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Permit (140) RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 1 2019 .11 " Req uest for Permit Action crry of ;-tGAl D TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tiAlWiNG DIVISION TO: CITY OF TIGARD g ta) Building Division P/c /f c7" 13125 SW Hall Blvd.,Tigard, OR 97223 �/� Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant © Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) 8 Inch Nails Construction Inc. Mailing Address: 7823 SW Cedarcrest St City/State/Zip: Portland OR 97223 Phone No.: 503-453-0786 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. ✓n REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit #: MST2018-00338 Site Address or Parcel #: 13490 SW Genesis Loop Project Name: Burdett Subdivision Name: Lot #: EXPLANATION: Homeowners had to use funds elsewhere- hope to move forward when legal proceedings are over and funds are recooped. Signature: Joshua Farrand Date: 07/15/2019 Print Name: Joshua Farrand Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. _rya, // ..- `/33, GIP _ foe rf -, (,sc OS. -- 5-2.o f /3 - 0/ .3Sy• 90 — 35 90 96.2• a6 F 0 .6,3 / /, 1"3 • FOR OFFICE USE ONLY Route to Sys Admin: Date '1- ll4 \C By S\'r- Route to Records: Date f.7 By 4/4 Refund Processed: Date d/.2 /f By Ziav Invoice Processed: Date By Permit Canceled: Date /P-/j 9 By,c1AV Parcel Tag Added: Date By I:\Building\Forms\RegPerrnitAction_12051 .doc II a TIGARD City of Tigard August 9, 2019 8 Inch Nails Construction Inc. 7823 SW Cedarcrest St Portland, OR 97223 Re: Permit No. MST2018-00338 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13490 SW Genesis Lp Project Name: Burdett Job No.: N/A Refund Method: Check#232893 in the amount of$840.63. Credit card "return" receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ . Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, .. ...&.-Th Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov I City of Tigard T l cf A Ei D Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: 8 Inch Nails Construction Inc. DATE: 8/2/2019 7823 SW Cedarcrest St Portland, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 420722&420920 Case#: MST2018-00338 Date: 12/11/2018& 12/27/2018 Address/Parcel: 13490 SW Genesis Lp Pay Method: CreditCard Project Name: Burdett EXPLANATION: Per applicant's request as customer canelled job. Refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Building Permit 230-0000-43104 $433.69 12%State Surcharge 100-0000-24001 52.04 Tig-Tual School CET 230-0000-24102 354.90 TOTAL REFUND: $840.63 APPROVALS: SIGNAL TJIt ES DAT : If under$5,000 Professional Staff `�/(/ If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: r:ty 7,/,Z/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 II CITY OF TIGARD RECEIPT i it 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: BURDETT Site Address: 13490 SW GENESIS LOOP Receipt Number: 436078 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2018-00338 $-433.69 Total: $-433.69 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232893 DHOWSE 08/27/2021 $-433.69 Payor: 8 Inch Nails Construction Inc Total Payments: $-433.69 Balance Due: $433.69 Page 1 of 1 CITY OF TIGARD RECEIPT I 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: BURDETT Site Address: 13490 SW GENESIS LOOP Receipt Number: 436079 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2018-00338 $-406.94 Total: $-406.94 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232893 DHOWSE 08/27/2021 $-406.94 Payor: 8 Inch Nails Construction Inc Total Payments: $-406.94 Balance Due: $840.63 Page 1 of 1 CITY OF TIGARD RECEIPT al • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T[GARD Project Name: BURDETT Site Address: 13490 SW GENESIS LOOP 461 /ZiG/�/�� Receipt Number: 420722 - 12/11/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2018-00338 Building Permit-Additions,Alterations, 230-0000-43104 $452.87 Demolition MST2018-00338 Plan Review 230-0000-43106 $352.37 Total: $805.24 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 211180 BTAGGART 12/11/2018 $805.24 Payer: Alissa Ricci Total Payments: $805.24 Balance Due: $0.00 ysa . 6F. 7 Fy . .� // Pace 1 of 1 CITY OF TIGARDIII RECEIPT : ' • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIc,ARD Project Name: BURDETT Site Address: 13490 SW GENESIS LOOP Q 72 / c/,V6zz_- Receipt Number: 420920 - 12/27/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2018-00338 Building Permit-Additions,Alterations, 230-0000-43104 $89.24 ¢ Demolition MST2018-00338 12% State Surcharge-Building 100-0000-24001 $65.05 F MST2018-00338 DC Provision Review, SF-Ping 100-0000-43112 $98.00 MST2018-00338 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $26.00 11x17) MST2018-00338 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $12.50 11x17) MST2018-00338 Tig-Tual School CET-Residential 230-0000-24102 $354.90 'e-- Total: $645.69 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 271218E3C-EB7, PUBLICUSERO 12/27/2018 $645.69 Payor: Joshua Farrand Total Payments: $645.69 Balance Due: $0.00 Pan. 1 of 1 CITY OF TIGARD MASTER PERMIT lig ■ COMMUNITY DEVELOPMENT Permit#: MST2018-00338 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/27/2018 T t i',A I.C� 9 Parcel: 2S103DB02500 Jurisdiction: Tigard Site address: 13490 SW GENESIS LOOP Subdivision: GENESIS Lot: 1 Project: BURDETT Project Description: 325 sq.ft. living room addition. Converting existing living room to a bedroom and remodeling kitchen. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 1 First: 273 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: Yes Total: 273 sf Value: $32,336.85 Rear: 0 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 Water Lines: 0 Drains: 0 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 Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 273 Owner: Contractor: BURDETT,BRIAN&MELISSA M 8 INCH NAILS CONSTRUCTION Required Items and Reports(Conditions) 13490 SW GENESIS LP 7823 SW CEDAR CREST ST TIGARD,OR 97223 PORLAND,OR 97233 PHONE: PHONE: 503453-0786 FAX: Total Fees: $1,450.93 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. Thos- ules are set forth in OAR 952-001-0010 through OAR 952-001-0090. may obtain a copy of the rules or direct questions to OUNC by calling 50 .2 0987 or -:...332.2344. Issued By: Permittee Signature: / Call 503.639.4175 by 7:00 a.m.for the next available inspection •ate. ," 7(:; 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 1,0 IZ 0111("1. 1 51 0\11 City of Tigard '°-wed Permit No.: Iiii 13125 SW Hall Blvd.,Tigard,OR 97223 RECEIV "• `�y /�I 1/ i �"'fr� 1`� U' . Review ` I Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 DateBy: 17, ( (� i-I C,A tt t) Inspection Line: 503.639.4175 i1 CC( q, f� Date ReadyBy: rug: ® See Page 2 for Internet: www.tigard-or.gov I)E t 1. 1 2018 No. . etho•9 , 7 / Supplemental Information ��III TYPE OF WORK CITY OF T `�A±i I, RE/IRED DATA:1-AND 2-FAMILI WELLING ❑New construction 0 DellaLD1 G DIVISION ISION 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 fo the CATEGORY OF CONSTRUCTION work indicated on this application. '52. S'S Mr1-and 2-family dwelling ❑Commercial/industrial Valuation: ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: ( 34iqQ 5UV h SOS ad New dwelling area: 2.7... square feet.2 City/State/ZIP: 116 Q3--- ((-122,--S Garage/carport area: square feet Suite/bldg./apt.no.: Project name: ` ug-30C Covered porch area: square feet Cross street/directions to job site: 111 ,96 -i!''11 ) .t,\ Deck area: square feet fV' 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. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DP i- } i DESCRIPTIONS / OF WORK work indicated on this application. ' n t)P C. 1 f 1/f l\ iz , C6'{'i Valuation: $ c51,(s n NO O Gt VI i Existing building area: square feet 1 ��1� 1`^-- V New building area: square feet ErPROPERTY OWNER 0 TENANT Number of stories: Name: Wl lA.lv .Y Ha/rya— 14 Type of construction: Address: 4.,0 SAN c r l S LOOP Occupancy groups: City/State/ZIP:----13 MU) QQ_ 61-7`2-1Z> Existing: Phone:(IP—SI 257 r 1 Li 7 Fax:( ) New: 0 JAPPPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: 5S t AUL l 1) (d y rr..tic-i t p i 1 Structural plan review fee(or deposit): Contact name: ,i� J k �ca,,A N�}`J Address: 7c62 $VJ w v�WL FLS plan review fee(if applicable): Total fees due upon application: City/State/ZIP:- \ 3O 4172' .-3 ��J Phone:(503) 1-1c3- -7Fax::( ) Amount received: E-mail:Ell (t )L e-Y-.l `t� '' \ \ 0-``�A -(W,(01 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: U NW- N tL� (o-l\ I—oV t 1\ Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 722, ` ,, cct t of ' -- 11 Jf Solar Installation Specially Code checklist. City/State/ZIP: 'phi - ',2"Z,. Permit Fee(includes plan review $180.00 and administrative fees): Phone:(Y7.3) (:-/- --ci Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: \(Act et a Total fee due upon application: $201.60 Authorizedsignature: This permit application expires if a permit is not obtained ��"��'""" within 180 days after it has been accepted as complete. Print name: A ,6L5(2 u.,C. I Date: 11 (4, L ( vi *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1l/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFF I('E I ()Nil iihCity of Tigard Received Permit No.: 14 13125 SW Hall Blvd.,Tigard,OR 97223 A ssoci Date/B : Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: Ti(.AKD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard-or.gov ❑ Other: '1711: FOLLOWING ITF.NIS ARF; REQUIRED FOR PLAN REVIEW tics No Ni' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ ■ • 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0 3 Verification of approved plat/lot. 0 0 ❑ 4 Fire district approval required. Name of district: • 0 0 ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . 0 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 ❑ 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 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 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 ❑ ❑ 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 ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 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 ❑ over 10 feet long and/or any_beam/joist carrying a non-uniform load. 20 Manufactured-floor/rootTruss design details. —_ ❑ --❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematie-is required 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 ❑ ❑ architect licensed in Oreton and shall be shown to be a•ilicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ 0 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. ❑ 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 ❑ 0 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ 0 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ 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 on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) RECEIVED DEC I 1 2018 Clean Water Services File Number CITY OF` '1AttD CleanWater\ Services 18-003614 UILDING BMS Area Pre-Screening Site Assessment 1. Jurisdiction: Tigard 2. Property Information(example 1 S234AB01400) 3. Owner Information Tax lot ID(s): Name: BRIAN&MELISSA BURDETT 2S103DB02500 Company: Address: 13490 SN GENESIS LOOP Site Address: 13490 SA/CBVE9SLOOP City,State,Zip: 11GAFD,OR,97223 City,State,Zip: ¶rAIRD.C 97223 Phone/Fax: 503-332-1482 Nearest Cross Street: SN GAARDE AND SN 115TH E-Mail: MEUSSABUFDETf@HOTMAIL ODM 4. Development Activity(check all that apply) 5. Applicant Information [ Addition to Single Family Residence(rooms,deck,garage) Name: AUSSA FICC ❑ Lot Line Adjustment ❑ Minor Land Partition Company: 8 INCH NAILSOONStFUCTION INC ❑ Residential Condominium ❑ Commercial Condominium Address: 7823 SN MAI:CREST ST ❑ Residential Subdivision ❑ Commercial Subdivision CI Single Lot Commercial La Multi Lot Commercial City,State,Zip: 97223 Other Phone/Fax: 503-860-2186 E-Mail: AUSS4@EHG111NCHNAILSCOM 6. Will the project involve any off-site work? ❑Yes I )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 Al-WA FRCO Print/Type Title OWNER ONLINE SUBMITTAL Date 11/30/2018 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 17-05, Section 3.02.1. 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 07-20,Section 3.02.1. 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 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 ,Q / Date 12/5/18 2550 SW Hillsboro Highway • Hillsboro Oregon 97123 • Phone (50'O 681-5100 • Fax '503)6804439 • novel cle.anv✓aterservices.org City ofTigard q COMMUNITY DEVELOPMENT DEPARTMENT 11111 f l ct n Building Permit Review — Residential Building Permit #: /74 5/ / —00,K , Site Address: /32,9(� �.01,ai S Loop Project Name: itStirdelI Atittli2by_ Lot #: (New dwelling=subdivision name;Ad tion or Alteration=last name of owner) Planning Review / -h Proposal: s/' a/ gre; �v i._ �,1I r-� ® t) n2G /770- . J on n9-- c { Verify site address/suite#exists and active permit system. jiver Terrace Neighborhood: 1✓f No ❑ Yes,See River Terrace Review Addendum Attached Sit Plan Elements: ree(3)copies of site plan LIdE f itng structures on site ?10 to plan must be on 8-1/2"x 11"or 11 x 17"paper ootprint of new structure(including decks)with finished rawn to scale(standard architect or engineer scale) floor elevations .rth arrow 4 i 'ty locations&easements(required for new and additions) TA Si address,project or subdivision name and lot numberSidewalk/driveway approach .licant information(name and phone number) w�:, ation of wells/septic systems It .t dimensions and building setback dimensions Lro Existing trees to be retained with drip line,and tree I +uare footage of buildings to be demolished protection measures OKarea,building coverage area,percentage of coverage and I y'i,eet tree size,type and location pervious area(applicable if R-7,R-12,R-25&R-40) Y.Street names PI roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes 4 4 foot differential) If yes,is a storm water quality facility shown? ❑Yes Too 0 Clean Water Sfivices—Service Provider Letter(lot platted prior to 9/10/1995): Required: Yes,applicant was notified E No Received: ❑ Yes IlKo 'ublic Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified No Applied For: Cl Yes ❑ No,stop intake tand Use Case#: /Zoning: ,e- L/.S-- MJ Required Setbacks: Front p�O Rear1„*. Side Street Side AS Garage 40 g1kandscape Requirement: 43 ! 0/0 i of Coverage Maximum: In Building Height: Maximum Height 3 c) Actual Height / -- N�� isual Clearance LYA Sensitive Lands: 1q Yes ❑ No Type kat?--1,64a 4;246i— u o Urban Forestry Plan •nditions "Met" rior to issuance ance of building permit Notes: ❑ Approved By Planning: Date: ,b/2///c Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw REs 061417.docx 1 Building Permit Submittal // Original Submittal Date: l-f/l!6 U Site Plans: # Building Plans: # 5 Building Permit#: Or =nter building permit#above. Workflow Routing: P! lanning Engineering Permit Coordinator wilding Workflow Sign-off: �- Sign-off for Planning(include notes from planning review) Route Application Documents: P Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: / r By Permit Technician: /i, ,A4 /� , fL1i( i Date: i En ineering Review a V/Slope at building pad: 1f 1f�a re onditions "Met"prior to issuance of building permit Ld asements (encroachments)per engineering conditions of approval and plat Ltd' Water Quality/Quantity Facility: A4/4 Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes CI No /LIDA Facility on lot: ❑ Yes ❑ No Final Plat Recorded: ❑ NOT Approved by Engineering: Date: Notes: I Approved by Engineering: ."7r 9 Date: a a/Jr" Revisions (after Building Submittal nly) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved El Not Approved Permit Coordinator Review RA-Conditions "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: Revision Notice 3: Date Sent to Applicant: XSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes q.N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes 4 N/A LIDA ❑ Yes 1 N/A IN;OK to Issue Permit Approved by Permit Coordinator: k8„4 d°` Date: 12`6 l {, I:\Building\Forms\B1dgPennitRvw_RES_010118.docx