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Permit y v CITY OF TIGARD BUILDING PERMIT • 1 COMMUNITY DEVELOPMENT Permit#: BUP2015-00312 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2015 Parcel: 1 S 136DC04402 Jurisdiction: Tigard Site address: 11990 SW 72ND AVE Project: TLB LLC Subdivision: FRUITLAND ACRES Lot: 31 Project Description: Demolition of a 1,416 sq.ft.house and(3)sheds. Contractor: NORWEST CONTRACTORS INC Owner: TLB LLC PO BOX 25305 PO BOX 25716 PORTLAND, OR 97298-0305 PORTLAND,OR 97298 PHONE: 503-291-6986 PHONE: FAX: 503-291-7036 Specifics: FEES Description Date Amount Type of Use: SF Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 11/05/2015 $393.11 Demolition Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 11/05/2015 $2.50 Dwelling Units: 0 11x17) Stories: 0 Height: 0 ft Erosion Control w/Development 11/05/2015 $80.70 Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 11/12/2015 $88.00 Value: $20,780 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $564.31 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: ittee Signature: L Call . .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. Building Permit Application Residential FOR OFFICE USE ONLY Received Q City of Tigard ‘v E DateBy. /f l) Permit No.. L /,!5=0 3 i A ill 13125 SW Hall Blvd.,Tigard,OR 9Plan Review 11 Phone: 503.718.2439 Fax: 503.59 fif,CV 01C Date/By: Other Permit: (l G A K C) Inspection Line: 503.639.4175 n'OV 2 J Date Ready/By: tuns: ® See Page 2 for Internet: www.tigard-or.gov 1t AQD Notified/Method: A ( �� Supplemental Information rIG K;p� � ,.,,;.,,t TYPE OF ..t;';tt 1�(�1©�`" REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction El ..."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: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ?$0� -and 2-family dwellin g ❑Commercial/industrial 2t El Accessory building 1:1 Multi-family Number of bedrooms: ❑Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: J i `}q t7 s,,v ?Z p t4 pole- New dwelling area: square feet City/State/ZIP: 'Tit A we:. , Ott. ei 7LZ3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: ies.._1-44-oc) Covered porch area: square feet Cross street/directions to job site: Deck area: square feet 72ND /►Nb [rrMCtiartA Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 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.: I SI 34. DGO 4 402_ equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. `0 Valuation: $ Existing building area: square feet New building area: square feet [PROPERTY OWNER I ❑ TENANT Number of stories: Name: 71-$1 L.LC.- Type of construction: Address: Po tJ_ 257((, Occupancy groups: City/State/ZIP: P t i L A t a x 1 O t z-_. `1-77_18 Existing: Phone:( ) Z7 I-VI Its Fax:(�o5) Z'1 _7o'3(. New: [— APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule Business name: Mt`,),R CtJ '5 \ 'PY--- Structural plan review fee(or deposit): Contact name: -D VAS off, FLS plan review fee(if applicable): Address: its:56 u.1 tatvtiELAN.It, Sr �„e rl� 17-0 Sr i Total fees due upon application: City/State/ZIP: -1-1 4.1 A.t t° i CO, et 77 3 Phone:(spa ) 24 4 . 0vr2- Fax: :(53) 244--o4i 7 Amount received: E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* lane, wkd q [o rv► J Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: NSetw�y-�- Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 72 35' Au �x- ,��� L- Solar Installation Specialty Code checklist. ^ e.. Permit Fee(includes plan review City/State/ZIP: Pevtru ,,,vb cR, `77 z.98 $180.00 and administrative fees): Phone:(>Sp-S) 29 1.fo q g Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: t9¢Zs'' Total fee due upon application: $201.60 Authorized signature: 4., This permit application expires if a permit is not obtained ...o/ r.-_-__ , within 180 days after it has been accepted as complete. Print name: Date: /( , 3, �r *Fee methodology set by Tri-County Building Industry �{p.1 �l4Sty7p 1Z- Service Board. I:kBuilding\Permits\BUP-RESPermitApp.doc 02/24/2011 44046131(11/02/COM/WEB) A 64 t.q )1 S-00.�1 J. Clean Water Services File Number C1eanWater Services 15-003600 Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: TIGARD RECEIVED 2. Property Information (example 1S234AB01400) 3. Owner Information NOV 9 2015 Tax lot ID(s): Name: James Lampus 1S136DC4402 Company: TLB,LLC CI-pi OF TIGAHQ Address: PO 25716 ��pING DIVISION Site Address: //Imo Su 7aZd°'�rtr City, State,Zip: Portland,Oreg n 298 City, State, Zip: Phone/Fax: 503 291 6986 Ri Nearest Cross Street: SW 72 at Dartmouth E-Mail: jlampus @norwestgc.com 4. Development Activity(check all that apply) 5. Applicant Information ❑ Addition to Single Family Residence(rooms,deck,garage) Name: Karl Koroch ❑ Lot Line Adjustment ❑ Minor Land Partition Company: TM Rippey Consulting Engineers ❑ Residential Condominium ❑ Commercial Condominium 7650 SW Beveland Street,Suite 100 Residential Subdivision Address: ❑ ❑ Commercial Subdivision ID Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Tigard,Oregon 97223 Other Phone/Fax: 503 443 3900 Demolition of House E-Mail: kkoroch @tmrippey.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 City of Tigard requires SPL for house demolition 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 Karl Koroch Print/Type Title Principal ONLINE SUBMITTAL Date 11/4/2015 FOR DISTRICT USE ONLY LJ 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 Date 11/4/15 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT s r �� R n Building Permit Review — Residential Building Permit #: dLt,P OI5 o3t4, Site Address: //99O c3 j,L) whak /9ve Project Name: 72-6/ LLe Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: 1')erite eX/S71[ i e c o?�P?SSC ? e7/ S Verify site address/suite#exists and active in permit syste . j Liver Terrace Neighborhood: ❑ Yes V No Sit; lan Elements: It ree(3)copies of site plan ►Y xisting structures on site 1P . e plan must he on 8-1/2"x 11"or 11 x 17"paper !1 +,otprint of new structure(including decks)with finished IL P rawn to scale(standard architect or engineer scale) poor elevations L l 'orth arrow Pl ility locations(required for new,may apply for additions) 09/• a address,project or subdivision name and lot number cation of wells/septic systems ( plicant information(name and phone number) rosion control(including drainage-way protection,silt fence A Lot dimensions and building setback dimensions esign,location of catch basin,etc.) 41,4 4t area,building coverage area,percentage of coverage and Street names impervious area (applicable if R-7,R-12,R-25&R-40) fleet tree size,type and location roperty corner elevations(2 foot contour lines if more than isting trees to be retained with drip line,and tree 4 foot differential) W protection measures ❑ Clean Water S .ces—Service Provider Letter(lot platted prior to 9/10/1995): / Required: Yes,applicant was notified ❑ No Received: 'Yes 1 /No c$'ublic Facilities Improvement(PF1)Permit: / /I II' I3-r. Required: ❑ Yes,applicant was notified V No Applied For: ❑ Yes ❑ No,stop intake tdiand Use Case#: 6oning. c� etbacks: Front © Rear O Side 0 Street Side MI Garage Aij , � is--Requirement: / [IQ .t Coverage Maximum: S J. Building Height: Maximum Height 47iS Actual Height AV A- 1" isual Clearance WAi asements 0_ ' ensitive Lands: ❑ Yes J No Type •II Jrban Forestry Plan ❑ Conditions "Met"prior to •ssuan - .f buil.• g permit Notes: Adri!S,i A 1 alei i -1 0 c L!. 4 , ? .ma._ :6* — 7 /_fig. Sc''- ' •,, / Approved :y Planning: < w a Date: I® S 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\B1dgPermitRvw_RES_070915.docx Building Permit Submittal Original Submittal Date: // 3 ACS Site Plans: # Building Plans: # /, Building Permit#: Enter building permit#above. Workflow Routing: 10--P-lanning ❑ Engineering ❑ Permit Coordinator ❑ Building Workflow Sign-off: , Sign-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,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: /�S/,�S Engineering Review \� ❑ Slope at building pad: CI 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 *L1 Assess Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: Date: 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: • \Y\ ✓ 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: 1:\Building\Fortes\B1dgPermitRvw_RES_0709I 5.docx