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Permit
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 Transmittal Letter TIGARD 13125 SW Hall Blvd. •• Tigard, Oregon 97223 •• 503.718.2439 •• www.tigard-or.gov w TO: DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: G�W RA/pp i- FEB 8 2012 COMPANY: f�_ I I Y OF 11GHHU PHONE: 54D./) - O )- V" 6 Co g 3UILDING DIVISION By: L Ov EMAIL: t01 PA�� RE: 9 c.c 5- S tAi -' 2S (Site Address) (Permit Number) (Project name or subdivision name and lot number) 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: FOR FFIE USE ONLY ^^ ,, Routed to Permit Techn��ic�i �mate: 2 ('( '7�2 Initials: +d/ Fees Due: ❑ Yes L�J Ncs" Fee Descrip ion: Amount Due: po s Special Instructions: 6/ Reprint Permit(per PE): ❑ Yes No ❑ Done Applicant Notified: Date: 3/,,7, ,� 7 Initials: j 1:\Building\Forms\Transmittal Letter-Revisions_073120.doc CITY OF TIGARD MASTER PERMIT Ill 2 -4 COMMUNITY DEVELOPMENT Permit#: MST2022-00023 Date Issued: 03/28/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S111 BD00600 Jurisdiction: Tigard Site address: 9665 SW DARMEL CT Subdivision: DARMEL NO.2 Lot: 33 Project: Ruppert Project Description: Add primary bedroom and bath. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 468 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 14.5 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Total: 468 sf Value: $61,111.44 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 2 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Tvpes Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3 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 N Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 468 Owner: Contractor: RUPPERT,JOHN D&CHARLENE L OWNER Required Items and Reports(Conditions) 9665 SW DARMEL CT TIGARD,OR 97224 PHONE: PHONE: FAX: Total Fees: $3,380.45 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 Q59_nM-OOlf thrnunh r1GR Q59SOI OOgO Vnn mw nhtain a nnnu n11ha ndae nr rIirart nuactinne 1n Al INC by nallinn co'1 9'19 tgR7 nr 1 eon'S9 9'1Ad w c-a-li.avt' Issued By: j j Vaw De VJeg r- A 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 of the project. Approved plans are required on the lob site at the time of each inspection. Building Permit Application v ; _/ Residential E �f FOR OFFICE USE ONLY i� ��� �� � Received �� . City of Tigard `"'i a/`1e22. Permit No.�/(STZ22^O O 2-3 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 1 fi 2022 Date e i L Plan Review / Phone: 503.718.2439 Fax: 503.598.1960 Date/By; a f y/p-)- '' Other Permit: TIGARU Inspection Line: 503.639.4175 +,.jT (1 j(f i] DateReady/By: 111 Juris: ® See Page 2for Internet: www.tigard-or.gov FaJP r WC3[1Mrj (A Notified/Method: Supplemental information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,an the nrnfit Fnrehe CATEGORY OF CONSTRUCTION work indicated on this application..,. _" K-t=-and 2-family dwelling ❑Commercial/industrial Valuation: $ f (et Ii(,f` ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 9 C 5+.v Dq,r itA / eT New dwelling area: square feet City/State/ZIP: /`Q Orel fir)jJ g7 �L _ Garage/carport area: L square feet Suite/bldg./apt.no.: J Project name: Pp ' i/IU ,'(, Covered porch�t}y T t< square feet Cross street/directions to job site:si / �'-7 Deck area: !! square feet 1 1 1 � ___It 9 6p?� / Other structure area: square feet / `,'yam„J(B REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 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 DDESCRITTION OF WORK ram-- work indicated on this application. i4// W !�--�v', �(^,di•)/7 /L� (rSa`/� Valuation: $ �T r/ ���rT Existing building area: square feet �,..eOwMe/s Si sm et_ eN £<Li 4.j 497,10eoVie+ —OCA"ry' New building area: square feet iir .s r cefirt f ,,,. tssG7Parr. `y�� P TY OWNER j� 0 TENANT Number of stories: Name: `'1/7 / ,IP 7 Type of construction: Address: CI CO , cf �/�,.4j"yy( 4 C'F Occupancy groups: City/State/ZIP: 7779 v�c9� 9.�-. Existing: Phone:t0 ,Cl `'}) 8 6� Fax:( ✓J 3------ -_.. New: $\APPLICANT XCONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) V Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Phone:( ) Flax::( ) Amount received: E-mail: on> epev SS e triad con PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* dN/ Commercial and residential prescriptive installation of C TRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: ��C ,1 Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: ----------- Total fee due upon application: $201.60 -1 —'Authorized signature: l -`-' Or- (/�`,lJ`�/'/ This permit application expires if a permit is not obtained �/ within 180 days after it has been accepted as complete. Print name: • �prr Date: _© . . *Fee methodology set by Tri-County Building Industry N ' +�� V ! •• Service Board. C\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46I3T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY Received City of Tigard h�r�»��n�_: IIiin 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: : Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: 24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing El Mechanical T I G A R D Internet: www.tigard-or.gov ❑ Other. THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. 0 ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft. intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ 0 0 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ ❑ systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ 0 ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. DOD 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 ❑ ❑ architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ 0 0 Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Permit No.: Date/By: • 13125 S W'Hall Blvd.,Tigard,OR 97223 Plan Reviewa Received li Phone: 503.718.2439Other Permit: Date/By: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: I ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST El New construction Addition/alteration/replacement Mechanical permit lees*arc based on the value of the work perfbrmed.Indicate the value(rounded to the nearest dollar)of all El Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building❑ RESIDENTIAL, Multi-family Master builder EOther: For special information use checklist. _ Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Job site address: 946 5 S W Pa,r f y j e.f cl" Air conditioning 46.75 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 7y Grey oak/ Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: dgOV/ Heat pump �,,{�. 61.06 Cross street/directions to job site: '/ Duct work V 23.32 ` _- Re n hot water system23.32 9 C f Residential boilerr(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: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DDESCRII ION OF WORK Gas fireplace/insert 33.39 n / `-w-./ / v a Ir-• '�Q Flue vent for water heater or gas !7 / �V fireplace 23.32 Al ttit��_ �� "" 6 Gd-hrd�l.. - A d Log lighter(gas) 23.32 �j��kr ��d Wood/pelletpl stove 33.392 Y�//�'� e � Wood fireplace/insert 23.32 _ 11- Chimney/liner/flue/vent 23.32 PROPERTY OWNER ❑ TENANT Other: 23.32 Name: / Environmental exhaust and ventilation: /v fly/y " !� Range hood/other kitchen Address: 9 5 S ty O�trAx4.( <T equipment 33.39 City/State/ZIP: q yr `7 r� Clothes dryer exhaust 33.39%/ U�. — 04 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) I 23.32 Phone:(M) Fax:( ) Attic/crawlspace fans 23.32 KAPPLICANT CONTACT PERSON Other: 23.32 Business name: ` Fuel piping: Contact name: o r//'. n $14.15 for first four;$4.03 for each additional � // / i Furnace,etc. Address: / �` l� Gas heat pump City/State/ZIP: Wall/suspended/unit heater Water heater Phone:( ) Fax::( ) Fireplace E-mail: . iist Thu 5-, e G, Ems^{ , (v Range CONTRACTOR Barbecue Clothes dryer(gas) Business name: Other: Address: N MECHANICAL PERMIT FEES* i A a`v Subtotal l^ City/State/ZIP: CV/ Minimum permit fee($90.00) d.0 r 0� Phone:( ) Fax:( ) Plan review(25%of permit fee) CCB tic.: State surcharge(12%of permit fee) TOTAL PERMIT FEE �y, _ This permit application expires if a permit is not obtained within 180 Authorized signs �[ _�l days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board Print name: 1 Wk./ kip Date: 02.. •--A1;t' , I:\BuildingTermits'MEC_PemdtApp_082520.doc 440-4617T(1 I/02,COM/WPB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Submittal Requirements: • (2) sets of plans, drawn to scale. • (2) sets of equipment cut sheets. • (2) copies of site plan for ground and roof top equipment location and screening per Tigard development code. Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. 1:\Building\Permits\MEC_PermitApp_082520.doc 2 Electrical Permit Application FOR OFFICE USE ONLY P" - City of Tigard Date/B Received Permit": II • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Date/B : Related Permit 4. Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: tuns. IH See Page 2 for TIGARD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction A Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. I less to ground,or exceeds 14,000 0 Commercial-use agricultural -and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. /C Multi-family ❑ Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 5"` - ` D Qr ❑100Addition more.f new motor load of system. Job#: I Job site address: 966� W IOOHP or more. ❑"A","E","I-2","1-3", 1 f/ ❑Six or more residential units. occupancy. City/State/ZIP: ��/ p pc,�- ❑Health-care facilities. ❑Recreational vehicle parks. f/ IdoKV l ❑Hazardous locations. ❑Supply voltage for more than Suite/bldg./apt.#: Project name: 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site: rr FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK / Limited energy,residential m'•_+t7lJ (with above sq.R.) 75.00 2 r.�C•/ - t �ti Limited energy,multi-family 75.00 2 ,(/, :0-/04,—; residential(with above sq.ft.) "'L- '" Renewable Energy ❑ See Page 2 PROPERTY OWNER I [r] TENANT Services or feeders installation,alteration,and/or relocation Name: Cif. / "" RKi 200 amps or less 100.70 2 Address: 65- 5 ! c 201 amps to 400 amps 133.56 2 ���*YYY 401 amps ttoo 600 amps 200.341 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:(,J)it(48,„),,,,,...P Over 1,000 amps or volts 552.262` j e/� Temporary services or feeders installation,alteration,and/orEmail: J S� 6 GYa[6_0 • Lot- 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 ese,(rent,or exchang according to 447,449,670,andr 701. 201 amps to 400 amps 125.08 2 Owner signatur • - "�" ,/ Date: 3., a�z'^ /�p DI amps to 599 amps168.54 2 APPLICANT I l,�[CONTACT PERSON Branch circuits-new,alteration,or extension, rer panel CC / _ A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: t_� _.�("i B.Fee for branch circuits without 7 O(f(�,Cvj��/ service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit ''A, 7.42 2 Miscellaneous(service or feeder not included) Phone: ( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ID See Page 2 2 Address: panel,alteration,or extension. City/State/ZIP: C5VMCd-c— Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie,: I Suprv. Lie.: specifically listed('Vs hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: ❑Plan Review Required(25%of permit fee): /� /n A Stale surcharge(12%of permit fee): Authorized signature:^ D^' ^ DJ TOTAL PERMIT FEE: /� /y� This permit application expires if a permit Is not obtained within 180 Print name:n/Dy./ J J? x/•'9{L&c( Date:/L days after it has been accepted as complete. V "�� _ - * Number of inspections allowed per permit I:\Building'Pemits'ELC_PermitApp_ELR ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE .c Fee for all residential systems combined: $75.00 Renewable QV. Raen I Total electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES 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 ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC • ❑ Instrumentation IT Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1/BuildinglPerrniu\ELC_PermitApp_ELR_ERP.doc Rev 10/26/2017 Plumbing Permit Application 'Building Fixtures FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: 1111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: leis ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. 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 "XI-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory building El SFR(3)bath 500.32 ❑ Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: ��� Job site address: rJ W q 9j,K Q,( Catch basin or area drain 18.76 �� well,leach line,or trench drain 18.76 City/State/ZIP: " tryVr Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job ?C Manholes 18.76 (:).. Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Stone sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ni,,,(. 45/._._0. 6� �L- ` Clothes washer 25.02 Dishwasher 25.02 e p1-• Drinking fountain 25.02 Ejectors/sump 25.02 PROP'PERT//Y OWNER ❑ TENANT Expansion tank 12.51 Name: �, / J f' J'x Fixture/sewer cap 25.02 ff Floor drain/floor sink/hub 25.02 Address: CG Garbage disposal 25.02 City/State/ZIP: q Hose bib '� 25.02 Phone:') / Fax: g `��p g� ( ) Ice maker 12.51 APPLICANT CONTACT PERSON Interceptor/grease trap 25.02 Business name: �� Medical gas(value:$ ) Page 2 Contact name: ----"A)--:L.--4--- Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan / 12.51 E-mail: T jelijirt 5i' �yar Urinal 25.02 Water closet / 25.02 CONTRACTOR ;-, I Water heater , 37.52 Business name: Water piping DW V 56.29 Address: Q s Other: 25.02 City/State/ZIP: �S- Subtotal Phone:( ) ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no• Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: Q TOTAL PERMIT FEE Print name: n / Date: d_ 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:iBuilding\Permits\PLMU-PermitApp.doc I0/01'09 440.4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1 a 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system. Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" 3„ Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: l:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2 i al City of Tigard 11111 COMMUNITY DEVELOPMENT DEPARTMENT ■ Building Permit Review — Residential TIGARD Building Permit #: pt sT 2.02Z OOOZ 3 Site Address: 1166 5 Ski. t y nj Project Name: nptT ( k)O .Z Lot #: 53 Planning Review 1� (� r _ Q A Proposal: d-eC be�r ou4A ,- `( - 'br( k et.dA1-po i pi Verifyaddress/suite #active in Accela. ❑ In River Terrace: p No ❑ Yes,River Terraev Review Addendum Site Plan Elements: BErasion-Eeatxel 103 copies of site plan on 8-1/2"x 11"or 11 x 17"paper (Drawn to scale(standard architect or engineer scale) 'Footprint of new structure(including decks)and FFE North arrow AfUtility locations&easements(required for new and additions) OSite address,project or subdivision name and lot number Sidewalk/driveway approach Applicant information(name and phone number) G7L.,..ati.,,.„f wc.1L/sep‘.system' PLot dimensions and building setback dimensions 06yua.c f,,.,tur,....fz,.. =gam 6,1,ikinolished tg3Street names Existing structures on site ( ' Ix ..,,beril L p b nd >1,000 sf of impervious area created or replaced? ❑Yes kNo 4 2,R-25 8rIt- 0) 1 ' r n-- v + ^^'�7 c 1 t,,... �No 'I�TT'�TTc'1F8tBL n___• ice Required: ❑ Yes,applicant was notified Cal No Received: ❑ Yes ❑ No Ni Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: 4 Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No cDC£yet Eirrn—frrr frl3,t~=a 1; .1 F +• n yse n ^'� Received: ❑ Yes ❑ No es mprovemen . Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake 0 Laud Use Case i* 4 Zoning. R - 3. t 0 Required Setbacks: Front: 2d t Rear: 1 St Side: 5 t, Street Side: 2-0 Garage: Zd l X `�Building Height: Max. Height: rt Actual Height: «•5 l ❑ T anrlc,Are4 ,• % g• Lot-Coverage Max: ' l+s-k-rm n� d3wa g f= g ree}l a a grees or ess Windows 4 Minimum 12%of area of all street-facing facades G ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,o the following is met: ds no more than 5'from wall and there is a covered extending beyond garage. ❑ Door extends no mo "'from wall and there' sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or less ss of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ R entrance ❑ Wall o se 1'Roof eave ❑ Roof offset ❑ Fires Lap Siding ❑ Roof pitch ❑ Gable,hip,o el roof ❑ Dormer ccent siding ❑ Window trim ❑ Window recess ❑ Window prolecno ❑ Balcony ® Visual Clearance C ULbau Forestry Mir p Sensitive Lands: ❑ Yes la No Type: ;te5, d /By Planning: k4i". J Date: j / i /i4Za_` Revisions (after Building Submittal only) Reviewer ` Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 0/AD/2O12 Site Plans: # 3 Building Plans: # 3 Building Permit#: Enter building permit#above. Workflow Routing: 2--Planning 0' Engineering [ Permit Coordinator 2-/Building Workflow Sign-off: L!Sign-off for Planning(include notes from planning review) Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: Date: ,00( Z Engineering Review fir-Slope at building pad: g% 2"-Conditions "Met"prior to issuance of building permit n/a Cam]' Easements (encroachments) per engineering conditions of approval and plat 2/Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 2/No Assess Water Quantity Fee in-lieu: D Yes L�J No �� LIDA Facility on lot: ❑ Yes IV/No Add Fee: El Yes 0 No IN Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: /� R Approved by Engineering: ��u^��f-l�^"`y Date: I J2(c)2p22 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review T'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: ,SDC Exemption: ❑ Received Does not apply ZSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes Z'N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes 71 N/A LIDA ❑ Yes ivi N/A OK to Issue Permit Approved by Permit Coordinator: Date: 2, [2 ,v - I:\Building\Forms\s IdgPermitRvw_RES_1208021.docx Water Meter Fixture Unit Worksheet for Addition Rwtsaad� Us J Please complete the follow[' formation: 4 7 CITY OF TIGARD Customer Name: r~ 1(�rY �n , OILDIN 3 ,t1 t 1� Service Address: Street/Suite#: 4,aG .ct) rJ Ci 1' city: T State: C9r Zip: 7'2, >e,C Phone Number a"- 8' 8` c v Email C- `dgfYf 5r5' Lr.fr,74,-=',' Cv c-, Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = Li _ 7 x 1 = Clothes washer ( x 4 = " x 4 = Dishwasher / x 1.5 = �.."" x 1.5 1'Outside Water Spigot / x 2.5 = 2' x 2.5 Water Spigot,each add'! / x I = I x 1 = Kitchen sink I x 1.5 = 7,? x 1.5 = Laundry sink x 1.5 = x 1.5 = Lavatory(bathroom sink) ^g x 1 = ... «— x 1 = a- Water closet,1.6 GPF(toilet) 2-%. X 2.5 = / x 2.5 = o� Bathtub/whirlpool x 4 = x 4 = Shower stall x 2 = / x 2 = r _ Bath/shower combo I x 4 = ) x 4 = Current Points: / !o'5 Proposed Increase: g 578 Current Points+Proposed Increase= _9- =New Total Points =Required Meter Size // Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points='/d' 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $_ (see page 1) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY No meter upsize is required based on these fixture counts J. Bentley 01/25/2022 Current Meter Size Confirmed with UB Signature ofUB Representative Date _ .. Page 2 I:/Building/Forms/WaterMeters_0701211tdd.d0 Cx / .. Water Meter Fixture Unit Worksheet for Additio > Us Please complete the followin ' rmatlon: JAN 2 41011 Customer Name: u.p i CITY OF TIGARD �' r ,n BUILDING DIVISION C Service Address: Street/Suite#: /- G 6S— Y/ C( f' �, G7 City: 76?T T) State: 0, Zip: 97'7- >ec- Phone Number: 0 8— .5." Emailc 4470-rV7ft 7' Sr-S" ( G' ' -- c r, Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total, the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = x 1 = Clothes washer / x 4 = Li x 4 = Dishwasher / x 1.5 /,r x 1.5 = 1st Outside Water Spigot / x 2.5 = 2- x 2.5 = Water Spigot,each add'l t x 1 = / -- --,__ x 1 = Kitchen sink / x 1.5 = ` ram x 1.5 = Laundry sink x 1.5 = x 1.5 = Lavatory(bathroom sink) 3 x I = 3 .7- x I = 7- Water closet,1.6 GPF(toilet) )•%- x 2.5 = / x 2.5 = 7 5- Bathtub/whirlpool x 4 = x 4 = Shower stall x 2 = / x 2 = -7-- Bath/shower combo / x 4 = t x 4 = Q Current Points: / l '5 Proposed Increase: g Current Points+Proposed Increase= 4)-S =New Total Points =Required Meter Size 578 Meter Sizes: l to 30 points=5/8" 30.5 to 37 points=3/4" 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $ (see page 1) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Current Meter Size Confirmed with UB Signature of UB Representative Date I:/Building/Forms/WaterMeters_070121_Add.docx Page 2 Branden Taggart From: Branden Taggart Sent: Tuesday, January 25, 2022 8:10 AM To: UB Online Subject: Water Meter Worksheet - 9665 SW Darmel Ct. Attachments: Water Meter Worksheet.pdf Please see attached water meter worksheet for approval. Thank you, Branden Taggart n City of Tigard a r Senior Permit Technician r , Community Development TIGARD 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov 1 RECP .'. VE 4r- Clean Water Services - Service Provider Letter JAN 1 9 2 z2 J NG Diui,',C ni Submission Date: 1/3/2022 Confirmation#: 723 Applicant Name: John Ruppert Review Type: Partner City Plan Review Contact Email: johnruppert55@gmail.com Ground Disturbance: 620 Sq. Ft. Contact Phone: 503-828-6685 New Impervious Area: 620 Sq. Ft. Primary Address: 9665 SW DARMEL CT Mod.Impervious Area: 0 Sq. Ft. Primary Jurisdiction: Tigard Development Activity: Single-Family Dwelling Addition Affected Tax Lots: 2S111BD00600 INSTRUCTIONS:This pre-screening report is the Service Provider Letter(SPL)as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22. PROVIDE A COPY OF THIS SPL TO THE JURISDICTION RESPONSIBLE FOR LAND USE REVIEW AND PERMIT ISSUANCE.This pre-screening review does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered and this review does NOT eliminate the need to obtain additional CWS permits or reviews if project changes in scope or location.All required permits and approvals must be obtained and completed under applicable local,State and federal law. -- ----- --- Permit or Review Required !Next Steps Environmental Site Assessment No Review Water Quality Treatment Review TBD Contact city(primary jurisdiction)responsible for land use review and permit and Stormwater Inspection issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit with Site Plan issuance. Line Tap Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Disconnection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Connection Permit with Plumbing TBD Contact city(primary jurisdiction)responsible for land use review and permit Plan issuance. Easement Review TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed.Our partners include municipalities,environmental organizations,and developers large and small. Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123 phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development Clean\ ter Services SENSITIVE AREA PRE—SCREENING SITE ASSESSMENT / Clean Water Services File Number 0/ 1 1. Jurisdiction: l _a 2. Property Information(example: 1S234AB01400) 3. Owner Inform nr Tax lot ID(s): Name: C�e9Ll✓ jr/ Company: Cy / Address: / Co�5— f w 4 cef Y OR Site Address: 5'cl6J S(L7 .6ctif`6�jr�L City,State,Zip: 7>��r' t � �r 97 f City,State,Zip: 7l cc-oi, ST0/cf Phone/fax: , b�,��8A_Y-,66 Nearest cross street: 7' Email p�`f✓ • 44/ 1:21—P`.30 ( G� - ��' 4. Development Activity(check all that apply) 4. Applicant Information W Addition to single family residence(rooms,deck,garage) Name: �I �_?Z� �� (� }� ' ❑ Lot line adjustment El Minor land partition Company: J�7" ❑ Residential condominium ❑ Commercial condominium Address: ❑ Residential subdivision ❑ Commercial subdivision City,State,Zip: ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: Other Email: 6. Will the project involve any off-site work? ❑Yes No ❑Unknown / i / Location and description of off-site work: i ' 957 w /J'(6),i - , U/I -fit= s / 6 aG 7. Additional Mt:litiozl4r mrq.9nts orr info atio that ma�f b-e needed q,understand your project: • This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete, and accurate. Yst Print/type name r .../ pltef 7 Print/type title a —2 I Signature Date /,.____ 4 FOR DISTRICT USE ONLY u c� El Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO r p ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural ,60 esources Assessment Report may also be required. Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the O site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VA • UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definiti• of•evelopme or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT OR SERVICE PROV R LETTER IS REQUI ED Reviewed by yC— - Date l50 3/?-.1- Once complete,a PLReview@cleanwaterservices.org • Fax: 3 681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro,Oregon 97123 Revised 212020 Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org Property Owner Statement RECEIVED Regarding Construction Responsibilities JAN242022 Oregon Law requires residential construction permit applicants who are not licensed%( lilhidIGARL Construction Contractors Board to sign the following statement before a building peirtitiDtt 86/ISION issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or kid I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. ) 1/_% 1 /ur Print it Applicant Signature of Permit Applicant Date Permit#: . F Address: NIA 3Y•Yd� � �•fcvr + Issued by: Date: This Copy for Permit Offices .F_ Information Notice to Owners About Ann Construction Responsibilities ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business Registry. For questions, call 503-945-8091. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 800-452-0288. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, go online to www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address: www.oregon.govlccb f/property_owner adopted 9-2016 This Copy for Permit Branden Taggart From: #Building Permit Technicians Sent: Tuesday, January 11, 2022 7:16 PM To: johnruppert55@gmail.com' Subject: Building Permit Submittal for 9665 SW Darmel Ct. Hello John, We received your Building permit submittal for the master bedroom and front porch. In your letter you asked if we could have this permit ready to issue by the end of January. Our timeline is currently 4-6 weeks. I would say that it is highly unlikely that we could complete plan review and have this permit ready to issue by the end of January due to our workload. I have routed your submittal to our Planning Department for review. We will let you know when the plan review fees can be paid online. Thank you, Brantien Taggart ° City of Tigard 2 Senior Permit Technician Community Development 13125SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov 1 City of Tigard / Building Dept 1-10--22 Ruppert Addition: Good afternoon- Please let me know if what the time line is for this permit, I need it by end of Jan ( is that possible?) it's a simple master bedroom addition and front porch . It's very straight forward. • Truss engineering attached- • Prescriptive path construction-so no other engineering with this build- (shouldn't need it ) • Clean Water Services approval letter attached Best contact Phone is 503-828-6685 Email Johnruppert55@gmail.com Thanks John