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Permit Support Document M TIGARD City of Tigard June 24, 2019 Venture Properties Inc. 4230 Galewood St, #100 Lake Oswego, OR 97035 Re: Permit No. SIT2018-00029 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11375 SW North Dakota St Project Name: Brightwood Subdivision Job No.: N/A Refund Method: ® Check#232454 in the amount of$325.00. ❑ Credit card "return" receipt in the amount of$ 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): Refund 100% of permit fees paid for site work permit that was not required. If you have any questions please contact me at 503.718.2430. Sincerely, 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 11111 City of Tigard TIGARD 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: Venture Properties Inc. DATE: 6/17/2019 4230 Galewood St, #100 Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 420565 Case#: SIT2018-00029 Date: 12/3/2018 Address/Parcel: 11375 SW North Dakota St Pay Method: Check Project Name: Brightwood Subdivision EXPLANATION: Site work permit was not required. Refund 100% of permit fees. REI UND`INFOR A I S P av tt �w s a s 3 Fee E Description Frc P NO� �. J evenue f F r � +tiF�xample: Buildin Perr t :. xample: 3 ,431 unt $Am Plan review 230-0000-43106 $325.00 TOTAL REFUND: $325.00 APPROVALS: SIGN ES/DATE: If under$5,000 Professional Staff '/7 ` 2 / 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 F.OR AccELA SYSTEM ADMINisTRATioN USE Case Refund Processed: Date: -(/'r", / By: eiir I:\Building\Refunds\RefundRequest.doc x 09/01/2010 II CITY OF TIGARD RECEIPT :1111 g 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Brightwood Subdivision Site Address: 11375 SW NORTH DAKOTA ST Receipt Number: 434459 - 05/21/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID S1T2018-00029 $-325.00 Total: $-325.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232454 DHOWSE 05/21/2021 $-325.00 Payor: Venture Properties Total Payments: $-325.00 Balance Due: $0.00 Paae 1 of 1 CITY OF TIGARD RECEIPT 111 u 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Brightwood Subdivision Site Address: 11375 SW NORTH DAKOTA ST Receipt Number: 420565 - 12/03/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID 51T2018-00029 Plan Review 230-0000-43106 $325.00 Total: $325.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 33725 DHOWSE 12/03/2018 $325.00 Payor: Venture Properties Inc. Total Payments: $325.00 Balance Due: $0.08 di yi Page 1 of 1 , City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED 11111 N Request for Permit Action APR -1 0 2019 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigararrOF TIGARD ISUILDItJO DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 VO 1 0 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov�f/7 /'7 FROM: El Owner P Applicant ❑ Contractor ❑ City Staff / Check(V)one REFUND OR Name: INVOICE TO: (Business or Individual) ( J C C I n _ 1 Mailing Address: 4 -C) (it, cN (0 0 City/State/Zip: 1.----A it.t 0 SW 6--q-co cam- a 70 36- Phone No.: 5° - . <1 -76 00 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): Ercir7_:.: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#: / J©2 Q /p la i70Q 2 Site Address or Parcel#: f/275 SA) A/d F 77j .c f/-t o 7 -4 .S f Project Name: -/-f✓-` o C)LI S 4 f. L1/ tor/B/V Subdivision Name: Lot#: F EXPLANATION: /-2,6 ---u 6 /OCR 7v /S /‘ -72>A T C(.J,3S 'Lk)7 /2= %7 z f/' el.... /t.9O /245/i eij /- --"/d 7 , CO/1/if' CoN V /0/9 Signature: Date: 4- /( 0 I C.i Print Name: - tt [,Qjyyki2 C G` 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. FOR OFFICE I SE ONLY Route to Sys Admin: Date B Route to Records: Dates/ /2/ By i,t Refund Processed: Date 6/7 /1 :?to Invoice Processed: Date t By Permit Canceled: Date 9(/ / F,io, Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 20 18.doc Building; Permit Application 0 1 D Site- Work , A, El FOR OFFICE USE ONLY City of Tigard Received i C 1. 2018 Date By: �I .r ir+f/1 Permit No.. �- r '1 I m 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ��/ r/�/ +�n ` g Plan Revie f 11111111 Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/ e: Ul j'Q — )N Inspection Line: 503.639.4175 Date Ready/By: Juris' B( See Page 2 for TICA1tD BUILDING 0IVISI(N Internet: www.tigard-or.gov ,, i`; Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑✓ Other: Grading equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ❑ 1-and 2-family dwelling ❑✓ Commercial/industrial Number of bedrooms: ElAccessory building ❑Multi-family ElMaster builder D Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11375 SW North Dakota Street New dwelling area: square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Brightwood Subdivision Covered porch area: square feet Cross street/directions to job site: Deck area: square feet SW North Dakota and SW 114th Ave Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Brightwood Subdivision Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 1 S134D800600 Indicate the value(rounded to the nearest dollar)of all ) equipment,materials,labor,overhead,and the profit for the I DESCRIPTION OF WORK work indicated on this application. Grading for residential subdivision Valuation: $ 45,000 Cut:870 cy, Fill 2650 cy valuation$45,000 Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: Venture Properties, INc. Type of construction: Address: 4230 Galewood Street,Suite 100 Occupancy groups: City/State/ZIP: Lake Oswego,OR 97035 Existing: Phone:( ) Contact Applicant Fax:( ) New: APPLICANT 0 CONTACT PERSON NOTICE Business name: AKS Engineering&Forestry All contractors and subcontractors are required to be Contact name: Maggie Gordon licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 12865 SW Herman Road,Suite 100 jurisdiction in which work is being performed.If the City/State/ZIP: Tualatin,OR 97062 applicant is exempt from licensing,the following reasons apply: Phone:(503 ) 563.6151 Fax: :( ) E-mail: gordonm@aks-eng.com CONTRACTOR Business name: NEI BUILDING PERMIT FEES* Address: PO Box 1609 (Please refer to fee schedule) City/State/ZIP: Sherwood,OR 97140 Structural plan review fee(or deposit): FLS plan review fee(if applicable): Phone:( ) 503.625.3100 Fax:( ) CCB lie.: 62761 Total fees due upon application: e \ 1 Amount received: Authorized signature'^��IN l5 �-_-Ay This permit application expires if a permit is not obtained Print name: Maggie Gordon Date: C within 180 days after it has been accepted as complete. v-L.... - i t_ Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB) } 1 City of Tigard: Site Work Permit Checklist Page 2-Supplemental Information Commercial,Multi-Family and One-and Two-Family Dwellings: No permit is required if fill is less than 50 yards(5 dump truck loads), or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill,it must be engineered fill. If fill is in a flood plain, drainage way, or wetland,the applicant must apply for a sensitive lands review (SLR). Please complete all items below,unless otherwise noted. Excavation Volume: 870 cu.yds. Grading Volume: (Soils report required for>5,000 cu.yds.) 3520 cu.yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 2650 90%of maximum density) cu.yds. Retaining structure? (Check one) ❑ Rock None-no walls. ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, ±33,600 sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the Plumbing Permit Application for site utilities plumbing work. Plans Required: See"Site Work Permit Application-Plan Submittal Requirements"attached. The following must accompany this application: ❑ Site Plan with Vicinity Map showing ADA *Parking(including ADA) and Lighting compliance Plan ❑✓ Grading Plan and details ❑ *Landscaping Plan ❑✓ Erosion Control Plan and details LL'.L Soils Report(if required) ❑ Retaining Structures *Does not apply to One-and Two-family dwellings. Plan Submittal: Permit Fee: TYPE OF SUBMITTAL #of Plans Valuation: Permit Fee: (New,Additions or Required at $.00 to$500.00 $51.09 minimum permit fee Alterations) Submittal $500.01 to$2,000.00 $51.09 for the first$500.00 and $2.69 for each additional$100 or fraction Commercial 3 thereof,to and including$2,000.00. $2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and $10.76 for each additional$1,000 or Multi-Family R-1 Occupancy 3 fraction thereof,to and including $25,000.00. One-&Two-Family Dwelling 3 $25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and $8.06 for each additional$1,000.00 or fraction thereof,to and including $50,000.00. $50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and $5.38 for each additional$1,000.00 or fraction thereof,to and including $100,000.00. $100,000.01 and over $809.42 for the first$100,000.00 and $4.49 for each additional$1,000.00 or fraction thereof. I:\Building\Permits\SIT-PetmitApp.doc 08/02/2016 2 m Site Work Permit Application Plan Submittal Requirements T I G A R D Commercial,Multi-Family and One- &Two-Family Dwellings A site work permit is required for all commercial projects including new buildings, additions, accessory buildings larger than 120 square feet,modular structures and multi-family R-1 occupancies. A site work permit is required for excavation, fill,grading,paving,retaining walls, fire hydrants and fire depattunent access on private property for work on individual lots not covered under the subdivision development. Note: A separate "plumbing"permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. Please see the Site Utilities -Plumbing Permit Application for plan submittal requirements. 1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic location labeled with: A. ❑ map &tax lot# ❑ project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name ❑ applicant phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads (drawn to scale) with project location. 2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only. All details listed below shall be incorporated into the plans: A. Site plan showing: 1) Required parking spaces and driveways. 2) A route, accessible to persons with disability,leading from the public way to an accessible building entrance. 3) Accessible parking spaces and adjacent access aisle connecting with the accessible route. 4) Curb ramps along the accessible route, curb, sidewalk and gutter. 5) Finish grade elevations along the accessible route. 7 B. Topographic survey plan showing grade elevations crossing the entire site. C. Overall grading plan. D. Utilities plan showing: 1) Fire hydrant location and pipe size if on private property. 2) If the building is to be protected with an automatic fire sprinkler system, show ti location of the water service vault and the fire department connection (FDC) within 70 feet of a fire hydrant. iji 3) Size of underground water service for the sprinkler system. E. Erosion control plan complying with the requirements of the Clean Water Services (CWS) agency showing. 1) Silt fence locations. 2) Bio-filter bags/other approved barrier material surrounding catch basins. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 3 3) Illustrations detailing the correct installation of the silt fencing and catch basin il protection. 4) Any other measures to ensure compliance with CWS standards. F. Landscaping plan. 3. ADDITIONAL REQUIREMENTS: A. Soils (geotechnical) report. A soils report is required for new buildings and additions to contain the following: 1) The report shall address the potential of soil liquefaction and instability (OSSC Sec. 1804.2). 2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1). 3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805). B. Fire flow and hydrant worksheet. C. Plan review deposit based upon project valuation. it I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 4 r I " I WYAT T FIRE PROTECTION, INC. 9095 S.W. Burnham Tigard,OR 97223 Fire Hydrant Fire Flow PROJECT SW 114th Ave & SW N. Dakota St. ADDRESS CROSS STREET FLOW 1 HYDRANT 11045 SW 114th PI. LOCATION STATIC 74 PITOT RESIDUAL 14 GPM 1407 4" HOSE MONSTER PORT GPM AT 20 PSI 2714 calculated per NFPA 291 DATED 11.01.18 9:15 AM MONITOR HYDRANT SW 115th Ave. & SW N. Dakota St. LOCATION STATIC 74 RESIDUAL 58 DATED 11.01.18 9:15 AM WITNESS WITNESSED BY Kay TITLE ORGANIZATION City of Tigard Public Works SIGNATURE PERFORMED BY Jack Gardner