Permit CITY OF TIGARD MASTER PERMIT
7 Permit#: MST2021-00074
��11 COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2021
T I C„4 R - 9 Parcel: 2S102CD01400
Jurisdiction: Tigard
Site address: 13565 SW ASH AVE
Subdivision: FREWING'S ORCHARD TRACTS Lot: 16
Project: Goulet
Project Description: Construct 20'x26'ranch style accessory structure in backyard.
520 sf accessory structure with 240 sf walk up storage attic.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 si Left: 5 Parking Spaces: 0
Height: 15 Bathrooms: 0 Second: 0 sf Garage: 0 si Front: 0 Smoke
No
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors:
Total: 0 sf Value: $37,034.80 Rear: 5
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain 0 Storm Sewer: 0
Tubs/Showers: 0 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
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<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 add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr. 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
GOULET,LAURA M&GERALD T TUFF SHED Required Items and Reports(Conditions)
13565 SW ASH AVE 2950 SE 73RD AVE 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 HILLBORO,OR 97123
PHONE: PHONE: 503-848-6088
FAX:
Total Fees: $1,365.37
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may oobttain a copyppp of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ` \aat� �✓ 3 t Permittee Signature: �� r li L��-t
•\\3 Call 503.E 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.
i-
RECEIVED
FEB 2 5 2021
Building Permit Application CITY OF-i iGARI� - 2**(2.1
Residential BUILDING Dl\)iSIO 1 ttu,n i ii i l ,i i,NI 1
City of Tigard k"'"dr 03 O� U2l v,7 r.uhNo:Me7202!C,I�O74
III 13125 SW Hall Blvd.,Tyod OR 97223 Mrs tte,aw. 2
Plane. 503.7152439 Fa: 503.59E 1960 Pha Rev C J 1., at
"
Panait
,cm 1, lmpection Line: 503.639.4175 Dies R.dylBy: r�q-ter 0 fi.x fop 3 4r
bumet'. www.tigrd-or.gov 'ustked: // 11C71 s�or�+�144rrtl..
TYPE OF WORK REQUIRED DATA:I-AND 3-FAMILY DWZLUNG
9 0 New cotuWetim ❑Demolition Permit fxs"we bred on the value of the wont pcfoemod
Indicate the value(rounded to the neatNI dollar)of all
\ 0
Additionhttenti taoen it 0 Otherequipmentmaterials,labor,overhead.end rho Mp�et,a
if CATEGORY OF corentucnor4 work end' icred on this imam_��/ �.5
Valuation: 5 ,
(]1-and 2-family dwelling ❑CmtmerciaVindusbial
0 Accessory building 0 Multifamily Number of bedrooms 0
❑Muter budder 0 other Number of bathrooms:0
JOB SITE INFORMATION AND LOCATION Total number of Boon: 2
Job site addicts: 13565 SW Ash Ave New dwelling area: square fest
City/State/ZIP: Tipard,OR 97223 Garage/wpm arm: square*et
Suitebl Japt no.: Project name: Coved area squarePoet .
a l-�-�
Cross Mteetidireetims to job MU: 1`'' Rum&et
SW Frewing Street Other st ed=rue 520 square Pont
REQUDRLD DATA:coMMz,r u1-RL CHECKLIST
S:dxbvialm: Frewtng's Orchard Tracts Lot na:16 Permit fees"are hued m the value of the wink performed
Indicate the value(rounded to the nearest dollar)of all
Tax nap/Parcel ao.: 2S102CD01400 equipment,misaidls.labor,overheat,ad the profs fur the
DESCRIPTION OF WORK work imitated on this application.
•
Construct 20x26 ranch style accessory structure in backyard. Valuation: $
Existing building area: square fee
New budding wee: squats feet
0 PROPERTY OWNER 0 TENANT Number of rimier
I Name:Laura&JT Goulet Type ofoonstruotion:
Address:13565 SW Ash Ave Occupancy groups'
Cary/SwdllP:Tigard,OR 97223 Exist ng. '
i Phone:(503) 91� w.0604 Fax:( ) Nr
0 APPLICANT 0 CONTACT PERSON BUILDING PERMTTTEES'
Plow rrrA'WA*rr f
Business name Tuft Shed Inc. Structural plan review fee(or divostt)'
Contact Emma Rhiannon Moore FLS plan review foe(if applicable):
Address: 6500 NE Halsey St,Ste A Total feel due upon appluattioto
City/Sum/ZIP: Portland,OR 97219
Amami raeixed
Phone (971)264-3941 Far (971 ) 254-3941
-- `- ---"` PHOTOVOLTAIC SOLAR PANR1.SYSTEM FEES'
E-mail nnoore@tuffshed.com
`--e--i44-- Cottmttdal and residential ptesaiptive installation of
CONTRACTORNele: to k M(Tbs. roof-top mounted PlatoVoltaic Soler Pond System
Business nerve Tuff Shed Inc. �.7La S pP•I7,�ra�ihset f�i't le.
Submit two(2)am of roof plat with connection details
.
— and fire department oneness,along with the 2010&rpm
a* Address 6500NEHalseySt,Ste A ;pt ,yes `r,C 645 Solar Jrtrmllatbn Specially Cod:checklist
Perron foe(includes plan review
A]! CiS orZ[i.Portland,OR 97213
Pbmc (971) 254-3941 S kr.oss K
fax (971)254-3941 ad ul ninisaaliae fora):
State surcharge(12A of pond tee): 5110.00
521.60
r •
CCH lie.:105914 Total foe due upon application. 5201.60
Authorized signature. !ate-.L \ s This permit►ppaxatlaa expires it r penult Is sot obta*ed
Y, Y wItlfi 160 drys after It has bees saretrd as toreplsaa
"Fee mcthodototo'set by In-County holding Industry
Prim twmx Rhlannon Moore f 2/24121 Baud
•
i-.uJuildms'Jeamaa:DUP-RESPermilAppdee 02/241201I 440-6137(1IN2/COMIWE0)
S
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE Fsi ON1.1
City of Tigard oar"
- e Permit No.:
• 13125 S W Hall Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mecha rical
TIGARD Internet: www.tigard-or.gov 0 Other.
THE FOLLON% ING ITEMS .‘RF. REQUIRED FOR 111.EAN' REVIEW 1es N'o NA
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ 2
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0
3 Verification of approved plat/lot. 0 0 ❑
4 Fire district approval required. Name of district: 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ® 0 ❑
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 0 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 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 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- 0 0 0
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. ❑ ❑ ❑
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 2 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 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 0 ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ® 0 ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
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 ❑ 0
architect licensed in Ore_on and shall be shown to be applicable to the .ro'ect under review.
.11RISDICTIONAL SPI•:('IFI('S
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
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 ii 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 El
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, 0 0
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-RESPennitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)
I
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard Received
ta+ Day, Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: 1
TIGARD Inspection Line: 503.639.4175 Date Ready/By: lure: F1 See Page 2 for
Internet: www.tigard-or.gov Notified/Methad. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition Des I Qty. f Ea.For special information are checklist
❑Addition/alteration/replacement ❑Other: cription Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Contmercial/industrial SFR(2)bath 437.78
®Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional batWtdtehen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION x Site utilities:
Job site address:13565 SW Ash Ave Catch basin or area drain 18.76
Drywall,leach line,or trench drain 18.76
City/State/Z1P:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
SW Frewing St Rain drain connector 18.76 ($-74.
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Frewing's Orchard Tracts Lot no.:16 Fixture or Rem:
Tax map/parcel no.:2S102CD01400 Backflowpreventer 31.27
DESCRIPTION OF WORK "' Backwater valve 12.51
Clothes washer 25.02
rain gutters to splash blocks for new 205(26' building being Dishwasher 25.02
constructed Drinking fountain 25.02
Ejectors/sump 25.02
l 1 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name JT Goulet Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13565 SW Ash Ave
Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97223 Hose bib 25.02
Phone:(503) 989-0604 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:JT Goulet
Roof drain(commercial) 12.51
Address:13565 SW Ash Ave Sink/basin/lavatory 25.02
City/State/ZIP:Tigard, OR 97223 Solar units(potable water) 62.54
Phone:(503) 989-0604 Fax::( ) Tub/shower/shower pan 12.51
E-mail:goulet6973@gmail.comUr
1°al 25.02
--- Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/13W W 56,29
Address: Other. 25.02
City/State/ZIP: '---- Subtotal t,t
Phone:( ) Fax;( ) Minimum permit fee: $72.50 5�7 1 .
CCB Lie.: Plumbing Lie.no.: Plan review (25%of permit fee)
ee)
Authorized signs State surcharge(12%of permit FEE
T. TOTAL PERMIT
r i -.
V
Print name �' ' ,,��- Date:. jjtn Z1T6'a permit application eaptrea if a permit L not obtained wltWn I80 days p
tS / after it bra been accepted as complete. l
"Pee methodology set by Tri-County Building Industry Service Board.
I:tBrildieg\Permta•PI.MU-Pn sApp.doc 10A1/09 440-4616T(i0/02/COMfWEa)
E
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Tow Square Footage: Permit Fee:
Footing drain-1"100' 50.03 D to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.543,601 to 7,200 $23320
--- ---7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62s4 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
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/lu
(minimum charge—1/2 hour) each additional$100.00 or fraction thereof,to
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 ur 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
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fie sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eve 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 MachiRcfrig.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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
z/Zs
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
:111111 II
Building Permit Review — Residential
TIGARD
Building Permit #: IASTZOZI -00074f-
Site Address: 11565 SW Ash Avenue
Project Name: Goulet Accesory Structure Lot #:
Planning Review
Proposal: New accesory structure
QVerify address/suite#active in Accela. El In River Ter ce: ❑ No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: rosion Control
Oi copies of site plan on 8-1/2"x 11"or 11 x 17"paper etained trees with drip line and tree protection measures
O P rawn to scale(standard architect or engineer scale) ootprint of new structure(including decks)and FFE
O orth arrow tility locations&easements (required for new and additions)
12.ite address,project or subdivision name and lot number ✓� idewalk/driveway approach
0Npplicant information(name and phone number) � cation of wells/septic systems
O A .• ensions and building setback dimensions treet tree size,type and location
liP.uare footage of buildings to be demolished ° treet names
1 `':: g structures on site ° orner elevations (2'contours if more than 4'differential
fM io t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? es ° o
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? es ° 'o
❑° Clean Water Services —Service Provider Letter (lot platted prior to 9/10/1995):
Required: El Yes,applicant was notified ❑ No Received: ❑. Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified El No Received: 0 Yes ❑s No
SDC Exemption for ADU applied for: ❑Yes El No Received: ❑ Yes ❑r No
Public Facilities Improvement (PFI) Permit:
Required: 0 Yes,applicant was notified El No Applied For: ❑Yes ❑ No,stop intake
Land Use Case#: El Zoning: R-4.5
Required Setbacks: Front: N/A Rear: 5 Side: 5 Street Side: N/A Garage: N/A
ElBuilding Height: Max. Height: 15 Actual Height: 15
mu
II . .ndscape Area: % ❑ Lot Coverage Max:
Entrance 1 Set back no more than 8'from street-facing wall \ ❑ P el to street or offset 45 degrees or less
Windows rms.- 12%of area of all street-facing facade(
Garage Gara door'• .ehind widest street-facing wall ' 0 Yes El No,one of the following is met:
Door extends n ...re than 5' from and there is a covered porch extending beyond garage.
Door extends no more • ' - .m wall and there is a 12 sq ft.window above garage on 2nd floor.
❑ Gara e door width is I 1 '.r less 1 50%or less of facade 60%or less and includes 7 of following:lg
Covered porch AP Recessed entrance 1 Wall offset 1'Roof eave Roof offset
Fire shi s Lap Siding ❑Roof itc Gable,hi ,or gambrel roof Dormer
ent siding Window trim Window Yee Window projection ❑Balcony
❑ Visual Cle, .. ce ❑ Urban Forestry Plan
❑ Se ': e Lands: ❑ Yes ° No Type:
RI ,,nditions met prior to issuance of building permit
No -s:
VA Approved By Planning: — Date: 3 _
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\F orms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: j2/25/dZ/
Site Plans: # 3
Building Plans: # 3
�y
Building Permit#: [ Enter buildin permit# above.
Workflow Routing: t' Planning U Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: El Sign-off for Planning(include notes from planning review)
Route Application Documents: t� Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
laBuilding. original permit application, site plans,building plans,engineer and
beam calculations a : t st details,if applicable,etc.
Notes: /
By Permit Technician: - " 4 'i Date: e3/d3�ZG2/
Engineering Review
Slope at building pad: l/'
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approv and plat
❑ Water Quality/Quantity Facility: e°0111/o
!�'� f�Assess Water Quality Fee in-lieu: ❑ YesAssess Water Quantity Fee in-lieu: ❑ Yes
LIDA Facility on lot: ❑ Yes
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
i Approved by Engineering: Date: Z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Qi-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 Lam-..Does not a ly
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
�ry LIDA ❑ Yes N/A
ah OK to Issue Permit
Approved by Permit Coordinator: Affle4A .
Date: 31%I 7421
I:\Building Wormsk131dgPermitRvw_RES_122419.docx
® °,+v''�r
RIVE
FEB 2 5 ZOZI Clean Water Services File Number
CITY OF ri BAR 'nl
BUILDING D.V1..,.Or C1eanWater� Services 19-002471
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard
2. Property Information(example 1S234A801400) 3. Owner Information
Tax lot ID(s): 2S102CD01400 Name: Gerald Goulet
Company:
Address: 13565 SW Ash Ave
Site Address: 13565 SW Ash Ave City, State,Zip: Tigard,Oregon,97223
City, State,Zip: Tigard,Oregon,97223 Phone/Fax: 5035210791
Nearest Cross Street: SW Frewing St E-Mail: jt@chown.com
4. Development Activity(check all that apply) 5. Applicant Information
( Addition to Single Family Residence(rooms,deck,garage) Name: Gerald Goulet
❑ Lot Line Adjustment ❑ Minor Land Partition Company:
lj Residential Condominium ❑ Commercial Condominium Address: 13565 SW Ash Ave
❑ Residential Subdivision ❑ Commercial Subdivision Tigard,Oregon,97223
U Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: g
Other 20 x 26 WORKSHOP Phone/Fax: 5035210791
E-Mail: jt@chown.com
6. Will the project involve any off-site work? ❑Yes gi 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,Site 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 Gerald Goulet Print/Type Title Mr
ONLINE SUBMITTAL Date 7/15/2019
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
SERVICE 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.
la 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 17-05, Section 3.02.1. 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
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 LETTER IS REQUI ED.
Reviewed by ( ��� Date 8/15/19
2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org