Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2015-00216
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/28/2015
Parcel: 2S112CB12700
Jurisdiction: Tigard
Site address: 15070 SW 81ST AVE
Project: Corbin Estates Subdivision: 1991-017 PARTITION PLAT Lot: 2
Project Description: Demo house(approx.1000 sf)and shed(approx.500 sf). Septic tank to be pumped and filled or removed.
Contractor: MAG LLC Owner: CORBIN, GARY S&TERRIE L
935 NECTARINE ST 15070 SW 81ST AVE
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503-781-5239 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/28/2015 $256.22
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development-Eng 07/28/2015 $80.70
Dwelling Units: 0 Info Process/Archiving-Sm$0.50(up to 07/28/2015 $2.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $12,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $339.42
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: 0
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 503.232.1987 or 1.800.332.2344.
Issued By: e Signature: —, .111-1111S—at
q,"7101.4175•9.4175 by 7:00 a.m.for the next available inspection die.
This permit card shall be kept in a conspicuous place on the job site until compl,tion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit AP ` :` I V E D
Site Work I(1k111I It I I 'l t1\I1
Received . M��r i `
City of Tigard JUL 2 2 2015 Z Permit No.: 1'-, j��
13125 SW Hall Blvd.,Ti Plan Review
OR 97223 Plan Review
I Phone: 503.718.2439 Date/By: — Other Permit:
�'4g '�f°IGARD
Inspection Line: 503 Date Ready/By: Juris: 121 See Page 2 for
=' �lNG DIVISION 3';mg L . Supplemental www.ti_.: Notified/Method: r' Su lementallnformation
rips OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction XDemolition 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: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling Valuation: $
®CommerciaUindustrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:15070 SW 81"Ave. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Corbin Estates Covered porch area: square feet
Cross street/directions to job site:SW Rosa St. Deck area: square feet
Other structure area: square feet
REQUIRED DATA: r
Subdivision: I Lot no.: Permit fees'are based on the value of the work performed.
Tax map/parcel no.:2S1 12CB/TL 12700 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
1 r DESCRIPTION OF WORK work indicated on this application.
1,6 M0ii'l-itx, es QXsS'1111q_ s1YUe.+U( . 1 /-le,,u_ Valuation: Oa9Y i 1Z�ClfYj—
`APP 14°�j 51° NOD ( ,re st -5L c,_:c i/yi j Existing building area: square feet
—rei It1 7U • ti 1-1►0f 6 FI LLF)
New building area: square feet
tEl PROPERTY OWNER 1 0 TENANT Number of stories:
Name:JT Roth,Inc. Type of construction:
Address:12600 SW 72°"Ave. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)6392639 I Fax:( ) New:
® APPLICANT 0 CONTACT PEON
moms
Business name:JT Roth,Inc. All contractors and subcontractors are required to be
Contact name:Tim Roth licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe required to be licensed in the
Address:12600 SW 72.4 Ave. jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)639-2639 I Fax::( )
E-mail:timr @jtrothinc.com
CONTRACTOR
Business name:to be determined Ill A a, LL- .. BUDDING PERMIT FEES*
Address: c3,s" S. �P_ rl Y�G Si (Pima seer Iola ta k
City/State/ZIP: / ^^M� 4-7 Structural plan review fee(or deposit):
C t' r Yv`Jr . t Of Fax:( // ) FLS plan review fee(if applicable):
Phone:543 ) 7g/.-..9 Fax:( )
CCB Pic.: i 7 _— , I ,
Total fees due upon application:
W' Il Amount received:
Authorized signature:
�i�
This permit application expires if a permit is not obtained
1 within 180 days after it has been accepted as complete.
Print name: ,J .—r,Tee. r t. t %R Date: i •21-(5 I . Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PennttApp.doc 10/01/09 440-46131(11/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Residential
e
Building Permit #: )O I ILL.P /5 c xc / (p
Site Address: 1 so 0 c vv <a l c t- tiVJ
Project Name: (gip r b i n e S tDi t-eJ Lot #:
(New dwelling=subdivision name;.Addition or;Alteration=last name of owner)
Planning Review
Proposal: D&mo Qe'nit A-- 0- e X iSTI ric Sv C -1-/ZS
/Verify site address/suite# exists and active in permit system.
--EtIGver Terrace Neighborhood: ❑ Yes -8 Ada
Site Plan Elements:
/Three(3)copies of site plan 'Existing structures on site
/Site plan must is 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 for new,may apply for additions)
Site address,project or subdi\'tsion nat, anrci lot number? "'8-Mcation of wells/septic systems
Applicant information(name and phone number) Erosion control(including drainage-way protection,silt fence
z,ef ot dimensions and building setback dimensions
Ls design,location of catch basin,etc.)
t area,building coverage area,percentage of coverage and treet names
v _ervious area (applicable if R-7,R-12,R-25&R-40) ,❑ treet tree size,type and location
❑Property corner elevations(2 foot contour lines if more than iCJExisting trees to be retained with drip line,and tree
4 foot differential) protection measures
—Flan Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified ❑ No Received: ❑ yes ❑ No
Public Facilities Improvement (PFI) Permit:
Required: Wes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
fLand Use Case#: Su ( 2.(�) I "i — 000Qq
/Zoning L
9 Setbacks: D e ryl o Front `e Rear Side Street Side & Garage
/Landscape Requirement: °'o -`' J
�
XLot Coverage Maximum: °l4
Building Height: Ikeiht Actual Height
Visual Clearance `J
7 Easements
Sensitive Lands: ❑ Yes ❑ No Type
die Urban Forestry Plan
Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: 1/1/3 V117-o_- 0 "to Date: 7/22.1 /-f
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
1:\Building\Forms\BldgPermitRvw_RES_0709 1 5.docx
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Manning ❑. fi ineering Permit Coordinator ❑
Workflow Sign-off: ,2 Si -off for Planning(include notes from planning review)
Route Application Documents: Engineering. (1) copy of permit application, (1) site plan, (1) building plan and
al plan review routing form.
Building. original permit application,site plans,bniiding.pl�„ e r and
Notes:
By Permit Technician: IPA . /_ ! Date: 74-)-/5"
Engineering Review
❑ Slope at building pad:
❑ 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
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: /ii,1 K,1� w Date: 7 /2— 1 S�
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:
Revision Notice 3: Date Sent to Applicant:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: -72-3��S
///-I:\Building\Forms\BldgPetmitRvw_RES_070915.docx
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Iif i if `„ Lk ~ . D. s EXISTING CONDITIONS AND 1'f ono nem Raison{" g \ MIS E..%RRP..\m. D< r......2. IN ,... mos DEMOLITION PLAN . �:.1 922817,74.10TON o ..
KIRTLY0.0.30*MO
1"' NNE rr:NE
CORRIN ESTATES PIONEER DEW.GROW.NC.
me TIGARD,OREGON VALID o oP o o-O-1E
mr OREGON* WASHINGTON
777 S.W. ARMCO AVENUE 1r HILLSBORO, OREGON 97123
(503) 693-6388 FAX (503) 693-7221 RECEIVED
- �), � ASBESTOS*LEAD
" - l ;l t3l ENVIRONMENTAL WA# SENT* JUL 2 2 2015
WA# IRSENI 972N5 CITY OF TIGARD
OF PORTLAND INC. SERVICES
BUILDING DIVISION
July 16, 2015
1T Roth Construction
Tim Roth
12600 SW 72nd Ave
Portland, OR 97223
Re: 15070 SW 81s`Ave,Tigard OR 97224
Tim-
IRS Environmental completed removal and proper disposal of asbestos containing materials at the
above referenced location for demolition on July 14, 2015. Materials removed included ceiling
texture. Materials were removed pursuant to all DEQ regulations by Certified Asbestos Supervisor
Ron Chaff Certification #S13655.
Should you have any questions or require any additional information, please feel free to call our office
at 503-693-6388.
Regards,
Project Assistant
RECEIVED
JUL 2 2 2015
SPEEDY SEPTIC CITY OFTIGARD
BUILDING DIVISION
EXISTING SYSTEM DECOMMISSIONING
Property Address is: I rU 7o 5W
5� f�lr O 4'72241
By my signature, I certify that the existing:
74,Septic Tank
❑ Seepage Pit
❑ Cesspool
was decommissioned in accordance with established standards of the
Department of Environmental Quality (DEQ). The DEQ standards
require the selected items to be:
1. Pumped by a licensed sewage disposal pumping service to remove
all septage AND filled with reject sand, bar run gravel or other
material acceptable to the county in which the property resides.
OR
2. The tank must be removed and properly disposed of.
The septage was pumped by: Speedy Septic Service
Signature: 'LI ,dt„e j Date: LI-/6-- 2evc-
Speedy Septic Service - PO Box 1260 - Boring, OR-97009
P. 503.663.2807- F. 503.663.9712
SEPTIC DATE START/STO
EMPLOYEE
SALES ORDER #
II 212 Boring, OR. 97009
X: 503663.9712 LIST OF MACHINERY & HOURS USED
.
-
Dm
•
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." I L./
. -
4.7 Fç
_
6)t,
SIGNATURE C740k,"1 _
?d of satisfaction survey
eyword CALL or TEXT 503-388-6258
NMI=
fl
•��_,G-voty DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH PROGRAM
j 3 < 155 North First Avenue,MS 5,Suite 160
Hillsboro,OR 97124
Telephone: (503)846-8722•Fax:(503)846-3705
OREGON www.co.washington.or.us/hhs/environmentalhealth
SEPTIC TANK DECOMMISSION (ABANDONMENT)
Property Owner Name: (please print)
Township: Range: Section: Tax Lot#:
Property Address: (include city,state,zip)
❑ Was pumped of sludge on:
Date: J) ,r' _C E Signature of Licensed Operator: �r(.4ACc v� 1.M..4/c CL/QA %�f�{ ��r
License#: E 3 F I S"---,6
❑ Was backfilled with sand or clean bank run gravel AFTER being pumped of sludge on:
Date:
Signature of Operator:
Oregon Administrative Rules 340-071-0185 Decommissioning of Systems
1) The owner must decommission a system when:
(a) A sewerage system becomes available and the facility the system serves has been connected to that sewerage system;
(b) The source of sewage has been permanently eliminated;
(c) The system has been operated in violation of OAR 340-071-0130(13)and a repair permit and Certificate of
Satisfactory Completion have not subsequently been issued for the system;
(d) The system has been constructed,installed,altered,or repaired without a permit required in this division,and a permit
has not subsequently been issued for the system;or
(e) The system has been operated or used without a required Certificate of Satisfactory Completion or Authorization
Notice and a Certificate of Satisfactory Completion or Authorization Notice has not subsequently been issued for the
system.
2) Procedures for Decommissioning:
(a) Tanks,cesspools,and seepage pits must be pumped by a licensed sewage disposal service to remove all septage.
(b) Tanks,cesspools,and seepage pits must be filled with reject sand,bar run gravel,or other material approved by the
agent,or the container must he removed and properly disposed.
The septic tank at the address above has been decommissioned in accordance with the Oregon Administrative Rules.
Property Owner Signature: Date:
12/11