Permit CITY OF TIGARD BUILDING PERMIT
•; ' COMMUNITY DEVELOPMENT Permit#: BUP2015-00219
T[Co.hRD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 2S1060003200
Jurisdiction: TIGARD
Site address: 13855 SW ROY ROGERS RD
Project: Polygon at West River Terrace Subdivision: 2002-032 PARTITION PLAT Lot: 3
Project Description: Demo existing structures:1,744 sf house, 125 sf shed&178 sf shed, Septic tank is to be pumped and filled or
removed. Upon final inspection SDC credits can be applied towards new construction.
Contractor: BULL MOUNTAIN RIDGE LLC Owner: MCMAHON, MARIANNE P REVOC LIVING
109 E 13TH STREET BY MCMAHON, MARIANNE P TR
VANCOUVER,WA 98660 13855 SW ROY ROGERS RD
SHERWOOD, OR 97140
PHONE: 360-695-7700 PHONE:
FAX: 360-693-4442
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/22/2015 $332.27
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development-Eng 07/22/2015 $80.70
Dwelling Units: 0 Info Process/Archiving-Sm$0.50(up to 09/22/2015 $2.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $17,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $415.47
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 ugh 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 B : Perm ittee Signet lre:
Call 503.639.4175 by 7:00 a.m.for the next available inapecti 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 p g-�
City of Tigard R E C E I V E 9....1+ Received"y r�rf permit No.:
.111 • 13125 SW Hall Blvd.,Tigard,OR 97223
Review
Phone: 503.718.2439 Fax: 503.598.1 2 2 2015 Date/By: OtherPexmit:
T G A RI, Inspection Line: 503.639.4175 U L !� Date Ready/By: -/ Jana See Page 2 for
Internet wwwtigard-or.gov ,ti Noufied/Ket od: 0. '•
� , Supplemental Information
CITY OFIP , PD / •y:
❑New construction ®Demolition Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement Other Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
Cr3TEGORY OF CONS'IRUC'}ION, work indicated on this application.
El1-and 2-family dwelling L.commercial/industrial Valuation: $ c4!:%e? f�
®Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
SITE INFORMATION AND LOCA'CION e�rgP%' "` Total number of floors:
Job site address: 13855 S\S Roy. Rogers Road New dwelling area: square feet
City/State/ZIP: Beaverton,OR 97007 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Polygon at West River Terrace(Area 2) Covered porch area square feet
Cross street/directions to job site: SW Roy Rogers Road Deck area: square feet
Other structure area: square feet
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.. 2S106/TL 3200
Indicate the value(rounded to the nearest dollar)of all
r , equipment,materials,labor,overhead,and the profit for the
is ei work indicated on this appliation.
Valuation: $
Demo existing structures on tax lot
Existing building area square feet
New building area: square feet
<' ` t 'e'RT3, a as tie .' i�', ,1`,A 1 Numberofstories:
Name:Polygon WLH,LLC Type of construction:
Address:109 E.13th Street Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing
Phone (360)695-7700 Fax (360 ) 693-4442
New:
PERSON BTr7tEF �-.,E�'�18$�`�1
Business name: Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Chris Walther
FLS plan review fee(if applicable):
Address: 109 E.13th Street
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received , r�
Phone:(360)695-7700 Fax::(360)693-4442 ��
E-mail: chrisyvalther@poiygonhomes.com 1 ,� �>ti ;� ,,Iq,,
as 7 � Commercial and residential prescriptive installation of
al � a eta i i roof-top mo ted PhotoVoltaic Solar Panel System.
Business name: Bull Mountain Ridge LLC Submit two(2) of roof plan with connecti details
and fire department a along wi 10 Oregon
Address: 109 E.13th Street Solar Installation Special ecklist.
City/State/ZIP: Vancouver,WA 98660 Permit Fe us plan $180.00
and administrative fees):
Phone:( 360 )695-7700 Fax:(360 ) 693-4442 Stale surcharge(12%of permit fee): .60
CCB lic.: 203735
Total fee due upon application: $201.60
Authorized signa - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Chri 7 h��S,_ *Fee methodology set by Tri-County Building Industry
s Walther Date:
Service Board.
1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
■ COMMUNITY DEVELOPMENT DEPARTMENT
71
T l G n rz u Building Permit Review — Residential
Building Permit #: PQL,x.Pc9,0 5-CO a.! 9
Site Address: /3BSs'- ,S'l3 / , rs e_r)2
Project Name: Pai�///�_ sL �'7L A - ,i er 7`' `�_ Lot #:
(New qy/ ' g= subdivision name;Addition or Alteration=last name of owner)
Planning R view VVVVV //,
Proposal: ij92[� ,SO -ess' 6--4. s j
erify site address/suite# exists and active permit system.
rd River Terrace Neighborhood: Yes ❑ No
Sit lan Elements: L/ .
( copies of site plan ICE sting structures on site
qGS - plan must be on 8-1/2"x 11"or 11 x 17"paper afootprint of new structure(including decks)with finished
te4. P wn to scale(standard architect or engineer scale) fl or elevations
YG_ .rth arrow [Jiility locations (required for new,may apply for additions)
fP -.address,project or subdivision name and lot number / ation of wells/septic systems
P. 'plicant information(name and phone number) rosion control(including drainage-way protection,silt fence
7 .t dimensions and building setback dimensions design,location of catch basin,etc.)
%Lot area,building coverage area,percentage of coverage and treet names
pervious area(applicable if R-7,R-12,R-25&R-40) b" t t tree size,type and location
roperty corner elevations(2 foot contour lines if more than xisting trees to he retained with drip line,and tree
�44 foot differential) protection measures
*lean Water Services—Service Provider Lette (lot platted prior to 9/10/1995):
equired: ❑ yes,applicant was notified No Received: ❑ Yes El No
lit Public Faciliti mprovement (PFI) Permit:
ipht quired: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake
Coning:
Use Case #: L�1Qcj1 Rc-- O
�C 'oning: 1- ,c,Toz
etbacks: Front / " Rear /S .S
Side � U
Street Side � / Garage 023
Landscape Requirement: p?0
/ t Coverage Maximum: �� %
IJ�' Building Height: Maximum Height cs_c)
Actual Height
xi n -ual Clearance
V a. ements
I. nsitive Lands: Yes D No Type L OW V f /( /` I2`-/---
v. Urban Forestry Plan
❑ Conditions "Met"prior t issuan e of building permit
Notes: /S
07Cr-
710, pQ17/71 / L/t'241
Approved By Planning: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: D Approved ❑ Not Approved
I:\Bui Iding\Forms\Bldg PermitRvw_RES_070915.docx
Building Permit Submittal
Original Submittal Date: -7/9,97/
Site Plans: # 3
Building Plans: #
Building Permit#: -a-Enter building permit#above.
Workflow Routing: Planning engineering —rmit Coordinator ❑`� kg
Workflow Sign-off: .ETSign-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.
E—Building: original permit application, site plans,6 i aud,
Notes:
By Permit Technician: /� (� Date: 7,4-4s—
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 0 No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: "7 191 1.5.-
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of bu ng permit
?KiDApproved,NOT Released: idol 6;7
Notes: /,4; 44 rrvC
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 /A
Tigard Trans SDC: ❑ YesPN/A
Parks SDC: ❑ Yes N/A
S
OK to Issue Permit //
Approved by Permit Coordinator: /0/17/77ZDate: 47,////"S--
I:\Bui I ding\Forms\BldgPennitRvw_R ES_0709 15.docx
( `Paa1s'(x 19
REC,E1VEP
SEP 9 2015
,ITV OF U'1GARD
BUILDING DIVISION
MHA15004 Polygon at West River Terrace(Area 2)-Tree Protection Monitoring
Morgan Nolen 9/6/2015
—,&—AJJOCIATEJ: Page 1 of 1
Inspection On Site Recommendation for Resolution
Item Condition or Comment
Date Inspector Contact Corrective Action Date
No site visit.Coordinated with Pacific
Community Design regarding tree protection
measures prior to demolition.Reviewed the Tree
Preservation and Removal Site Plan. There are None at tax lot 3000;coordinate with the project
Tree no trees planned for preservation in proximity to arborist to verify the installation of tree
7/27/2015 Morgan None Protection demolition activities for tax lot 3000,Case protection measures along the southern 09/04/15
(Demo) Number BUP2015-00220 and no tree protection property boundary adjacent to the demo for tax
measures are needed.Protection fencing will be lot 3200,Case Number 8UP2015-00219.
needed along the southern property boundary
prior to demolition at tax lot 3200,Case Number
BUP2015-00219,which is several weeks out.
Tim Protection measures sa ' factorily in place and in
4 2015 Morgan LooneyTree
9
/ / Protection good repair where eded across the proje None. N/A
(NEI) site.
General Comments:
None.
n rv—e.�j /tit-
911—
Morgan rlolen&Associates,LLC
Consulting Arborists and Urban Forest Management
3 Monroe Parkway,Suite P220,Lake Oswego,OR 97035
morgan.holen@comcastnet 1971.409.9354
CITY OF TIGARD FEE AND PAYMENT HISTORY
i R 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
BUP2015-00219 - 13855 SW ROY ROGERS RD, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-Additions,Alterations, 230-0000-43104 $332.27 $332.27 $332.27 7/22/15 Check 201774 $0.00
Demolition
Erosion Control w/Development-Eng 100-0000-43134 $80.70 $80.70 $80.70 7/22/15 Check 201774 $0.00
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $2.50 $2.50 $2.50
11x17)
Totals for Fees $415.47 $415.47 $412.97 $2.50
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
201774 Check 070475 Polygon WLH LLC 07/22/2015 $412.97
Total Payments: $412.97
Balance Due: $2.50
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13855 SW ROY ROGERS RD, TIGARD, OR, June 20, 2017 at 7:54:59 AM
97224
Record Type: Record ID:
Residential - Building BUP2015-00219
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