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Permit CITY OF TIGARD : , MASTER PERMIT 2 _ COMMUNITY DEVELOPMENT /a Permit #: MST2013 -00078 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 �� Da te Issued: 04/30/2013 Parcel: 2S111BCO3400 • Jurisdiction: Tigard , Site address: 10405 SW VIEW TER Subdivision: DOUGLAS HEIGHTS Lot: 7 Project: Juttelstad Project Description: Office Addition, enclose carport. 7/2/13, per inspector adding, (2) backwater valves, >100' of footing drain, (2) rain drain risers and (1) hose bib. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 264 sf Garage: 360 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 264 sf Value: $46,633.28 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 2 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 100 Ice Maker: 0 Hose Bib: 1 Backwater Value: 2 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 4 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 264 Owner: Contractor: JUTTELSTAD, PHILIP 8, HOLLY OWNER Required Items and Reports (Conditions) 10405 SW VIEW TER TIGARD, OR 97224 PHONE: 503- 673 -0455 PHONE: FAX: Total Fees: $2,139.97 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 - -• • - «: ' 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. • ENTION: Oregon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -•01 -0010 thr• gh OAR 952 -00 -• • •0. ou ay obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.332.2344. lei.Ae_t_at Issu • = By: / / � t 0 Permittee SignaturC X Call 503.839.4175 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. III I CITY OF TIGARD MASTER PERMIT 1 , C OMMUNITY DEVELOPMENT Permit MST2013 -00078 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/30/2013 T Ca a` \. [t. Cf g Parcel: 25111 BCO3400 Jurisdiction: Tigard Site address: 10405 SW VIEW TER Subdivision: DOUGLAS HEIGHTS Lot: 7 Project: Juttelstad Project Description: Office Addition, enclose carport BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 264 sf Garage: 360 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 264 sf Value: $46,633.28 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add9 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 4 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: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 264 Owner: Contractor: JUTTELSTAD, PHILIP & HOLLY OWNER Required Items and Reports (Conditions) 10405 SW VIEW TER TIGARD, OR 97224 PHONE: 503 - 673 -0455 PHONE: FAX: Total Fees: $1,985.87 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 C64 952 -0 -0090. You may obtain n acopy of the rules or direct questions to OUNC by calling 503.232.1 7 orrr 111 8800.3 '.2344. Issued By: l C a C .YLit / &. l { Permittee Signature: / "11"7 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 completio of the project. Approved plans are required on the job site at the time of each inspection. RECEIVED � '' Information Notice to Owners About APR 2 9 2013 . C onstruction Responsibilities CITY OFTIGARD )UILD DIVISION t✓ (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 em ployer, 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 Em ployment 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, call 503 - 945 -8091 or go to htto://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • 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 503 - 947 -7815. • 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, call the IRS at 1- 800 - 829 -4933 or visit their website at 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 ensur e 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 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052 Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007 Website Address: www oregon.gov /ccb f /property_ owner adopted 9 -23 -08 This Copy for Permit Applicant Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing per mits. 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: s'•e '•,or il ' •_: -- a rea Ph /gyp t/i4 7 Name CCB# Expiration Date I will inform my general contractor that a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or V I ' I be pem w ooerty I w I re, I w ill eside in. If I rfor hire subcontractorsing ork n prp , I will o hire n, only a subcontracto residence that licensed side in or with a the Construction residence that 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. Pn p L/14/Th 5r74v Print Name of Permi Applicant V V7 Signatu f ' -rmit Applicant Date Permit #: N` cO I3- 000 007 g Address: 10'4 SuJ V I L'u) r L �i ± r TI6 AR 6, DP_ 41a A. ;r- ' ' r Issued by: Date: 43 1.1 I This Copy for Permit Offices • I - P(eks A-P eL ,, F- s /9 5 c2. D( — OCC2,7 8 Electrical Permit Application City of Tigard and Received Permit No.: p� � / J O (N o 78 - 13 125 SW Hall Blvd., Tigard, OR 97 Plan Review • Phone: 503.718.2439 Fax: 503.598.1960 . J ^I t 1 11 1� e �0 + Other Permit: Datc/By: D TiGARD inspection Line: 503.639.4175 a pp Date Read ;,By: tens' I See Pttge2for Internet: www.tigard ofilG N _i '1 e N�'f ® titied/Method: Supplemental Information 1 xrit Tl'PE OF WO [ , �CjV•' � J �`0 PLAN REVIEW ❑ New construction ddition /alteratit p lacement Please check all that apply (submit 2 sets of plans w /Items checked below): ❑ Service or feeder 400 amps or more ❑ Bui lding 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. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling El Commercial/industrial ❑ Accessory building amps far all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA of ' ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION (� ❑ Additio of nc�v motor load of ❑ "A ", "E ", "I ? ", "I -3 ", Job no.: e6 - ( Job site address: 7 D 5 C� 1 1iee 100 or et more. occupancy. d vv J Cl ❑ Sit Or morn residential units. ❑ Recreational vehicle parks. n tate ZIP: CI /S/ / - \ ❑ Health-care facilities. ❑ Supply voltage for more than r��^ / r 7-e ��Ce ❑ Hazardous locations. 500 volts nominal. , Suite/bldg./apt. te/bldg. /apt. no.: Project name: ) ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross streeudiret:tions to job site: oewripttoa I any l Fr<. I Total f • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. it or less 168.54 4 Ea. add'I500sq. II. or portion 33.92 I Tax mapiparcel no.: Limited energy, residential ' DESCRIPTION OF WORK ^ (with above sq. ft) 75.00 2 I /� / Limitedenagy,multi-family 75.00 2 /Je OMi,c f / „410-1 / ' i i , 4 s4 4, e . , / residential (with above sq. ft.) ft.) / / Renewable Energy ❑ See Page 2 i :c /V('(-k G/ h t� R l e� / ..5 pq, V Services or feeders installation, alteration, and/or relocation ID PROPERTY OWNER V ❑ TENANT 200 amps or less 100.70 2 Name: 201 amps to 400 amps 1 33.56 2 ' 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City. /State ZIP: Temporary services or feeders installation, alteration, and/or Phone: ( ) F ax: ( ) relocation 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuit-%- new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with above service or feeder fee, 7.42 Business name: each branch circuit B. Fe for branch circuits without Contact name: service or feeder fee, first 56 13 2 Address: branch circuit Each add'I branch circuit 7,42 2 City/State/ZIP: Miscellaneous (service or feeder not included) Each manu or modular 67.84 2 Phone: ( ) Fax: : ( ) dwelling, service and /or feeder E - mail Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: t t _e_c9 G (e lfy(C L L (_ Signal ttt(s) or limited-energy See o / p�nepanel. allteraeration, or extension. Page 2 2 Address: 1 � 50- 4. ( ,- Each additional inspection over allowable in any of the above J Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: C & / b (7 ~1 n ”) 0 6D Investigation (1 hr min) 66.25/hr Phone: (503) - 8i _ ? J i Y 7 ! Fax: ( - 7/,1 ) 'e � /, 3 Industrial plant (I hr min) 78.18/ br +o f Inspections for which no fee is CCB Lie.: i 6l 3g - 3i Electrical Lie.: () ce /f Suprv. Lie.: 57 (32S specifically listed (% hr min) 90.00/ hr // &--- < ELECTRICAL PERMIT FEES Suprv. Electrician signet rc, required: Subtotal: Print name: 1.Y.if 0 / e (( Date: C - Plan review (25% of permit fee): Or `"'� I�` (�� State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: This permit application expires if a permit is not obtained .within 180 Dom' days after it has been accepted as complete. • Number of inspections allowed per permit. I.Uluildicg5Permhs \ELC Permit App_ELR_ERE.doe Rev 05.2 1.'2013 440.4615TI I IRS /COM.AVEB Pf -e4 ABC.-. ( is rz A - 7 X 6 (3 — 0007 FR I.. 1Z896817£09 oil'oiiT pezi6Jeu3 d££:LO £6 Cl, unf Building Permit Application Residential RECEIVED FOR OFFICE USE ONLY j L City g of Tigard C 2 J Permit N Q� 2013 Date Received B 3� O ST ,3 -0 0 13 111/ 13125 SW Hall Blvd., Tigard. OR 97223 LIAR 2 8 2��J Plan R ` 1e` � ` t � ' '. other Permit Phone: 503.718.2439 Fax: 503.598.196C A \�Av. TIGARD Inspection Line: 503.639 Date Ready' 30 /� �/, � ® Se Pa e 2 for CITY OF TIGARD ' " J I K Internet: www.tigard- or.gov � 'a a v' �G ""Y Notifi Method: Supplemental Information BUILDING DIVISION o to 1 f GAA, 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. M 1- and 2- family dwelling ❑ Commercial /industrial Valuation: S 'Jj 16 CO ❑ Accessory building ❑ Multi - family Number of bedrooms: I El Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: ( 0405 S W V 1£W Ter212A(.E New dwelling area: • bok— square feet City /State /ZIP: 1 6412. D Ott 0 1 - 2_ 7_ 4 Garage /carport area: 966 square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet M G O0h,4 i,b ro ( 0 3 f0 V t elm rc121-ACE Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: ?U A L.&' 11- IG (4 13 l Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: L 01 } equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. OFFICE kDDiTIDiJ ; eNcLo5E ail Po (LT Valuation: $ Existing building area: square feet New building area: square feet [.a PROPERTY OWNER ❑ TENANT Number of stories: Name: P1-I (L( P 4 1O LLI J U rfEL', MO Type of construction: Address: 10 40 Gj S W V lCW TI2-12-IcGt Occupancy groups: City /State /ZIP: 'n 61 /WV 0 1 } 2.21 — Existing: Phone: (5 61-3 0465 p ltefa Fox: ( ,) 81%1 - 093 €77 co 14 rp-ef New: 1,4 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee (or deposit): Contact name: PHIL J utrrn., TW FLS plan review fee (if applicable): Address: t 0 4— 0 ' ) U L t'J - Tre- 2 jt-i _ Total fees due upon application: City /State /ZIP: Tt(il'kW 03 27-4 Amount received: 34,tp, 7D Phone: ( 9) 81°1 s°13 5 Fax:: ( ) E -mail: pL1 l L J (A T T F (N-e ma T a G M AU. , CO M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of C(»1TiPA+CTaOR Q IA) IJ 01 / L ff )'i rV4-t- r7! roof -top mounted PhotoVoltaic Solar Panel System. Business name: P t t L J vt rte LZ 11PrD Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 10 4 0 � i7 cjlti V 1e1N inl- ./F Solar Installation Specialty Code checklist. City /State /ZIP: T"1 P e rm i t Fee (includes plan review ' E AYLp 9 2Z and administrative fees): $180.00 Phone: (S D ..) 8 1," - 8 g 3 ) Fax: ( �7 State surcharge (12% of permit fee): $21.60 CCB lie.: / Total fee due upon application: $201.60 This permit application expires if a Authorized signature: f PP permit is not obtained p P within 180 days after it has been accepted as complete. Print name: P fl V 170...1-911415 Date: (Pi 2 S 13 * Fee methodology set by Tri- County Building Industry Service Board. L\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM/WEB) Plumbing Permit Application Building Fixtures RECEIVE I FOR OFFICE (SI.. ON l.1 City of Tigard Received ( i / 44:, t ^� / 3 Permit No.: / (�( 5r zUl 2, (JOU 46 ■ 13125 SW Hall Blvd., Tigard, OR 97223 APR 2 9 2013 Date/By: l : DateBy: I Phone: 503.718.2439 Fax: 503.598.1960 an Review Other Permit No.: I !GAR D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lu See Page Z for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: � Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist �,� Description I Qty. Ea. I Total LJ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 2.1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family 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: I eft) .S c.(0 \I (�\I T'h (E Catch basin or area drain 18.76 City /State /ZIP: Ilk 'r '--i--ZA Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/diredions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 n Clothes washer I 25.02 1 0_G`"0 � 0 12-y / iv\S M ' Dishwasher 25.02 A-1 4-1 Drinking fountain 25.02 Ejectors /sump 25.02 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: }7 � 1 1 OR rr -� t 7 rwo Fixture /sewer cap 25.02 tom �n Floor drain/floor sink/hub 25.02 Address: l 0 q C7 C7'U PA V L-S t 1r n 4 Garbage disposal 25.02 City /State /ZIP: ¶\ l4 ej-0.4 OTT Z Z 9 Hose bib 25.02 Phone: ( 7J 2) a 1 (?) 0 ) -5 Gl Fax: ( ) Ice maker 12.51 11r APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: g kfu• Roof drain (commercial) /0/2- 12.51 Address: Sink/basin/lavatory ( 4 3 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax:: ( ) T shower/ • er pan I 12.51 E -mail: U 25.02 Water closet I 25.02 CONTRACTOR Water heater 37.52 Business name: /- 67 0 LrlJL Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: 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 \Peimita\PLMU- PermitApp.doc 10/01/09 4404616T(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 n 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 Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to p 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 (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . 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 Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. - Domestic ❑ Any complex structure as defined in OAR918 -780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 3" Isometric or Riser Diagram - 4 " ❑ 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 Water Closet Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2 Mechanical Permit Applicatio FOR OFFICE USE ONLY CEIV Received ' L n City of Ti g ard { DateBy: — f r9"f 3 Permit No.: � 24 % Z 0 U t? • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review APR 2 9 Z013 Date/By: Other Permit: TIGARD Inspection Line: 503.639 Date Ready/By: tutus: ® See Page 2 for Internet: www.tigard or.gov Notified/Method: -1-1( Supplemental Information CITY OF TIGARD TYPE OF waitILDNG DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction [ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES" P 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: i 0 40 4C(.) 