Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2016-00203
T[GA.R.[) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 251060003800
Jurisdiction: Tigard
Site address: 16550 SW FRIENDLY LN
Project: River Terrace East Subdivision: None Lot: None
Project Description: Demo 2,694 sf house&1,592 sf barn,on septic.UPON FINAL INSPECTION,DEMO CREDITS FOR SDC FEES
MAY APPLY.
Contractor: NORTHWEST EARTHMOVERS INC Owner: ADLV LAND HOLDINGS LLC
PO BOX 1609 BY FORSUM, MICHAEL
SHERWOOD, OR 97140 7600 E DOUBLETREE RANCH RD, STE
SCOTTSDALE,AZ 85258
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/13/2016 $301.85
Demolition
Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 07/13/2016 $0.50
Dwelling Units: 0 11x17)
Stories: 0 Height: 0 ft Erosion Control w/Development 07/13/2016 $80.70
Bedrooms: 0 Bathrooms: 0
Value: $14,800
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $383.05
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: Permittee Signature:
Call 503.639.4175 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.
I
Building Permit Application
Residential NE( a/E FOR 01.11(1 1 SI. o.I.\
City of Tigard Received�' Date/B : - O /4' Ji Permit No.: Pi,/G,64 aac
13125 SW Hall Blvd.,Tigard,OR 963Y 2 0 201 fi Plan Review
' a Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 CITY OF TR(.zMH D Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.govB IiLDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK 41 REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction i 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
INl-and 2-family dwelling ❑Commercial/industrial Valuation: $5 7►/�gpC)
0 Accessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: j(4 6St7 l'i2,1 f1J1)LY New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldgiapt.no.: Project name: River Terrace East Covered porch area: square feet
Cross street/directions to job site: East of SW Roy Rogers Road,South of Deck area: square feet
SW Scholls Ferry Road 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.: 2S106 Lot 3800 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Demo existing structures,gravel driveway,and sidewalk Valuation: $
Existing building area: square feet
2i Q(_//_ 4C t;t13.E) I 5-9 $ M c' �d
g f-� c- New building area: square feet
m PROPERTY OWNER 0 TENANT Number of stories:
Name: ADLV Land Holdings LLC a.0`1 )-L( '7 Type of construction:
Address: 7600 E.Doubletree Ranch Rd.,Suite 100 Occupancy groups:
City/State/ZIP: Scottsdale,AZ 85252 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT ErCONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Polygon WHL LLC Structural plan review fee(or deposit):
Contact name: Angie Grajewski
FLS plan review fee(if applicable):
Address: 109 E.13th Street
Total fees due upon application:
City/State/ZIP: Vancouver,WA 98660 _ .-
Phone:(360 )695-7700 Fax::( 360 )693-4442 Amount received:
E-mail: angels.grajewski@polygonhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Northwest Earthmovers,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 13600 SW Galbreath Drive PO Box 1609 Solar Installation Specialty Code checklist.
City/State/ZIP: Sherwood,OR 97140 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 503 )849-8540 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 62761 Total fee due upon application: $201.60
Authorized signature: �(I� �����C-v(/`J 4 : This permit application expires if a permit is not obtained
A. ,g7
c/ " r �' If
! within 180 days after it has been accepted as complete.
Print name: ewsf- Date: 60 '� e r� "Fee methodology set by Tri-County Building Industry
y4 ` lx Service Board.
I:1Building\Permits\BUP-RES itApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
)& 1P f_i-t o At/Lrt 1 T>
City of Tigard 7"-EA- -/' 15 T)"
IIIC COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
Building Permit #: u 0 ( Le -O 0?U
Site Address: \ a) ; Trl-CVIC;01 LAN---'
Project Name: -----k`.J 12__--' 6,1-S , Lot #:
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: 9emo 2Y i aaesgot 1 ,..-W-J'Ci:'`tz'S
Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ No 1(Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Three (3)copies of site plan xisting structures on site
Site plan must he on 8-1/2"x 11"or 11 x 17"paper i ootprint of new structure (including decks)with finished
i'gklDrawn to scale (standard architect or engineer scale) floor elevations
iorth arrow -'" tility locations(required for new,may apply for additions)
te address,project or subdivision name and lot number ►= .cation of wells/septic systems
Applicant information(name and phone number) ,Ar xisting trees to be retained with drip line,and tree
i\liff]Lot dimensions and building setback dimensions protection measures
t ( Lot area,building coverage area,percentage of coverage and 0 treet tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
Property corner elevations(2 foot contour lines if more than
4 foot differential)
Clean Water Services —Service Provider Letter (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified IN No Received: ❑ Yes ❑ No
TA Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified K No Applied For: ❑ Yes ❑ No,stop intake
,etc-Land Use Case#: p p a oj15-- Q X O(0 I Slag-7ol s-- 79 i Sjf,e-2eAr-Der
`�'l Zoning: -V— •5
etbacks: Front Rear Side Street Side Garage
ge
J Landscape Requirement: lJ A
X Lot Coverage Maximum pc
0,0
Building Height: Ni 1 Maximum Height Actual Height
Visual Clearance
XEasements ���" ."
Sensitive Lands: , Yes ❑ No Type LOW-e Y y 0l O t 1Cf li" 1/G1\ `
L Urban Forestry Plan
( Conditions "Met"prior to issuance of building permit ii
otes: ���. � O �� �� W �r lA l�1 P►`u Y
lSSkA0 K.C4 .
Approved By Planning: 4(QJ.-f- J, _
Date: iLe
Revisions after Buildi Submittal onl ) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:1Building\Forms\BldgPermitRvw_RES_060116.docx
,
Building Permit Submittal
Original Submittal Date: (P/$Df/fo
Site Plans: # 3
Building Plans: # i-------
Building Permit#: 2—Enter building permit#above.
Workflow Routing: Er Planning B-tngineering 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 Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: �x//6
ngineering 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: 0 Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes: DApproved by Engineering: ,U Date: 1277.40.4_,4
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
1:' Approved,NOT Released: Date: /*).--3.A6
Notes: 4 ) r6/)0- - f--_—
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: 0 Yes -nPN/A
Tigard Trans SDC: 0 Yes en.N/A
Parks SDC: ❑ Yes N/A
11 K to Issue Permit
Approved by Permit Coordinator: Date: /7/
l:\Building\Forms\B IdgPermitRvw_RES_060116.docx
•
Albert Shields
From: Angela Grajewski <Angela.Grajewski@polygonhomes.com>
Sent: Thursday, June 23, 2016 3:18 PM
To: Albert Shields
Subject: Re: Demos, River Terrace East
Albert,
We are in process of installing the tree protection fence on River Terrace East and will get the arborist report
done when that is complete. We are anticipating having it the first week of July.
Angela Grajewski
PROJECT MANAGER
Angela.Grajewski(apolvgonhomes.corn
Office 360.695.7700 Fax 360.816.7817
PolygonHomes.corn
Sent from my Verizon Wireless 4G LTE DROID
Albert Shields <albert@tigard-or.gov> wrote:
Angela, I have 4 demo permits here for River Terrace East but I don't see that we've received an arborist's report that
the required tree protection measures are In place. Would you please let me know if you have a copy of one that you
can send me? Otherwise I'll put these on Hold until we get one.
Albert Shields
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16550 SW FRIENDLY LN, BEAVERTON, OR, June 20, 2017 at 7:44:54 AM
97007
Record Type: Record ID:
Residential - Building BUP2016-00203
Inspection Type: Inspector:
299 Final inspection David Young
Result:
FA I L
Comments:
Provide approved final erosion control prior to final inspection.
Provide pump and fill receipt for septic or proof of tank removal.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16550 SW FRIENDLY LN, BEAVERTON, December 27, 2018 at
OR, 97007 12:01 :21 PM
Record Type: Record ID:
Residential - Building BUP2016-00203
Inspection Type: Inspector:
299 Final inspection Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor