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PUBLIC WORKS <br /> REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 9/28/2017 <br /> Permit#: PW1709-051 <br /> PROJECT ADDRESS: 3623 HOYT AVE Unit 1,2,3 <br /> DESCRIPTION OF WORK: SITE WORK FOR NEW 3-PLEX RESIDENTIAL STRUCTURE <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: SIDHU SURINDER S&SUKHPAL NAME: VITAL LAUREN <br /> ADDRESS: 2715 NW 166TH TERRACE ADDRESS: <br /> BEAVERTON, OR,97006 <br /> PHONE: PHONE: 4252586400 <br /> EMAIL: SURINDERSIDHU@HOTMAIL.COM EMAIL: <br /> CONTACT: 0 Owner 0 Applicant ❑Other <br /> NAME: SEND EMAIL TO OWNER TOO <br /> PHONE: <br /> EMAIL: <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: <br /> PW Permit Required?, 'YES 0 NO W.O.#: <br /> Notes: Associated Bldg./PW Permit#: 3 1702-04-7 <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ,YES—Type 13_R (If yes, add to TRAKiT under Reviewer Comments on Bldg Permit and Stamp Drawings) <br /> ❑ NO <br /> Explanation: <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: 00 FIRE SERVICE: Z 9f <br /> ,'YES—Amount$ 2900 , YES—Amount$ <br /> 0 Meter Only, ?'Complete Service, Size 1 0 3/4"Detect Meter Only, XFire Service Size / <br /> ❑ NO ❑ NO <br /> Explanation: Explanation: <br /> ❑ RPBA Needed at premise?-(Plumbing permit for backflow device needed due to High-Hazard Site per Tim Markham's review) <br /> ❑Water Department Cost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> PittYES—Amount$ 70 )(New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> %YES—Amount$ 14930 0 See Attached Spreadsheet <br /> ❑ NO—No Change of Use/Other <br /> Explanation: <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? -21 _/7 <br /> (YES—Amount$ 7Z00--❑ 0 See Attached Spreadsheet <br /> ❑ NO Per- ►°►'like 24001(3 = `' 7200 5 v ne90vesfecl Ura email. frail Mike Brie. <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> Z YES—TYPE in —fei i %See Attached Letter <br /> ❑ NO <br /> PW Reviewer: Date: <br /> n2 OLc k.( rk —2q-17 <br /> REVISED 10/11/2016 <br />