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Permit CITY OF TIGARD SITE WORK PERMIT I COMMUNITY DEVELOPMENT Permit#: SIT2021-00015 TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 10/7/2021 Parcel: 2S 114AC00600 Jurisdiction: Tigard Site address: 16625 SW 92ND AVE Project: Davala Subdivision: None Lot: None Project Description: Site work permit for erosion control and clearing brush for future detached dwelling Contractor: RENAISSANCE DEVELOPMENT CORP Owner: DAVALA, LAURIE&STEVE 16771 BOONES FERRY RD 8590 SW LODI LN LAKE OSWEGO,OR 97035 TIGARD, OR 97224 PHONE: 503-636-5600 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 09/30/2021 $77.99 Plan Review 09/10/2021 $50.69 Type of Use: SF 12%State Surcharge-Building 09/30/2021 $9.36 Class of Work: OTR Info Process/Archiving-Sm$0.50(up to 09/30/2021 $0.50 11x17) Project Valuation: $1,500.00 Erosion Control w/Development 09/30/2021 $80.70 Site Specifics: Excavation Volume. cu.yd. Fill Volume: cu.yd. Impervious Surface: sq.ft. Engineered Fill: Soil Report Required: Paving: Grading: Landscaping: Site Prep: Storn Drains: Retaining Wall: Fire Underground: Accessible Parking: Fence: Total $219.24 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules Issued By: Ho{l y Vav De lnlege Permittee Signature: Ow App-Lix.cotizto- Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application DECEIVE S 13-$ 21 Site Work FOR OFFICE USE ONLY AUG 18 2021 EieI D7 / Ae ' Permit N f7 �f 4/—OO 01$ • 1312i S�1lTigard,OR 97223 CITY OF TIGARD Y y vv _ Phone 503.718.2439 Fax 503 598.196(BUILDING DIVISION DateBy IV ,r Other Permit TiGARD Inspection 503 639 4175 See Page 2 for p Date Ready;`By: Juri_ Internet' w'wvv.tigard-or goy Notified%Method: I /N /ai7..... 'Tie' Supplemental Information & 1 Oi."Adt...- TYPE OF %%ORK REQUIRED DATA;'I-AND 2-FAMILY DWELLING Eil Ness 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 CO❑NSTRUCTIONhmd- ustrial stork indicated on this application. -and 2-family dwelling Valuation: $ , 1,500 Conunercia ❑Accessory building • ❑Multi-family Number of bedrooms: El Master builder El Other • : Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / = le?d T New dwelling area: square feet 1 .f` City/State/ZIP: ,-a'"• t £' Garage/carport area: square feet Suitei"bldg./apt.no.: / Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet .-- GWS 37Z{Jr C P ire 111�sG`�- .. '� REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: 4.6 Permit fees*are based on the Value of the work performed. ` I I) . TLi r2 f 'Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no•. ' equipment,materials,labor.overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: S Minor Site Preparation work clearing blackberries and installing etjosion control/measures for future SFR Existing building area: square feet permit New building area: square feet ( PpROPERTY OWNER ❑ TENANT Number of stories: Name: `�;�yy; / ',;.,/� Type of construction: Address: t Occupancy groups: City/State/ZIP: Existing: Phone:( ) z. Fax:( ) LIAL PPLICANT 0,CONTACT PERSON NOTICE Business name: 5 ,,- P ,,,,.t/s'' All contractors and subcontractors are required to be Contact name: % licensed with the Oregon Construction Contractors Board J'" 6 ,. ,' under ORS 701 and may be required to be licensed in the Address: , ���y a _5:4,../ p'l A,;,c,,, 5'G`l� � jurisdiction in which work is being performed.If the City/State 7IP. /�i4%?>s,,y l t G>r-7 ,f-' applicant is exempt from licensing.the following reasons / � / apply: Phone:(CJ ) g/ :.'f Fax: :( ) E-mail 1 lb<,,,.1. e_. ip' r4v?J R v,,,,,r (-7:---- CON-TRACTOR Business name: v rr.r 9'4'l�t'' - / ,.,, BUILDING PERMIT FEES* Address: F (Please refer to fee schedule) /tit s P ' �y� FLS plan review fee(if applicable): Structural plan review, fee(or deposit): ©. Cityi'State;ZIP•• f` ( , 11 Phone: ) ./7 z. Fax:( ) CCB lic.: i/ff I Total fees due upon application: 0 53 / Amount received: Authorized signature: ® _LPL' This permit application expires if a permit is not obtained : f- ,j�1` �✓� Date: ss ithin 180 days after it has been accepted as complete. Print name '/ 1 f /Z j * Fee methodoloav set by Tri-County Building industry I Service Board. 1'Building`.Permits`:SIT-PernitApp.doc 08/02/2016 440-4613T(11/02iCON'l/WEB) C1eanWater Services Our commitment is clear. CWS File Number Service Provider Letter 21-000455 This form and the attached conditions will serve as your Service Provider Letter in accordance with Clean Water Services Design and Construction Standards (R&O 19-5, as amended by R&O 19-22). Jurisdiction: City of Tigard Review Type: No Impact Site Address 16625 SW 92nd Ave SPL Issue Date: July 21,2021 /Location: Tigard,OR 97224 SPL Expiration Date: July 21,2023 Applicant Information: Owner Information: Name LAURIE DAVALA Name SAME AS APPLICANT Company Company Address 8590 SW LODI LANE Address TIGARD,OR 97224 Phone/Fax (503)313-6879 Phone/Fax E-mail: davala44@gmail.com E-mail: Tax lot ID Development Activity 2S114AC00650 Single Family Residence Pre-Development Site Conditions: Post Development Site Conditions: Sensitive Area Present X On-Site X Off-Site Sensitive Area Present: X On-Site X Off-Site Vegetated Corridor Width: Variable Vegetated Corridor Width: Variable Vegetated Corridor Condition: Good/Marginal Enhancement of Remaining Vegetated Corridor Required: X Square Footage to be enhanced: 89,850 Encroachments into Pre-Development Vegetated Corridor: Type and location of Encroachment: Square Footage: No encroachments proposed 0 Mitigation Requirements: Type/Location Sq. Ft./Ratio/Cost No mitigation required 0 Enhancement of on-site Vegetated Corridor required 89,850 X Conditions Attached X Development Figures Attached(3) Planting Plan Attached Geotech Report Required This Service Provider Letter does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. Page 1 of 6 City of Tigard n COMMUNITY DEVELOPMENT DEPARTMENT 1111111 TlcAltD Building Permit Review — Residential Building Permit #: 5 (T2-t 21•- Do D )S Site Address: I(0(oZS SUJ I Z nL Atte Project Name: ONALA Lot #: Planning Review Pro osal: ?, r WY— P r of Verify address/suite#active in Accela. In River Terrace: No ❑ Yes,River Terrace Review Addendum Sitlan Elements: ston Control 4 opies of site plan on 8-1/2"x 11"or 11 x 17"paper ed trees with drip line and tree protection measures 2Cawn to scale(standard architect or engineer scale) F sprint of new structure (including decks) and FFE orth arrow rr ty locations&easements(required for new and additions) �.l e address,project or subdivision name and lot number Sidewalk/driveway approach plicant information(name and phone number) .�p. Location of wells/septic systems 2 Lot dimensions and building setback dimensions r" [lS reet tree size,type and location OSquare footage of buildings to be demolished [ S eet names r ❑Existing structures on site Corner elevations (2'contours if more than 4'differential) C Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes DI�T� im ervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes No IQ Clean Water Se ices—Service Provider Letter (lot platted prior to 9/10/1995): Iquired: Yes,applicant was notified El No Received: ❑ Yes ❑ No V'egater Meter Fixture Unit Worksheet—Additiioo s,Remodels and ADUs quired: ❑ Yes,applicant was notified ,�J No � Received: ❑ Yes ❑ No C Exemption for ADU applied for: ❑ Yes 2N.. ��No Received: ❑ Yes ❑ No YJ Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake ❑ Land Use Case#: ❑ Zoning: El Required Setbacks: Front: 'W Rear: /- Side: S� Street Side: /S Garage: 2 0 ❑ Building Height: Max. Height: g0 Actual Height: /OA El Landscape Area: t fkr. % El Lot Coverage Max: • rance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees o ess Windows IN •..-'..urn 12%of area of all street-facing facades Garage ❑ Garage door :-..nd widest street-facing wall ❑ No,one of the following is met: V X CI Door extends no . - than 5'from wall an. •- - s a covered porch extending beyond garage. \" ❑ Door extends no more than .._ . all and there is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is or less ❑ !0• or less of facade ❑ 60%or less and includes 7 of following: ❑ Cov- -. .orch ❑ Recessed entrance • 1•.. e set El 1'Roof eave ❑ Roof offset ■ Fire shingles El Lap Siding ❑ Roof pitch ❑ a. , •'. or gambrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess ❑ Win.. .rojection ❑ Balcony ❑ isual Clearance ❑ rban Forestry Plan 'nsitive Lands: 1CJ Yes ❑ No Type: I t YD S1f00)19c41%r� S, Sc-ge�s onditions met prior to issuance of building permit Not %fe Wo ()anew IS C.45Ailitl r WIN kikt tuAS AfftWO kg. pMnn v1L..Approved By Planning: PI P> Date: g/hbf Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: i'/We?" Site Plans: # 3 Building Plans: # 3 Building Permit#: (' —Enter building permit#above. Workflow Routing: 'Planning —neering ermit Coordinator Q-Building Workflow Sign-off: [a-Sign-off for Planning(include notes from planning review) Route Application Documents: El—Engineering: (1) copy of permit application, (1) site plan, (1) building plan and o_rj..ginal plan review routing form. Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: /f 3 By Permit Technician: ______K G/✓//e44-ti Date: �I 2-' Engineering Review &`/Slope at building pad: SZ Conditions "Met"prior to issuance of building permit $A- D/Easements (encroachments)per engineering conditions of approval and plat ,ei/µ RI/Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 2-No Assess Water Quantity Fee in-lieu: ❑ Yes Ef. No LIDA Facility on lot: ❑ Yes No a Final Plat Recorded: a(f' ❑ NOT Approved by Engineering: Date: Notes: FoY E L kStC p a v! , [ Approved by Engineering: 77vA.,74—grct is ' Date: 9/i Li/2.02 1 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review XConditions "Met"prior to issuance of building permit Approved,NOT Released: Date: Notes: ..‘,..t w I t, r Wvv 1 JI IUvv Liu") i• K r.,. , - . _ Ai VN(M"I, 1.w. Revisions (after Building Submittal only) 'V liC, v I v Revision Notice 1: Date Sent to Applicant: i` Revision Notice 2: Date Sent to Applicant: 1, - I SDC Exemption: ❑ Received t2IT Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes t N/A Parks SDC: ❑ Yes X N/A LIDA ❑ Yes N/A OK to Issue Permit Approved by Permit Coordinator: Altli - Date: I:\Building\Fonns\BldgPennitRvw_RES_122419.docx