1/ tel.4,) Mi Furnace 100,000 BTU (ducts/vents) 46.75 City/State /ZIP: '(`( p -f/(.1 0) ?- 2 Z Furnace 100,000+ BTU (ducts/vents) 54.91 Heat pump 61.06 . Suite/bldg. /apt. no.: Project name: Duct work 23.32 Cross street/directions to job site: 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 c Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map /parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 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 £ -iROPERTY OWNER I ❑ TENANT Other: 23.32 ( 'I. Environmental exhaust and ventilation: Name: i V 1 ( 't/1lC-/j f v Range hood/other kitchen equipment 33.39 Address: i 0 4-0 Gj 5 V0 V t SIAJ TIv t Clothes dryer exhaust 33.39 i City /State /ZIP: r (6 }-YLV 0 :- '2,Z -44' Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 Phone: ( ss t c) S g 3C Fax: ( ) Attic/crawlspace fans 23.32 Er-APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: I Fuel piping: 7 $14.15 for first four; $4.03 for each additional Contact name: P k t I J u rr ., fA-u Furnace, etc. Address: 1 0 41 0 ty U Lb'w 1--1i Gas heat pump Wall /suspended/unit heater City/State /ZIP: 1\ (. 17 a) 4 -Z"L i j' Water heater Phone: ( , p) S I o ej 9 +; Fax: : ( ) Fireplace Range E -mail: Barbecue CONTRACTOR Clothes dryer (gas) Business name: P \ \ tA T,.7 r'{/1'0 Other: �� l! MECHANICAL PERMIT FEES* Address: I 0 y V 9 » V( SiU te,r`'t- c�� Subtotal City /State/ZIP: n (( t O q )-- z 4 Minimum permit fee ($90.00) COI) � ®I g � � Fax: ( ) Plan review (25% of permit fee) Phone: ( / State surcharge (12% of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Authorized signature: • Fa methodology set by Tri- County Building Industry Service Board Print name: I Date: I \ Building \Pmnits\MEC_PermitApp_040113.doe 440 -4617T (11/02/COM/WFB) Mechanical Permit Application - City of Tigard - Page 2 - Supplemental Information 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. Note: All new commercial buildings require 2 sets of plans. I:\ Building\ Permits \MEC_PermitApp_040113.doc 2 Electrical Permit Applicati City of Tigard EC I I Received �• Per mit No : A 1 5T Z l [7 (7 •J g D FOR OFFICE USE ONLY DateB a 3 (> 1�� " - " 13125 SW Hall Blvd., Tigard, OR 972246.1 R 2 9 2013 Plan Review Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Jug ✓j (� la See Page 2 for T 1 G A R I) CITY Internet: www.tigard or.gov TIGARD Notified/M (t Y' Su pp lemental Information TYPE O ISION PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ 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. X1 less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. M - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ", Job no.: Job site address: 10 I/O 5 5W V J 674./ l E12/1a4'L£ 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: T l 4f 14921) 94- - 2 Z + ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 7500 2 residential (with above sq. ft.) Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and/or relocation (4ROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: Pei 1 / %/14 r>,c, 401 amps to 600 amps 200.34 2 Address: I 0 40 h 'W VIEW 1s4k CC 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State /ZIP: 17 6 14'217 Olt- 9 9.1 Z .4 Temporary services or feeders installation, alteration, and /or Phone: ( %b 2 7 ) t3 l l - S 9 77 c Fax: ( ) relocation 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel _ III PPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with nII 1 above service or feeder fee, 7 42 2 Business name: 4:211A, each branch circuit B. Fee for branch circuits without Contact name: 1 "i / Jvt 1 re. Srlty service or feeder fee, first 56.18 2 branch circuit Address: 10 7 t► 0 c 1/1434/ T41C-G Each add'I branch circuit 7 7.42 2 City/State /ZIP: 11 4 !`} Y(,O Q) 3 'ZZ Miscellaneous (service or feeder not included) S Each manufactured or modular 67.84 2 Phone: ( ) Fax: : ( ) dwelling, service and/or feeder Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or extension. Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection (I hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Phone: ( ) Fax: ( ) Industrial plant (1 hr min) 78.18 / hr Inspections for which no fee is 90.00 / hr CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed (%: hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (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: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. L \ Building\ Permits \ELC_PermitApp_040913.doc 440.4615T(1I/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 • Fee for all residential systems combined $75.00 Description I Q�. I Fee I Total I Renewable 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 ❑ Garage Door Opener* 50.0i co 100 kva 552.26 2 • >100 kva (fee in accordance with OAR 918- 309 - 0040) 552.26, 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:_ System* Each additional kva over25 . 