The URL can be used to link to this page

Permit (155) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT (617j//f Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov HLUL-IVD TO: CITY OF TIGARD Building Division OCT 1 2019 13125 SW Hall Blvd.,Tigard,OR 97223 .w,Y OF j WD Phone: 503-718-2439 Fax: 503-598-1960 Ti ardBuildin Pe or FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) !(�72! c , Ski.cer- Mailing Address: l q c7U) i h nc74n City/State/Zip: L `Jac . de___ Ql ;�-3 Phone No.: �� (� c/5- —55 76/g- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit #: / )5 l 9—ax)Li -' Site Address or Parcel #: l 7 gO c3 3; 4374` ! ar4c/2 92;23 Project Name: She. e,r-Adeftitio Subdivision Name: /dQenidef Lot#: EXPLANATION: det cei/ud /v 5T vv 1z ,y-2„ ,✓. aiA- 14 // ff ., l),5L /-/_S r �-1 / Vic. S�WJL :( ,� -�,/ .r..,7� /v?5-7 c )1 '-cv364. Signature: /(P �� Date: /0 -/ •-/`I Print Name: ill SE � ��1 e.-a-r-e.r 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 post servic N 6 3. Please allow 3-4 weeks for processing refund requests. - y/ 'sz. oy - 4,C/ . 4.3 i �o .�.y _ 7�. /g /P. os �a z, sce(vc.'c s7 e, 1:()it OFFICI: USE ONLY Route to Sys Admin: Date /0 / I 1 By , 7 Route to Records: Date P '_)7 / B •1 Refund Processed: Date fp 3 /y B Invoice Processed: Date By Permit Canceled: Date/d �/eT 'l'� Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 0 8.doc I1 S . TIGARD City of Tigard October 11, 2019 Emmet& Elise Shearer 9980 SW Johnson St Tigard, OR 97223 Re: Permit No. MST2019-00044 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9980 SW Johnson St Project Name: Shearer Job No.: N/A Refund Method: ® Check#233589 in the amount of$1,247.12. ❑ Credit card "return"receipt in the amount of$ 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 to cancel permit as scope of work changed and was resubmitted under MST2019-00368. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 1(9 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 _ " City of Tigard T[G A R 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: Emmet&Elise Shearer DATE: 10/4/2019 9980 SW Johnson St Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 421723 Case#: MST2019-00044 Date: 2/25/2019 Address/Parcel: 9980 SW Johnson St Pay Method: Check Project Name: Shearer EXPLANATION: Per applicant's request to cancel permit as scope of work changed and resubmitted under MST2019-00368. 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 Fee 230-0000-43104 $601.63 12%State Surcharge 100-0000-24001 72.19 Tig-Tual School CET 230-0000-24102 573.30 TOTAL REFUND: $1,247.12 APPROVALS: SIGNATURES/DATE: 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: .1/..)7/a-/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 71 CITY OF TIGARD RECEIPT II{ 13125 SW Hall Blvd.,Tigard OR 97223 r�, q 503.639.4171 If G it R.D Project Name: SHEARER, Site Address: 9980 SW JOHNSON ST /J>\ Receipt Number: 436101 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2019-00044 $-1,247.12 Total: $-1,247.12 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 233589 DHOWSE 08/27/2021 $-1,247.12 Payor: Emmet& Elise Shearer Total Payments: $-1,247.12 Balance Due: $1,247.12 Page 1 of 1 CITY OF TIGARD RECEIPT I . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: SHEARER, Site Address: 9980 SW JOHNSON ST ii/21 4/11797--- Receipt Number: 421723 - 02/25/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER 2.v7-u^f- PAID MST2019-00044 Building Permit-Additions,Alterations, 230-0000-43104 P-a 9e $752.04 Demolition MST2019-00044 12%State Surcharge-Building 100-0000-24001 Fa le $90.24 <--.__ MST2019-00044 DC Provision Review, SF-Ping 100-0000-43112 $98.00 MST2019-00044 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $6.00 11x17) MST2019-00044 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $7.50 11x17) MST2019-00044 Tig-Tual School CET-Residential 230-0000-24102 /ot 70 $573.30 At— Total: $1,527.08 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 9042 JDRINKWATER 02/25/2019 $1,527.08 Payor: Emmet& Elise Shearer Total Payments: $1,527.08 Balance Due: $0.00 Page 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action l I G A R D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD RECEIVED Building Division RECEIVED C 13125 SW Hail