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Permit CITY OF TIGARD MASTER PERMIT II ` - COMMUNITY DEVELOPMENT Permit#: MST2022-00040 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2022 Parcel: 2S110DA08200 Jurisdiction: Tigard Site address: 10693 SW LADY MARION DR Subdivision: ERICKSON HEIGHTS Lot: 43 Project: Bancroft Project Description: Inground fiberglass pool. Trade permits to be pulled separately. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: a sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Total: 0 sf Value: $40,000.00 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 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 Drywall-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 SrvclFeedere Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 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 10004-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: Ecom asin cnpton.: :p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: OTR SF V B R-3 0 Owner: Contractor: BANCROFT,ALEXANDER A&SHANNOhPREMIER POOLS&SPAS OF OREGON Required Items and Reports(Conditions) 10693 SW LADY MARION DR PO BOX 346 PORTLAND,OR 97224 WILSONVILLE,OR 97070 PHONE: PHONE: 503-855-4117 FAX: Total Fees: $1,214.57 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-nnl-nnln thrminh rise 059..nn1-noon Vn.,mow nhtain a rnm,of thn name nr dirart mia¢finn¢tA ril 1MJC Inv rollinn cog 9'19 10R7 nr 1 Ann n't 9'taa Issued By: Ed9A.t'do-Ma,Ldoln, - Permittee Signature: 14.8,appUtcof 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 lob site at the time of each inspection. N. Building Permit Application li1,-2h\22., Residential RECEIVE* FOR OFFICE USE ONLY Er City of Tigard __ Received 2IW12U22 �1) r ^-�q L'"�i -i ,., °"r' Datv: Cl� Permit No.'.Mc2021.-00040 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 2/2/ 2 -/i" Phone: 503.718.2439 Fax: 503.598.1960 DateB : J Ale Other Permit: Inspection Line: 503.639.4175 CITY OF TIGARD Date Read/B . TIGARD Y Y L� ® See Paget for Internet: www.tigard-or.gov -,I • ntp if' ri m• ' tified/Meth Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0]New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ElI-and 2-family dwelling 0 Commercial/industrial Valuation: $Yrfr©p0 Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: , JOBp SITE INFORMATION/ p AND LOCATION Total number of floors: A Job site address: 06 l J �v.,, I„d„a) f A e j 10 yl p( New dwelling area: square feet City/State/ZIP:'n 6(x/, 0(L. q 7 1.2 li Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Car O- h Q00( Covered porch area: square feet CrossCr street/directions to job site: 3 w (-7 of tr '(li/r`d�LC, Deck area: square feet ,X/[4 -C gwie,e-c' Gc 2y/ / aoz." l Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. tc(/\961-(li111) 13 Ku;` t,C30v,Ae (1ipc(4IAys toy( Valuation: $ t 1'y\ Udd;c(�(t A VI V\tM 1 ] W ft/; rt , p i e e Existing building area: square feet CvJ t 7 a'tf J���)t� J New building area: square feet ill PROPERTY)OWNER ❑ T'EN(A T „ire- Y Number of stories: Name: Anp, ( / i4 Cv-64,h Type of construction: Address: i06 3 w Gaol MG/r0"1 Of Occupancy groups: City/State/ZIP: I- t 4A.r(% t" q7 11 (4 Existing: Phone:((' ) 5 L - 6 0 Fax:( ) New: ff1 APPLICANT t CONTACT PERSON BUILDING PERMIT FEES* Business nameN ter V 00(( & SQa) (Please refer(a fee schedule) Contact name: L`C1�' 90 AV Ivsr *i t( Structural plan review fee(or deposit): Address:q 15n1 5 W Qi Q m e,f-i (-E stn:A FLS plan review fee(if applicable): City/State/ZIP: l(190 Vl aOq_ 01.7 Q'/ Total fees due upon application: W Phone:g03) 4 ��,50 Fax::( ) Amount received: E-mail: C : c s 4)Q/h s c_Qkrk,-, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: NV\'C ti. c-QOC 5 & 5? Submit two(2)sets of roof plan with connection details /�,�lJ and fire department access,along with the 2010 Oregon Address: q(So 5� 2ion .( C`f 7Ci 1( t G Solar Installation Specially Code checklist. City/State/ZIP: (,(/i(c00 vi (Ce -7U Permit Fee(includes plan review ©� ( and administrative fees): $180.00 Phone:6Olj )s,4 t lry (7, 9Q Fax:( ) State surcharge(12%of permit fee): $21.60 CCB tic.: I t C. e�yt, 0Z/��2,? Total fee due upon application: $201.60 V� Authorized signature: „ (//Ut • This permit application expires if a permit is not obtained LtVi %]�/!(/ within 180 days after it has been accepted as complete. 1/ 0 V *Fee methodologyset byTri-County BuildingIndustry Print name: --� i C � ( �; J Date: `.( `�� rl�� Service Board. ty 1:\Building\Permits\BUP-RESPerrmitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) MST2022-00040 Clean WaterServices • SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 22-000599 1. Jurisdiction: Tigard RECEIVED 2. Property Information(example: 1S234AB01400) 3. Owner Information Tax lot ID(s): Name: Shannon and Alex Bancroft MAR 0 4 2022 2S11ODA08200 Company: D Address: 9150 sw pioneer et suite g BUILDING p VISION OR Site Address: 10693 SW Lady Marion Dr. City, State,Zip: wilsonville, or, 97070 City, State,Zip: Tigard, or, 97224 Phone/fax: 714-595-8448 Nearest cross street: sw 107th terrace Email: shannon@techedconnect.com 4. Development Activity(check all that apply) 4. Applicant Information ® Name: eddie shavlovskiy Addition to single family residence(rooms,deck,garage) Y ❑ Lot line adjustment 0 Minor land partition Company: Premier Pools and Spa ❑ Residential condominium IDCommercial condominium Address: 9150 sw pioneer ct suite g ❑ Residential subdivision 0 Commercial subdivision City, State,Zip: wilsonville,OR , 97070 0 Single lot commercial ❑ Multi lot commercial Phone/fax: 5035441250 Other Installing 12'x26'in ground fiberglass pool Email: eddies@ppas.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 eddie shavlovskiy Print/type title Project Manager Signature ONLINE SUBMITTAL Date 2/14/2022 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 LLETIEER IS REQUIRED. Reviewed by /n •'•^ '`"zd- 019 Date 2-17-22 Once complete, email to: SPLReview@deanwaterservices.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 r City of Tigard r COMMUNITY DEVELOPMENT DEPARTMENT C T l A 1;n Building Permit Review — Residential Building Permit #: MS"t2O22.- 000y0 Site Address: !0(0 T3 zitl (440)/ MAC lulLJ Project Name: 1-IA 1\}(_goF r Lot #: Planning Review Proosal: f/S/ aOtAl0 '9 1---- or Verify address/suite #active in Accela. .mil In River Terrace: LYNo ❑ Yes,River Terrace Review Addendum Site P n Elements: Erosion Control copies of site plan on 8-1/2"x 11"or 11 x 17"paper 1 ta1ned trees with drip line and tree protection measures to scale (standard architect or engineer scale) th arrow L/J�F otprint of new structure(including decks) and FFE [ Utility locations&easements(required for new and additions) Site address,project or subdivision name and lot number Sidewalk/driveway approach cant information(name and phone number) Location of wells/septic systems [ tot dimensions and building setback dimensions Street tree size,type and location 14,,q7u, are footage of buildings to be demolished Street names 2.1 Existing structures on site Corner elevations (2'contours if more than 4'differential) Lot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes 0-N/oo I impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes 21 o Clean Water S jviices-Service Provider Letter(lot platted prior to 9/10/1995): tired: Err-Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No Water Meter 5ktt1re Unit Worksheet-Additions,Remodels and ADUs Requi ed: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No -0 )C Exemption for ADU applied for: ❑ Yes B N -- Received: ❑ Yes El No Public Facilities Improvement (PF1) Permit: Required: ❑ Yes,applicant was notified Applied For: ❑ Yes ❑ No,stop intake ❑ Lind Use Case#: Zoning: 'f 2• ,..1— Required Setbacks: Front: Rear: LS Side: Street Side: IS- Garage: 46 IA- 0 Building Height: Max. Height: Prr Actual Height: A/A- ❑ Landscape Area: W/ % ❑ Lot Coverage Max: /VA- % trance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less Window, n'mum 12%of area of all street-facing facades Garage ❑ Garage 's behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door exten s n e than 5'from wall and there is a covered porch extending beyond garage. ❑ Door extends no more than wall and there is a 12 sq ft.window above garage on 2°a floor. ❑ Garage door width is ❑ 12'or less less of facade El 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance ❑ Wa o ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable, mbrel roof ❑ Dormer ❑ Accent siding ❑ Window trim ❑ Window recess El Window pr ' ' n ❑ Balcony reisnal Clearance t Urban Forestry Plan Sensitive Lands: ❑ Yes 12"-1"Vo Type: ❑ Conditions met prior to issuance of building permit Not Approved By Planning: �—_� Date: 22 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: 2,-1'Z2. Site Plans: # Building Plans: # 3 Building Permit#: [Enter building permit#above. Workflow Routing: (Planning [Engineering [2[-"Permit Coordinator [ Building Workflow Sign-off: [Sign-off for Planning(include notes from planning review) Route Application Documents: [Engineering: (1) copy of permit application, (1) site plan, (1) building plan and � original plan review routing form. 21/Building original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: s�� v Gn'()_ -1Q-e5,e _ Date: 2`1''1`22 Engineering Review [Slope at building pad: [Conditions "Met"prior to issuance of building permit fl 1h / Easements (encroachments)per engineering conditions of approval and plat h( Er-Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ef No Assess Water Quantity Fee in-lieu: ❑ YesL` 'No LIDA Facility on lot: ❑ Yes LJ No Add Fee: 0 Yes ❑ No [Final Plat Recorded: 14/` ❑ NOT Approved by Engineering: Date: Notes: [Approved by Engineering: - r6? Date: 2/ f/z4z Revisions (after Building Submittal only) Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: 0 Approved 0 Not Approved Permit Coordinator Review Ni4i't;onditions "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 fIZ Does not apply SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes , N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes eZf N/A LIDA 0 Yes /6 N/A pOK to Issue Permit Approved by Permit Coordinator: Date: 2 22- I:1Buiding\Forms'B1dgPermitRvw_RES_1208021.docx