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 I charged at an hourly (1 hr min) Inspections for which no fee is 90.00 / hr specifically listed (V: hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR' 918- 309 -0000) Plan review, if required (25% of permit fee): . State surcharge (12% of permit fee): Check Type of Work Involved: TOTAL_PERMIT FEE: • This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. S;. ❑ Boiler Controls • ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC. ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* y ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \ Building\ Permits \ELC_PermitApp_040913.doc III Building Division Development Code Provision Review TI GA RD Residential Projects Building Permit No.: {BSI( 3-000 7 8 Project /Subdivision Name: :S u i e - sTA b , Lot #: Site Address: /0 'f-O v i ( =cJ �G242.— y CWS Service Provid r Letter: Required: Yes No ❑ Received: Yes ❑ No ❑ Plans Routed: Original Plan Submittal Date: 3) 2 � ,3 Routed By: 1St Revision Submittal Date: ❑ Site Plan Only Routed By: 2 Revision Submittal Date: ❑ Site Plan Only Routed By: To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact A G[C V at (503) 718 -Z4 21 or S (L @tigard- or.gov) \ � VV Land Use Case No. Zoning R 5:5" CJ Setbacks: Front 20 Rear i Side r-✓ Street Side N I P Garage 14 1& ll 20 / ❑ Maximum Building Height: a Actual Building Height ❑ )Tisual Clearance N /P [� Easements 1 l'Sensitive Lands Type: 0 o Nv El Street Trees ti /4.1-- ❑ Protected Treestgp Notes: Original Plan: Approved IFI Not Approved ❑ Date: 3 !mil 1 3 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 1: \CURPLN \ Masters \Development Code Provision Review \ DCPR_RES.doc Rev. 01/16/13 Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) Actual Slope: 1 a Notes: Original Plan: Approved Not Approved ❑ Date: 3 4/1 5 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at (503) 718 -2426 or albert@ tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes 'CJ Ap No ❑ Date Routed to Building: (///, 5 /11 Page 2 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RF,S.doc Rev. 01/16/13 RECEIVE Q APR 2 9 2013 !' OFTIGARD Clean Water Services File Number CleanWate xi , LLB • v . ces OON 13 0q5 G Sensitive Area Pre - Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Holly & Philip Juttelstad Company: Address: 10405 SW View Terrace Site Address: • 10405 SW View Terrace City, State, Zip: Tigard OR 97224 City, State, Zip: Tigard OR 97224 Phone /Fax: 503 - 673 -0455 Nearest Cross Street: 103rd E -Mail: PhilJuttFineArt @ gmail.com 4. Development Activity (check all that apply) 5. Applicant Information IA Addition to Single Family Residence (rooms, deck, garage) Name: Holly & Philip Juttelstad ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: 10405 SW View Terrace ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial Li Multi Lot Commercial City, State, Zip: Tigard OR 97224 Other Phone /Fax: 503- 673 -0455 E -Mail: PhilJuttFineArt @gmall.com 6. Will the project involve any off -site work? ❑ Yes IE) No ❑ Unknown Location and description of off -site work 7. Additional comments or Information that may be needed to understand your project • This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Slte Development Permits, DEQ 1200•C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands andlor 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. ' Print/Type Name Holly & Philip Juttelstad Print/Type Title t ONLINE SUBMITTAL Date 4/2/2013 FOR DISTRICT USE ONLY Li Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A ERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources 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 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 r discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and t 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 i 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 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached. I ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR 1 SERVICE PROVIDE LETTER IS REQUIRED. �� Reviewed by -1 '. i . 4 -&'. — Date 4 /1 A 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cteanwaterservices.org RECEIVED APR292 TY OF TIGARD Clean Water Services File Number '! DING DIVISM C1eanWater Services 13 CAD 0155 Sensitive Area Pre - Screening Site Assessment 1. Jurisdiction: Tigard 2. Property information (example 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Holly & Philip Jutteistad Company: Address: 10405 SW View Terrace Site Address: 10405 SW View Terrace City, State, Zip: Tigard OR 97224 City, State, Zip: Tigard OR 97224 Phone /Fax: 503 - 673 -0455 Nearest Cross Street: 103rd E -Mail: PhilJuttFineArt @gmail.com j 4. Development Activity (check all that apply) 5. Applicant Information • Addition to Single Family Residence (rooms, deck, garage) Name: Holly & Philip Jutteistad ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: 10405 SW View Terrace ❑ Residential Subdivision ❑ Commercial Subdivision CI Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: Tigard OR 97224 Other Phone /Fax: 503 - 673 -0455 E -Mail: PhilJuttFineArt @ gmail.com 6. Will the project involve any off -site work? ❑ Yes El No ❑ Unknown 1 Location and description of off -site work 7. Additional comments or information that may be needed to understand your project I This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEQ i' 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. t 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. . Print/Type Name Holly & Philip Juttelstad Print/Type Title ONLINE SUBMITTAL Date 4/2/2013 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A ERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources 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 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 07.20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, State, and federal law. I❑ Based an 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 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDE j LETTER IS REQUIRED. ,---.....„ � Reviewed by - Z- -f i ,Z44.------ Date � /I � 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone: (503) 681 -5100 • Fax: (503) 681 -4439 • www.cieanwaterservices.org liiii=iiiiiiimiliiii 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 'PI ■ Transmittal Letter i i , ; ,\ i< i, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: 43/ K) N eJ7M DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: nnn 4-u 1 11 APR 2 9 2013 COMPANY: CITY OF TIGARD BUILDING DIVISION , PHONE: c10 77 &c°) Q 22 r'I RE: t O 4-0 ci 9w U (-FA) 1 -1�-1 6 oM T Z -p civ i Zr OOO 7-5 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: I Description: Additional set(s) of plans. Revisions: Cross section(s) and details. 3 Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. 3 Engineer's calculations. Other (explain): REMARKS: fLevl/p 7c44-76-4( 44-770 Ai FOR O FIC USE ONLY •� Routed to Permit Technician: Date: A ) ( (' Initials: ) Fees Due: ❑ Yes E J Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1:\Building\ Forms \TransmivalLetter - Revisions.doc 05/25/2012 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 205 Footing 05/01/2013 12:00 MST2013-00078 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 215 Footing drain 05/10/2013 MST2013-00078 PART NOTE. Exterior footing drain, located at addition front and about 1/2 of left side. EZ Flow foundation drain with back water valve ok for cover. Also, EZFlow installation instructions provided by contractor. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 250 Roof nailing 06/05/2013 00:00 MST2013-00078 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 215 Footing drain 05/10/2013 MST2013-00078 PART NOTE. Exterior footing drain, located at addition front and about 1/2 of left side. EZ Flow foundation drain with back water valve ok for cover. Also, EZFlow installation instructions provided by contractor. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 335 Rain drain 05/10/2013 00:00 MST2013-00078 FAIL 1. AAV’s Air Admittance Valve (Studor vent) not installed as per State Ruling 07-1 [ASSE 1050 & 1052], at: back yard sink, they need to be accessable and removable. 2. Provide approved method of supporting pex water piping, zip ties not approved. Table 3-2 Recall inspection when completed. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal FAIL MST2013-00078 George Heimos 1. Provide one earthquake strap on top of water heater. 508.2.1.2 All else ok philjuttﬁneart@gmail.com Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2013-00078 Herb Stabenow Partial inspection only-apparent discrepancies what permittee installed-- unable to reach permittee Energized Electric LLC to verify permit fees and work done- corrections are missing plates NEC 2011 Sect.314.25 boxes not ﬂush in combustible material NEC Sect. 314.20 unable to reach ceiling outlets requiring access per NEC Art.100 and OSSC 100.1 electrical contractor to be on site for the re-inspection Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - No C of O MST2013-00078 Jeff Grove Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10405 SW VIEW TER, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2013-00078 Jeff Grove Violation Summary: Inspector Contractor