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Permit , III CITY OF TIGARD MASTER PERMIT a COMMUNITY DEVELOPMENT Permit #: MST2009 -00084 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/16/2009 Parcel: 2S104CD07200 Jurisdiction: Tigard Site address: 13533 SW BRIM PL Subdivision: HILLSHIRE ESTATES Lot: 72 Project: Steele Project Description: 768 sq ft addition. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 2 First: 38 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 1 Second: 384 sf Garage: 0 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $78,297.60 Rear: 15 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 2 Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 1 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'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'l Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: HVAC: Security Alarm: Vaccuum System: Garage Opener: All Other: Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) PITTS• JEREMY D & PINEHURST HOMES STEELE, TANYA L, 13533 SW BRIM P.O. BOX 3665 PL Tualatin, OR 97062 PHONE: PHONE: 503- 407 -1102 FAX: 503 - 336 -0437 Total Fees: $2,344.47 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 d- of issua -, or if work is sus.. -nded for more the 180 d s. ATTE : Oreg•- law requires you to follow the rules adopted by the Oregon Utility Ngtificati . C= er. Those rules - "set forth in OAR 952 -001- 010 thr•ugh OAR 9 -:11-0100 • may obtain a co. of the rules or direct questions to OUNC by calling ' :.•699 or 1.800.332 I /L J Issued • �� - Permittee Signature: Building Permit Application Residential R€CEWE L FOR OFFICE USE ONLY City of Tigard `'f g DateBya �/ f 9 C ( Permit No.: i tz, r( (�(N / r • 1114 I 13125 SW Hall Blvd., Tigard, OR 97223 Plan D Rev iew eBy: it Phone: 503.639.4171 Fax: 503.598.1960 MAR 19 2009 Lt -! - O9 ail Other Permit: Ti G }t U Ins Line: 503.639 � t+� Tt t� t� Date ReadyBy ( J uri 0 See Page 2 for Internet: www.tigard - or.gov CI 1 1 OF IGARD Notified/Me o H- ' 1 ' G ` `. 1 "7 4 ) Su pp Information RT11T.T)INGDIVISION s .. 1 • — L-- , TYPE OF WORK REQUIRED DA : 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. �¢ Indicate the value (rounded to the nearest dollar) of all 1"') Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 7-R / Zq 4-.60 xi 1- and 2 -famil dwellin Valuation: S l N I �O y g ❑ Commercial�ndustrial -7 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / '3 53 3 5 c, .,, ? C L E New dwelling area: ? (o $ square feet City/State/ZIP: e ,,, 6 2 ? 7 2 2 Garage/carport area: square feet Suite/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 REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: 72 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. Valuation: S H DD,.j4 12 7o CsF S,o D/' ,4 Existing building area: square feet New building area: square feet PROPERTY OWNER I ❑ TENANT Number of stories: Name: ;4,QY,a / - I - 7v az ■ P/ Type of construction: Address: /- S S w / .,2 , ,. p cA c. C Occupancy groups: City/State/ZIP: ![7 v,,1,2. , 6 Z 9 2 Z y Existing: Phone: ( cog) S a/ _i (., 0 s Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/ State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: ?,,,,g-,,..,,„ s 7 yon s S BUILDING PERMIT FEES* (Please refer to fee schedule) Address: g oi, 3 c.c., Structural plan review fee (or deposit): City/ State/ZIP: -7 ,� - / Q /l 5 70 ( a FLS plan review fee (if applicable): Phone: (Sos) d 07 —! /0z I Fax: (5 33G -n Y 3 7 ��,{{ r \ Total fees due upon application: P y 7'r CCB lic.: l `. (o l\' �R \O Amount received: i/-/,0,9, 97 Authorized signature: C This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: I y A") L A r- ,Grt.o i ,, Date: 3/, 7/d *Fee methodology set by Tn County Building Industry Service Board. 1: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB) Mechanical Permit Applic FOR OFFI( F USE ONLY City of Tigard � F'I D D Rev < 09 y i/ Y �� / Permit No.:� / �' .. g , ✓ • 13125 SW Hall Blvd., Tigard, OR 97223 Plan iew Phone: 503.639.4171 Fax: 503.598.18 1 9 2009 Date/By:1ef Permit: r , , ,/ /, I , Inspection Line: 503.639.4175 Date Ready/By: Jail 0 See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction $ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ c$ I - and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ Commercial /industrial ❑ Accessory b uilding For special information use checklist. ❑ Multi - family ❑Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: / 3 S3 3 cc,' 'X2 e ..-. ?tA C. E (requires site plan showing placement) / 14.00 City/ State/ZIP: Furnace 100,000 BTU ( ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) i 17.90 Suite/bldg./apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 r a 5 GH V I a � r ..", ( 7 t.AL S Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: '7 Z Flue/vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater _ 10.00 Gas fireplace 2.1 10.00 A0 p , ,.s ` /2 2 l TD L € F T 5 /41 or h'. Flue vent for water heater or gas fireplace 10.00 J %21s P cA L6 As G "i.,/ tar La i 1..4 A Log lighter (gas) 10.00 S to . ru /t ,t).., x A).*4 al /c 1404 t 2 t 6r Dvc r Wood/pellet stove 10.00 R. Wood fireplace/insert 10.00 l` c 1 ap. -+..5 PROPERTY OWNER ❑ TENANT Ot Chimney/liner/flue/vent 10.00 Other: 10.00 Name: * TA P.* y A , 7-'5. a. .„ y ?i 7 Environmental exhaust and ventilation Range hood/other kitchen Address: 3 ,. 3 Z S i.w /3 ? , -.-. P 4:48 L e " equipment 10.00 City/State/ZIP: T! (a A A 6 0,2 9 7 2 2 `/ Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (Co 3) 5-2 / - 1 t o el Fax: ( ) toilet compartments, utility rooms) `, 6.80 PS APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: Pinehurst Homes Fuel piping Contact name: Ryan Langhaim $5.40 for first four; $1.00 for each additional I Address: PO Box 3665 Furnace, etc. Gas heat pump City/State/ZIP: Tualatin, Or. 97224 Wall/suspended/unit heater Phone: (503) 407 -1102 Fax: : (503) 336-0437 Water heater Fireplace ,.. E -mail: Ryan @pinehursthomes.us Range CONTRACTOR Barbecue Clothes dryer (gas) Business name: RO7y /l C. Other: Address: /7 0 73 Or. / Z G S MECHANICAL PERMIT FEES* City/ State/ZIP: d 1lwt11 y Subtotal 7e y t p 2 �' 3 Minimum permit fee ($72.50) Phone: (Col ) 7(.4. Fax: (1 ) 2 Up - 3 y7 (?) Plan review (25% of permit fee) CCB lie.: / Y 600 State surcharge (12% of permit fee) 9j7 TOTAL PERMIT FEE I Authorized S] gnatu e7b„p,,1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. n ... •• � 114frc•1c C r,...,.. / 7/0 7 I * Fee methndnloev set by Tri- County Rnildinn Industry Service Board Plumbing Permit Applicatio� , Building Fixtures IICCCC FOR OFFICE USE ONLY City of Tigard MHR pp 9 2009 Received C n C Date/By: .^- / d /c k Permit No.: � ToD l . - D , ' ? , iillq • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review t3 Phone: 503.639.4171 Fax: 503.5 1 1 O OF TIG ARD Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: 1 Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Descri t tion • . Ea. Total A Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 _ 0 .1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: t 35- 3 3 s s -u fj.n , .-,-, t) L, L c Catch basin or area drain 16.60 City /State/ZIP: 1 .02 13 O / I -? 2 2 Li Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: -g aN rtI `/ S',,...j Manholes 16.60 Rain drain connector / 16.60 Sanitary sewer (no. linear ft.: I ) Page 2 Storm sewer (no. linear ft.: /00) ' Page 2 Subdivision: I Lot no.: "72 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 R a-0,04 S < <,,, C U f- 5 7,a , . /-4.4-r--(.- A,47d Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER 1 ❑ TENANT Drinking fountain 16.60 Ejectors /sump 1 6.60 Name: Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City /State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 4 APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: p,,„ S!-t i,,i t7 ,4 S Interceptor /grease trap 16.60 Contact name: 21,4„....) 4 .4,..1c y.4 ,. ----, Medical gas (value: $ ) Page 2 Address: ?,,D a ,, 3 G (o Primer 16.60 Ci City/State/ZIP: Roof drain (commercial) 16.60 ty r �,4 LA -7' ...3 0 2 7 7 a 2� Phone: (5'1,3 ) Yo? - //0 7 Fax:: ($ ) 3 3 L S cf 37 T u b show show 2.. 16.60 Tub /shower /shower pan 1 16.60 E -mail: ? ,„,\., ,`"",., 2, n _, c u.1 s 7� p .-r-, - S . > $ Urinal 16.60 CONTRACTOR Water closet i 16.60 Business name: /- rie4v .4..f 2 c 0,4,, b ? .., ,,, G Water heater 16.60 Address: 2 G b c, A- Si - Other: Subtotal City/State/ZIP: Fo 2 a s'7 G 20 t■� _,, o 2 97/1‘. r � - Minimum permit fee: $72.50 ...72 Phone: (303 ) 7, 3 _ iit3 3 % Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: / -7 4, Soo Plumbing Lic. no.: 3 s Plan review (25 % of permit fee) aQ State surcharge (12% of permit fee) / �- Authorized signature: . 7 --- i= - TOTAL PERMIT FEE Print name: 7---,e,,_, c7 <Dh, ti 5 -L Date: 3 ./l /C 9 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:\ Budding \Prnnits\PLMF- PermilApp.doe 12 /27/06 440- 4616T(10 /O2JCOM/WEB) Electrical Permit ApplicationRECEIVED FOR OFFICE USE ONLY _ City of Tigard Received '9 t'Q oo Permit sr t'_€ i )g 13125 • SW Hall Blvd., Tigard, OR 97223 MAR •19 2009 plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/B Date/By: Other Permit: T 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 7r ' ' 0 See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: ' / /G Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction l 'Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. - CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: / 35'3 3 S' (� al e 1 ( Six or or more residential R occupancy. rtion ❑ Six or more residential units. ❑Recreational vehicle parks. City/State /ZiP: A2 t7 2 / 2 2 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 42—, C 4.7° V . / � ��� t3 Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: '7 Z• 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 A- 4De,v L 24 u c. S A.- n s c,,, . c.H c-.4-3 S /6 AJDi7iv,,j residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with M APPLICANT I ❑ CONTACT PERSON above service or feeder fee, - 6.65 2 each branch circuit Business name: �/ uC 6/u.2 ST hlnt.e s S B. Fee for branch circuits without service or feeder fee, Contact name: p y,4,.1 1- A-ti f HAW. . first branch circuit 46.85 2 Address: p O � � x � G 46— Each add'I branch circuit 2, 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: , 4LA . o ? 9 704 Each manufactured or modular Fax: dwelling, service and/or feeder Phone: 90.90 2 (503) va7 - F ($ 3) 3 36 -6 ' 1 3 - 7 Reconnect only 66.85 2 E -mail: 2y ",,� pi", ir.e un t7flo..r+s S. u S Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: A--- 0 D/ q j< E L E C 1 /2 t G.. energy panel, alteration, or Address: 9 $ ( ✓� 5--6-- extension. Describe: Page 2 2 Sv 0,...y $` 14:t !� City/State /ZIP: S'4 L S . r �, 04 9 30 G. Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (S ) s s /_ / Z s`/ Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: ac:, / 996 Electrical Lic.: 4 t Suprv. Lic.: S! j'' S Industrial plant per hour 73.75 Z t/ s 2 $ - C ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: C6 ! S - Print name: Date: 3/ Plan review (25% of permit fee): i4 �s�2 3� r vO State surcharge (12% of permit fee): "?.�. Authorized signature: J OTAL PERMIT FEE: 4 This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\ Building \Pennits\ELC- PermitApp.doc 05/23/06 440- 4615T(t1/05 /COM/WEB .. Apr. 2). 20139 9:54AM No. 8346 P. 1 ''' CEIVED From:Amber r1 E (: f I U E ri1 I� � '2..-00C)(- CC) cE APR 1 7 2009 1[J CITY OFTIG Clean Water Services File Number 1 1 BUILI W 1 0 7- C)OO C 3 O 1 • By - sitive Area Pre - Screening Site Assessment • , 1. Jurisdiction: C / n, 176 4Z,a 2. Property Information (example 1S234A801400) - 3. Owner Tax lot ID(s): 7S' / p y ('0q,-ZpCI Name: T's /r."- Y ?,775 Company: Address: /5 3 3 S L, 13 „, , P(. Site Address: / 3533 S' B /2,,.., PL. City, State, Zip: 7 OA 9?22.4 City, State, Zip: 'Ti 4414.0 M 17 22 y Phone /Fax: 5 1-- S al .- /(60?) Nearest Cross Street: 11P,,,e.wp,a.,.v E -Mail: - 4. Development Activity (check all (ha( apply) 6. ApplicaiInformatIon CV to Single Family Residence (rooms, deck, garage) Name: k y ,4,J I- q,./ C H , q ,— Q Lot Line Adjustment ❑ Minor Land Partition Company: /) i,u b un_s 7 fin...., u 5 Q Residential Condominium 0 Commercial Condominium address: 1 (e B b 9 S' e P A vii- 1 g 1 Q Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial Multi Lot Commercial City, State, Zip: t:d�o� o S km C. 0 04 97 035 Other Ao0, ...%4 ' Ss t c ?F, Ctri'7 or Phone /Fax: 5 3 - YO -I/0 Z F- tV.�s>f • E -Mail: Ryes”) a) RAJ U5 6. Will the project involve any off -site work? %Yes 4No Q Unknown Location and description of off -site work 7. Additional comments or information that may be needed to understand your project This appllcatlon does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Pennits, 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, admowtedges 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 projec(.site. I certify that I am familiar with the information oonlained in this document, and to the best of my knowledge and belief, this information is true, complete, and accurate. Print/Type Na A..' 1.-401-04.4./ 4.• Print/Type Title Signature Date y / FOR DISTRICT USE ONLY Q Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OFA 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 SenslUve areas do nol 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 teller as required by Resolution and Order 07 -20, Section 3.02,1, All required permits and approvals must be obtained and completed under applicable trice', Slate, and federal law. Based on review of the submitted materials and best available information the above referenced project will not signtfrcenty impact the exlsUng or potentially sensitive area(s) found near (he site. This SersiliveArea Pre - Screening Site Assessment does NOT eliminate the need lo evaluate and protect addilionelweter quality sensitive areas If they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state and federal law. C i Thls Service Provider Letter is not valid unless CWS approved slte plants) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 919195 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQU . Reviewed by /� r y �� T`l � '~J �—� Date `] Z eq °.1i e. ,„, T4 . s.F tiSa . e r '-' .. ae- -3 I2 — 17* ry - r . ^ti.., } t .K.,-,f'-':0-:W.74• i � m 2550: SW Hill bnro Higlh y H 1 llc );..01 uin 7123, Y l 1)orio «O3) hil 101. AL � 13x ( rl'i )i' 1A •� :1 r l a ,ve,aliar �I V cos :o t ■ CITY OF TIGARD - SIT E LAN REV RECEIVED BUILDING PERMIT NO: " F 'O Street Tre es MAR 19 2009 Protected T es: Approved ❑ Not Approved PProv CITY OF TIGARD B : • • /... ❑ Not Approved ' ° es: MU ligaller 6 BUILDING DIVISION 0 e 1 CITY OF TIGARD - SITE PLAN REVIEW - ,, BUILDING PERMIT NO.: 1. i i i♦ ��SL17 J 3 PLANNING DIVISION: ''" '0 i I St Required Setb ks: ❑ Approved, ❑ Not Approved _ " -' c E 1 Tr Side: Street Side: ts - n Front. � Garage: 24) Rear: v` co ki ■ / isual Clearance: ❑ Appr ved ❑ N- pproved °"" k"' ' ' aximum Building Height feet 4 II i .. Service Provider Letter Required: ❑ Y s ❑ No ; R ceived " o e Date: 3 •' MAR §' ' ±. NN:i;INEERIN D PARTMENT: Actual Slope:% ❑ Approved ❑ N t ApprVed'� - '�' J � D q Ill Site PI: pp • ❑ N 't Appr ''\ „---- y` i B • /_ _1_,- late _ NOI��,; a� ■ ■ t :n W Q cam Rai: o w R ilL 10_ , iii ji , (4 / Lt ,1 100 s ZZ al> ‘r PLAN Q use AMMO. MU all OM PLAct �I! .0 / LOT 12 ,1•110/421 ID. Yaws:. CI 111,46 Marta+ cowry, 011110014 maw © — Alai % 1