Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2016-00049
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11l2016
Parcel: 2S1070001305
Jurisdiction: Tigard
Site address: 16780 SW BULL MOUNTAIN RD
Project: Polygon at South River Terrace Subdivision: None Lot: None
Project Description: Demolition of(2)existing structures and concrete: (1)2,368 sq.ft.house and(1)1,674 sq.ft.structure. Property
is not billed for sewer.UPON FINAL INSPECTION,DEMO CREDITS FOR SDC FEES WILL APPLY.
Contractor: WILLIAM LYON HOMES INC Owner. ADLV LAND HOLDINGS LLC
109 E 13TH STREET BY FORSUM, MICHAEL
VANCOUVER,WA 98660 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 360-695-7700 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/11/2016 $487.01
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development 07/11/2016 $107.60
Dwelling Units: 0 Info Process/Archiving-Sm$0.50(up to 07/11/2016 $2.00
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: C
Value: $27,675
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $596.61
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: �rt 1 �2 Permittee Signature: ccee
_ ./ ��
. ���JJJ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. Cl�,L/,C�/
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 Lc .-2 0 (P
Residential i()u u1 1-II I. I FIC nAi-1
City of 11 ., �� Received
1 C j le i'c i No.:i3 (A;2C)%4`—O.:kit II'
• 13125 SW Hall Blvd.,Tigard,OR 97 � h ^p1 Plao Review
°� •
Phone: 503.718.2439 Fax: 503.598.l9 < 1 V r� Date/By: Other permit.
I l l A P 11 Inspection Line: 503.639.4175 < tt Y`+ a Reedy/By; r I B See Page 2 roe
Internet: www.tigard-or.gov C G P et hod: j 7 Supplemental Information
TYPE OF WORK ,,,„.-014— REQIJIREDDATAtI-AND 2FAMILYDWELLING
❑New construction ®Derakiii 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 OFCONSTRUCTION work indicated on this application. e�
Valuation: $07 7 G �S!/
® I-and 2-family dwelling 0 Commercial/industrial !
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
`JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address ( � 7 7 ,t'2)Lf// 4 New dwelling area: square feet
City/State/ZIP:Tigard,OR,97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:South River Terrace Covered porch area: square feet
Cross street/directions to job site:SW Bull Mountain Road&SW Roy Rogers Ro Deck area: square feet
Other structure area: square feet
._.REQUIRED DATA--COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
no.:2SIW Tax Lot 1305 Indicate the value(rounded to the nearest dollar)of all
Tax
map/parcelequipment,materials,labor,overhead,and the profit for the
DESC_ RIprION'QF WORK work indicated on this application.
Demo of existing structures Valuation: $
A--i 5, /lci i *,_ A r Existing building area: square feet
New building area square feet
PROPERTY OWNER ❑ TENANT Number of stories:
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:
❑ APPLICANT ® coNFAcr PERSON BUH DING PERMIT FEES*
Business name:Polygon WLH LLC lWaos rrfo Ahexd
Structural plan review fee(or deposit):
Contact name:Chris Walther
FLS plan review fee(if applicable):
Address:109 E 13*.Street
City/State/ZIP:Vancouver,WA 98660 Total fees due upon application: J IC . Gni
Amount received:
Phone:(360)695-7700 Fax::(360)693-4442
E-mail:ChrisWaltherQPolygonhIomea.com PHO'FOVOLTAICSOLARPANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business nam . main C t.t) /L.L jr9P-1 L (t/J tNf 63. I ii� Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:109 E.13'h Street Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver,WA,98660 Permit Fee(includes plan review
$180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)693-4442 State surcharge(12%of permit fee): $21.60
CCB Iic.:- 03-733— ,„A-I 7 t2 LI 2 Total fee due upon application: $201.60
Authorized signature: /7 This permit application expires if a permit is not obtained
within 180 days atter it has been accepted as complete.
