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Permit (49) CITY OF TIGARD MASTER PERMIT 12j' COMMUNITY DEVELOPMENT11 Permit#: MST2017-00494 TIC3,,a1..RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2017 Parcel: 1 S 134DC13500 Jurisdiction: Tigard Site address: 11438 SW SUZANNE AVE Subdivision: MISSION MEADOWS Lot: 7 Project: Mission Meadows, Lot 7 Project Description: New SF. DEMO CREDITS APPLIED FROM BUP2017-00110. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1289 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 24 Bathrooms: 3 Second: 1709 sf Garage: 432 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2998 sf Value: $361,815.93 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 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 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 l 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 asin Y Other: N Other Description: Ecom p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2998 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: $9,792.41 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. You may obtain a co e rules or direct questions to OUNC by calling 503.232.19 .800.332.2344. Issued By: Apt.,-/,.........,.' — Permittee Signature: a- 3.639.4175 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 I OR O1:1:1( L I sI:Oy1.I • -' Received City of Tigard 1 Permit No.: f Date/By. �� 7 i 7.t/l.J !i 13125 SW Hall Blvd.,Tigard,OR 97223 '" plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: )2.�)3-)7 Other Permit: t/7-4 pry, , I c;\R1) Inspection Line: 503.639.4175 DEC 7 2017 Date ReadyBy: Juris: I E See aP ge 2 for Internet: www.tigard-or.gov fied/Method: /�flr::7:tSupplemental Information TYPE OF weItOILDING DIVISION REQUIRED DATA;1-AND 2-FAMILY DWELLING ®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 0 Other: equipment,materials,labor,overhead,and the profit for the 4 CATEGORY OF CONSTRUCTION work indicated on this application. (8.,1 1-and 2-family dwelling 0 Commercial/industrial Valuation: $35 3 6'/ $' ElAccessory building ❑Multi-family Number of bedrooms: 4 0 Master builder 0 Other: Number of bathrooms: 3 0 JQB SITE INFORMATIONAND LOCATION Total number of floors: 2 343 0 , Job site address: 11438 SW Suzanne PL New dwelling area: 2998 square feet 4 City/State/ZIP:Tigard Or 97223 Garage/carport area: `1106/4square feet Suite/bldg./apt.no.: Project name:Mission Meadows Covered porch area: '432 14,5"square feet 1709 Cross street/directions to job site:Springwood ST to 1156 AVE Deck area: square feet 9 Other structure area: square feet ��++ REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Mission Meadows Lot no.:7 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 w„ a+ 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 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee scheduf) Business name:Mission Homes NW Structural plan review fee(or deposit): Contact name:Ben Dalbey ., + FLS plan review fee(if applicable): 'jy Address:PO BOX 1689 Total fees due upon application: Cit /State/ZIP:Lake Oswego Or 97 City/State/ZIP: g 935 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 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: $201.60 Authorized signature: , This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Ben Dalbey Date:8-8-17 *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR Ol ICI: I SE 0.11.y City of Tigard Received Er""I° ! Date/By: Permit No.: III13125 SW Hall Blvd.,Tigard,OR 972 ) E ', - ,, y: Phone: 503.718.2439 Fax: 503.598.1 . 4i Plan Review 1 I ,\.1:I) Inspection Line: 503.639.4175 Date/By: Other Permit: Internet: www.tigard-or.gov r c 7 2017 Date Ready/By: Jurs: See Page 2 for C_1. Notified/Method: Supplemental Information Yof ":.. A11) TYPE OF ���w ��tr li�`��� COMMERCIAL FEE* SCHEDULE USE CHECKLIST .. l ®New constructionU! Mechanical permit fees*are based on the value of the work 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address:11438 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.: Project name:Mission Meadows Heat pump 61.06 Duct work 23.32 Cross street/directions to job site:Springwood St to 115"'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.:7 Other: 23.32 Other fuel appliances: Tax map/parcel no.: 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 la PROPERTY OWNER El 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, toilet compartments,utility rooms) 4 23.32 Phone:(503)5935324 Fax:(503)2148524 Attic/crawlspace fans 23.32 Z 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 E-mail:benldalbe y@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) Plan review(25%of permit fee) Phone:(503)3935315 Fax:( ) State surcharge(12%of permit fee) CCB lie.: 174260 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 (j/�-----"� days after it has been accepted as complete. Print Authorizedsignature: * Fee methodology set by Tri-County Building Industry Service Board Print name:Ben Dalbey Date:12-5-17 I.\Building\Permits\IvffiC_PermitApp_04o1 I3.doc 440-4617T(11/02/COM/WEB) Electrical Permit Application FOR OFFlcE I Se ON 1.1 City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 Date/BR : Y Illinglinfin "' ..+ �' Plan Review Phone: 503.718.2439 Fax: 503.5 I ' - Date/B : Related Permit#: Inspection Line: 503.639.4175 '.""°'° Ready Date/By: ruris: IB See Page 2 for Internet: www.tigard-or.gov _ 7 `.017 Notified/Method: Supplemental Information TYPE OF WOR �'� 1 PLAN REVIEW t 11, ®New construction 0 Addition/alter 4eiii ,c(1,t,:,, Please check all that apply(submit 2 sets of plans w/items checked): el IS9I`"7 t�-*`` 0 Service or feeder 400 amps or more ❑Demolition 0 Other: A g{L Dt Ni,` ❑Building over three stories. 1 i 1 where the available fault current 0 Marinas and boatyards. CATEGORY OFC STRUCTION exceeds 10,000 amps at]50 volts or 0 Floating buildings. 0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fireum P P 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address:11438 SW Suzanne PL ❑Addition of new motor load of system. 10OHP or more. ❑"A","E","l-2","1-3", City/State/ZIP:Tigard Or 97223 ❑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 oll5th AVE FEE SCHEDULE Description I !ti- I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision:Mission Meadows Lot#:7 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 75.00 2 residential(with above sq.ft.) p1Rt3Pl6RTY OWNERRenewable Energy 0 See Page 2 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 .4 APM ICANT 1 0 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 'Cif/LiIndustrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 65444 Electrical Lie.: 24-248C Suprv.Lic.:36„//9 specifically listed(%hr min) 90.00/hr Suprv.Electrician signature,required: /� ELECTRICAL PERMIT FEES Subtotal: Print name: Marvin Bergevin Date: 12-5-17 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 DAlbey Date: 12-5-17 days after it has been accepted as complete. * Number of inspections allowed per permit. I.\Building'Permits\ELC_PennitApp_ELR_ERE.doe 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: Fee for all residential systems combined: $75.00 rt. moo Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva III 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 _© Wind l 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 IN 552.26 _© >100 kva(fee in accordance with OAR 918-309-0040 III 552.26 -© ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 1.1 7.42 _© ❑ Vacuum Systems* >100 kva-no additional charge 1.10.0 _© 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 -. secificall listed(''h hr min L # 1 1 i ., .• • -Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: [] Audio and Stereo Systems El Boiler Controls El Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELCPermitApp_ELR ERE.doc Rev 06/17/2015 Plumbing Permit Application Building Fixtures voiz 0111( 1 ISE 0y1.1 • City of Tigard , - ---% IVE t' eived• Permit No.: ;. 11 13125 SW Hall Blvd.,Tigard,OR 97223 `fit - '"' e 1 `+'"eBy. � �- ,f"� �e .i�� I an Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: Inspection Line: 503.639.4175 1)'c r 7 2 U 1 Date Ready/By: 7uris: ® See Page 2 for II. ARI) a.-t.. : Internet: www.tigard-or.gov r ` Notified/Method: Supplemental Information TYPE OF WORK'CI Y OI e l(A+ I FEE* SCHEDULE ®New construction 0 Demolition �!( OtV!" � N For •special information use checklist Description I Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 0 Accessory building IDMulti-familySFR(3)bath 1 500.32 ID Master builderEach additional bath/kitchen 25.02 El Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:11438 SW SUZANNe PL Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard Or 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Mission Meadows Manufactured home utilities 50.03 Cross street/directions to job site:SPringwood St to 115th AVE Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Missiom Meadwos I Lot no.:7 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 k... 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 �. APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Mission Homes NW Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Ben Dalbey Roof drain(commercial) 12.51 Address:PO BOX 1689 Sink/basin/lavatory 5 25.02 City/State/ZIP:Lake Oswego OR 97035 Solar units(potable water) 62.54 Phone:(503)5935324 Fax: :(503)2148524 Tub/shower/shower pan 3 12.51 E-mail:benldalbey@gmail.com Urinal 25.02 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. Plan review (25%of permit fee) /^/� State surcharge(12%of permit fee) Authorized signature: 7 77 TOTAL PERMIT FEE Print name:Ben Dalbe Date: 10/6/17This permit application expires if a permit is not obtained within 180 days Y after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pennits\PLMU-PermitApp.doe 10/01/09 440-4616T(I 0/02/COM/WEB) City of Tigard illill q COMMUNITY DEVELOPMENT DEPARTMENT ■ T 1 G A R D Building Permit Review — Residential Building Permit #: / 5%-26/7 cibi/`i Site Address: //27I Project Name: sk �i'(,),,,L sbmcOf Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 0 -ett) . Verify site address/suite# exists and actio mstem.ermit system. Y ❑ River Terrace Neighborhood: No ❑ Yes,See River Terrace Review Addendum Attached Sit/Plan Elements: L i ree(3)copies of site plan 3, ting structures on site ite plan must be on 8-1/2"x 11"or 11 x 17"paper 11 Footprint of new structure(including decks)with finished yawn to scale(standard architect or engineer scale) .11 floor elevations ,orth arrowI tility locations&easements(required for new and additions) ite address,project or subdivision name and lot number LTA Sidewalk/driveway approach •plicant information(name and phone number) \t11 .cation of wells/septic systems Y. ;t dimensions and building setback dimensions ll a 'sting trees to be retained with drip line,and tree E • are footage of buildings to be demolished rotection measures 1l• I t area,building coverage area,percentage of coverage and !l treet tree size,type and location inpervious area(applicable if R-7,R-12,R-25&R-40) Street names Pro aerty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? P iYes ❑� oot differential) If es,is a storm water auali facili shown? ❑Yes VNo PA r can Water Services—Service Provider Lett: (lot platted prior to 9/10/1995): a NZ)1/'E'.i /0 c• Or/ 1-6 --e__. •equired: ❑ es,applicant was notified J No Received: ❑ Yes ❑ No FA Public Facili 'es Improvement(PFI) Permit: f'7 )of Required: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake ifand Use Case#: �l-'l.? 0-/ - CUY oning: /2 —q S Required Setbacks: Front ,..2 0 Rear /cc-- Side ---- Street Side (1\.* Garage =_,2 kandscape Requirement: % Nd of Coverage Maximum: cYo !1 BuildingHeight: 1i g Maximum Height 0 Actual Height (J00 LP Vesual Clearance nsitive Lands: ❑ Yes ❑ No Type 7 rban Forestry Plan yConditions "Met"prior to issuance of building permit Notes: Approved By Planning: _ / Date: P� � Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Fonns\BldgPermitRvw REs o61417.docx Building Permit Submittal Original Submittal Date: )1217/i 7 Site Plans: # Building Plans: # Building Permit#: nter building permit#above. - Workflow Routing: arming LSF n �gineering - 1 it Coordinator i ing Workflow Sign-off: gn-off for Planning(include notes from planning review) Route Application Documents: ❑-ngineering: (1) copy of permit application, (1) site plan, (1) building plan and o al plan review routing form. Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: rc. .„2---- _ By Permit Technician: , ' G Date: 4 Engpeering Review Sl eat building pad: 5. S 7° IL onditions "Met"prior to issuance of building permit sements (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: CI Yes No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: Approved by Enineerin : // Date: /�`/4` 7 Revisions (after Building Submitta only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: El Approved ❑ Not Approved Permit Coordinator Review El 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: DC Fees Entered: Wash Co TransDc: Tax: Yes ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: i '1-,Yes ❑ N/A LIDA ❑ Yes ® N/A 'OK to Issue Permit A>-- Approved by Permit Coordinator: ate: �� � / I:\Building\Forms\BldgPernvtRvw_RES_111617.docx Plumbing Permit Application Building Fixtures ",..,-,„:„. City of Tigard " . nck # rOR OFrICE ISI: O.N►.l' Received 7 it 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: / S U 7 4 Permit N .S��/>_/�y�,� $ Phone: 503.718.2439 Fax: 503.598.1041\1 0 ?fl"� Plan Review / [A(� Inspection Line: 503.639.4175 Date/By: Other Permit No.: I I( 1hr) p Internet: www.tigard-or.gov t 1 g r ;;_ . _-) Date Ready/By: .tuns GO;iO ; #ptb See Page 2 for qq �� Notified/Method: - TYPE OF '�i1. ., DINCI G Supplemental Information ®New construction FEE* SCREDIJLE ❑Demolition For special information use checklist ❑Addition/alteration/replacement " Description Qty. Ea. Total 0 Other: t s.,.. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTIO '' , SFR(1)bath ® 1-and 2-family dwelling � 0 Commerci+/in' •; al SFR(2)bath I 437.78312.70 ❑Accessory building ❑Multi-family SFR(3)bath 1 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: JOS SITE INFORMATION.AND LOCATION,, u Fire sprinkler( sq.ft.) Page 2 _ Site utilities: Job site address: [[13 J'SW Suzanne PL Catch basin or area drain 18.76 City/State/ZIP:Tigard Or 97223 Diywell,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.: 7 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORT 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 PROPERTY OWNER l3 IENlI�II' 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 r: APPLI 'CANT ' '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 City/State/ZIP:Lake Oswego OR 97035 Sink/basin/lavatory 5 25.02 Solar units(potable water) 62.54 Phone:(503)5935324 I Fax: :(503)2148524 Tub/shower/shower pan 3 12.51 E-mail:benldalbey@gmail.com Urinal 25.02 CONTRACTOR Water closet 3 25.02 Business name:The Mullen Company Water heater 1 37.52 Address: 1601A SE River RD Water piping/DWV 56.29 Other: 25.02 City/State/ZIP:Hillsboro OR 97123 Subtotal Phone:(503)6400113 1 Fax:( ) 7//7/1,z() Minimum permit fee: $72.50 CCB Lic.:92689 Plumbing Lic.no.:3 4-/ 6,,,9-i.", Plan review (25%of permit fee) Authorized signature: / / State surcharge(12%of permit fee) IPrint name:Ben Dalbey` ts'/ TOTAL PERMIT FEE I IDate: 1-24-18 I This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\PermitswLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) City of Tigard • COMMUNITY DIWHI,OPMl NT DI PARlM1:NT ' _ 41111 Request for Permit Action 1 c,A R i) 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 TigardBuildingPerrnits@tigard-or:gov FROM: ] Owner A Check(✓)one ' Applicant 0 Contractor 0 City Staff REFUND OR Name: r INVOICE TO: (Business or Individual) j/ff,1/ pa Ham J itif i"." Mailing Address: too 6c, X /6/ 4-,..--4-41,..,},.,. City/State/Zip: O (} Of k f7 er,S Phone No.: Sv 3—S/3 1 ?2- l/ 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). 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#: L7f l-- (Z Project Name: /v1 455/0/\ Me o 1,.v- Subdivision Name: /A/5S/un fr/e ,,ja✓t Lot#: EXPLANATION: 014k fi/ (y-c J ).Z,°A. Signature: J/%yF -C----"' Print Name: ��er� t9,.11'i Date: �c).-/ Refund Policy 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 of plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date By Route to Records: Date Refund Processed: Date By Permit Canceled: Date g�. Invoice Processed: Date By Parcel Tag;Added: Date Byl:\Building\t um,s\ReypcnnitActiun_n923I4.doc i City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11438 SW SUZANNE AVE, TIGARD, OR, 97223 May 29, 2018 at 9:31 :56 AM Record Type: Record ID: Residential - Master Permit MST2017-00494 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: 11438 SW SUZANNE AVE, TIGARD, OR, 97223 May 29, 2018 at 9:31 :33 AM Record Type: Record ID: Residential - Master Permit MST2017-00494 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: 11438 SW SUZANNE AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2017-00494 Inspection Type: Inspector: 699 Mechanical final Allyson Armstrong Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11438 SW SUZANNE AVE, TIGARD, OR, 97223 May 31 , 2018 at 2:32:25 PM Record Type: Record ID: Residential - Master Permit MST2017-00494 Inspection Type: Inspector: 299 Final inspection David Young Result: PASS - CofO Comments: Note: tempered window on order per contractor for replacement of upper level master bath above tub. Corrections complete as listed on previous final inspection report. Final erosion control approved. Street tree certification received. Moisture content form received. Moisture barrier form received. Blower door test report checked. Insulation certification checked. C of 0 left on site at kitchen counter. Violation Summary: Inspector Contractor