Permit (161) ki
CITY OF TIGARD BUILDING PERMIT
Ili
2 ' COMMUNITY DEVELOPMENT Permit#: BUP2019-00090
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/16/2019
Parcel: 1 S 134 D B00600
Jurisdiction: Tigard
Site address: 11375 SW NORTH DAKOTA ST
Project: Brightwood Subdivision Subdivision: BRIGHTWOOD SUBDIVISION Lot:
Project Description: Demolition of a 804 sq.ft. building on septic. Septic tank to be pumped and filled. UPON FINAL INSPECTION,
DEMO CREDITS FOR TRANSPORTATION AND PARKS SDC FEES WILL APPLY.
Contractor: NORTHWEST EARTHMOVERS INC Owner:
PO BOX 1609
SHERWOOD, OR 97140
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 04/16/2019 $301.85
Demolition
Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 04/16/2019 $4.00
Dwelling Units: 11x17)
Stories: Height: ft Erosion Control w/Development 04/16/2019 $80.70
Bedrooms: Bathrooms:
Value: $15,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $386.55
Required: Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 may obtain a copy of the rules or direct questions to OUNC by calling 503.23 'or 1.800.332.2344.
1111111ft iii,
Issued By: / '� Permittee Signature: �� 7eAfi•.-
all 503.639.4175 by 7:00 a.m.for the next available in pection 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.
Clean Water Services File Number
CleanWateServices 18-000561
Sensitive Area Pre-Screening Site Assessment
RECEIVED
1. Jurisdiction: City of Tigard
2. Property Information (example 1S234AB01400) r \3. Owner Information APR 6 2019
Tax lot ID(s): Name: Gretchen A.Fehrenbacher,Trustee
1S134DB00600 Company: Gretchen A.FehrenbacherIrLDING
Q
ivisioN
Address: 1605 N.Simpson Street
Q8 Site Address: 11375 SW NORTH DAKOTA City, State,Zip: Portland,OR,97217
City, State,Zip: Phone/Fax: Please contact applicant
Nearest Cross Street: E-Mail: Please contact applicant
4. Development Activity (check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: Mimi Doukas
❑ Lot Line Adjustment ❑ Minor Land Partition AKS Engineering gineering&Forestry
❑ Residential Condominium ❑ Commercial Condominium
Address: 12965 SW Herman Road,Suite 100
U Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial City, State,Zip: Tualatin,OR 97062
9 ❑ Multi Lot Commercial
Other Phone/Fax: 503-565-6151
E-Mail: mimid@aks-eng.com
6. Will the project involve any off-site work? ❑Yes 0 No ❑Unknown
Location and description of off-site work Extension of SW North Dakota Street sidewalk to SW Gallo Avenue
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,
DEO 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 co ta'ned in ti' i t ment, nd to the best of my knowledge and belief,this information is tr e,complete,and accurate.
Print/Type Name ' • QUt�c3 Print/Type Title cr,-i/-G
Signature ' , Date l �
I � � (si 8
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.
XBased 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 17-05,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 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 ` Date 2/19/18
Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 6/2017
City of Tigard
11111 'I COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Residential
Building Permit #: J /9 r(jJJ()
Site Address: 11 fi5 w \,AL. 9c1,;11,' S z-
Project Name: �r jk c,,,,,,� );th ., Pe.,","-1 1r Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: DEIN
0 Verify address/suite#active in Accela. JI/In River Terrace: lid No ❑ Yes,River Terrace Review Addendum
Sit: Ian Elements: E cion Control
L.3 opies of site plan on 8-1/2"x 11"or 11 x 17"paperetained trees with drip line and tree protection measures
C 4 .wn to scale(standard architect or engineer scale) Footprint of new structure(including decks)and FFE
t .rth arrow iR'!• •ty locations&easements(required for new and additions)
yf
e address,project or subdivision name and lot number :�Si.-walk/driveway approach
az>pplicant information(name and phone number) (Vocation of wells/septic systems
I [dimensions and building setback dimensions r_A_s eet tree size,type and location
are footage of buildings to be demolished i (St t names
xisting structures on site Ly-tomer elevations(2'contours if more than 4'differential)v
' ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑YesIld'No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Y1No
LST (:lean Water�',S/ervices—Service Provider Letter(lot platted prior to 9/10/1995):
)quired: Ldyes,applicant was notified ❑ No Received: ❑ Yes ❑ No
V Public Facilitie Improvement(PFI)Permit: �
equired: IVYes,applicant was notified CI No Applied For: la'Yes ❑ No,stop intake f fl.lo Ui''CJZ 2
ERand Use Case#: AUC t?-0 000.-i Cil Zoning: K- 1-S
equired Setbacks: Front: 2_.0 Rear: (S Side: S Street Side: 1- k Garage: 2?
lir uilding Height: Max. Height: 3 0 Actual Height: We
it Landscape Area: ISA % ❑ Lot Coverage Max: V}
MA- Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less
Windows ❑ Minimum 12%of area of all street-facing facades
Garage ❑ Garage door is behind widest street-facing wall ❑ Yes ❑ No,one of the following is met:
"W ❑ Door extends no more than 5'from wall and there is a covered porch extending beyond garage.
Vrw,( ❑ Door extends no more than 5'from wall and there is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is ❑ 12'or less ❑ 50%or less of facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset ❑ 1'Roof eave ❑ Roof offset
❑ Fire shingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer
❑ Accent sidingP Window trim CI Window recess CI Window projection ❑ Balcony
❑�/yisual Clearance Urban Forestrypan
l.V Sensitive Lands: ❑ Yes No Type:
Conditions met prior,to issuance of buildingpermit ! i.
1�(o s: C,�,,;i�I-c ‘1, 1,1t f4.J-p-- - pu,, ` if-1' -- Aatt,J) f - b V- dF ti1� aPP17 14 itu a ttu
Approved By Planning: } Date: 9-4-11
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\BldgPemutRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: 111/011
Site Plans: #
Building Plans: #
Building Permit#: 2.-- 2.15.r.-building permit above. �'
Workflow Routing: E- nning l engineering h�sermit Coordinator ❑ Building
Workflow Sign-off: [ 'Si i-off for Planning(include notes from planning review)
Route Application Documents: Ig•-•E gineering: (1) copy of permit application, (1) site plan, (1) building plan and
orial plan review routing form.
WE'Tuilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: .��.-0.7 ,,,e'— Date: "w p9
Engineering Review
a/
Slope at building pad: 2/e
❑ 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: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: =rii_co�� Date: d
Aim-
Revisions
Revisions (after Building Submittal only) / Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ 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:
ix7vision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ON/A
Tigard Trans SDC: ❑ Yes /A
Parks SDC: ❑ Yes /A
LIDA ❑ Yes l N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: P4(/14°/1/
I:\Building\Forms\BldgPermitRvw_RES_022819.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11375 SW NORTH DAKOTA ST, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Building BUP2019-00090
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - NoCofO
Comments:
Septic tank pumped and removed from site.
Demo work on existing home appears complete.
Violation Summary:
Inspector Contractor