Blvd.,Tigard,OR 97223 SEP 11 2019 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuiidingPermits@tigard-or.gov FROM: Owner Applicant ContractorCITY OF TIGARD ❑ pp ❑ El �1LfG DIVISION Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) ai``6e. 6 1-tie4stz Etz... Mailing Address: Ci C180 6i.4 3 i o.J 5'r City/State/Zip: M4 5AJ D , OQ• 1`122.3 Phone No.: 5'03 4.2.0 'i 41 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. lir REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR PEES DUE(attach case fee schedule and provide explanation below). Perrriit#: \dT 0 1c1 - 000.441 Site Address or Parcel#: l 9 5 t J ..Sc)1-kNi6oi--.: ►`. Project Name: 'J .(2 Ac, -2•S10$B e13oo Subdivision Name: Lot#: t300 EXPLANATION: L04114•4 4 E 1 g•l ‘SG.ofC— c od•k o.4E. •s-tt�cz-,�- . 1�F GJ,v Tcr e a. Eca T t;Lt4: 677 - Signature: C Date: c1 - l 1 - l cl Print Name: gr> 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. • l'1ot 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. Route to Sys Admin: Date VT, ,q By 7 Route to Records: Date By Refund Processed:, Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\ReyPemritAction_120518.doc CITY OF TIGARD MASTER PERMIT N ■ COMMUNITY DEVELOPMENT Permit#: MST2019-00044 Date Issued: 02/25/2019 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 T t c_, IF.ng Parcel: 2S102BB01300 Jurisdiction: Tigard Site address: 9980 SW JOHNSON ST Subdivision: NORTH TIGARDVILLE ADDITION,AMENDE Lot: 16 Project: SHEARER, Project Description: Two story home addition to include(1)bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 288 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 17 Bathrooms: 1 Second: 153 sf Garage: 0 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 441 sf Value: $52,236.45 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 Drains: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 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'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: ALT SF VB R-3 441 Owner: Contractor: SHEARER,EMMETT J JR&ELISE C ROYAL REMODELING RESOURCES INC Required Items and Reports(Conditions) 9980 SW JOHNSON ST PO BOX 230805 TIGARD,OR 97223 TIGARD,OR 97281-0805 PHONE: 503-620-3141 PHONE: 503-684-7873 FAX: Total Fees: $1,986.90 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: Ore n 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 0 952-001- 90. Yui.may obtain a •. of the rules or dir ct questions to OUNC by calling 51- 32.1987 orX8 32.23'4 Issued By: Z /6 / ermittee Signature: / Call 603.639.4175 by 7:00 a.m.for the next available inspectio 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. Building Permit Application Residential - . D FOR OFFICE 1_SFONLY Received � �� j �l City of Tigard �EpEN DateBy: 3 , /��,a-t// / �jwziy 13125 SW Hall Blvd.,Tigard,O 97223 Plan Review Q Phone: 503.718.2439 Fax: 503.598pE9 1 3 2019 Date/By a i,1 Other Permit: hail: Ea See Page 2 for Inspection Line: 503.639.4175 Da Ready P~ B I'4( ARE) p D tfiedad etL �1 Supplemental Information Internet: www.tigard-or.gov CITY OF TIGAR G . BUILDING DIVISION TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 Demolition Permit fees*are based on the value of the work performed. 0 New constructionIndicate the value(rounded to the nearest dollar)of all "% CATEGORY ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 5 ..., 3 4Q Valuation: $ O 0,1-and 2-family dwelling 0 Commercial/industrial Number of bedrooms: 0 ❑Accessory building 0 Multi family 0 Master builder ElOther: Number of bathrooms: 1 JOB SITE INFORMATION AND LOCATION Total number of floors: Z Job site address: CIQ '5 iO4 sp4�A,.i,X,� '6"t. New dwelling area: +q 4 t square feet 1 ; City/State/ZIP: 'r 4 Ay p E>4. cr l Z7. Garage/carport area: 0 square feet aJ 21, Suite/bldg./apt.no.: Project name: d,pi ere Covered porch area: 1 square feet Cross street/directions to job site: Deck area: 0 square feet Other structure area: I"' square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 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.: 2..5).02.613 G► t3Cap equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ (2 4)71.00. b to win& AI<TGI T 10r1J Existing building area: square feet New building area: square feet `$PROPERTY OWNER 0 TENANT Number of stories: Nanme: .v,,,e. 6 440.4eine efe CA4,4?Q(.1 444.1- ♦� Type of construction: j>d Address: .A ti' Occupancy groups: City/State/ZIP: ^1� Existing: Phone:(5.03) 4,20 3%A i Fax:( ) New: 0 APPLICANT dli4CONTACT PERSON BUILDING PERMIT FEES' (Please refer to fee schedule) Business name: ff.4.4 TQC 1 NI. 0€1614 N iivc, Structural plan review fee(or deposit): Contact name: 1s O gpE,y GZ FLS plan review fee(if applicable): Address: �X 6,5 S13 Total fees due upon application: City/State/ZIP: ( z-i-L I1D pie ciEZ3t,b Amount received: Phone:(5a3) aj 03 13 Fax: :( ) PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Necot e end 106i e d estd N .4o•-•-.J Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: 9.0.1-444. 2641,NonEUn.41 „6�/�6, 6Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: flt, eir.)X 2 545 806 Solar Installation Specialty Code checklist. City/State/ZIP: T,4A(Ltio 4 O *11 1.41,\ Permit Fee(includes plan review $180.00 and administrative fees): Phone:(+Sp ) 4%4. 1 sIls Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: CI Ot 4 4„, F7/71.2-0 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 complete. Date: *Fee methodology set by Tri-County Building Industry Print name: 111117' _ Service Board. _ I:\Building\Permits\BUP-RESPy itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist • One- and Two'-Family Dwelling FOR OFF (F: LSE oNL,\ City of Tigard Received Permit No.: $ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical T l( ARI) Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \`'' No N A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 Pi - 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 Er 3 Verification of approved plat/lot. 0 0 00 �' 4 Fire district approval required. Name of district: • 0 0 5 Septic system permit or authorization for remodel. Existing system capacity . Je 0 0 e 6 Sewer permit. 7 Water district approval. 0 0 2r 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 ❑ 12r basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 14er 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 2 0 0 and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 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. g 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. 0 0 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 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 Z. 0 0 over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 0 20 Manufactured floor/roof truss design details. le 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required kr 0 0 for four or more appliances. 0 0 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or je 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". f 0❑ ❑ 24 Two(2)sets each are required for Items 16,19,20 and 22 above. 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. ❑ ❑ ' 27 'Drawn to scale"indicates standard architect or engineer scale. ❑ 0 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard a ❑ 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 and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, id 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) Clean Water Services File Number CleanWater Services 19-000274 Sensitive Area Pre-Screening Site AssessmCEIVED 1. Jurisdiction: i.igard FEB 13 2019 3. Owner Information CITY OF TIGARD 2. Property Information (example 1S234AB01400) BUILDING DIVISION Tax lot ID(s): Name: ELISE SHEARER 2. 1023801300 Company: Address: 9920 SW jOHNSON Sr Site Address: 9980 SW JOHNSON ST City, State, Zip: TiGARD,OR,97223 13 City, State,Zip: TIGARD,OR,9722.3 Phone/Fax: 50340093 Nearest Cross Street: E-Mail: elisesarge2u grail.cornn 4. Development Activity(check all that apply) 5. Applicant Information (� Addition to Single Family Residence(rooms,deck,garage) Name: ED SPENCER ❑ Lot Line Adjustment Li Minor Land Partition Company: Endpoint Design Li Residential Condominium Li Commercial Condominium Address: PO BOX 55333 ❑ Residential Subdivision ❑ Commercial Subdivision City, State,Zip: Portland, 97238 1:3 Single Lot Commercial ❑ Multi Lot Commercial ..F Other 289 SF ADDITION Phone/Fax: 50.346:.,9813 E-Mail eci@endp6nt.design.com 6. Will the project involve any off-site work? Li Yes 0 No IJ 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 ED SPENCER Print/Type Title EL PRESIDENT,. ONLINE SUBMITTAL Date 1/26/2019 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. lit 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. 54 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 bym•�. r w� - Date 1/29/19 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • Phone (503;681-5100 • Fax 1503)681-4439 • cleanevaterservices org oject EN,DP0/vr oE;9/aN1 SHEARERrPROJECT P.O.BOX 55333 FtAND OR 97Tm6 OWNER room.,46®-93/3 G15P/ce 4p EDI T I ON ADDRESS E-Meu tea'. oAla,s 4zceal razata dpo/ntdes/cgncom LOT SIZE drawn date LEGAL E I-2-19 ZONE ,S, (E)MAIN (N)MAIN (E)UPPER (N)UPPER TOTAL AINDICATES PROPER 40 INDICATES EXIST'G. j INDICATES NEW WAL -41V,,--.2-- i EXIST'Cx. � INDICATES WALLS EASEMENT i HtH t /iXIST'G. %. ..� NOME ` ,H / /' 1 /i /V / *it i - / r l 1 w / I i /// a I / EXI ST'G // /(ARDDEN 4 4 (E) SITE PLAN > INCity of Tigard 4 COMMUNITY DEVELOPMENT DEPARTMENT U G A R:l Building Permit Review — Residential Building Permit #• /4_S�Q�y i, LlI./ Site Address: / isiel Project Name: ' ��ht.i.trtr Alail1 Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Z A r- 1A4,�� d9 -fV 1 l �c lvik ( Fhrr eh LY Verify site address/suite#exists and active " permit system. EVRiver Terrace Neighborhood: [ No 0 Yes,See River Ten-ace Review Addendum Attached Site Plan Elements: �ee(3)copies of site plan . }fS a plan must be on 8-1/2"x 11"or 11 x 17"paper s structures on site �D P P Footprint of new structure(including decks)with finished . to scale(standard architect or engineer scale) floor elevations B •rth arrow ' ty •ie address,project or subdivision name and lot number locations&easements(required for new and additions) rrA A:.licant information(name and phone number) il nt i. anon/driveway approach " ''�� •t dimensions and building setback•dimensions P� anon of wells/septic systems xisting trees to be retained with drip line,and tree u quare footage of buildings to be demolished protection measures P Y.: •t area,building coverage area,percentage of coverage and 4 .eet tree size,type and location •..pervious area(applicable if R-7,R-12,R-25&R-40 s f/ • R-40) I' [�Street names roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes 11‘.o 4 foot differential) If yes,is a storm water quality facility shown? ❑YJNo Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): )equired: E Yes,applicant was notified ❑ No Received: f Lid Public Facilities Improvement(PFI)Permit: Yes o Required: 0 Yes,applicant was notified [la No Applied For: 0 Yes 0 No,stop intake 1*.and Use Case#: Of/Zoning: K_ 4,5 ud Required Setbacks: Front i_'..O Rear S Side Street Side 14 Garage Zo IA Landscape Requirement P of Coverage Maximum: % As V r. "ding Height Maximum Height 30 Actual Height j .� c. i isual Clearance �� 4 If Sensitive Lands: 0 Yes [ No Type Urban Forestry Plan "Met"prior to issuance of building permit Notes: lvk -{t % (7-,3 Approved By Planning: ✓• n Date: '2-13-Iii Revisions (after Building Submittal only) Revision 1: 0 Approved 0 Not Approved Reviewer Date Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved I:\Building\Forms\BldgPermitRvw_RES_061417.docx Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Engineering O'cPermit Coordinator E -Building Workflow Routing: Planning gm g Workflow Sign-off: prSign-off for Pinning(include notes from planning review) Route Application Documents: I 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 f beam calculations and trust details,if applicable,etc. Notes: / � i ,g1/3)/ By Permit Technician: r I i 41 �J��-d� Date En?' eering Review !P Slope at building pad: .2 ❑ Conditions"Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility Assess Water Quality Fee in-lieu: 0 Yes 0 No Assess Water Quantity Fee in-lieu: 0 Yes 0 No LIDA Facility on lot: 0 Yes 0 No ❑ Final Plat Recorded: Date: ❑ NOT Approved by Engineering: Notes: Approved by Engineering: Date: 2 Revisions(after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review C-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: (DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes l/A Tigard Trans SDC: 0 Yes N/A 7OK Parks SDC: ❑ Yes /ALIDA ❑ Yes M N/Ato Issue Permit l�q ) Approved by Permit Coordinator: Date: 2/ 1:\Building\Forms\B1dgPermitRvw_RES 010118.docx