Permit CITY OF TIGARD BUILDING PERMIT
. COMMUNITY DEVELOPMENT Permit#: BUP2016-00048
Date Issued: 07/11/2016
Tt(„qj{D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1070001300
Jurisdiction: Tigard
Site address: 16830 SW BULL MOUNTAIN RD
Project: Polygon at South River Terrace Subdivision: None Lot: None
Project Description: Demolition of(2)existing structures and asphalt removal:(1)3,023 sq.ft.house and(1)1,335 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 7600 E DOUBLETREE RANCH RD STE 130
VANCOUVER,WA 98660 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 $542.11
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: 0
Value: $32,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $651.71
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: r( t , 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.
Building Permit Application r c- 1 S c /p
Residential
City of Tigard ! t� �Q1b R ?A) iru ���. Permit No.:/ , ,/
;�I ■ 13125 SW Hall Blvd.,Tigard,OR 97223 r N-V •Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 G P�, Other Permit:
i i r;;,,h n Inspection Line: 503.639.4175 `"t,O`,G Ie tcadyBy: ruic ® See Pagel for
Internet www.tigard-orgov `!c( Q ;a1`�I�`Notified/Mcthod: /,T.,, I Supplemental Information
tj
TYPE OF WORII' jv" REQUIRED DATA I-AND 2-FAMILYDWELLING
❑New construction ®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 CONSTBUCITON work indicated on this application.
Valuation: $ 302 j00• Se--
® I-and 2-family dwelling 0 Commercial/industrial
❑Accessory building El Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site ado I i�j 3(4). sSvL) jt2 // 1/ ,Pc( 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: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:2S1W Tax Lot 1300 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Demo of existing structures Valuation: $
it:: h / , ! Existing building area: square feet
fi .-y.cT
New building area: square feet
N PROPERTY OWNER 1 . ❑TENANT;,- Number of stories:
Name:Polygon W LH LLC Type of construction:
Address:109 E 13ts Street Occupancy groups:
City/State/Z1P:Vancouver,WA,98660 Existing:
Phone:(360)695-7700 Fax:(360)693-4442 New:
❑-APPLICANT = ® CONTACT PERSON BUILDING PERMiT FEES
(Please refer mfer+ch k1
Business name:Polygon WLH LLC
Structural plan review fee(or deposit):
Contact name:Chris Walther
FLS plan review fee(if applicable):
Address:109E 13"Street p Total fees due upon application: _.5!..7 f
City/State/ZIP:Vancouver,WA,98660
Amount received:
Phone:(360)695-7700 Fax::(360)693-4442
E-mail:ChrisWalther@PolygonHomes.com
-.: Commercial and residential prescriptive installation of
COIPI RACfOR roof-top mounted PhotoVoltaic Solar Panel System
Business name.o..0 Moms._:_R d e 1 t Q._A.?ALL/,g.M i...1 Cn; t/Ed`"11 .S 1, submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:109 E.13"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)6934442 State surcharge(12%of permit fee): $21.60
CCB lic.:103-735 ' c2 0 `2a y 7 Total fee due upon application: $201.60
Authorized signatu - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Chris Walther I Date: �—0/G *Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
_ COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Residential
Building Permit #: ,d, i/ - oo.
Site Address: R4B3 S'4) / // . gozd
Project Name: , 1 r c� � i✓�- .2ce Lot #:
(Ne 'ng=subdivision name;Addition or Alteration=last name of owner)
Planning Review /
Proposal: _frte etyi�7'�%!g ,4 21 77.,r-e
Verify site address/suite# exists and active permit system.
River Terrace Neighborhood: IId'Yes ❑ No
Sit 'Ian Elements:
tee (3)copies of site plan �xisting structures on site
S.
to plan must be on 8-1/2"x 11"or 11 x 17"paper IP ..tprint of new structure(including decks)with finished
awn to scale (standard architect or engineer scale) Nifty
elevations
rth arrow i•:polity locations (required for new,may apply for additions)
e address,project or subdivision name and lot number I:• ;' cation of wells/septic systems
Y A.plicant information(name and phone number) 1 rosion control(including drainage-way protection,silt fence
I•I *it dimensions and building setback dimensions sign,location of catch basin,etc.)
IV I.!t area,building coverage area,percentage of coverage and Street names
plipervious area(applicable if R-7,R-12,R-25&R-40) to eet tree size,type and location
Property corner elevations (2 foot contour lines if more than Fisting trees to be retained with drip line,and tree
4 foot differential) protection measures
; Rlean Water Services —Service Provider Lette (lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified No Received: ❑ Yes ❑ No J
❑ Public Faciliti Improvement (PH) Permit: barn° Drl/ ..
equired: Yes,applicant was notified ❑ No Applied For: ❑ Yes No,stop intake
V and Use Case#: 7)Ro20jS"_ )3 / ,S//A 0.0/S 2
FA Zoning: /2-f
II f tetbacks: Front Rear Side Street Side Garage
I PI Landscape Requirement: %
1 r:f.ot Coverage Maximum: °'o
I i'iuilding Height: Maximum Height Actual Height
I N.fl/isual Clearance
1IIV i asements 1 ,�,�
Sensitive Lands: I(L Yes ❑ No Type j,U— VaVi j k b
1 IIII\Urban Forestry Plan
❑ Conditions "Met"prior to issuance of building permit
Notes: C:21,1??Y!Q iiYJ9.,14 c Q,�r9/` '77a / SL Tice rl
A1717, 'S' �jU.I vAe /7
Approved By Planning: � Date: JD
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B IdgPcrmitR vw_RES_0709I 5.docx
Building Permit Submittal
Original Submittal Date: 02/6/(je
Site Plans: # ,gl,
Building Plans: # )-
Building Permit#: [ - 1 erer building permit#above.
Workflow Routing: L4-Manning C gineering 13-Trernut Coordinator ❑ Building
Workflow Sign-off: ,,,.,-!i -off for Planning(include notes from planning review)
Route Application Documents: L tigineering: (1) copy of permit application, (1) site plan, (1) building plan and
o 'al plan review routing form.
Cf Building original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: NOt �j/14 % E- e;
By Permit Technician: Date: /////(o
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 D No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes 0 No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: > LJ� Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
Permit Coordinator Review
0 Conditions "Met"prior to issuance of building permit
Approved,NOT Released:eas c / Date: .Z//' //�
Notes: in y� t ` /7N Y J 4i-ex �.G"da l
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 , N/ 4
Tigard Trans SDC: 0 Yes IS"N/A
Parks SDC: ❑ Yes N/A
' OK to Issue Permit /Approved by Permit Coordinator: ate: //o i
l:\Building\Forms\BldgPermitRvw_RES_0709 15.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
•