Permit (131) CITY OF TIGARD MASTER PERMIT
iiii �
�
COMMUNITY DEVELOPMENT ) Permit#: MST2019-00365
.r j } Date Issued: 09/16/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1
v ,c 0 u, Parcel: 2S108DB01000
Jurisdiction: Tigard
Site address: 15075 SW DANUBE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: 8
Project: SOUSOU
Project Description: Outdoor covered structure with outdoor BBQ and gas fireplace. 12/23/2019: REPRINT permit to
add (1)service.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left: 5 Parking Spaces:
Height: 9 Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: 5 Detectors:
Total: sf Value: $9,553.04 Rear: 5
PLUMBING
Sinks: 1 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: 1 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
Natural Gas Heat Pump: N Hoods: 0 Other Units: 1
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 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: 8
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
Owner: Contractor:
SOUSOU,NATALY ALL OREGON LANDSCAPING INC Required Items and Reports(Conditions)
15075 SW DANUBE DR 19785 SW CIPOLE RD
TIGARD,OR 97224 SHERWOOD,OR 97140
PHONE: PHONE: 503-646-6426
FAX: 503-625-9668
Total Fees: $1,081.00
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. ATTENTIOO : 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 t-�1!{�J y _8
R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1g8tvr00.332.2344.
Issued By: r J'�k-t-- Permittee Signature: t"--' ------\\'':
Call 503.639.4175 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.
Electrical Permit App1icaCEIVED q n IOu ill=i•lu l.�l. i1�1.1
illCity of igard J 2019 Date/By:/;,/ 3 /`J , Permit#/S
13125 S W Hall Blvd.,Tigard,OR 97 � 4=
$ -1 Plan Review
Phone: 503.718.2439 Fax: 503.59V69 OF TIGARD Date/By: Related Permit#:
11C Ut1) Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Innisfd See Page 2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TIME OAF Wim. PT4N REVIEW
Please check all that apply(submit 2 sets ofplans w/ite,ns checked):
0 New construction I Addition/alteration/replacement
0 Demolition
I. QthCC: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
-c4r4.;'', 1 ' -OF c9NEWRt '' exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® l and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-famil amps for all other installations. buildings.
Y ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
O,5O 1,IlaT.E00 4.1119/%1 Apo ,Q "JAk i : 0 Emergency system. larger separately derived
( 70b Site address. t �„ ,U IDAddition of new motor load of system.
Joh#:
tsl`irV �� 100HP or more. ❑"A","E","I-2","t-3",
Clty/State/ZIP: �(� �, t -tl:Six or more residential units. occupancy
1 !LZ-LI ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: D US 0 V 0 Hazardous locations. ❑Supply voltage for more than
Cross street/directions to job site:
❑Service or feeder 600 amps or more. 600 volts nominal.
'�`� FEE Segvixt I j�
i '1D11.1-/ 1/ tiler Di., n�nptwn I Qty. I each I 'total I , t
// New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft,or less 168.54 4
oR +101 t,, '-•--, Ea.add'1500 sq.ft.or portion 33.92 1
$ t,°1.;. Limited energy,residential 1111(>l��C."(it-1 tA-L Jr>l+UI(._ '
..zs I ��� �b �19�J with above s .ft. 75.00 - 2
/� +'- Limited energy,multi-family III
'2S� S r . e-- ---t--', " residential with above s'.ft. 75.00 2
47
14-] t` Renewable Ene a ❑ See Pa.e 2 Services or feeders installation,alteration,and/or relocation
Name: t rVt1 ) ' tN Ar-TAI Sou SV 200 amps or less 100.70 2
Address: 150 7 5- ' J
tetj J I)/'tAj ij iD' 201 amps to 400 amps 133.56 21
City/State/ZIP: G ,/ 6 1 7 21.4
401 amps to 600 amps 200.34 2
( 601 amps to 1,000 amps 301,04 2
Phone:(x113) -7 9°f i(85 I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps1
to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
, K '. , ;;. Branch circuits-new alteration,or extension 1e randl
/� ,1 , 4,'O r f A.Fee for branch cireuits with
Business name: 'I C./7*0 (/4‘, (s each above servicebranchcir
orcuit feeder fee, .
Contact name: �3 7.42 2
�®r4 ki ° R4)"�-r7 B.Fee for branch circuits without
Address: I I 18 ` I !/tT O service or feeder fee,first
0ro
branch circuit 56.18 2
City/State/ZIP: ffG�'14,0)0( 0 R.- 911 4 Each add'l branch circuit I 7.42 2
r Cv 8(o si J I Fes::( ) Miscellaneous(service or feeder not included)
Phone:(<'oJ)
Each manufactured or modular
Email: - e, (((yy-`�o L dwelling,service and/or feederIII
67.84 2
Reconnect only 111111 67 84 -- 2
Pump or irrigation circle 111111 67 84 2
Business name:r,/W.tl 1 * Sign or outline lightingEll
IIIIII 67 84 2
Address: p ib Y-Y Signal circuits)or limited-energy
el alterati or extension. E SeePage 2 2
City/State/ZIP: iThIA.aq, Clt g a g Each additional ins eetion over allowable in an of the above
Phone Additional inspection(1 hr mitt) 66.25/hr
3 s I Fax:( ) Investigation(1 hr nun) 90,00/In
Email: 00,-,„_e 4j Industrial plant(1 hr min) 1111 78.18/hr
Inspections for which no fee is
CCB Lic.:220.924(
I Electrical Lie.:` A197 I Suprv.Lie.: Sk 4136 listed 'Fr hr win III90 00/hr
Suprv.Electrician signature,requite.
Print name: efie i Subtotal:
°',, Date: r 7/f 0 Plan Review Required(25%of permit fee):
State surcharge(12%0 of permit fee):
Authorized signature: :,- it 6 TOTAL PERMIT FEE:
Print name: jef ,• II ' This permit application expires if a permit is not obtained within 180
o'� Date: days after it has been accepted as complete.
1\BuildingTermits''ELC_PermitApp_ELR_ERE.duc Rev 06/17/2015 * Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
CITY OF TIGARD MASTER PERMIT
'IN I ' COMMUNITY DEVELOPMENT Permit#: MST2019-00365
T i(_A R 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2019
Parcel: 2S108DB01000
Jurisdiction: Tigard
Site address: 15075 SW DANUBE DR
Subdivision: POLYGON AT BULL MOUNTAIN Lot: 8
Project: SOUSOU
Project Description: Outdoor covered structure with outdoor BBQ and gas fireplace.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement sf Left: 5 Parking Spaces:
Height: 9 Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: 5 Detectors:
Total: sf Value: $9,553.04 Rear: 5
PLUMBING
Sinks: 1 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: 1 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
Natural Gas Heat Pump: N Hoods: 0 Other Units: 1
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3
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: 8
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
Owner: Contractor:
SOUSOU,NATALY ALL OREGON LANDSCAPING INC Required Items and Reports(Conditions)
r.
15075SW DANUBE DR 19785 SW CfPOLE RD
TIGARD,OR 97224 SHERWOOD,OR 97140
PHONE: PHONE: 503-646-6426
FAX: 503-625-9668
Total Fees: $968.21
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. his 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.• law rr:, ires • to follow -- rules ='•opted by the Oregon Utility Notification Center. . - are set forth in OAR
952-001-0010 through O' •' ••2-0' .409Q. Yo ay obtain a••py of th;�es or direct questions to OUNC by calling 503.232.1987 0 1.800.332.2344.
ip
Issued By: .ilik A4./� Permittee Signature: ��.` 'Signature: ——% j�
Nih
Call 503.639.4176 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.
Building Permit Application
Residential
FOR OFFICE USE ON El
City of Tigard Received 7 /a 9
13125 SW Hall Blvd.,Tigard,OR 972235 ;� I 'i :r 019
Date/By: �' /)` ./�/� �"""
III
Phone: 503.718.2439 Fax: 503.598 1960 Plan Review Ot' Z '(�''�r Cit/!/
Date/By: ` / I I ° '� : -'•-' it //•-�)
T I ,‘R D Inspection Line: 503.639.4175 ( v
4� ' ' ) Date Read/B 0 See Page 2 for/
Internet: www.tigard-or.gov 1 , Ready/By: Juris
t`'rwS€c � .a i,+l / ���� Notified/Method: Supplemental Information
;.' . .'. ,w„ vomwxawnn.......... :;.-w.-.-an.. ...�,......,,,�..._._,.___._...
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
®Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY-OF CONSTRUCTKIN '_ work indicated on this application.
® I_and 2-family dwelling 0 Commercial/industrial Valuation: $Zqye 1 I SC
❑Accessory building 0 Multi-family Number of bedrooms:/ J
❑Master builder
0 Other: Number of bathrooms:
JOB SEA. INFORMATION AND LOCATION Total number of floors:
Job site address:15075 SW Danube Dr. New dwelling area: square feet
City/State/ZIP:Tigard OR 97224
Garage/carport g arport area: square feet
Suite/bldg./apt.no.: Project name:Backyard covered structur
Covered porch area: square feet
Cross street/directions to job site:150"'/Danube Dr.
Deck area: square feet
Other structure area: 392 square feet
.i QVJRED DATA CO cIAL-USE CHECKLIST
Subdivision: Lot no.: 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 indicated on this application.
Outdoor covered structure with outdoor BBQ and gas Fireplace Valuation: $
Existing building area: square feet
New building area: square feet
El ° t ER 11 1'E1�1ANT Number of stories:
Name:Imad&Nataly Sousou
Type of construction:
Address:15075 SW Danube Dr.
Occupancy groups:
City/State/ZIP:Tigard OR 97224
Existing:
Phone:(503)789.9185 Fax:( )
New:
_«G A?1t1C l. f , CONTACT PERSON
BUILDING-PERMIT FEES*
sche
Business name:All Oregon landscaping Inc. (l'kaserejerfeedule)
Contact name:Tony Prunty Structural plan review fee(or deposit):
Address:19785 SW Cipole Road FLS plan review fee(if applicable):
City/State/ZIP:Sherwood,OR 97140 Total fees due upon application:
Phone:(503)849.5869 FA ;4,514162S-Q6611. ,-
�. — - r_._
E-mail:tony@alloregon.com pHOTOVOLTAIC ALAR PI$EL SYSTEM FEES*
, CO �C1tJR - Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:All Oregon Landscaping Inc. Submit two(2)sets of roof plan with connection details
Address:19785 SW Cipole Road and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP:Sherwood,OR 97140 Permit Fee(includes plan review
Phone:(503)849.5869 Fax:( )
and administrative fees): $180.00
State surcharge(12%of permit fee): $21.60
CCB lid.:194221 &1_2/
Total fee due upon application: $201.60
Authorized signature:
7.....—...,-7.....—...,—.. t111 -------------....___ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Tony Prunty I Date:8/22/2019 I *Fee methodology set by Tri-County Building Industry
Service Board.
I:A Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application Folz OFFICE I.SF ONLv
r City of Tigard Received
Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit:
-1 I(,A 1z D Inspection Line: 503.639.4175
Internet: www.tigard-or.gov Date Ready/By: kris: 91 See Page 2 for
Notified/Method: Supplemental Information
x? 'x 8F WORK ri GQ ;'FEE* SGiTEI�,1 '.. S,>M c, Ircimis:'
-nx� r Mechanical permit fees*are based on the value of the work
®New construction ! Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition N7 Other: mechanical
s� �
g materiaequipment,4.
labor, anp o
fit.
Value:$..
,s� a x
... a- .. w .._ <. s.:'tt '4xylt .,4'^ .. 7.4 4I!ul. l 4SYSTEMSFEES*:.:
❑ 1-and 2-family dwelling 0 Commercial/industrial
❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder
®Other:pooUbbq/FP Description
Qty. Ea. Total
V: _ '1`,.i 4 �ak Heating/cooling:
Job site address:15075 SW Danube Dr. Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:Sousou pool/bbq/fireplace Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:150m/Danube Dr. Hydronic hot water system 23.32
Residential boiler(radiator or
hydropic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/ventnfor any of above 23.32
Other: bt.*q P SAX 1 2332
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: x Water heater 23.32
° � ?�;�l Y a 1 , ttK ,4' Gas fireplace/insert 1 33.39
Gas piping for pool,outdoor BBQ,and outdoor Fireplace Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
n,t4.14" .i, e OWNER .. Other: kook1,......4...e- 23.32
Enviro mental exhaust and ventilation:
Name:Imad&Nataly Sousou Range hood/other kitchen
Address:15075 SW Danube Dr. equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)789.9185 Fax:( ) Attic/crawlspace fans 23.32
` tl�i - M `. C ,. P' 1 '�Q, l Other: 23.32
Business name:All Oregon landscaping Inc. piping:
$14.15 for first four;$4.031/for each additional
Contact name:Tony Prunty Furnace,etc.
Address:19785 SW Cipole Road Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Sherwood,OR 97140 Water heater
mt. 1 20
Phone:(503)849.5869 Fax::( ) Fireplace 1 16
Range
E-mail:tony@alloregon.com
Barbecue 1 18
El Clothes dryer(gas)
Business name:Universal Plumbing Other:
,.
(3hS1 s1 *
Address:8811 SW Spruce Subtotal
City/State/ZIP:Tigard,OR 97223 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)816.3004 Fax:( ) State surcharge(12%of permit fee)
CCB lic.:185212 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:David Oakley Date:8/26/2019
I:A Building\Permits\MEC_PennitApp_040113.doc 440-4617T(11/02/COM/WEB)
Clean Water Services File Number
CleanWater Services � 1 k%)28'
Sensitive Area Pre-Screening Site Ass - ,
1. Jurisdiction: Tigard
SEPI 2019
2. Property Information(example 1S234AB01400) 3. Owner Information
Tax lot ID(s): 3
Name: Imad and I4
2s108DB01000 ,INI 1 %xrWk.t• -
Company:
Address: 15075 SW Danube Drive
OR Site Address: 15075 SW Danube Drive City, State,Zip: Tigard, Oregon, 97224
City, State,Zip: Tigard, Oregon, 97224 Phone/Fax: 503.789.9185
Nearest Cross Street: 150th E-Mail: natalysousou@outlook.com
4. Development Activity (check all that apply) 5. Applicant Information
ID Addition to Single Family Residence(rooms,deck,garage) Name: Tony Prunty
❑ Lot Line Adjustment ❑ Minor Land Partition Company: All Oregon Landscaping Inc.
❑ Residential Condominium ❑ Commercial Condominium
❑ Address: 19785 SW Cipole Road
Residential Subdivision
❑ Commercial Subdivision
❑ Single Lot Commercial laMulti Lot Commercial City, State,Zip: Sherwood, OR, 97140
Other Phone/Fax: 503.849.5869
14'x 28'covered structure E-Mail: tony@alloregon.com
6. Will the project involve any off-site work? ❑Yes (Ell No ❑Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
Pool under separate permit.covered structure is 392 sq.ft. Pavers are permeable concrete pavers
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 Tony Prunty Print/Type Title V.P& Operations
Signature ONLINE SUBMITTAL
Date 8/26/2019
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 19-05, 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'1!.11_ 1 pmt
.�.1 (.:_,J.r. _ ..-..-... ..a.:. .. ,.:. ...:c. ...._._._._.. _....... �.Vr�lGl lllUlly...._..,......:,�.,.......:.;�..r..-..
Sef1ODe Areal's)Lound 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 19-05,Section
t2.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
P. his 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 I REQU 'ED. &Otto ./j3 l4"
Reviewed by 41 1 / 1
i Date
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
q COMMUNITY DEVELOPMENT DEPARTMENT
I
T 1 G A o Building Permit Review — Residential
Building Permit #: „ $ 02a -, 3 ,
Site Address: il,CiTr0 I idiP :_ r-
Project Name: . 'Oit4u ✓-e Ottg -C_ Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Pr. .osal: /ecer, d <77/774 4--e_ in L,C /
VA Verify address/suite# active i Accela. V In River Terr e: ❑ No 1,: Yes, River Terrace Review Addendum 0
Sit Plan Elements: iV Ero ion Control
k opies of site plan on 8-1/2"x 11"or 11 x 17"paper ��'aired trees with drip line and tree protection measures
VVawn to scale(standard architect or engineer scale) •' i.tprint of new structure(including decks)and FFE
'(orth arrow IF • •ty locations&easements(required for new and additions)
e address,project or subdivision name and lot number Sid-walk/driveway approach
plicant information(name and phone number) 11 �e:cation of wells/septic systems
Lot dimensions and building setback dimensions SS eet tree size,type and location
\ hA►0• are footage of buildings to be demolished L1Q5eet names
Mxisting structures on site Vtorner elevations (2'contours if more than 4'differential)
W t area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ❑Yes
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes Z
0<ean Water Services—Service Provider Lette of platted prior to 9/10/1995): /*Yes
Re.uired: I=1Yes,applicant was notified No Received: ❑ No
\10 sublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applie. or: ❑ Yes ❑ No,stop intake
` VOI and Use Case#: 1E Zoning: .c-
V0Bequired Setbacks: Front: ‘3\K Rear: c— Side:_C----. Street Side: OK Garage: I/f'
uil.• g Height: Max.Height: . Actual Height: til
V, 1, ,ndscape Area: % of Coverage Max:
E rance \ : .ack no more than 8'from street-facing wall ❑ Parallel to street o : set 45 degrees or less
Windows ❑ Minimum -' • .f area of all street-facing facades
\K
Garage r. 'es ❑ No,one of the following is met:
g ❑ Garage door is behin. ••; t street facing wall
❑ Door extends no more than •• wall , •: M ere is a covered porch extending beyond garage.
❑ Door extends no more than 5' . wa I a : I ere is a 12 sq ft.window above garage on 2nd floor.
❑ Garage door width is • or less ❑ 50%or less o . ,.e ❑ 60%or less and includes 7 of following:
❑ Cover-. :.rc ❑ Recessed entrance ❑ Wall offset li ' i .of eave ❑ Roof offset
iith -
r \ _
❑ Accent siding ❑ indow trim ❑ Window recess ❑ Window projection � Balcony
, I' isual Clearance rban Forestry P n
�►` e.sitive Lands: LiYes Nao Type:
►� �:onditions met prior to issuance of building permit
No
s:
c
Approved By Planning: , Date: JD J
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPermitRvw_RES_022819.docx
Building Permit Submittal
Original Submittal Date: ?//0//9
Site Plans: # _
Building Plans: #
Building Permit#: P Enter building permit#above.
Workflow Routing: :I Planning Engineering Permit Coordinator Building
Workflow Sign-off: ► Sign-off for lanning(include notes from planning review)
Route Application Documents: 1.4 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: j
v
i/ /
r ./
By Permit Technician: j 4/,//w . iil/Av�� Date: 7//a `74
Engineering Review
—B—Slope at building pad: LI o/
0
..-E"..-Conditions "Met"prior to issuance of building permit
"Easements (encroachments)per engineering conditions of approval and plat
-g--Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: E Yes No
--B--Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
['(Approved by Engineering: jb ---- Date: 1 • l2. 7-0(1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El 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:
RevisionRe� Notice 3: Date Sent to Applicant:
-___._, "4::0C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes C`3'N/A
Tigard Trans SDC: ❑ Yes CVN/A
Parks SDC: ❑ Yes CyjN/A
7O
LIDA ID Yes N/A
K to Issue Permit
' (-2-1 11
Approved by Permit Coordinator: Date:
LI:\Building\Forms\BldgPermitRvw_RES022819.docx