Permit CITY OF TIGARD MASTER PERMIT
lily- u
COMMUNITY DEVELOPMENT Permit#: MST2017-00158
Date Issued: 07/18/2017
Tic AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r ° Parcel: 2S111BD01513
®®/7 el- Jurisdiction: Tigard
Site address: 14980 SW 100TH AVE
Subdivision: ALDERBROOK FARM Lot: 6
Project: KNEZ
Project Description: 1,288 sq. ft. addition to backside of property. Trade work under separate permits.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 1288 sf Basement: sf Left: 5 Parking Spaces: 0
Height: 25 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors:
Total: 1288 sf Value: $145,093.20 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 RainStorm Sewer: 0
0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell-Trench Drain: 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
Ecompasing: N
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 1288
Owner: Contractor:
KNEZ,JOHN S JR&VICKI L RENOVATE INC Required Items and Reports(Conditions)
14980 SW 100TH AVE 8425 SW CHARLOTTE DR 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224 BEAVERTON,OR 97007
PHONE: PHONE: 503-502-0323
FAX: 503-356-2338
Total Fees: $4,939.55
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 ma obtain a co ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued By: ..... - �� Permittee Signature: 2 6T7�
Call 50 . 39.4175 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.
CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2017-00158
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 07/18/2017
TIa.^�R. s 9
Parcel: 25111 BD01513
Jurisdiction: Tigard
Site address: 14980 SW 100TH AVE
Subdivision: ALDERBROOK FARM Lot: 6
Project: KNEZ
Project Description: 1,288 sq. ft. addition to backside of property.Trade work under separate permits.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 1 First: 1288 sf Basement: sf Left: 5 Parking Spaces: 0
Height 25 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: 1288 sf Value: $145,093.20 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 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Drains: 0
9Water 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'I 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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 1288
Owner: Contractor:
KNEZ,JOHN S JR&VICKI L Required Items and Reports(Conditions)
14980 SW 100TH AVE 1 Ersn Cntrl 503-639-4175
TIGARD,OR 97224
PHONE: PHONE:
FAX:
Total Fees: $4,939.55
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other -.plic.'le 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 uspen.ed for more the 180
days. ATTENTI N: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos- rules -re set forth in OAR
952-001-0 through AR 95 - 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: %.• . 2. .44.
Issued : 1 Permittee Signature: _ ' h i
Call 603.639.4175 by 7:00 a.m.for the next available inspection date.
f r-
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
Residential ,� r FOR OFFICI. 1 SF.011.1
City of Tigard ue, 1":"'' Received �' Permit No.: (
. Date/By: i /7 /47,,r_ >/ ,20
17 WCL,
13125 SW Hall Blvd.,Tigard,OR". Plan Review
C Phone: 503.718.2439 Fax: 503.''8.1960 1 20 Date/BY: S•'9 , 17 Other Permit:
T 1 C A K D Inspection Line: 503.639.4175 �� Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov � ` ik� �y Notified/Method:6,tit/f'/ i7 J I Supplemental Information
0 GO" 0w ,1- ,Lcci 11(' )cei^cc,2
TYPE OF i i ',,%1N REQUIRED DATA: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
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
�
- CATEGORY OF CONSTRUCTION work indicated on this application.
211-and 2-family dwelling ❑Commercial/industrial Valuation:
r
❑Accessory building 0 Multi-family Number of bedrooms: "" 11 1
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ) �i Qrg 4 ,04e) New dwelling area: raLI _1 uare feet
City/State/ZIP: 71l4 (I/� �''�''�Vvv��Y ' / G �a�_j`; +' _�nT'� square feet
7...
Suite/bldg./apt.no.: Project name: kv v`.A Covered porch area: square feet
Cross street/directions to job site: p, �l' l 4jDeck area: gi square feet
�x '''S`t „ ' �{� t ° f.l -i Other structure area: square feet
,% :► t ,..' a' REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ' ' ¢l0 Lot no 77:›10.
. Permit fees*are based on the value of the work performed.
Tax map/parcel no.: i" •1 , . , - - dicate the value(rounded to the nearest dollar)of all
{ +l`►.` r° ' ' equipment,materials,labor,overhead,and the profit for the
�'fDDESCRIPTION OF WORK� ,daggifil.work indicated on this application.
�P01I t ' f t6/ v 1 14.,„„)..)53-e,
�J4 73 , Valuation: $ (2f, 6
Existing building area: Gl square feet
New building area: f square feet
❑ PROPERTY OWNER 0 ENANT Number of stories:
Name: V/eVe,j Kr\i -, Type of construction:
Address: Q /� g� j
4 /_ Occupancy groups:
City/State/ZIP: , Existing:
Phone:co 1 J r Qr^f� Fax:( )
Q New:
0 APPLICANT ONTACT PERSON BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
f A-(&A W` , Structural plan review fee(or deposit):
Contact name: (/� 4!�
FLS plan review fee(if applicable):
Address:
l f
t
Toaees due upon application: y�
3,/ 7. 044City/State/Z1P:
Phone:( e 6. ' 7i..67 )3 Fax::( ) Amount received:
E-mail: 1 A.ej„, 1g1✓B)6,6, /tGi6l2190 l�r�N,L,, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR!I 1 Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: /�/ /� (.• Submit two(2)sets of roof plan with connection details
4 / ' L ! p - and fire department access,along with the 2010 Oregon
Address: 2,2,, il\/ (�fr' � Solar Installation Specialty Code checklist.
City/State/ZIP: �`'r 6t.--• 7,-
6 a Permit Fee(includes plan review $180.00
�6� and administrative fees):
Phone: lZ ?j• .3 �3 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 1 tet d Q Total fee due upon application: $201.60
authorized/signature: �/ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as
1�/ p f *Fee methodology set by Tri-County Building In(
't name: '1/` � 4 YV Date:5 I i T Service Board.
ding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling ro lz 01 i lc is LSI. ()Nil
City of Tigard Received
Permit No.:
13125 SW Hall Blvd.,Ti ard,OR 97223
g Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175
0 Electrical 0 Plumbing 0 Mechanical
T I G A R D Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW' 1u \o y/.'
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ E o
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 'Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
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
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
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 0 0
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.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0 0
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- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
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 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Ore on and shall be shown to be a licable to theproject under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. A A 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings ff
on a lot of record approved prior to September 9, 1995. I
uilding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
M COMMUNITY DEVELOPMENT DEPARTMENT
■
T I G A R D Building Permit Review — Residential
Building Permit #: //2,54-??4)/ 7_ (yj1 -g
Site Address: /4F30 &&) /O OM ,
Project Name: b2€ Ji icn%._ Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review I ag e
Proposal: A,14,0 Sgi
Vr?ierify site address/suite#exists and active - permit system.
river Terrace Neighborhood: No CI Yes,See River Terrace Review Addendum Attached
Si Plan Elements:
ree(3)copies of site plan 'sting structures on site
e plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
awn to scale(standard architect or engineer scale) fl.or elevations
orth arrow to I t.*ty locations(required for new,may apply for additions)
�te address,project or subdivision name and lot number P 1 °.<tion of wells/septic systems
pplicant information(name and phone number) /,Existing trees to be retained with drip line,and tree
�.t dimensions and building setback dimensionsprotection measures
! area,building coverage area,percentage of coverage and 0 et tree size,type and location
• pervious area(applicable if R-7,R-12,R-25&R-40) Street names
L Property corner elevations(2 foot contour lines if more than
4 foot differential)
❑ Clean Water ervices—Service Provider Letter(lot platted prior to 9/10/1995): /No
Required: Yes,applicant was notified ❑ No Received: CIYes
ia ublic Facilities Improvement(PFI) Permit
Required: ❑ Yes,applicant was notified l 1 No Applied For: ❑ Yes ❑ No,stop intake
11 1,and Use Case#:
Neq
ing: off', S.C.
uired Setbacks: Front c:Q 0 Rear1� Side � Street Side �� Gara e Q
0
9 fk,ands cape Requirement:
0 riot Coverage Maximum:
rl Building Height: Maximum Height �5 () Actual Height /--
J isual Clearance
1asements
' nsitive Lands: ❑ Yes ❑ No Type
ban Forestry Plan
nditions "Met"prior to issuance of building permit
Notes:
Approved By Planning:
o, Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPermitRvw RES 091216.docx
Building Permit Submittal
Original Submittal Date: Si/ / 7
Site Plans: #
Building Plans: # _ `3
Building Permit#: nter building permit#above.
Workflow Routing: arming 0'r ngineering 11"1'ermit Coordinator tJiiutiding
Workflow Sign-off: gi.--� �--off for Planning(include notes from planning review)
Route Application Documents: �YEngineering: (1) copy of permit application, (1) site plan, (1) building plan and
o .nal plan review routing form.
[ 1uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: VO
By Permit Technician: Date: 4,A)
�_ >, ..
ss'�"" `.. '^.F�m." so-_ .14' �.� "5£` 'r" .. ,.� � .!.,
Engineering Review
�,Siope at building pad: 44:1
Conditions "Met"prior to issuance of building permit
lir sements (encroachments)per engineering conditions of approval and plat
itaX-
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Xi-No
Assess Water Quantity Fee in-lieu: ❑ Yes CJ No
.* LIDA Facility on lot: p'Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes: b/D4 /6174,:}fiefi
Approved by Engineering: f�z ci) Date: q:?_,„" 7
Revisions (after Building Submittal only) /Reviewer t Date
Revision 1: Approved CI Not Approved (.�tr, ,5 i.►', 4 --13 1 7
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Permit Coordinator Review
0 Conditions "Met"prior to issuance of building permit1#1/F-'-'----------
?*(46i
pproved,NOT Released: /4/D/4^ 47.144.4.4.1-
vu
�c !Yn
,, 'eta t e: S
��P/� �
Notes: / .' )+`L `�wk � ��
r�
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
rDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes /A
Tigard Trans SDC: 0 Yes ,' N/A
Parks SDC: ❑ Yes N/A
.0000.47,-,% to Issue Permit 4.,/1)4,--
pproved by Permit Coordinator: P' Date:
/9"/K b/31/. ----
I:\Building\Forms\BldgPermitRvw_RES 091216.docx
�,. Clean Water Services File Number
17-001536
C leanVv ter Services
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: Tigard
2. Property information(example 1S234A801400) 3. Owner Information
Tax lot iD(s): 2S111BD01513 Name: John Knez JUL 1 8 2017
Corneas:. GlTY(�F 7VleiAFfL)
QB Site Address: 14980 SW 100th Ave Cddresat Same as Site Addr+e: U I LL)l N to !V(S[(.)del
City,State,Tip:
City,State,Zip: Tigard,OR 97224 Phone/Fax; 503-3814497
Nearest Cross Street E-Mail:
4. Development Activity(check all that apply) 5. Applicant information
Q Addition to Single Family Residence(moms,deck,garage) Name: Michael Sawyer
Q Lot Line Adjustment O Minor Land Partition Company; Renovate,Inc
Q Residential Condominium Q Commercial Condominium Address: 8425 SW Charlotte Dr
O Residential Subdivision O Commercial Subdivision
O Single Lot Commercial Q Multi Lot Commercial City,State,Zip: Beaverton,Or 97007
Other Phone/Fax: 503-502-0323
E-Mail:kris'iat�n3novateincorporated.cx,m
6. WIIl the project involve any off-cite work? Q Yes a No Q 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 Centre!Permits,Connection Permits,Building Permits,Site Development Permits,
DEO 121BhC Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands and/orDepar6ment 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,acknowledgesemployees of Clean Water Services have authority to enter
the project sheat all reasonable times for the purpose � �alms that
of inspecting project site conditions and gathering information related to the project site. I certify that b am
familiar with the information contained in this document,and to the hest of my knowledge and belief.this information We,comrade,and accurate.
Print/Type Name Mich el Prfntflype Title
Signature
Dab 511/17
FOR DISTRICT USE ONLY
CI Sensitive areas potentially exist on site or within 200'of the site.THE APPUCANT MUST PERFORM A SITE ASSESSMENT PRIOR TO OMANi;E OF A
SERVICE PROVIDER LETTER. It Sensitive Arms exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report rimy 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 veterquality sensitive areas if they are subsequently di red.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.
XBased 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 Sle Assessrner t 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 07-20,Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal lir.
❑ This Service Provider Latter is net valid unless CWS approved site plans)are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 919/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE
PROVIDER 1t r f tH IS REQUIRED.
Reviewed by e Date 5/9/17
Once complete,email to:SPLReviewecleanwaterservlces.org • Fax:(503)681-4439
OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro,Oregon 97123
.est
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14980 SW 100TH AVE, TIGARD, OR, 97224 June 4, 2018 at 7:45:19 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00158
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
No plumbing on this permit.
Trade work under separate permit.
PLM 2017-00284
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14980 SW 100TH AVE, TIGARD, OR, 97224 June 4, 2018 at 7:43:51 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00158
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
No electrical on this permit.
Trade work under separate permits.
ELC 2017-00724, ELC 2018-00008
Violation Summary:
Inspector Contractor