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Permit CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: BUP2015-00217 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2016 Parcel: 251070000101 Jurisdiction: TIGARD Site address: 16515 SW BULL MOUNTAIN RD Project: Polygon at Roshak Ridge Subdivision: CHURCHILL FOREST Lot: C Project Description: Demolition of 3,612 sq ft residential structure;all debris to be removed and septic pumped/filled prior to final inspection. DEMO credits for transportation and parks SDC apply. Contractor: WILLIAM LYON HOMES INC Owner: ROSHAK, KEVIN A 109 E 13TH STREET 16515 SW BULL MOUNTAIN RD VANCOUVER,WA 98660 TIGARD, OR 97224 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, 07/22/2015 $453.95 Demolition Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 07/11/2016 $1.00 Dwelling Units: 1 11x17) Stories: 0 Height: 0 ft Erosion Control w/Development-Eng 07/22/2015 $80.70 Bedrooms: 0 Bathrooms: 0 Value: $25,000 Floor Areas: Total Area: 3612 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $535.65 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 t ug1LOAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .1987 or 1.800.332.2344. .�2'��' Issued J SJ Permittee Sign.tures ��� `, ��,. �- (�`� �i�ccc�i�QQ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application ECEIVEP Residential 11.11_ `� 01 ioR 01:1.l( L 1 Sl:0y1.1 City of Tigard t �f Received w�s- .7 • 13125 SW Hall Blvd.,Tigard,OR�4 3 (� ��� DateB : � V►�►- PennitNo�et/V0/5.--c�2 t � N�1R DIVISION Plan Review '! Phone: 503.7182439 Fax: 5"' 1 1 1 Dates : Other Permit: 1 lir,A K tJ Inspection Line: 503.639.4175 Date Ready/By: Duns: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information y Z e 'W, t ::1 1 t 1 t 't'$; 1 .1'''''' „ l'41 0 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 ` t ;=` =;i work indicated on this application. ®1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 25,000 ®Accessory building 0 Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: i' Total number of floors:y ;. l it ! Job site address: 16515 SW Bull Mountain Road New dwelling area: square feet City/State/ZIP: Tigard,OR 97224 Garage/carport area: square feet Suite/bldg./apt.no.: I Project name:Polygon at Roshak Ridge(Area 4) Covered porch area: square feet Cross street/directions to job site: SW Roy Rogers Road and SW Bull Mountain Road Deck area: square feet Other structure area: square feet °_ f aa . t °t t > '`' Vit '. . € Permit fees*are based on the value of the work performed. Subdivision: I Lot no.: Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: 2S107/TL 101 equipment,materials,labor,overhead,and the profit for the }fa work indicated on this application. Demo existing structures on tax lot Valuation: $ n g/j f �"0A-i e,�77 ' •/e �ei 7--/ ),/ /� Existing building area: square feet 177z7 r dN ,c6707-7 C -/I/Ct 2t=ZU2 z 47-,a 4. ,072_. New building area: square feet r '"t i ' Number of stories: Name:Polygon WLH,LLC lift P 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: ,� ca t t lit l ° 'i H,LLC t� Business name: Polygon WL 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: Phone:(360)695-7700 I Fax::(360)693-4442 IcAM @Po yg t r � t a= a t Va 5-.."5V-'..h E-mail: chriswalther 1 onhomes.com Commercial and residential prescriptive installation of , roof-top mounted Photo Voltaic SolarPanel System. Business name: lG/,GL./t41',/ L yew,/*/11E$ /N a_Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 109 E.13th 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 I Fax:(360 ) 693-4442 State surcharge(12%of permit fee): $21.60 CCB lic.:-493193'' c2.49 2,7)97 Total fee due upon application: $201.60 Authorized signature: i�7 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Chris Walther Date: 2-/2Gt/,S- *Fee methodology set by Td-County Building Industry Service Board. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) y of Tigard COMMUNITYCitDEVELOPMENT DEPARTMENT T I G A R D Building Permit Review — Residential Building Permit #: / up,2045-e0 / 7 Site Address: ` 6 51 S 5v\/ Buil M 0 un tzi 1 rt Project Name: Po19 9 On 61,4— ROSVIC,, g-isci9C Lot #: (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: Dopylic O F ex i 3 tw)c2 f tvcA-vct1 Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: 1 Yes CI No Site Plan Elements: / I Three copies of site plan Q J,5r C(44 ,xisting structures on site ///Site plan must be on 8-1/2"x 11"or 11 x 17"paper 'Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) oor elevations "North arrow Al Utility locations (required for new,may apply for additions) %Site address,project or subdivision name and lot number QZocation of wells/septic systems applicant information(name and phone number) Erosion control(including drainage-way protection, silt fence t dimensions and building setback dimensionsdesign,location of catch basin,etc.) `$Lot area,building coverage area,percentage of coverage and ,Street names impervious area (applicable if R-7,R-12,R-25&R-40) ''BSreet tree size,type and location .. Property corner elevations (2 foot contour lines if more than -$1*xisting trees to be retained with drip line,and tree 4 foot differential) protection measures ❑ Clean Water Services—Service Provider Letter (lot platted prior to 9/10/1995): 0 Required: ❑ Yes,applicant was notified E No Received: ❑ Yes ❑ No ❑ Public Facilities Improvement (PFI) Permit: Required: E Yes,applicant was notified ❑ No Applied For: E Yes ❑ No,stop intake ❑ Land Use Case#: ❑ Zoning: ❑ Setbacks: Front Rear Side Street Side Garage Cl Landscape Requirement: ❑ Lot Coverage Maximum: 0/0 Cl Building Height: Maximum Height Actual Height ❑ Visual Clearance ❑ Easements ❑ Sensitive Lands: ❑ Yes ❑ No Type ❑ Urban Forestry Plan ❑ Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: /14 0 nil et, I/271'f o�a..e.A.A.L._. Date: 7/-2//.1 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_070915.docx Building Permit Submittal Original Submittal Date: 7/7,11 13 Site Plans: # Building Plans: # 2 Building Permit#: Enter building permit#above. Workflow Routing: $' Planning Engineering Permit Coordinator ❑ Building Workflow Sign-off: /6 Sign-off for Planning(include notes from planning review) Route Application Documents: engineering: (1) copy of permit application, (1) site plan, (1) building plan and ix/3 Ali-,j y ;' original plan review routing form. ,,,-,,r �,,L,�� /�c� ❑ Building: original permit application, site plans,building plans, engineer and S,A,re72. . beam calculations and trust details,if applicable, etc. Notes: SO 3._Cv PI - `-'/0 06- CG(,15 ;# Aio C/rte %o/? 5&--4/ , j� - By Permit Technician: /i Alrie 1-- Date: ?/�SPS 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: Put) $'fit"'4 t Notes: b. ' /' Z�sS Date: 7 Approved by Engineering: �,tKrt, 4.�1"yam. I 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 C O�....--7-40---g 'Date: "3 t ?PApproved,NOT Released: /�� 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: ,iel SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes (--N/A Tigard Trans SDC: ❑ Yes /A Parks SDC: ❑ Yes ( /A ,-- K K to Issue Permit Approved by Permit Coordinator: Date: ✓ '' Ii... I:\Building\Forms\BldgPennitRvw_RES_070915.docx Albert Shields From: Albert Shields Sent: Monday, September 14, 2015 2:18 PM To: 'Chris Walther' Subject: RE: Demo Permit Tax Lot 101, Roshak Ridge Chris, on your other demo permit, BUP2015-00217 for Tax Lot 101 I am also lacking an arborist's report attesting that approved tree protection is in place. If you have a report on this one please forward it to me. Thanks, Albert Shields. From: Chris Walther [mailto:Chris.Walther© olygonhomes.com] Sent: Monday, September 14, 2015 1:52 PM To: Albert Shields Subject: Demo Permit Tax Lot 3200 Albert, As per your request earlier today, please see the attached arborist report foer the above mentioned tax lot. Let me know if I can pick up this permit tomorrow or if you have any questions. Sincerely, Chris Walther Project Manager Polygon Northwest A William Lyon Homes, Inc. Company Cell#503-312-6213 1 Albert Shields From: Albert Shields Sent: Monday, February 29, 2016 4:40 PM To: Chris Walther(Chris.Walther@polygonhomes.com) Subject: 16515 SW Bull Mountain Rd, Demo Permit BUP2015-00217 Chris I have one here that may have slipped through the cracks. BUP2015-00217,for a demo of 16515 SW Bull Mountain Rd. has never been issued. It has been on Hold since last July as"Approved but Not Released" pending receipt of an arborist's statement that appropriate tree protection was in place. Has the demo has already taken place? If so, we need to clean this up by getting the permit issued so that you can receive any available credits. Do you have an arborist's statement for this property? Thanks, Albert. 1 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 16515 SW BULL MOUNTAIN RD, TIGARD, December 27, 2018 at OR, 97224 12:08:15 PM Record Type: Record ID: Residential - Building BUP2015-00217 Inspection Type: Inspector: 299 Final inspection Chip Barnett Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor