Permit CITY OF TIGARD BUILDING PERMIT
' COMMUNITY DEVELOPMENT Permit#: BUP2017-00190
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2017
Parcel: 1 S135BD00400
Jurisdiction: Tigard
Site address: 10895 SW 95TH AVE
Project: Ash Creek Village Subdivision: MEADOW VIEW Lot: 8
Project Description: Demolition of(1)1,538 SF house,(1)120 SF detached garage,(1) 120 SF shed,and(1)100 SF shed.UPON
FINAL INSPECTION,DEMO CREDITS FOR SDC FEES WILL APPLY.
Contractor: K&G CONSTRUCTION CO Owner: CTH INVESTMENTS LLC
26090 NW TIMBER CO 1800 NW 167TH PL STE 150
FOREST GROVE, OR 97116 BEAVERTON, OR 97006
PHONE: 503-681-2370 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/06/2017 $564.15
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development 07/06/2017 $107.60
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $35,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $671.75
Required: Required Items and Reports(Conditions)
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:
Cal 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 •• . oject.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Residential FOR OFFICE USE ONI.V
Ci of Tigard RECEIVE() Received 7 3 t 7 �, ._
`7 g PermitNo.: �y
13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: /2- c r)M
g Plan Review U
Phone: 503.718.2439 Fax: 503.598.1960 A, Date/By: Other Permit:
Inspection Line: 503.639.4175 JUN 2017 Date Ready/By: Juris:
1 1�;,A h 1) Y Y� BJ See Page 2 for
Internet: www.tigard-or.govS' OF
TIGr,RD Notified/Method: tr...6 Supplemental Information
iniki
' F. t; I V r g r .�
❑New construction Z 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
._,. .... �..:. ��. work indicated on this application.
,,. r , a, , a .ice , .� r ; .a , rr ,e• ,
Valuation: $ r-.
Z 1-and 2-family dwelling ❑Commercial/industrial J i�'
❑Accessory building ElMulti-familyNumber of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
f, J i' ! 6 t TOS Total number of floors:
Job site address:10895 SW 95th Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Ash Creek Village Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW North Dakota St11) y
(,IN( sC,�.vC��,— �; /1 Other structure area: square feet
7/(/ 7 /3 e 1 3 DA A s 6, 0
Subdivision:Ash Creek Village J Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
, , k r ,� � e �`Fey
equipment,materials,labor,overhead,and the profit for the
e 6 t e work indicated on this application.
............ ,(0 ,"4„„„ Valuation: $
Existing building area: square feet
New building area: square feet
*.,4"*.* ' Number of stories:
Name:Sage Built Homes,LLC Type of construction:
Address:1815 NW 169[6 Place,Suite#1040 Occupancy groups:
City/State/ZIP:Beaverton,OR 97006 Existing:
Phone:(503)969-8298 Fax:( ) New:
l')t ,
Business name:Sage Built Homes,LLC
Structural plan review fee(or deposit):
Contact name:Cale Doney
FLS plan review fee(if applicable):
Address: 1815 NW 169[6 Place,Suite#1040
City/State/ZIP:Beaverton,OR 97006 Total fees due upon application: v i 75'
Phone:(503)969-8298 Fax: :( ) Amount received TT /
`P 68 *.
E-mail:Caled@sagebuilthomesllc.com ,,,
,., Commercial and residential prescriptive installation of
,,.. , ;s4 „ ; ,, „:','.•,) ,-,1••'••,,' roof-top mounted PhotoVoltaic Solar Panel System.
Business name:K&G Construction Co Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:26090 NW Timber Road Solar Installation Specialty Code checklist.
City/State/ZIP:Forest Grove,Oregon 97116 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)681-2370 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:28711
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.
Print name: i 'ial Date:6/4?-7/,&9/"7 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
IIII
T l A R o Building Permit Review — Residential
Building Permit #: 844:10/ 7 -c e.;f/0
Site Address: 108'45 5(•) cT5T AvE
Project Name: Ash Cfe.n,V. v k 0%Te Lot #:
(New dwelling=subdivision name; dition or Alteration=last name of owner)
Planning Review
Proposal: Cx'LG -Q, c,11-}Y5 A��5 a n 5 ,T e
riherify site address/suite# exists and active in permit system.
'p, River Terrace Neighborhood: GS No ❑ Yes,See River Terrace Review Addendum Attached
Site Plan Elements:
Vrihree 1.)copies of site plan (Pot Jo:4)1 c.o p,ey-w4-> Existing structures on site
T(5ite plan must be on 8-1/2"x 11"or 11 x 17"paper (Footprint of new structure(including decks)with finished
kZ'Drawn to scale(standard architect or engineer scale) floor elevations
11261orth arrow l': tility locations&easements(required for new and additions)
tifSite address,project or subdivision name and lot number N!.i idewalk/driveway approach
YApplicant information(name and phone number) (,7t ,cation of wells/septic systems
Vta1�Lot dimensions and building setback dimensions a Existing trees to be retained with drip line,and tree
[ quare footage of buildings to be demolished ��qq protection measures
t)(Lot area,building coverage area,percentage of coverage and V V Street tree size,type and location
impervious area(applicable if R-7,R-12,R-25&R-40) Street names
t1/4)443roperty corner elevations(2 foot contour lines if more than >1,000 sf of impervious area created or replaced? ❑Yes KNo
4 foot differential) If yes,is a storm water quality facility shown? - LJYes L1No)0/4"
TA Clean Water Services-Service Provider Letter(lot platted prior to 9/10/1995):
equired: ❑ Yes,applicant was notified Al No Received: CI Yes CI No
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: [ 'Yes ❑ No,stop intake
,"/Land Use Case#: ? (42.10 t%-4000i 5'-k 2o15-OoocP
I..d" Zoning: T--,.4 5(PDT) TL-\L( In>)
tip Required Setbacks: Front Rear Side Street Side Garage
Vlt Landscape Requirement:
ViirtLot Coverage Maximum:
'& Building Height: Maximum Height Actual Height
V ri Visual Clearance
Kt' Sensitive Lands: ❑ Yes ❑ No Type
V jJrban Forestry Plan
Pi Conditions "Met"tprior t issuance of buildin permit
Notes: cswAc lt'11`t7r1.5 _-(- 1 ' - r r ":„ & P4 NreS -j .. .1.(1- . qce. •r,br
.. .2 4(.. 11 • .,. /.. r e t4 Q t.. 1
Approved By Planning: �� i / �/ �i Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPermitRvw REs o61417.docx
Building Permit Submittal
Original Submittal Date: 6117
Site Plans: # ,22
Building Plans: # _
Building Permit#: nter building permit#above.
,� ,.�iCIWorkflow Routing: li",� tanning ngineering LI--Ijermt Coordinator Building
Workflow Sign off: 1�9-5�1 -off for Planning(include notes from planning review)
Route Application Documents: L'1.."-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
[wilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 4no, Gytir;
By Permit Technician:�/ ,„"' " /'.-11111111. Date: 773/j7
Engineering Review
ja Slope at building pad:
pConditions "Met"prior to issuance of building permit
ZEasements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No v A_
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes Cl No
❑ NOT Approved by Engineering: Date:
Notes: 'b. M,0
Approved by Engineering: Pk' I K 1 Date: -1 IL/f 7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: El 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:
DC Fees Entered: Wash Co Trans Dev Tax: El Yes N/A
Tigard Trans SDC: El Yes N/A
Parks SDC: ❑ Yes 04 N/A
LIDA ❑ Yes [ r.N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: l
I:\Building\Forms\BldgPermitRvw_RES_061417.docx