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Permit Ili CITY OF TIGARD BUILDING PERMIT a COMMUNITY DEVELOPMENT Permit#: BUP2015-00314 TRGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2015 Parcel: 1 S136DC04100 Jurisdiction: Tigard Site address: 11860 SW 72ND AVE Project: TLB LLC Subdivision: ISAACS SUBDIVISION Lot: 1 Project Description: Demolition of(1)2,294 sq.ft.house,(1)479 sq.ft.house,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 $464.97 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 11/12/2015 $107.60 Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 11/12/2015 $88.00 Value: $25,100 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $663.07 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 wit 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: Permittee Signature: a,./LIINL_e 110 �� • Call 503. 39.4175 by 7:00 a.m.for the next available insp: ion 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 City of Tigard RECEIVED Received — Si' INUI Other Perms _• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,---- ' /' ' : IC ' Phone: 503.718.2439 Fax: 503.598.1960 NOV 3 2015 Date Ready/By:TIGARD Inspection Line: 503.639.4175 eady/By: ® See Page 2 For Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: i� 9 IS �1I 1� Supplemental Information DING DIVISION ( t '`�'l _ TYPE OF W 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. Valuation: $ 21 I. --- ne 1-and 2-family dwelling ❑Commercial/industrial l ❑Accessory building El Multi-family Number of bedrooms: ❑Master builder ID Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I i 34o p 72u0 A New dwelling area: square feet City/State/ZIP: -r(1,0,z,;=. Ok... 112 Z3 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: rern.t om 4 j DO Covered porch area: square feet Cross street/directions to job site: Deck area: square feet 72-tap 44.1D stir`Mck.f t1 Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: ndicate the value(rounded to the nearest dollar)of all 1 Si SI 3L DG o+l Od equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ T1oA4 elF 49r1 l•li TIAker . Existing building area: square feet New building area: square feet VPROPERTY OWNER I 0 TENANT Number of stories: Name: -1-1...e,1 B LL - Type of construction: Address: pc) r4:4„ 257((, Occupancy groups: City/State/ZIP: rneur A,, I Co_ 417 Zq 8 Existing: Phone:( f- 4,18(o Fax:( •''+j) MI -703(P New: APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: MI L-o'R-} Il!bt4L1 Structural plan review fee(or deposit): Contact name: -J Viks.z v . FLS plan review fee(if applicable): Address: 7(o57o 50.1 ,,,,..1D �rria 17-0 Total fees due upon application: City/State/ZIP: - -i-i A.tZQ I Ca-- 4 213 Amount received: Phone:(5 ) 244. corn . Fax::(573) 244--b417 - E-mail: d0.+h� r►^d p Gp M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* J i —CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted Photo Voltaic Solar Panel System. Business name: klertuaa.ST' Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 72 35' .1/.3tw LAw.te Solar Installation Specially Code checklist. City/State/ZIP: iotR'tL. .ryb �. Le'g Permit Fee(includes plan review $180.00 and administrative fees): Phone:(Sirs 2q 1.4618(4, Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.: $et 4.7.0 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. ' lij�� � I 11 3. /4"-7� I *Fee methodology set by Tri-County Building Industry Print name: Date: l . Service Board. 1:1 Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) on.3/e7 Clean Water Services File Number C1eanWater Services 15-003597 Sensitive Area Pre-Screening Site Assessment CE�VE0 1. Jurisdiction: TIGARD FiE X1`5 2. Property Information (example 1S234AB01400) 3. Owner Information \e 9 Tax lot ID(s): Name: James Lampus of �'[ �® 1S136DC4100 Company: TLB,LLC C`�1�G p1�j�1()N Address: PO 25716 BU Site Address: Il yr,i) ir,j 7r2 fjvt City, State, Zip: Portland,Oregon 97298 City, State, Zip: Phone/Fax: 503 291 6986 Nearest Cross Street: SW 72 at 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 ❑ 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 ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State, Zip: Tigard,Oregon 97223 Other Phone/Fax: 503 443 3900 Building demolition E-Mail: kkoroch @tmrippey.com 6. Will the project involve any off-site work? ❑Yes ►.1 No I] 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 demolition of single family house. 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 true,complete,and accurate. Print/Type Name Karl Koroch Print/Type Title Principal ONLINE SUBMITTAL Date 11/4/2015 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. XBased 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 SiteAssessment 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 e0.e .... .Gi�---- 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 71 ■ • COMMUNITY DEVELOPMENT DEPARTMENT TI G A R D Building Permit Review — Residential Building Permit #: eip20/..5---Qd.3- / / Site Address: lq,() SW 72nd Nye-. Project Name: T_B LLC■ Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: demo ex 1 S+1 J s rvIa u.fe' Verify site address/suite#exists and active in permit system. 41-River Terrace Neighborhood: ❑ Yes g No Sir Plan Elements: ��/ ree(3)copies of site plan 6 Existing structures on site Utf5ite plan must Le on 8-1/2"x 11"or 11 x 17"paper ,e/ootprint of new structure(including decks)with finished Ig awn to scale(standard architect or engineer scale) 1•or elevations rth arrow n Utility locations(required for new,may apply for additions) mee 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 t dimensions and building setback dimensions sign,location of catch basin,etc.) ` -Lot area,building coverage area,percentage of coverage and Street names cipervious area(applicable if R-7,R-12,R-25&R-40) Street tree size,type and location property corner elevations(2 foot contour lines if more than -Existing trees to be retained with drip line,and tree 4 •of differential) protection measures et Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: V Yes,applicant was notified ❑ No Received: PO •, r\ 0 -4 Public Facilities Improvement(PFI)Permit: 145-07- Required: El Yes,applicant was notified la No Applied For: • Yes ❑ No,stop intake s/and Use Case#: lig Zoning: t\f Ai Setbacks: Front Rear Side Street Side Garage Landscape Requirement: giN Lot Coverage Maximum: Building Height: Maximum Height Actual Height Visual Clearance Easements 'Sensitive Lands: ❑ Yes IN,No Type $-Urban Forestry Plan $Conditions "Met"prior to issuance of building permit only 1 Notes: 1'10 COtls�-r 'on to ;�'ili '.;-;ez,,i).. C�e.xvyo prOFOS�; SPL r ife] Approved By Planning: / v 414 Date: 1 13115 Revisions (after Building Su,mittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:\Building\Forms\BldgPenni t Rvw_RES_0709I 5.docx Building Permit Submittal Original Submittal Date: ii /is Site Plans: # Building Plans: # Building Permit#: 'Enter building permit#above. Workflow Routing: la-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 original plan review routing form. D-B'uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: //,�/,CS- �y `` Engineering Review ❑ Slope at building pad: ri ❑ 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: 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 ID Approved,NOT Released: Date: i� 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\For ms\BldgPetmitRvw_RES_0709I 5.docx