f [oR ()1.-rl( 1 I tiL ().1.1
' City of Tigard Received 9 2017 Date/By: l(> 110 /7 �4 ermit No,Yfj/
13125 SW Hall Blvd.,Tigard,OR 97223 CT // ���i STO�UI7_(„e3.-
0 rjf
• II Phone: 503.718.2439 Fax: 503.598.1960 PDateBeview \ I M'1� Other Permit:54.44,),67/2—‘,,a//
t iz t, Inspection Line: 503.639.4175 CH's( C.I 1ff3,' RD
Date Ready/ed/Mel o /��. /0 Juns: ® See Pagel for
Internet: www.tigard-or.gov BUILDING DIVISION otified/Metho : l��/V'`--/ C� Supplemental Information
TYPE OF WORK REQUIRED DATA:!- FAMILY DWELLING
0 New construction 0 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 this application.
Cc1 it
® 1-and 2-family dwelling 0 Commercial/industrial
Valuation: '" gg�3
ElAccessory buildingNumber of bedrooms: 4 , 8�
0 Multi-family
0 Master builder 0 Other: Number of bathrooms: 3 SiJOB SITE INFORMATION AND'LOCATION Total number of floors: 2 3° ) S314W-1-
/ /
Job site address: 11445 SW SUZANNE PL New dwelling area: .1S43� square feet
City/State/ZIP:Tigard Or 97223 Garage/carport area: 406 square feet
Suite/bldg./apt.no.: Project name:Mission Meadows Covered porch area: 218 square feet J So,
Cross street/directions to job site:Springwood ST to 115th AVE Deck area:
square feet,S 12
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Mission Meadows Lot no.:3 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:
;® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mission Homes NW (Please refertofee 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
Phone:(503)5935324 and administrative fees):
Fax:(503)2148524
State surcharge(12%of permit fee): $21.60
CCB lic.: 186849
,--I Total fee due upon application: $201.60
Authorized signature: 6`��'z 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)
Electrical Permit ApplicatKRECEIVED l'OR orric'i: I oil.,
City of Tigard9 Received
13125 SW Hall Blvd.,Tigard,OR 97223ooT U 2017 Date/B �rifilir � r�� 3
,11
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 •y OF TIGARD Date/B : Related Permit#:
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK ' PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑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 ❑Commercial/industrial 0 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 ['Emergency system. larger separately derived
Job#: Job site address: 11445 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.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Mission Meadows ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Springwood ST t o115th AVE FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Mission Meadows Lot#:3 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.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNERRenewable Energy ❑ See Page 2
I 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
0 APPLICANT y # 13 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'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 ❑ 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 /C2//(/r Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 65444 Electrical Lic.: 24-248C Suprv.Lic.: 7k78 specifically listed(V2 hr min) 90.00/hr
Suprv.Electrician signature,required:
ELECTRICAL PERMIT FEES
/0.--- ,,,--77
,— Subtotal:
Print name: Marvin Bergevin Date:/�r�'] 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Ben D lbey Date:/vr �� days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Mechanical Permit Application FOR 0!I l( I: ► I.()y1.1
City of Tigard Received
J
1111 IIIa`_ g ! DateBy: Permit No.: 5 c 7'
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Date/By:E Phone: 503.718.2439 Fax: 503.598.1960 OCT 9 2017 Other Permit:
Inspection Line: 503.639.4175
I I( r\R[ Date Ready/By: Jugs: ES See Page 2 for
Y Y�
Internet: www.tigard-or.gov CITY Vii:- TIG ARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder 0 Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: 11445 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
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Mission Meadows Duct work 23.32
Cross street/directions to job site:Springwood St to 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 Lot no.:3 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32
DESCRIPTION OR 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
1:+ PROPERTY OWNER I 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Mission Homes NW Range hood/other kitchen
equipment 1 33.39
Address:PO BOX 1689 Clothes dryer exhaust 1 33.39
City/State/ZIP:Lake Oswego Or 97035 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 4 23.32
Phone:(503)5935324 Fax:(503)2148524 Attic/crawlspace fans 23.32
a',APNACANT ❑"CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Mission Homes NW
$14.15 for first four;$4.03 for each additional
Contact name:Ben Dalbey Furnace,etc. 1
Address:PO BOX 1689 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Lake Oswego Or 970335 Water heater 1
Phone:(503)5935324 Fax: :(503)2148524 Fireplace 1
Range
E-mail:benldalbey@gmail.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Advantage Heating LLC Other:
MECHANICAL PERMIT FEES*
Address:2355 Hyacinth ST NE Subtotal
City/State/ZIP:Salem Or Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)3935315 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:174260 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ,----"C.----"'""-*---- * Fee methodology set by Tri-County Building Industry Service Board
Print name:Ben Dalbey Date: .--6':—/7
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures RECEIVED ioi ()► 1.1( 1: t Sl.
City of Tigard � ReceivedII/ ill )......64.),_ cc
g ( (' Permit No.41 S Td�-U/ ,
13125 SW Hall Blvd.,Tigard,OR 972$YT 2��` • Date/By: `
Plan Review
Phone: 503.718.2439 Fax: 503.59L1,90,-.. Other Permit No.:
C;�I°f L s .ARD Date/By:
I I t l.1 Inspection Line: 503.639.4175 r, Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 1 500.32
0 Accessory 0 Multi-family
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: 11445 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 115"'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.:3 Fixture or item:
Tax map/parcel no.:3 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
r PROPERTY OWNER I ❑ 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
3 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:2229 NE BURNSIDE ST#81 Other: 25.02
City/State/ZIP:Gresham OR 97030 Subtotal
Phone:(503)5440477 I Fax:( ) Minimum permit fee: $72.50
gi62q7 Plan review (25%of permit fee)
CCB Lic.:174351 Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: 6,e__-------- TOTAL PERMIT FEE
Print name:Ben Dalbey Date: 10/6/17 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4916T(10/02/COM/WEB)
City of Tigard
1111 h1 COMMUNITY DEVELOPMENT DEPARTMENT
a
T 1 c A R D Building Permit Review — Residential
Building Permit #: ziztc7----„Lei 7 — ( ,__?�/
Site Address: 111-11-1S SW Si/1261111 v PI
Project Name: Mlsslcwn VA-69146WC Lot #: 2'
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review ,Ly
Proposal: OfV� ST V-- // 7 /7ViseZ Si7E"` ri-4--ii
£ Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
ce9.ree(3)copies of site planFxisting structures 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
Drawn to scale(standard architect or engineer scale) floor elevations
ZNorth arrow ,t4 i tility 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) \*\ ocation of wells/septic systems
N-Lot dimensions and building setback dimensions xisting trees to be retained with drip line,and tree
ti li.quare footage of buildings to be demolished protection measures
of area,building coverage area,percentage of coverage and AfStreet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) ,Street names
, Property corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? s C No
4 foot differential) If yes,is a storm water quality facility shown? s o
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ,K No Received: ❑ Yes ❑ No
4 Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified $. No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: SV V2?,)1(j- 00001
Zoning: fl- Lk.
Required Setbacks: Front '20' Rear IS t Side S4 Street Side vv/4- Garage '/D
Landscape Requirement: N
- Lot Coverage Maximum: II. A
Building Height: aximum Height ' DI
Actual Height±27
/V Visual Clearance
a'Sensitive Lands: CI Yes gr No Type
j/ ) Urban Forestry Plan.— 1111 1 7
i Conditions "Met"prior to issuance of building permits
Notes: v rt Q' )1 i O,„,e7 5 be /?'f-a71.-/o i r— j'iO i S S'4,,,,, e.‹.
ti 11-4 oc! +6'r s /4 r7 A9S` &Pon i'dopves qr
Approved By Planning: le Date: kyq /7
Revisions (after Building Submittal on y) "nah Reviewer Dat
Revision 1: A Approved ❑ Not Approved NOVrt. I of 1
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Building Permit Submittal
Original Submittal Date: 7 o7 7/7
Site Plans: #
Building Plans: # 5'
Building Permit#: Enter building permit#above.
Workflow Routing: PlanningEngineering ermit Coordinator , Building
Workflow Sign-off: (2 Sign-off forlP anning(include notes from planning review)
Route Application Documents: p 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:
ByPermit Technician: 1 / 3, Date:
���=�� to l/old,?
Engineering Review
elope at building pad: / S�
0/Conditions "Met"prior to issuance of building permit
❑ y.asements (encroachments)per engineering conditions of approval and plat 5140,-1 P 1 5Tft E,i1.6.-.44"1/1—
Y-Water
�L "1/1—LNWater Quality/Quantity Facility: Ii &/ d/v.s/ TE
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: /0/0 7
Notes:
Approved by Engineering: Date:
Revisions (after Bilding Submittal o' !y) Date
0IV'
Revision 1: Approved _, Not Approved �/ *L4s-f /i/ 7
Revision 2: CIApproved CINot Approved 0
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
kRevisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant: /a//// 2-- ,1 y1�,� F I ,vvK S. tio4". -
Revision Notice 2: Date Sent to Applicant: � B, is! 1.
Revision Notice 3: Date Sent to Applicant:
76 SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: IS Yes ❑ N/A
.LIDA ❑ Yes N/A
XOK to Issue Permit ` . f t'. S.
Approved by Permit Coordinator: Date: q()6\0
I:\Building\Forms\BldgPermitRvw_RES_061417.docx
Albert Shields
From: Albert Shields
Sent: Wednesday, October 11, 2017 9:58 AM
To: 'benldalbey@gmail.com'
Subject: MST2017-00381, 11445 SW Suzanne Pl.
Ben, on reviewing your plans and application for the above permit Engineering has noted that a 10 foot private storm
easement exists on the East side of the lot but is not shown on your site plan. Please revise the site plan accordingly and
resubmit it as a revision. Please let me know if you have any questions.
Albert Shields
Permit Coordinator
City of Tigard
Albert@tigard-or.gov
503-718-2426
1
Plumbing Permit Application
Building Fixtures
'_,' FOR ()FFICL ISE o\El
City of Tigard Received
II 13125 SW Hall Blvd.,Tigard,OR 97223)to32.018 Date/By: �/� Permit No. S ��� �/
Phone: 503.718.2439 Fax: 503.598.1960' Plan Review
I WARD Inspection Line: 503.639.4175
Date/By: Other Permit No.:
Internet: Line:www.tigard-or.gov t^ ja , k' .p.,...,,..,.,„.._,
°1` ..1 Date ed/MeAids: I ®See Page 2 for
= ,-,,,,,-,i;,, it a '`. Note Ready/By:
Notified/Method:
TYPE OF.,;i?p l l t1�l s > i 4�1...I i.$' Supplemental Information
FEE* SCHEDULE
®New construction 0 DemolitionFor special information use checklist
• )e cri.tion
❑Addition/alteration/replacement 0 Other: tt, f' au Ea. Total
„ig�t w 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY Off CONS RUCT>:ON 1 1•"
® 1-and 2-family dwelling111111"1-
�u _ R(1)bath 312.70
❑Comrnerctal/industna SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 1 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler( sq.ft.) Pa e 2
Site utilities:
g
Job site address: !lijlj$ 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
Cross street/directions to job site: Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision:Mission Meadows Water service(no.linear ft.: ) Page 2
I Lot no.: 3 Fixture or item:
Tax map/parcel no.:
Backflow preventer 31.27
DESCRIFTIQN 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
ROPEI2y OWNER 25.02
P
, 1E1 1 O TENANT Expansion tank 12.51
Name:Mission Homes NW Fixture/sewer cap
25.02
Address:PO BOX 1689 Floor drain/floor sink/hub 25.02
City/State/ZIP:Lake Oswego OR 97035 Garbage disposal 1 25.02
Phone:(503)5935324 Hose bib 1 25.02
Fax (503)2148524 Ice maker
1 12.51
APPY.,ICANT '- a.CONTACT PEI1SON. Interceptor/grease trap
Business name:Mission Homes NW 25.02
Medical gas(value:$ ) Page 2
Contact name:Ben Dalbey Primer 12.51
Address:PO BOX 1689 Roof drain(commercial) 12.51
City/State/ZIP:Lake Oswego OR 97035 Sink/basin/lavatory 5 25.02
Solar units(potable water) 62.54
Phone:(503)5935324 Fax: :(503)2148524 Tub/shower/shower pan 3
E-mail:benidalbey@gmail.com 12.51
Urinal 25.02
CONTRACTOR Water closet 3 25.02
Business name:The Mullen Company Water heater 1 37.52
Address: 1601A SE River RD Water piping/DWV 56.29
Other: 25.02
City/State/ZIP:Hillsboro OR 97123
Phone:(503)6400113 Subtotal
Fax:( ) •- : It �) Minimum permit fee: $72.50
CCB Lic.:92689 Plumbing Lic.no.: 3t Plan review (25%of permit fee)
/-�G� _!
Authorized signature: State surcharge(12%of permit fee)
IPrint name:Ben Dalbey TOTAL PERMIT FEE
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.
t:\Building\Permits\PLMU-PemntApp.doc 10/01/09
440-4616TO 0/02/COM/WEB)
i
City of Tigard • COMMUNITY DEVELOPMENT NT IM PAR'1'MEN'I'
N 4
Request for Permit Action
A I!,1) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or
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: Ie Owner
Check(✓)one �' ` Applicant ❑ Contractor
❑ City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual)
/if/142 0,1 e. A/CA"'
Mailing Address: Q & •
City/State/Zip: Ap. N OfIA/e O D ' 17d35-
Phone No.:
"PhoneNo.: c) 3—,s / 3 ~S ?2 -`/
PLEASE TAKE ACTION FOR THE ITEMS)CHECKED(✓):
❑ CANCEL/VOID PERMIT APPLICATION.
❑❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). )
REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#:
Site Address or Parcel#: ✓ l
Project Name: /55�v t' j J A_Ito
Subdivision Name: M TSS/u . 0✓l,
Lot#:
EXPLANATION: P r
Signature: � G.^
Print Name: Date: (-90•—/
jithadadicx
1. The city's Community Development Director,Building Official or City Isngineer may authorize the refimd 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.
FOR OFFICE ( SF ONLY
Date B Route to Records: Date
Date B Invoice Processed: Date B
Permit Canceled: Date B`, B
REHEMEMI
L\lluildingWorms\RcgpennitAction 092314.doc Date B
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 May 1 , 2018 at 7:12:38 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved sidewalk and approach inspection prior to building final inspection.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 April 25, 2018 at 2:04:38 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Hard cap non used raindrain stand pipe by back patio.
Correct back pitched pan drain at water heater. 309.4
Provide missing top to WC tank, upper main bath. 309, 402.8
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 April 25, 2018 at 11 :33:09 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
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:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 April 25, 2018 at 11 :34:36 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
FA I L
Comments:
Not ready for inspection.
No hood vent installed.
Gas line shut off no working per manufacturer installation requirements at back patio.
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:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 April 27, 2018 at 12:01 :41 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
No A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 April 27, 2018 at 12:00:12 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Corrections completed.
Water pressure =60 psi
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11445 SW SUZANNE AVE, TIGARD, OR, 97223 May 1 , 2018 at 7:12:38 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00381
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved sidewalk and approach inspection prior to building final inspection.
Violation Summary:
Inspector Contractor
1 -
TIGARD
City of Tigard
March 1,2018
Mission Homes Northwest LLC
Attn: Ben Dalbey
PO Box 1689
Lake Oswego, OR 97035
Re:Permit No. MST2017-00381
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 11445 SW Suzanne Ave.
Project Name: Mission Meadows,Lot 3
Job No.: N/A
Refund: ® Check#227730 in the amount of$28.02.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: A change in the scope of work to remove laundry tray resulted in overpayment of
permit fees;refund difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
��3 5 SW Itl l lvc� • T.14.47peg on 97223 • 503.639.4171
I:\Building\Refun s strahon tr a d- ve a.
TTY Relay: 5016y84.2772 • www.tigard-or.gov
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
71 I. Request for Permit Action
TIGARD 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 FPContractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) /-7/S S/o,&J i(/.17z7wevEs% c_
Address: / 0 4-eX /6 /?
City/State/Zip: 2.-.41LE Qf&J: 6D Ox_ 97$
Phone No.: d 3 - 3F' .3 7._.<3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
VOID PERMIT APPLICATION.
REFUND RMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: /7- i c2d/ 7 - Oc tf/
Site Address or Parcel#: //1/ YS ��47 `t
Project Name: /1/S s 0 Al S
Subdivision Name: Lot#:
EXPLANATION: 72-& I 4/6
47 -
Signature: i j Date: ,Z/fer
Print Name: /1/Z77-05C
Refund Policy � // - G l l/��L lT`�* 1---4,4k/e."¢-A77- - 7
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date v2. ,p /4? By t-1Fir
Refund Processed: Date 2//e?3//P :.• 'Ia Invoice Processed: Date By
Permit Canceled: Date 4.1/4" B 'arcel Tag Added: Date By
T:\Ruildinn\Fnrmc\1prIPprmitArtirm Ag7 14rinr
FOR OFFICE USE ONLY—SITE ADDRESS:
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
111 Transmittal Letter
i c, ,Ei t, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: idyll DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
,JAN 8 2018
FROM: &,v, ,/ CITY OF FIGARD
ui SSS,UN - 4/1,)
3UILDING DIVISION
COMPANY: f
PHONE: 603J 513- 5307ey BY:8),�
RE: l i y ( ' . yt� (5-c., 4/-74A/Ate_ (CA 5T of 7_c 3Xrj
Site Ad i ess L0-5-3-` 2 Number)
(l)Ssi- bd. ' " I beriL3( �ect name or subdivision name and of num
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: _ Description:; Copies: ' Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: E`l du,lfv ' (i) /G(,Nejvvi Ply.f
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: J-- g J 7 Initials: 11
Fees Due: Yes ❑No Fee Description: Amount D e:
$
$
$
Special
Instructions:
Reprint Permit(per PE): .l Yes ❑No 0 Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012