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Permit i Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE: ESE ONLY City of Tigard Received Permit No.: II • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: T I G A R 1) 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No NI.k 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 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: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 0 6 Sewer permit. ❑ ❑ 0 7 Water district approval. ❑ ❑ 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- 0 ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 ❑ 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. ❑ 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 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 ❑ 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 ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 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 ❑ ❑ architect licensed in Ore on and shall be shown to be .licable 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 24 Two(2)sets each are required for Items 16,19,20 and 22 above. 0 ❑ 0 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 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. 0 0 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 ❑ 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, 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. 1:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB) Plumping Permit AuplicatkRR EC \v!ED Building Fixtures FOR Onto[ I SF. OnLy city of Tigard JUL 2 6 2021 Received Date/By: PermitNcM S i 2021- 00 2-S9 lig • 13125 SW Hall Blvd.,Tigard,OR 972 Y OF TIGARD Plan Review C Phone: 503.718.2439 Fax: 503.59 �� Cher Permit No.: - Inspection Line: 503.639.4175 f UfLDING DIVISION Date BY: BI See Pagel for T 1 CARD Internet: wuw.li and-or. ov Date Ready/By: h g g Notified/Method: Supplemental Information TYPE OF WORK FEE" SCH DULE ❑New construction 0 Demolition For special information use checklist Description 1 Qty. ( Fa Total 0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 !pet-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.it) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: r 110!0 S W /4 u,( t,vp(. Catch basin or area drain 18.76 �/ Drywell,leach line,or trench drain 18.76 City/State/ZIP: 0//.a ,ej vc, 077�eci Suite Bldg,/apt.no.: Project names Ues a Footing drain(no.linear _) Page 2 t e. -N Apr,o,t ie Manufactured home utilities 50.03 Cross street/directions tojjobsite: coy,he f ��j 4. rlicoOnoC -r Manholes 18.76 col' hate k & , vl 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.: p D S(( 5(g 5 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer ( 25.02 2 5, Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER 1 0 TENANT Expansion tank 12.51 C I_�) S hJ /.t,o V In Fixture sewtir cap 25.02 Name: /I / l.w� / Floor drain/floor sink/hub 25.02 Address: /(IO I(� S W f"yy���(,(rt tVpr, Crarbage disposal 25.02 City/State/ZIP: 7T ,4 , biz 4-10 ke Hose bib 25.02 Phone:(rip O i.f 01- ?-8.3 g Fax:( ) Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 Contact name: Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory fk 25.02 SO,Oil City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: O��N rl Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal -75, U10 Phone:( ) Fax;( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: Plumbing Lie.no.: State surcharge(12%of permit fee) Authorized signature:(f '' _ TOTAL PERMIT FEE -as,0(, Print name:rh ri S1y/w``6 uV l n Date: -7 iv"/ it 7I This permit application expires if a permit is not obtained within 180 days VV 'I7 after it has been accepted as complete. "Fee methodology,set by Tri-County Building Industry Service Board. I:1Badding\Penults 1PLMU-PemttApp.doc 10/01/09 440-4616T(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-Ia 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 ofnormal business 90.00/hr S25,001.00 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-112 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 folio-wing. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate g with water service 2"and Baptistry/Font ❑ greater,exce new pt systemcial s designed and stamped bylicensed Bath: -Tub/Shower engineer. y p -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 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 ❑ 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\Pemuts\PLMF_PermitApp.doc 08/04/2011 2 1Jul1UESa)y' 1'1 211.1411 W City of Tigard :ECEIV ""' Permit11s.ts 2021'-002.-s"9 III13125 SW hall Blvd..Tigard OR 97223 t Plan Review f Phone: 503718.2439 Pak: 503.598.1' G AUGbu1Be: Other Pernik No.: 1�� r.d.t inspection Linz: 503.639.4175 /A nn71 pate Readr�`m B See Page 3 tar Internet www:tigardor goer Notified/Method, Supplemental Informilim TYPE OF WORK ClirYt OFTIGARD FEE' Sc7f .D1TLE ❑New construction 0 r `h WING DIVISION For ornm1ioe we cFeaktiat t71Description Qty. 1 Ea. i Total 1Yr''Addition/alteration/replacement ❑Other: New f-2-tandly dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 I-and 2-family dwelling 0 Commercial/industrial SFR(1)bath 437.76 SFR(3)bath 50032 ❑Accessory building 0 Multi-family Each additional bathAdte:him 25.02 ❑Master builder ❑Other. Fire sprinkler(____sq.1t) Page 2 JOB SITE INFORMATION AND LOCATION 9Ite WHlties: lyUr0 SW ''1°t_, l �M 4kv� Ca�hbasiBa area drain 18.76 Job site address. ( City/State/ZIP: 775(1,141 0 ei K. �da t f Dirndl,leach line,or trench Grain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt no.: Project namc6 uest e64:3tilliktprfottudManufachued home utilities 50.03 Cross street/directions to job site: cA,nh,ye / 4 4' MCadn (4 Manholes 18.76 LAG k /t_rn 1 _` Rain drain connector 18.76 -CO�ofC bit en OC Sanitary sewer(no.linear ft.:, 1 Page 2 Storm sewer(no.linear ft: ) Page 2 Water service(no.linear ft: ) Page 2 Subdivision: T Lot no: Fixture or Item Tax map/parcel no.: �O5 I\ D5/� 5 BeckBowproventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Mitt-owl �,sL Chilies washer , 25.02 `,Z 5.0k, ()VvC INAt ie{ {v tarernetnt) bun. (ocyth /yla,of tto l Dishwasher 25.02 S]nk ar(t ilitt Drinking fountain 25.02 Ejectors/sump 25.02 e ❑^PROPERTY OWNER 0 TENANT Expansion lank 12.51 • Name: / ,�r)�.1.,/ (,(yln FiidurrJsewer rip 25.02 Address:(/ j//0 la StAl I kL.'( p`v/. Ftartbair✓flar sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: jryaaa+ �! paiz lg7 Y Nose bib 25.02 RPhone:(91/) 41 - ests,7y$ Fax.( ) lee maker 12.51 Si3O APPLICANT 0 CONTACT PERSON lnttrceptorlgrease trap 25.02 Medical gas(value:S_) Page 2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory ' 25.02 SO,Olt City/State/ZIP. Solar units(potable water) 6254 Phone( ) Fax..( ) 7tbishower.'shower pan 1251 E-mail: Urinal 25.02 ---- Water closet 25.02 CONTRACTOR• {.. Water healer 37.52 Business name: ✓/91ilN l.�' Water pipmg'DWV 56.29 Address. Other. 25.02 CitylSteteJ1,,1P: I Subtotal 75, C)&, Phone:( ) r>x:( ) Minimum permit fee: S72S0 • CCB Lie.: Plumbing l.ic.no.: Plan review(25%ofpermit fee) -_-- State surcharge(12%of permit fee) Authorized signatureO ,e_ l,.�, 1'OTAI.PERMIT FEE ?s,04._.1 Print mime: h rf (l/.V"! V Date /t U r2•iJ This ptnnit app8wlion expires if a permit is not obtalt ed*Whin 18a days �r} �jiy C j(rt (n 7!4 __-� after it tons been accepted as complete. t "Fat methodology so be 7 ii-County Building Industry Service Board 1'StdidPF'.Pe srs'YL3eli.ktmUpidec IGr'I/n5 44 4616T(1sL('OMM'EB) City of Tigard 71 C p COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Residential T, Building Permit #: MSTZ02.X-OOz S`'1 Site Address: jyo/O SW 1-1 VD . TICsA2!, ojR Project Name: _ LA)12lltf ADPrnON/ Lot #: Planning Review Propel: A j Ok) lb • ttvons 1,..)/ 1 11 1C) 2 e Qel1b nft Pe-Verify address/suite# active in Accela. In River Terrace: No ❑ Yes,River Terrace Review Addendum Site an Elements: 101 Erosion Control opies of site plan on 8-1/2"x 11"or 11 x 17"paper wined trees with drip line and tree protection measures allD n to scale(standard architect or engineer scale) Foo .Tint of new structure(including decks) and FFE aiN_o th arrow I■ . 'ty locations&easements(required for new and additions) address,project or subdivision name and lot number I, idewalk/driveway approach Itrepplicant information(name and phone number) Location of wells/septic systems Lot dimensions and building setback dimensions SSeeet tree size,type and location NH [PS are footage of buildings to be demolished Q,§deet names xisting structures on site Corner elevations (2'contours if more than 4'differentiaal-l)// N1, Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? EYes LQNo 1 impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? EYes 2 o Clean Watery S ices—Service Provider Letter (lot platted prior to 9/10/1995): /R equired: fL' Yes,applicant was notified E No Received: E Yes E No Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs /Required: IIVYes,applicant was notified E No �� Received: ❑ Yes ❑ No I_L],/SDC Exemption for ADU applied for: El Yes IQ No Received: ❑ Yes 17 No Ja Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified o No Applied For: ❑ Yes ❑ No,stop intake 0 Land Use Case#: NA ning: R' i. 'equired Setbacks: Front: /5 ' Rear: /S t Side: •5—' Street Side: An Garage: 2e7' ❑ t ".cling Height: Max. Height: 3s-i Actual Height: Landscape Area: Z % [2"-tot Coverage Max: - . . .nee ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Windows a • -,- um 12%of area of all street-facing facades Garage ❑ Garage .00 .ehind widest street-facing wall ❑ Yes ❑ No,one o - of owing is met: ❑ Door extends no • e than 5'from wall and there is a covered pot . - ending beyond garage. 011\ 7 Door extends no more tha -' rom wall and there is a 1 .: -.window above garage on 2°d floor. ❑ Garage door width is ❑ 12'or less 113 t°o • s of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed e : ce ■ • , offset ❑ 1'Roof cave ❑ Roof offset ❑ Fire shingles ❑ .. -1•ing ❑ Roof pitch ■ . .le,hip,or gambrel roof ❑ Dormer ❑ Accent si.'•: ❑ Window trim ❑ Window recess ■ "-.dow projection ❑ Balcony ❑ Visual Clearan ❑ Urban Forestry Plan ❑ S-•:.: ,e Lands: ❑ Yes ❑ No Type: • Conditions met prior to issuance of building permit Nods: Approved By Planning: _ Date: <0/2 t/ ( Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved 1:\Building\Forms\Bldg PermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 6\7.Z1 Z-1 Site Plans: # Building Plans: # 3 Building Permit#: 2,�,///Enter building permit#above. Workflow Routing: E7 lanning l"Engineering C34Permit Coordinator atuilding Workflow Sign-off: NW: Sign-off for Planning(include notes from planning review) Route Application Documents: II/Engineering: (1) copy of permit application, (1) site plan, (1) building plan and 1original 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: (o\z01iZL Engineering Review R' Slope at building pad: et•/ Ems]'Conditions "Met"prior to issuance of building permit y E9/Easements (encroachments)per engineering conditions of approval and plat h/�- "Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 2/No Assess Water Quantity Fee in-lieu: ❑ Yes E 'No LIDA Facility on lot: ❑ Yes 2/No 2/Final Plat Recorded: "es-- • NOT Approved by Engineering: Date: Notes: EvApproved by Engineering: 7ev..41 fdnliery Date: 6/.zg/flyz/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review 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: .r SDC Exemption: ❑ Received JU Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes kr N/A Tigard Trans SDC: ❑ Yes / N/A Parks SDC: ❑ Yes 0 N/A LIDA ❑ Yes ICJ N/A "in- OK to Issue Permit Approved by Permit Coordinator: Date: (p t3o 12414 I:\Building\Forms\B1dgPermitRvw_RES_122419.docx RECEIVED SEP 8 2021 CleanWater, Services SENSITIVE AREA PRE-SCREENING SITE ASSE5SIVIDIFID BULLING DIVISION Clean Water Services File Number 21 -002264 1. Jurisdiction: Tigard 2. Property Information(example: 15234AB01400) 3. Owner Information Tax lot ID(s): Name: christy gurin R0511565 Company: Address: 14010 sw hall blvd. OR Site Address: 14010 sw hall blvd. City, State, Zip: tigard, OR, 97224 City, State, Zip: tigard, OR, 97224 Phone/fax: 971-409-2838 Nearest cross street: Mcdonald St. Email: christy.gurin©gmail.com 4. Development Activity(check all that apply) 4. Applicant Information I Addition to single family residence(rooms,deck,garage) Name: christy gurin ❑ Lot line adjustment IDMinor land partition Company: ❑ Residential condominium ❑ Commercial condominium Address: 14010 sw hall blvd. ❑ Residential subdivision ❑ Commercial subdivision City,State,Zip: tigard, OR,97224 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 971-409-2838 Other Email: christy.gurin@gmail.com 6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: Remodel enclosing 39 sq. feet of our front porch/patio area in two places that are already on the house foundation 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. Print/type name Christy gurin Print/type title Signature ONLINE SUBMITTAL Date 8/5/2021 FOR DISTRICT USE ONLY O 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. O 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 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. ki 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 VALID UNLESS 1 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 PROVIDER LETTER IS REQUIRED. Reviewed by D6v.yiu Date 09/08/2021 Once coMplete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review, Clean Water Services,2550 SW Hillsboro Highway, Hillsboro,Oregon 97123 Revised 2/2020 Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org •• DocuSign Envelope ID:AC1ED3DC-5C53-4329-A626-E8CSAB872DC6 Property Owner Statement RECEIVED 2021 Regarding Construction Responsibilities `INN 2 3 ITY OF TIGARARD Oregon Law requires residential construction permit applicants who are not licensed with the DIVISION 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 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 x 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. Christy Gurin Print Name of Permit Applicant 6/23/2021 (7—A —/'--) — Signature of Permit Applicant Date Permit #: Address Issued by: __ Date: This Copy for Permit Offices Julie Drinkwater From: #Building Permit Technicians Sent: Tuesday, August 17, 2021 12:16 PM To: Matt Greiner Cc: Allyson Armstrong Subject: RE: MST2021-00254, 14010 SW Hall, Gurin Hello Matt This email is to confirm that the water meter fixture unit worksheet is not required. Once we have the service provider letter and the fees have been paid, we will be able to issue the permit for you. Thank you Julie Drinkwater Permit Technician City of Tigard Building Department 13125 SW I Iall Blvd Tigard, OR 97223 503-718-2804 Due to an increased demand for services, please expect longer wait times for responses to emails,voice messages and building inspections. Requests for permit status may not be responded to until the permit is ready to issue. Other requests deemed non- essential,such as fee estimates, may take longer to respond. In the meantime, please view this quick guide on how to submit common service requests. From:Allyson Armstrong<AllysonA@tigard-or.gov> Sent: Monday, August 16, 2021 8:04 AM To: Matt Greiner<Ixarchdesign@gmail.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: RE: MST2021-00254, 14010 SW Hall, Gurin Matt, Sorry for the delay. I have been out on vacation. No water meter fixture sheet is needed. I have copied the permit technicians to let them know it's not required. Thank you, Allyson From: Matt Greiner<Ixarchdesign@gmail.com> Sent:Thursday,August 5, 2021 11:38 AM To:Allyson Armstrong<AllysonA@tigard-or.gov> Subject: Fwd: MST2021-00254, 14010 SW Hall, Gurin Caution!This message was sent from outside your organization. Allow sender I Block sender Allyson, 1 Could you clear up this issue for us please?There should not be any water meter worksheet. Thanks Matt Forwarded message From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Date: Thu,Aug 5, 2021 at 11:29 AM Subject: RE: MST2021-00254, 14010 SW Hall, Gurin To: Christy Gurin <christy.gurin@gmail.com> Cc: Matt Greiner<Ixarchdesign@gmail.com> Hi Christy, According to the notes by our permit tech, Service Provider Letter, Water Meter Worksheet, & plumbing contractor information required prior to permit issuance. Please provide this documents and we will issue the permit. For questions about these documents, please contact Julie Drinkwater(julied@tigard-or.gov) Thank you, Holly Van De Wege Program Development Specialist City of Tigard I COMMUNITY DEVELOPMENT 13125 SW Hall Boulevard Tigard,Oregon 97223 www.tigard-or.gov From: Christy Gurin<christy.gurin@gmail.com> Sent: Wednesday, August 4, 2021 10:30 AM To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Cc: Matt Greiner<Ixarchdesign@gmail.com> Subject: Fwd: MST2021-00254, 14010 SW Hall, Gurin 2 4-lello, This has been paid. Please let me know when I can come pick up the permit and begin work. Thanks! Christy Forwarded message From: Matt Greiner<Ixarchdesign@gmail.com> Date: Thu,Jul 29, 2021 at 12:28 PM Subject: Fwd: MST2021-00254, 14010 SW Hall, Gurin To: Christy Gurin<christy.gurin@gmail.com>,Ted Gurin <ted.gurin@gmail.com> Forwarded message From: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Date:Thu,Jul 29, 2021, 12:23 PM Subject: MST2021-00254, 14010 SW Hall, Gurin To: Ixarchdesign@gmail.com <Ixarchdesign@gmail.com> Hello Matt • The permit for the Gurin project is ready to be issued.The balance due is$236.52 Attached please find the invoice for your review. The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number under the Building tab. There is a service fee of 3%for payments by card, and there no service fee for payments made by e-check. On the payment screen, select the payment method from the dropdown list next to the `payment' field. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that they can issue the permit and make it available for pick up. 3 Thank you Julie Drinkwater Permit Technician City of Tigard Building Department 13125 SW Hall Blvd Tigard, OR 97223 503-718-2804 Due to an increased demand for services,please expect longer wait times for responses to emails,voice messages and building inspections. Requests for permit status may not be responded to until the permit is ready to issue. Other requests deemed non- essential,such as fee estimates,may take longer to respond. In the meantime, please view this quick guide on how to submit common service requests. DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." LXDESIGN Matt Greiner,Architectural Designer ph. 503.866.4281 4 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 11111111 Transmittal Letter T I G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DE PT: BUILDING DIVISION FROM: Matt Greiner RECEIVED COMPANY: LX Design JUL ' PHONE: 503-866-4281 CITY OF TIGARD By: q-� BUILDING DIVISIOr EMAIL: Ixarchdesign@gmaiI.com RE: 14010 Southwest Hall Boulevard, Tigard, OR MST2021-00254 (Site Address) (Permit Number) Gurin (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. 4 sheets Other(explain):A0.1,A1.0, S1.0(ALL UPDATED); S2.0(ADDED) REMARKS: FOF OF CE USE ONLY Routed to Permit Technici Date: / al Initials: P Fees Due: ❑ Yes ) No Fee Descriptio : Amount Due: J � $ Nj $ 2 Special Instructions: Reprint Permit(per PE): ❑ Yes '''6.No 11 Done Applicant Notified: Date: Initials: 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 _ II Transm ittal Letter T I G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVE:: FROM: Matt Greiner 'JUL 1 3 2021 COMPANY: Ix Design CITY OF TIGAHII BUILDING DIVISII PHONE: 503-866-4281 y' EMAIL: Ixarchdesign@gmail.com RE: 14010 Southwest Hall Boulevard,Tigard,OR MST2021-00254 (Site Address) (Permit Number) Gurin (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. 3 sheets Other(explain):Added Sheets A2.0&S1.0 and updated Sheet A1.0 REMARKS: FO OF ICE USE ONLY Routed to Permit Technician: Date: 7 ---) D-1 Initials: Ait Fees Due: ❑ Yes ISr:No Fee Description: �j, Amount Due: $ , i.. V $ q� V $ Special Instructions: Reprint Permit(per PE): ❑ Yes No ❑ Done Applicant Notified: Date: Initials: