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Permit
• CITY OF TIGARD 1 MASTER PERMIT IN sy.n /e '2`� i�! ' Permit#: MST2014 00156 COMMUNITY DEVELOPMENT T I GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2014 Parcel: 2S 102C D00200 Jurisdiction: TIGARD Site address: 9640 SW FREWING ST Subdivision: FREWING'S ORCHARD TRACTS Lot: 25 Project: Aspen LO LLC Project Description: Remodel house, structural wall work, new beam, new windows installed. Trade work under separate permits. 10/29/14,garage added back into scope of work under this permit. BUILDING Floor Areas Reauired Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 635 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 0 sf Value: $100,000.00 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Twes 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 SrvclFeeders 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: ADD SF VB R-3 0 Owner: Contractor: ASPEN LO LLC THE TASK MAN LLC Required Items and Reports(Conditions) PO BOX 25430 15450 BOONES FERRY RD#9-365 1 Ersn Cntrl 503-639-4175 PORTLAND.OR 97298 LAKE OSWEGO,OR 97035 PHONE: 503-505-5647 PHONE: 503-351-3160 FAX: Total Fees: $2,435.73 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. ATTE •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-'110 through O•- 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling .232.1987 or 1.800.332.2344. ^ Issu=d By: / .://.' y Permittee Signat E r GA fr ).--/ Call 503.639.4175 by 7:00 a.m.for the next available inspecti ate. 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. p CITY OF TIGARD MASTER PERMIT le. COMMUNITY DEVELOPMENT Permit#: MST2014-00156 T j G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2014 Parcel: 2S 102CD00200 Jurisdiction: TIGARD Site address: 9640 SW FREWING ST Subdivision: FREWING'S ORCHARD TRACTS Lot: 25 Project: Aspen LO LLC Project Description: Remodel house,structural wall work, new beam, new windows installed. Garage removed from scope of work. Trade work under separate permits. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 635 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: 0 sf Value: $100,000.00 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 Drywell-Trench Drain: 0 Other Fixtures: 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: ADD SF VB R-3 0 Owner: Contractor: ASPEN LO LLC THE TASK MAN LLC Required Items and Reports(Conditions) PO BOX 25430 15450 BOONES FERRY RD#9-365 1 Ersn Cntrl 503-639-4175 PORTLAND,OR 97298 LAKE OSWEGO,OR 97035 PHONE: 503-505-5647 PHONE: 503-351-3160 FAX: Total Fees: $2,435.73 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ..plicable 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 •pended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. T ,se s are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy oft - - -s or direct questions to OUNC by calling 503.232. 7 or 1.8''.33 44. Issued By: i-. _..ter -- ••'I•e Signature: rte. Cal .,- .175 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 e project. Approved plans are required on the job site at the time of each inspection. L Building Permit Application Residential GE -- FOR OFFICE USE ONLI ilv City of Tigard DateBya A3//� �4p Permit No.: jT�/l�-�!s� III 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review ` s Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit:,�3�ceA � l9 �EP 3 C� r Juris: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for Internet: www.tigard-or.gov CITY Ok.116 HD Notified/Method: Supplemental Information TYPE OF iSWIr NGDM 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 tg-Addition/alteriion/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the crr CATEGORY OF CONSTRUCTION work incl. ted on this application. lei-and 2-family dwelling ❑Commercial/industrial Valuation i $ ❑Accessory building ❑Multi-family Number of bedr4e� ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: qVq 0 5V J 6,4,4,"- j ''`"`� 5 /- - New dwelling area: uare feet City/State/ZIP: �[rA d& 9 1 2.23 Garage/carport area: square feet ] Suite/bldg./apt.no.: J Project name: 9 (-{ 1 Covered porch area square feet Cross street/directions to job site:c 1 Deck area: square feet 4+ ""r/` &I‘ — 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 DESCRON OF WORK work indicated on this application. • ' 4 y t/,vL vi-pt( fr1 Valuation: $ r _ j IN11dW5 yiS 17-,,t 1~� Existing building area square feet N(= w New building area: square feet - PROPERTY OWNER ❑ TENANT Number of stories: Name: rystA Lam- Type of construction: Address: P 4 1• tcvid--f5-Eiq 0 1 Occupancy groups: City/State/ZIP: i P r D [ 7 21 8 Existing: J �'n` J g� Phone:()?) %" / 5.-, 7 Fax:(�jn7) /24, t•f&. I' New: APPLICANT ,CONTACT PERSON _ BUILDING PERMIT FEES* (Please refer ro fee schedule) Business name: Ar ejvI j L. Structural plan review fee(or deposit): Contact name: O L4r d - ... p Address: S yyuQ-- (r e ld 1 2l� ? 7 71 Q5 C/ FLS plan review fcc(if applicable): City/State/ZIP: (��`l ( Total fees due upon application: Phone:( ) SwvWC. Fax::( ) Amount received: E-mail: L:144 k, T t rr� 6 gre frki- /y,c�,,it PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* / Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: '"r_ ,i--46 //l,,,,,, L_� Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 15 L 0 vaP`,,e_S �'rYNI a -2,65 Solar Installation Specialty Code checklist. City/State/ZIP: iI- 09-' C71 07 c Permit Fee(includes plan review $180.00 and administrative feesL Phone:(5 b ';G)( 67 /r`�L Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: 16_1 - 1`l./! f Total fee due upon appication: $201.60 Authorized signature: / \. J2_1h/' f [ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. q *Fee methodology set by Tri-County Building Industry Print name: D � 'j`',i rY�. Date: 9 ii,-3 !y Service Board I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4`613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLI" City of Tigard Received Permit No III Date/By: + 13125 SW Hall Blvd.,Tigazd,OR 97223 Associated permits: ■ Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 0 Electrical ID Plumbing ❑ Mechanical TIGARD Internet: www.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 es No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity CI ❑ CI 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑ 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- ❑ ❑ ❑ 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. ❑ ❑ ❑ 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- ❑ ❑ ❑ 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 ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ 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 ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ 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 ❑ ❑ ❑ architect licensed in Ore'on and shall be shown to be I.'livable to the 'ro'ect under review. .11 RlSl)I( "I'IONAL 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". ❑ ❑ ❑ 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. ❑ ❑ ❑ 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. ❑ ❑ ❑ 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, ❑ ❑ ❑ 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, ❑ ❑ ❑ 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. 1:\Buil ding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) I i 71 City of Tigard ■ COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential Building Permit #: OQD/4 `"00 / 0 , Site Address: C pLQ cv\J Ffew 1 Project Name: Lj {� Lfj . L Li Lot #: (New d'Yelling=subdivision name;Addition or Alteration=last name of owner) Planning Review . Proposal: 1 Wa I-Verify site address/suite #exists and active in permit system. Site Plan Elements: l Three(3)copies of site plan _xisting structures on site Site plan must hc on 8-1/2"x 11"or 11 x 17"paper ,footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations ' - . . North arrow -Utility locations(required fot new;may apply for additions) B'Site address,project or subdivision name and lot number location of wells/septic systems pplicant information(name and phone number) . Erosion control(including drainage-way protection,silt fence ,2Lot dimensions and building setback dimensions design,location of catch basin,etc.) 2tot area,building coverage area,percentage of coverage and j2Street names impervious area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location lZProperll,corner elevations(2 foot contour lines if more thatlf existing trees to be retained with drip line,and tree 4 foot differential) protection measures Clean Water Services—Service Provider Letter: (lot platted prior to 9/10/1995): Required:)Yes—Applicant Notified ❑ No Received: j2r Yes ❑ No Land Use Case#: . 'Z o n i n g: ik14.5 ❑ Setbacks: Front Rear r,5 Side GJ Street Side 15 Garage 2 .0"Landscape Requirement: N.46_ 'Lot Coverage Maximum: 1 El Building Height: Maximum Height D Actual Height ±11 .Visual Clearance ❑ Easements 0 Sensitive Lands: ❑ Yes _X No Type Z.Urban Forestry Plan Conditions Met Notes: Approved By Planning: p Date: I u�I I Revisions (after Building Submittal only) J, J Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved Revision 3: El Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw_RES_042914.docx r Building Permit Submittal Original Submittal Date: /e/.://///./ Site Plans: # 3 Building Plans: #,�/ -3 Building Permit#: I� Enter building permit#above. Workflow Routing: 1241anning j Y ngineering D---Tfermit Coordinator I uilding Workflow Sign-off: /Sign-off for Planning(include notes from planning review) Route Application Documents: cl/gngineering: (1) copy of permit application, (1) site plan, (1)building plan and o al plan review routing form. ding: original permit application,site plans,building plans,engineer and 0420,-;;;D_-)0 beeam calculations and trust details,if applicable,etc. Notes: 1-L)'"lG ,o G[-•�X�-f 'Q-Q 0.7 - P,I✓kLI ' By Permit Technician: ( It)t zt- Date: lU/9 dy Engineering Review Io 7K Actual Slope: / 4 ❑ Conditions Met - Notes: Approved by Engineering: if, Date: V Pr I Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not App oved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 11 ,..4 S a Permit Coordinator Review ❑ Conditions Met-Prior to Issuance of Building Permit 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: oK to Issue Permit Approved by Permit Coordinator: G_ r / Date: /6/1-'4#1 1:1Building\Forms\BldgPermitRvw_RES_092914.docx Debbie Adamski From: Debbie Adamski Sent: Tuesday, September 23, 2014 4:09 PM To: 'david.turra @gregoryfunding.com' Cc: #Building Permit Technicians Subject: 9640 SW Frewing St, Tigard, OR David, When you decided to add the garage back on to the scope of work for this project, I forgot to ask for a site plan of the lot showing the garage addition. Because of the addition and the change to the existing footprint of the structure we will require (3)copies of a site plan. The site plan needs to be drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if 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; impervious area; existing structures on site; and surface drainage. We will also require a Clean Water Services Pre-Screen letter of approval prior to issuance of this permit. You can apply for this approval on line at Clean Water Services while we are doing the review. You will need to have a copy of the approval from them prior to us issuing your permit. Here is the link to their online submittal: http://www.cleanwaterservices.org/PermitCenter/PreScreen . Once I have received the site plans I can forward the permit on for plan review. We will expedite the review as quickly as possible. Below are a listing of the permits we have. I think all of the required permits have been applied for. 9640 SW Frewing St 13510 SW Ash Ave BCC2014-00019 MEC2014-00516 MST2014-000156 PLM2014-00320 PLM2014-00310 ELC2014-00540 ELC2014-00539 M EC2014-00515 Debbie Adamski Senior Permit Technician City of Tigard I Community Development 13125 SW Hall Blvd., Tigard, OR 97223 503-718-2450 1 Debbie Adamski From: Branden Taggart Sent: Monday, September 22, 2014 5:24 PM To: Debbie Adamski; Dianna Howse Cc: David Young Subject: BCE2014-00019: 9640 SW Frewing & 13510 SW Ash Attachments: Branden Taggart.vcf I couldn't recall if there was an email that was sent about BCE2014-00019, but this situation turned out to be fairly complicated, so I thought I would send an email. David is waiting for electrical, mechanical, and plumbing permits for both addresses listed above, in addition to a MST permit for the address on Frewing, before he lifts a stop work order. All permits must be received and paid for before the stop work order is removed. The investigative fee will only be added to the MST when it comes in, not the trade permits. I updated the parcel tag, which basically says this much. The mechanical contractor submitted both permits for these addresses, but I informed him of the situation, and he will pick up the mechanical permits once we receive all other permits. The fees have not been paid for, but we gave him the option to pay them online. These permits are now in the ready file. If anyone has a question... ask David. =) Branden Taggart IIIw City of Tigard Permit Technician Community Development 13125 SW Hall Blvd { Tigard, OR 97223 (503)718-2449 brandent©tigard-or.gov DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 9 .z/ie law r, = /55/6 ,.,qr- /1(.L, —3Ce as 14-OOo / 9 H f e- 8011/ oo 5l4, (....-11,-(S) 00 330 �°"` 0 P / 9d / o0 3/O (45/0,, /414 PLH 9-0/4- C /-40-6-) �c 2.0/e/-6c,57/6 l for e-co Ss- (am.- A ) H57 p014 - 001s4, 1 Clean Water Services File Number C1eanWate\ Services 14-002667 Sensitive Area Pre-Screening Site Assessment AECE 'JEJ 1. Jurisdiction: Tigard 2. Property Information (example 1S234AB01400) 3. Owner Information OCT 21 2014 Tax lot ID(s): Name: Aspen Lo LLC 200 Company: Aspen Lo LLC (,UU � Address: PO Box 25430 411 4 Site 9640 SW Frewing StAddresE City, State,Zip: Portland Cit Phone/Fax: 5035055647 Tigard, State, ZIr E-Mail: david.turra @gregoryfunding.com Ach AUPNeareE 4. @ytygjcsImpt Activity(check all that apply) 5. Applicant Information 1 Addition to Single Family Residence(rooms,deck,garage) Name: David Turra ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Other Phone/Fax: 5035055647 E-Mail: david.turra @gregoryfunding.com 6. Will the project involve any off-site work? ❑Yes El No ❑Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project Attached 2 car garage addition where a carport used to be 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 andlor 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 is true,complete,and accurate. nf Print/Type Name David Turra Print/Type Title ]W I t144uA J ,a ONLINE SUBMITTAL Date 9/23/2014 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 07-20, 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 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 _ err: `"c f/<t 4,`t s/ Date 09/30/14 2550 SW Hillsboro Highway • Hillsboro.Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org