/G *Fee methodology set by Tri-County Building Industry
Print name:Chris Walther Date: �,—�
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(l 1/02/COM/WEB)
City of Tigard
11
11111 COMMUNITY DEVELOPMENT DEPARTMENT
2
TIGARD Building Permit Review — Residential
Building Permit #: , /4/9 6 ho -CXX)itq
Site Address: (per p t 1) ,teu / i j ii
Project Name: cc // Bever- 7e,,rza, Lot #:
w Iling= subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: i ex-An S'73udo-PS
�erify site address/suite# exists and active permit system.
er Terrace Neighborhood: Yes ❑ No
Sit plan Elements:
free (3)copies of site plan {{xyisting structures on site
Pill to plan must he on 8-1/2"x 11"or 11 x 17"paper 6btprint of new structure(including decks)with finished
I!!J xawn to scale(standard architect or engineer scale) '�1yo��o�r elevations
rth arrow PLJ'tility locations(required for new,may apply for additions)
address,project or subdivision name and lot number 4M cation of wells/septic systems
IJ Applicant information(name and phone number) -:rosion control(including drainage-way protection,silt fence
iill;air.t dimensions and building setback dimensions /sign,location of catch basin,etc.)
is t area,building coverage area,percentage of coverage and IL?J treet names
impervious area(applicable if R-7,R-12,R-25&R-40) CO:''eet tree size,type and location
II Property corner elevations(2 foot contour lines if more than 1)5 i sting trees to be retained with drip line,and tree
4 foot differential) protection measures
lean Water Services—Service Provider Lette of platted prior to 9/10/1995):
Required: ❑ Ye ,applicant was notified No Received: ❑ Yes ❑ No
❑ Public Faci i Improvement(PH) Permit: /
Iequired:
Yes,applicant was notified ❑ No Applied For: El Yes No stop intake CPI
And Use Case#: Abe'?oS --
/ — 0000 Si3 S 026/ dboo
Eli Zoning: t-3-
od/Retbacks: Front Rear Side Street Side Garage
andscape Requirement:
%
Ftot Coverage Maximum:
$ °o
uilding Height: Maximum Height Actual Height
isual Clearance
asements
izil
Sensitive Lands: 0 Yes 0 No Type L )72?) /If libi*2.4 i -h1.P
flrban Forestry Plan 11
❑ Conditions "Met"prior to issuance of buildin permit
Notes: 5Pogi:i:nn. /1?Lrg lyt2 s')j')Ur 7‘ itS"Ifte� �1rn,)
/ l ,A
Approved By Planning:\ . Date: _ ,271.204(e2_,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:1Building\Forms\BldgPennitRvw_RES_070915.docx
Building Permit Submittal
Original Submittal Date: a /oJ/G
Site Plans: # �,2
Building Plans: #
Building Permit#: nter building permit Bove.
Workflow Routing: lanning ngineering rmit Coordinator ❑ Building
Workflow Sign-off: ,,� �off for Planning(include notes from planning review)
Route Application Documents: �r ngineering: (1) copy of permit application, (1) site plan, (1) building plan and
on . 1 plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam.� calculations and trust details,if applicable,etc.
Notes: Y- 6) /r1 /gr" -e.se —
By Permit Technician: � , ? Date: 4,2,�//�(p
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: E Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
E NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: p Date: 7-4z-/,‘
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved E Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
Approved,NOT Released: f O Date:-2,/1 74'fr
Notes: /4i4v/. ti tc �nGC aCi
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: E Yes (VN/A
Parks SDC: ❑ Yes ?g:D N/A
rOK to Issue Permit �/
Approved by Permit Coordinator: Date: 7/��
I:\Building\Forms\BldgPennit Rvw_RES_070915.docx
Albert Shields
From: Albert Shields
Sent: Wednesday, February 17, 2016 1:48 PM
To: Chris Walther(Chris.Walther@polygonhomes.com)
Cc: Monica Bilodeau
Subject: Demp Permits, Polygon at South River Terrace,BUP2016-00047, -00048, &-00049
Chris, before we can release these three demo permits we need to receive a report from your project arborist certifying
that all required tree protection has been installed at those locations. Meanwhile, we'll put these on Hold as "Approved
but Not Released." Please have a copy of the arborist's report sent to me so that I can expedite these permits. Albert
Shields
1