Permit 11/ r CITY OF TIGARD BUILDING PERMIT
• COMMUNITY DEVELOPMENT Permit#: BUP2016-00342
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2016
Parcel: 251070001200
Jurisdiction: TIGARD
Site address: 14992 SW ROY ROGERS RD
Project: Polygon at River Terrace Edge Subdivision: CHURCHILL FOREST Lot: C
Project Description: Demolition of 955 sq ft house on septic and 202 sq ft well house. Upon final inspection SDC credits may apply to
future construction.
Contractor: UNITED EXCAVATORS Owner: UPCHURCH, GERALD S
4804 NW BETHANY BLVD STE 1-2 PBM 361 14992 SW ROY ROGERS RD
PORTLAND, OR 97229 SHERWOOD, OR 97140
PHONE: 503-914-7166 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 12/20/2016 $464.97
Demolition
Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 12/20/2016 $0.50
Dwelling Units: 11x17)
Stories: Height: ft Erosion Control w/Development 12/20/2016 $107.60
Bedrooms: Bathrooms:
Value: $25,300
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $573.07
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 1. The permit holder will need
certificate that the septic tank
Fire Alarm: Protected Corridors: 2 2. An engineer will need to
Smoke Detectors: Manual Pull Stations: verify compaction of the earth at
Accessible Parking: 3 3. Will need to have the water
master of Washington County
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: 7 iPermittee Signature: 2:2,„j
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/176
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.
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City of Tigard r,"°a /a nib' ,.✓ =VIA 1. 1 (o 44 3
13125 hS501.711 Blvd..2439 Tigard,5O 9 l9 S 1 i, h Plan Review -- - R Omer Pamir. Pp/Z.�i S—ooDO
111111 R Phone: 503.718.2434 Fax: 50 . I pa, : . 1
Inspection Line: 503.6391411111
03.639.4 7 �y 1 c" � Dau Ready/By: jw": -
0 tt3 A r?' NotifiedaMet od:
Internet www,ngard-or.g � t9i
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❑New contra tion µ ]Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/repiacent 0 Other: equipment,materials,labor,overhead,and the profit for the
la. :. ,.- ' ._ . .:rT.::- r
s" work indicated on this application
e Fz. c r.
Valuation: S 25,300
®1-and 2-family dwelling ❑CommerciaVndtntrial
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder 0 Other: Number of bathrooms:
1 " ''TT-2_,,i ` @ , r t 11,c 'CI: t%,.',--' o Total number of floors:
Job site address: 14992 SW Roy Rogers Road New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bIdg/apt.no.: I Project name: Polygon at River Terrace Edge Covered porch area: square feet
Cross street/directions to job site: East of SW Roy Rogers Road,South of Deck area: square feet
SW Bull Mountain Road Road Other structure area: square feet
G f 3 n a L.',1,:E 1e .r,r,• ': 7� "i - 'r
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax t no.: 23107 Lot X200 Indicate the value(rounded to the nearest dollar)of allP equipment,materials,labor,overhead,and the profit for the
, �, t ,• .�'- � ,. .�� work indicated on this�.�y.lication.
Demo existing structures and driveway Valuation: $
Existing building area: square feet
New building area: square feet
s 7:i ' Number of stories:
Name: Polygon WLH,LI,C Type of construction:
Address: 109 E.13th Street Occupancy groups:
Oty/State/ZIP: Vancouver,WA 98660 listing:
Pirate:(360 ) 695-7700 Fax:(360 )693-4442 New:
Business name: Polygon WLH LLC
Structural planreviewfee(or deposit): _■
Contact name: Angie Grajewsl3
FLS plan review fee(if applicable): 11.111111111111111111111
Address: 109 E.13th Street Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
�
Amount received:
Phone:(360 )695-7700 I Fax::(360 )693-4442 r
E-mail: augela.grajewskigipolygonhomes.com Commercial—
and
residential prescriptive installation of
e. . . ' � ..1�,. i7-7:1,t. '�. `. '.. - - roof-top meiarted Photovoltaic Solar Panel System.
Business name: United Excavators Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4804 NW Bethany Blvd Ste 1-2 PBM 361 Solar Installation ',,ectal Code checklist.
/State/ZIP: Portland,OR 97229 Permit Fee(includes plan review $180.00
Cityand administrative fees:
Phone:(503 )914-7166 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:198822 /A - Total fee due upon application: $201.60
Authorized signature:
e(66/41/3/
� ;�r� (/{, This permit application expires if a pen&is not obtained
jwithin 180 days after it has been accepted as compsPrint name: 1q evA
r ,� /! : / 11 *Semeodologyset by Tri-County Building IndustryI:\BuildingIPermitsBBUP-RESP ermmiitApp.doc 02/24/2011 440.4613T(1 I /COM/WEB)
City of Tigard
liga COMMUNITY DEVELOPMENT DEPARTMENT
■
Building Permit Review — Residential
TIGARD
M
BuildingPermit #: -- r3 LL ago t1 - DO 341 -
Site Address: )9 9°12 cw 6-°.y a-09-c--Ki 124
Project Name: pb 1 vj y oY) q 4.- iZ t€x -re trA L¢.. Got ),Q., Lot #:
(New orwelling=subdivision name;Addition or Alteration=last nate of owner)
Planning Review
Proposal: D-M V pv.fen i-k--
71�P�Verify site address/suite# exists and active in permit system.
r1�yo
River Terrace Neighborhood: ❑ No yr Yes,See River Terrace Review Addendum Attached/p P.t''m i+-
Site Plan Elements: '`�/A-
/Three(3)copies of site plan Existing structures on site
Site plan must be on 8-1/2"x 11"or 11 x 17"paper Footprint of new structure(including decks)with finished
Nraven to scale(standard architect or engineer scale) floor elevations
orth arrow [VUtility locations(required for new,may apply for additions)
Aite address,project or subdivision name and lot number lLocation of wells/septic systems /n
A
Applicant information(name and phone number) Existing trees to be retained with drip line,and tree I V ,-i'
Lot dimensions and building setback dimensions protection measures Id�f ►1
1 Lot area,building coverage area,percentage of coverage and Street tree size,type and location (�
impervious area(applicable if R-7,R-12,R-25&R-40) Street names f rinn It
CI 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 ❑ No Received: ❑ Yes ❑ No
jA Public Facilities Improvement(PFI) Permit:
Required: E Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Land Use Case#: pov,oif- 0O00'1 , SUe2OIS-00019
/ Zoning:
❑ Required Setbacks: Front Rear Side Street Side Garage
❑ Landscape Requirement: %
❑ Lot Coverage Maximum:
1\1)Pr ❑ Building Height: Maximum Height Actual Height
Q,,, 00 Visual Clearance
C/' ❑ Easements
❑ Sensitive Lands: ❑ Yes ❑ No Type
❑ Urban Forestry Plan
❑ Conditions "Met"prior to issuance of building permit
Notes:
Approved By Planning: M, r'-- 0'1/N._ - Date: 1 i/9/ 1 b
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Fonns\BldgPennitRvw_RES 091216.docx
Building Permit Submittal
Original Submittal Date: I2 f% I I‘o
Site Plans: # a
Building Plans: # /sib,"
Building Permit#: 'Enter building permit#above.
Workflow Routing: -Planning .engineering a-I ermit Coordinator ��Building
Workflow Sign-off: CXSign-off for Planning(include notes from planning review)
Route Application Documents: engineering: (1) copy of permit application, (1) site plan, (1) building plan and
� o giinal plan review routing form.
Lit Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ( � p
By Permit Technician: Date: /3.4/
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: Date: iz—jz
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:
i?NSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes P` t"/A
Tigard Trans SDC: ❑ Yes PPN/A
Parks SDC: ❑ Yes pN/A
K to Issue Permit
Approved by Permit Coordinator: Date: 0 2-/1
I:\Building\Forms\B1dgPermitRvw_RES_091216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14992 SW ROY ROGERS RD, SHERWOOD, OR,
97140
Record Type: Record ID:
Residential - Building BUP2016-00342
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:
14992 SW ROY ROGERS RD, SHERWOOD, December 27, 2018 at
OR, 97140 12:04:29 PM
Record Type: Record ID:
Residential - Building BUP2016-00342
Inspection Type: Inspector:
299 Final inspection Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor