Report (4) uP2o22- OOt 71
6 8 35 SW co.tv-r ov. ST
CleanWaterr\ Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 21-001928
1. Jurisdiction: Tigard
2. Property Information (example: 1 S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Erik Pattinson
1S136DD03100, 1S136DD02900, 1S136DD0300 Company: REACH Community Development
Address: 4150 S Moody Avenue
OR Site Address: 6835 SW Clinton St City, State,Zip: Portland, Oregon, 97239
City, State, Zip: Tigard, Oregon, 97223 Phone/fax: 5039571517
Nearest cross street: SW Clinton St, SW 69th Ave, SW 68th Ave Email: epattinson@reachcdc.org
4. Development Activity(check all that apply) 4. Applicant Information
❑ Addition to single family residence(rooms, deck, garage) Name: Kristian McCombs
❑ Lot line adjustment ❑ Minor land partition Company: Humber Design Group, Inc.
❑ Residential condominium ❑ Commercial condominium Address: 110 SE Main St.Suite 200
❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Portland, OR, 97214
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5039465358
Other Mixed use, affordable housing development Email: kristian.mccombs@hdgpdx.com
6. Will the project involve any off-site work? p Yes •❑ 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 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 Kristian McCombs Print/type title
Signature ONLINE SUBMITTAL Date 6/22/2021
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.
X 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.
X 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 06¢44/2,16A, Date 07/30/2021
Once co fete, 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
TUALATIN VALLEY WATER DISTRICT Test#: 1275
FIRE HYDRANT FLOW TEST REPORT Hydrant ID #: 1S1W36D17FH50
Location: SW CLINTON ST&SW 68TH AVE Date: 3/212017
Test made bv: HERB &JAMES
Witness: Time: 11:35
TUAL14TIN!';BEY FIRE&RESCUE
Project name: APPROVFn_....
CONDITlO NALLY APPROVED,_,»„ [
APPROVAL OF PLANS IS NOT AM APPROVAL OF
Discharge coefficient: .54816 OMISSIONS OR OVERSIGHTS
SEE A C E -
Inside dia. of outlet= 4.5 inches --�..f
EXAM1 :�.w 2-
Pitot reading = 35 psi Pitot 2 = 0 y
Observed flow rate = 1958.3 gpm
Flow method: HOSE MONSTER
Static pressure: 85 psi Residual pressure: 71 psi
Flow at 20psi residual pressure (calculated): L487 gpm
Location map: To be attached to test report and to show which hydrants were
used to monitor residual pressure and flow.
Gage information:
Static and residual pressure gape: 3602536332 Pitot gage: 2-A5F6U-20-1
Hydrant information:
Hydrant ID Year Make Notes
Flow hydrant: 1 S1 W36D17FH50 2005 CLOW see map for location
Read hydrant: 1S1W36D18FH50 1983 MUELLER see map for location
Remarks:
The mapping,flow or pressure information contained herein reflects conditions on the date and
time of the test. Tualatin Valley Water District makes no representation as to the system's
ability to meet specific fire flow requirements. Future system capability may differ from the
flows reported herein because of subsequent modifications to the district's system and/or
because flow and pressure may vary by time of day and season. Test gage callibration
information available upon request.
TUALATIN VALLEY FIRE & RESCUE
MOBILE EMERGENCY RESPONDER RADIO COVERAGE (MERRC) APPLICATION
This application is to be used when requesting approval for participation in the TVF&R MERRC program
in lieu of providing an in-building OFC 510 emergency responder radio coverage system
North Operating Center South Operating Center
11945 SW 70th Avenue 8445 SW Elligsen Road
Tigard, OR 97223 Wilsonville, OR 97070
Phone: 503-649-8577 Phone: 503-259-1500
Building Information MERRC FEE:
(Separate Application Required for Each Building)
Approved Fee Schedule (as of 1112015)
Business/Building Name: Dartmouth Crossing North First 0 -50,000 sq.ft. = $0.50 per sq.ft.
Additional sq.ft.from 50,001 - 100,001 = $0.30 per sq.ft.
For each sq.ft. over 100,000 = $0.10 per sq.ft.
Proposed Use of Building: multifamily residential affordable housing Example fee for 300,000 sf building:
First 50,000 sq.ft. x$0.50 = $25,000 +
6835 SW Clinton St 50,001 to 100,001 sq.ft.x$0.30 = $15,000 +
Address: 100,002 to 300,000 sq.ft. x$ 0.10 = $19,999
TOTAL= $59,999
City/County: Tigard OR 84,278
Total Square Footage:
Building Permit# tbd
50,000 SF x$0.50 = $25,000
Applicant Contact Information 34,278
SF x$0.30 = $10,283.40
Contact Person: Christian Cutul,Bora Architects
Phone: 503-802-5030 SF x$0.10 =
Email: cutul@bora.co
TOTAL MERRC FEE: $ $35,283.40
As an authorized representative for the above referenced building, I hereby request the building be permanently approved
under the TVF&R Mobile Emergency Responder Radio Coverage program as having an approved method of compliance
with Oregon Fire Code Section 510 and TVF&R Resolution 2015-09. If the application is accepted, I understand that full
payment of the calculated MERRC fee is required prior to completing the approval process. For construction projects under
a building permit, payment must be received prior to plan review completio , unless otherwise approved by the Fire Marshal.
Alma Flores, Director of Housing Development June 7 2022
Name &Title of Authorized Representative Signature Date
For Fire Marshal's Office Use Only
This section is for APPLICATION APPROVAL ONLY. This section is for FINAL APPROVAL ONLY.
Application Approved by Fire Marshal: YES or NO Payment Total:
Reviewer Name: Received By:
Reviewer Signature
Date:
Date:
Comments:
Comments:
Provide a signed, approved final copy to applicant.
Revised 1/2019