Permit a CITY OF TIGARD NMASTER PERMIT
` _. COMMUNITY DEVELOPMENT Permit#: MST2021-00542
Tigard OR 97223 503.718.2439,
13125 SW Hall Blvd. Ti Date Issued: 01/20/2022
Tf[�ARI� g
Parcel: 2S103CA02300
Jurisdiction: Tigard
Site address: 11880 SW JAMES CT
Subdivision: TRAVPORT PARK Lot: 3
Project: Crandall
Project Description: New 500 sq. ft. detached shop
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 5 Parking Spaces: 0
Height: 13.5 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No
Total: 0 sf Value: $26,563.04 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 Drains: 0 Storm Sewer 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
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 add'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
N
Other: N Other Description: Ecompasing.
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT ACS VB R-3 0
Owner: Contractor:
CRANDALL.BRADLEY R ITIELS CARPORTS&METAL BUILDINGS Required Items and Reports(Conditions)
11880 SW JAMES ST PO BOX 1139 WOODBURN 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97223 WOODBURN,OR 97071
PHONE: PHONE: 503-984-2415
FAX:
Total Fees: $1,095.11
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
oc9-nni_nnin thrni inh(1AP Qc9-nnl-nnon Vnn may nhtnin n rnnv of the ri lice nr rlirort nileefinne to(ll Mr'by rnllinn An1 9'29 10A7 nr 1 Ann'n'n ,1.4.4
Hatty Va.vt, De Wege
Issued By: Permittee Signature: Ow Atom ,cufiz-v.'
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 iob site at the time of each inspection.
3- 12113121
ituildine Permit Application /i •V
Residential FOR OFFICE USE ONLY
RECEIVED
ltecerved 4/
Cityof Tigard /��� Z/ —�% ! Permit No sT�021-�5Z1L
', 4 13125 SW Hall Blvd,,Tigard,OR 97223 - Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DEC 021 Date/Bti: a./ OtherPcrmnt.
TIGARD Inspection Line: 503.639.4175 Date Ready/By: , 0 See Page 2 for
Internet: www.tigard-or.gov CITY Oh TIGARD N 'fed/Method: i ( Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DA I AND 2-FAMILY DWELLING
Indicate the value(rounded to the nearest
construction ❑Demolition ' Permit fees*are based on the value of the work performed.
._,.".,.�.. .._.. ___ _..... ,_.... __...__ dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
"" mm" work indicated on this application. C`-
�k-i 3
,,. _.....� CATEGORY OF CONSTRUCTION Valuation: S
❑ 1-and 2-family dwelling 0 Commercial/industrial �
Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms: i"`
JOB SITE INFORMATION AND LOCATION Total number of floors: /
Job site address: /J , Q)97a Gfr New dwelling lea: (ii square feet
City/State/ZIP: Ti',,,...: al/ ;7 ;7�-'� 3 - carrport area: ' ,,•i t square feet
Suite/bldg./apt.no.: Project name: Covered porch area: 45 square feet
Cross street/directions to job site: I Deck area: f square feet
Other structure area: ¢7 square feet
RIQUIRE:II DATA:COSIMEltC_lAL-135E CUE(kttSt
Subdivision: rroU Y,/— rail< Lot no.:3 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.. (� L`� equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
/ Valuation: $
tit t'! Y� '' X iutlir 1^cr
Existing building area: square feet
New building area: square feet
I iPROPERTY OWNER 1 0 TENANT Number of stories:
Name: j 3c1.i' i.3 &C'n Of/ Type of construction:
Address: t ti '47 5 G Occupancy groups:
City/State/ZIP: -Tic„ / Q, , / Existing:
Phone:(1.).3 �' x Fax:( ) New:`APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: Mcraere(erloleeschedule't
,r --. Structural plan review fee(or deposit):
Contact name: t (, �7 a ade/it
-.,.„�,_ - FLS plan review fee(if applicable): ' ZI 7�y8 I
Address: /f tea .*i tl jC.'yne.5 t i
// /.,7* - Total fees due upon application: 'j 7 q
City/State/ZIP: it t tl `7! 1 _ f
.:-"-
- ---�� -- --- Amount received:
Phone: ) P — Fax::( ) ..
N" PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E.-mail: ' " — d 6( T ill '- heal YnoI ,
Commercial and residential prescriptive installation of
CON11IACI OR i roof-top mounted PhotoVoltaic Solar Panel System.
+ Submit two(2)sets of roof plan with connection details
Business name: ;el/ C.-a ort. J" !/1 1' >� 1-"VIP "I" P
_ j': k -Y� and fire department access,along with the 2010 Oregon
Address: j a, JX )I,33 .07' i 76 dt2T )1't K .• /me )2i Solar Installation Specialty Code checklist.
} / y Permit Fee(includes plan review
City/State/ZIP: ' e. 0d 2, 9 t 0 7 $180.00
1 . - , , ._ _ and administrative fees}:
Phone:(,� ) dq � 9 j Fax:( ) t State surcharge(12%of permit fee): $21.60 1
CCB]ic.:' /6 1 Total fee due upon application: $201.60 ,
�iuthurixcJ,ien;u"ll1.1: This permit application expires if a permit is not obtained
within 180 days after It has been accepted as complete.
t *Fee methodology set by Tri-County Building Industry
Pratt ttfira« 1 �n �/ Date: ' —11 � ' Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
toildirte Permit Application Checklist
FOR OFFICE USE ONLY ..
One- and Two-Family Dwelling
1?ece rd Permit No.:
.t City of Tigard rite, , _..,,.:.
` As i edmantaf
,,+.* 13125 SW Hall Blvd.,Tigard,OR 97223
l ! Phone: 503.718.2439 Fax: 503.598.1960 ❑ Electrical ❑ Plumbing ❑ Mechanics[
WARD 24-Hour Inspection Line: 503.639.4175 ❑ piper
Internet: www.tigard-or.gov -
_.. Yc•s 10 Ni.
i THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
0 „F„ —
2 Zoning Flood plain,solar balance{mints;seismic soils desitation,historic district,etc. All ,
3 Verification of a ... oved; lat/lot. _ ,
0 p �
4 Fire district approvalrequired. Name of distract: - Q N �„
Q 1
5 Septic sstemrltertnit or authorization for remodel. Existing system capacity 6 Sewer L?ermit. _
protection,silt fence design and location of catch-
7 Water district approval. 0
8 Soils report. Must carry on na plicable stamp and siatature on file or with application,
—9 lampermit required. Include drainage-way
9 Erosion control ❑p 0 q
basin rotection,etc. /I
10 _3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state
1----
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
i
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
i copyrIght violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if °—
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
1 �
surface drainai.�e.-- ... vj �i
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. rq
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, t!.i
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 D
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. Q
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-
prescriptive path analysis provide specifications and calculations to engineering standards. n
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
Et 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 [J
over 10 feet long and/or an beam/ ist cartvtn a non-uniform load.
20 Manufactured floor/roof truss design details. 8 Ei 4-0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0
u
for four or more a, iliances. Q (�
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Ore•on and shall be shown to he a=+licable to the .to'ect under f View.
JURIS0ICTIHNAI4 SPECIFICS w_
23 Three331 site plans are required for Item 11 above.-Site plans must be 8-1/2 x 11"or 11"x IT".
id 0
' 24 Two(2)sets each are required for Items 16, 19,20 and 22 above.
no
`-25 Buildin fans shall not contain red lines or to ons. "Mirrored"buildin plans will not be accepted. til
.."" plans must meet criteria outlined in the Permit&System Development Fees document.
' 26 "Reversed"building /�
', 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 E
Street Tree List. driplines,
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, s, 0 �
and protection measures must be drawn to scale and must include the project arbonst's signature of arproval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment o m structures requiredi t existing residential additions,ngs v I
covers(over non-impervious surface)and accessory
including decks,patio
on a lot of record approved prior to September 9,1995. _.
doc 02/24/2011 440-4613T(11/02/COM/WBB)
I:�Building�Permits�BUP-RESPermitApp. •
•
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE: FSE ONLY
City of Tigard Received
Date/By: Permit No.:
II II 13125 SW Hall Blvd.,Tigard,OR 9722DEC 2 7 2021
I. Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 Date/By: Other Permit No.:
'1 I C A R I) CITY OF TIGARD_ Date Ready/By:
Internet: www.tigard-or.gov oJuris: See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK n' \C)‘"�� ��'�„�-�C FEE* SCHEDULE
aNew construction ❑Demolition ' For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-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
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11880 Sw James Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard/OR/97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 1 18.76 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Travport Park Lot no.: 3 Fixture or item:
Tax map/parcel no.: 2s103ca02300 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Drain gutters from new building to splash blocks or other day light Dishwasher 25.02
dispersal approved by inspector. Drinking fountain 25.02
Ejectors/sump 25.02
At PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Name: Bradley Crandall Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11880 Sw James Ct
Garbage disposal 25.02
City/State/ZIP: Tigard/OR/97223 Hose bib 25.02
Phone:(503 )830-8526 Fax:( ) Ice maker 12.51
`F' APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Bradley Crandall
Roof drain(commercial) 12.51
Address: 11880 sw James Ct Sink/basin/lavatory 25.02
City/State/ZIP: Tigard/OR/97223 Solar units(potable water) 62.54
Phone:(503)830-8526 Fax::( ) Tub/shower/shower pan 12.51
E-mail: brad-crandall@hotmail.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Home Owner Water piping/DWV 56.29
Address: 11880 Sw James Ct Other 25.02
City/State/ZIP: Tigard/OR/97223 Subtotal 18.76
Phone:(503 )830-8526 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lie.: Plumbing Lic.no.:
Plan review (25%of permit fee) 18.13
State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 99.33
Print name: Bradley Cran II Date: 12/26/2021 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.
1:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/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-l'' I00' 50.03 0 to 2,000 _ $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(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
t Baptiste/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
as defined in OAR918-780-0040.
I -Drive Thru
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.
'
k Floor Drain/sink: -2"
Isometric or Riser Diagram
ft 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
t+ -Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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_PetmitApp.doe 08/04/2011 2
y r;
City of Tigard .,,,„,,,,...
r " COMMUNITY DEVELOPMENT DEPARTMENT ,/
a
Tl GARD Building Permit Review — Residential
Building Permit #: M S12 I-oo5412.
Site Address: j f 060 Ski avws p-.
Project Name: 1 ravedri- par Lot #: 3
Planning Review f Proposal: Grar,dal t D46, 'kid Gd *
xVerify address/suite# active in Accela. ❑ In River Terrace: y No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: L eeienrCenhrol
IA3 copies of site plan on 8-1/2"x 11"or 11 x 17"paper a a.tne
Drawn to scale(standard architect or engineer scale) $1Footprint of new structure(including decks)and FFE
$North arrow $Jtility locations&easements(required for new and additions)
gSite address,project or subdivision name and lot number WSidewalk/driveway approach
Applicant information(name and phone number)
)4Lot dimensions and building setback dimensions
ptreet names
l xisting structures on site pitC orner elevations(2'contours if more than 4'differential)
>1,000 sf of impervious area created or replaced? ❑Yes 10No
impervious area(applicable if R-7,R-12,R-25&R-40) ❑Yes ❑No
.
VIP Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
I Required: if Yes,applicant was notified ❑ No Received: il4 Yes ❑ No
Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified ier No Received: ❑ Yes ❑ No
• Or a . es o
rtrrermii:
Required: ❑ Yes,applicant was notified ei21 No Applied For:
D❑ (Yes ❑ No,stop intake
. C'�tse#: • 018Zoning: Tom' (• 5
fa Required Setbacks: Front: I Rear:_ 6 Side: Street Side: I$a Garage: 7.0
g Building Height: Max.Height:_15 6 _ Actual Height: 13. S
an scape % P- .C„y„ag,-Nfif
e o
0 o area o a street- acing
❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No, f the following is met 3
no more than 5'from wall and there is a covere extending beyond garage.
❑ Door extends no more t ' wall and th • sq ft.window above garage on 2°a floor.
❑ Garage door width is ❑ 12'or le 0°0 or de ❑ 60%or less and includes 7 of following:
❑ Covered porch cessed entrance ❑ Wall offset e ❑ Roof offset
❑ Fire s • ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roo ormer
ccent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Ba
V Visual Clearance {VI Urban Forestry Plan `� '/
Di Sensitive Lands: ® Yes ID No Type:Tett,6rOVsi GIA)S Veri 'mil Cd r!'i�edr'
❑ Conditions met prior to issuance of building permit
Notes: fete' sC't PC.c k -Po e C %5j; 41416ka 1aril e. 1"sole{,fii-J,>,s
c4
ni, Approved By Planning: Date: S
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: /-0&40-21
Site Plans: # C3
Building Plans: # 3 1
Building Permit#: O'Enter building permit#above.
Workflow Routing: [rPlanning IIKEngineering Et-Permit Coordinator G—wilding
Workflow Sign-off: rfr-Sign-off for Planning(include notes from planning review)
Route Application Documents: C!/Engineering: (1) eoriy of permit application, (1) slte plan, (1) building plan and
original plan review routing fgrm.
[(Building: original permit application,site plans,building plans, engineer and
beam calculations and st details,if applicable, etc. ,.
Notes:
By Permit Technician: :: Date: t2 /6 Z0Z1
Engineering_, Review 4
Slope at building pad: S'%
E-Conditions "Met"prior to issuance of building permit n Ce\
[{''Easements (encroacliments)per engineering conditions of approval and plat 171�
CrWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes CB/No
Assess Water Quantity Fee in-lieu: ❑ Yes S No
LIDA Facility on lot: ❑ Yes CYNo
CB/Final Plat Recorded: ill/4
❑ NOT Approved by Engineering: Date:
Notes:
Q'Approved by Engineering: 774�ivrf"6h� X'l Date: 14( 6(Lc ZI
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 ,Approved ❑ Not Approved ,
Permit Coordinator Review ,.
frConditions "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:
7 SDC Exemption: ❑ Received f2 Does not apply
7 SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 'N/A
. T,itatd Tran SDC: ❑ Yes Zr N/A
Parks SDC: ❑ Yes N/A
>. .:.. ;„ • , LIDA- ❑ 'Yes , N/A
,''*'`' " OK to issue Permit
Approved by Permit Coordinator: 16,rA.
Date: t2J 120/2/11
is
I:\Building\Forms\BldgPermitRvw_RES_122419.docx
RECEIVED
DEC I. �, 021 •
CieanWater Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENkILDINGDVSION
Clean Water Services File Number 21-002864
1. Jurisdiction: Tigard
2. Property Information(example: 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Bradley Crandall
2S103CA02300 Company:
Address: 11880 Sw James Ct
OR Site Address: 11880 Sw James Ct City, State,Zip: Tigard, OR, 97223
City, State,Zip: Tigard, OR, 97223 Phone/fax: 503-830-8526
Nearest cross street: Email: brad-crandall@hotmail.com
4. Development Activity(check all that apply) 4. Applicant Information
I] Addition to single family residence(rooms, deck, garage) Name: Bradley Crandall
❑ Lot line adjustment 0 Minor land partition Company:
❑ Residential condominium ❑ Commercial condominium Address: 11880 Sw James Ct
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Tigard, OR, 97223
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503-830-8526
Other detached 20x25 garage Email: brad-crandall@hotmail.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:
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 Bradley Crandall Print/type title
Signature ONLINE SUBMITTAL Date 9/22/2021
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.
® 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.
❑ 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 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 Z a41-4..� ��r�. - � �d ' Date 11/10/2021
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
Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503.681,3600 f:503,681.3603 • cleanwaterservices.org