Permit y CITY OF TIGARD BUILDING PERMIT
3' COMMUNITY DEVELOPMENT Permit#: BUP2015-00313
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2015
Parcel: 1 S136DC04300
Jurisdiction: Tigard
Site address: 11930 SW 72ND AVE
Project: TLB LLC Subdivision: FRUITLAND ACRES Lot: 31
Project Description: Demolition of(1) 1,304 sq.ft.house,(1)detached garage,and(1)shed.
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 $362.69
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: $18,520
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $533.89
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: C�T rmittee Signature: W,
Call 3. .4175 by 7:00 a.m.for the next available inspe tion date.
This permit card shall be kept in a conspicuous place on the job site until completion oft • project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard 3RECEIVED iv t�f =�
III ' . .�
• 13125 5W Hall Blvd.,Tigard,OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit:
T I G A R D Inspection Line: 503.639.4175 NOV 3 2015 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ii 4 AMR= Supplemental Information
CITY OF TIGARD to-mot t Jai,
TYPE OF W _J LDING DIVISION 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: equipment,materials,labor,overhead,and the profit for the
�� CATEGORY OF CONSTRUCTION work indicated on this application.
(Yf 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 1 J SZA"r
❑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: n"la 5,0 72 rv0 ts,. New dwelling area: square feet
City/State/ZIP: Tc ku-� 1 cv,.- q-t ZZ-5 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: FA(Loa_->, , 00 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
72WC) Aw]D t r'p -1Ae0r41 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.: l S f 3c bL 0 4.3 00 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
(PROPERTY OWNER ❑ TENANT Number of stories:
Name: -71.0... L L .- Type of construction:
1
Address: '0 rte. 25-71c„ Occupancy groups:
City/State/ZIP: 'P�-�nanA•.1.1:›1 Old 97 pi g Existing:
Phone:( cell O!< I--(p9 8(, Fax:(So3) 271 -7o3(P New:
APPLICANT t--�� ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: 140_,t(��.I i-L�,[ V yt �D (Please refer to fee schedule)
le)
\ - Structural plan review fee(or deposit):
Contact name: -J JA- vt
FLS plan review fee(if applicable):
Address: y(,57o Su.) I?; Ar4D rte- _ic[IG iZp
l Total fees due upon application:
City/State/ZIP:
--rill A(tap i CR... 9/213
Amount received:
Phone:(%3 ' 244 . 01-5-2- Fax: :(03) 244-4417
E-mail: dah PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
� sysdt r,- --
` Go Iv%
J CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 40.3e Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 72 3 S' •Ctl) icN LA-We Solar Installation Specialty Code checklist.
City/State/ZIP: P�ort-tl.�s� �. L9 8 Permit Fan(includes plan review $180.00
� and administrative fees):
Phone:(51b ) .2,e1 l.6q me Fax:( 1 State surcharge(12%of permit fee): $21.60
CCB lie.:
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
-��
Print name: � 1 �
Date: /(,3� � Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l 1/02/COM/WEB)
1
,6'u/, )5-vc 13
Clean Water Services File Number
Clem-Water Services 15-003599
Sensitive Area Pre-Screening Site AssessmeRECEIVED
1. Jurisdiction: TIGARD NOV 9 2015
2. Property Information (example 1S234AB01400) 3. Owner Information
Tax lot ID(s): Name: James Lampus CITY OF TIGARD
15136DC4300 Company: TLB,LLC BUILDING Li1V1510N
Address: PO 25716
Site Address: /1"?30 5c,� ?a'� City, State,Zip: Portland,Oregon 97298
City, State, Zip: Phone/Fax: 503 291 6986
Nearest Cross Street: SW 72,south of Clinton 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
Li 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
IJ 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 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
[j 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.
j 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 G:i.4 ,l :..�� ----' 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
IN UCOMMUNITY DEVELOPMENT DEPARTMENT
T I G A R t) Building Permit Review — Residential
Building Permit #: 81APdt l 5-oz1 3/3
Site Address: 1 lq3 SW '12nd Ave
Project Name: TLj 1 LLC, Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: demo ex l s'i`l 9 si-rA_ch.,s eJ
(Verify site address/suite#exists and active in permit skstelm.
Z River Terrace Neighborhood: ❑ Yes lnK'No
Sit Plan Elements:
I ree(3)copies of site plan 12<xisting structures on site
7 ySEte plan must be on 8-1/2"x 11"or 11 x 17"paper $Footprint of new structure(including decks)with finished
q rawn to scale(standard architect or engineer scale) or elevations
:203rth arrow tility locations(required for new,may apply for additions)
te address,project or subdivision name and lot number 'cation of wells/septic systems
Mr plicant information(name and phone number) INtrosion control(including drainage-way protection,silt VfLot dimensions and building setback dimensions sign,location of catch basin,etc.)
- tot area,building coverage area,percentage of coverage and LJStreet names
impervious area (applicable if R-7,R-12,R-25&R-40) $SZreet tree size,type and location
mProperty corner elevations(2 foot contour lines if more than Bsting trees to be retained with drip line,and tree
4 foot differential) protection measures
'07±I Clean Water S ices—Service Provider Letter(lot platted prior to 9/10/1995):
tO
Required: V Yes,applicant was notified ❑ No Received: es `!J o
E1—Public Facilities Improvement(PFI) Permit: H 9PS6'T'.
Required: ❑ Yes,applicant was notified No Applied For ❑ Yes ❑ No,stop intake
15/Land Use Case#:
5 Zoning. C,(j
$Setbacks: Front Rear Side Street Side Garage
$Landscape Requirement:
$Lot Coverage Maximum:
e- Building Height: Maximum Height Actual Height
$ Visual Clearance
$Easements
$Sensitive Lands: ❑ Yes NS. No Type
- Urban Forestry Plan
-1;1. Conditions "Met"prior to issuance of building permit
Notes: no eons}'rue-� Oft Onkl demo pcoposea ; SPL, r9,uired
Approved By Planning: .. ' IIt It f A, Date: 1113\15
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved •
I:\Building\Forms\BldgPermitRvw_RES070915.docx
Building Permit Submittal
Original Submittal Date: /1 3_ /IC-
Site Plans: #
Building Plans: # .
Building Permit#: ❑''Enter building permit#above.
Workflow Routing: [ Planning ❑ 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
riginal 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: / .57
Engineering Review
,
W ❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
1 ❑ 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: 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:
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 Worms\BldgPermitRvw_RES_0709I 5.docx