Permit (2) 1)111/1
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2021-00003
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/18/2021
Parcel: 1 S 134CB02500
Jurisdiction: Tigard
Site address: 12120 SW SUMMER CREST DR
Project: Chibli Subdivision: SUMMER HILLS PARK Lot: 23
Project Description: Erosion control only permit for expansion of existing driveway and new approach off of 121 st Ave.
Contractor: TUANI TRADES LLC Owner: CHIBLI, ELIAS&ALISSON
PO BOX 728 14476 SW HUNTWOOD CT
CASCADE LOCKS, OR 97014 PORTLAND, OR 97224
PHONE: 208-695-6885 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only 02/18/2021 $322.80
Info Process/Archiving-Sm$0.50(up to 02/18/2021 $0.50
Type of Use: SF 11x17)
Class of Work: ALT
Project Valuation: $12,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $323.30
Required Items and Reports(Conditions)
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 t OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 2/7_4,a E :4,:. J Permittee Signature: 0 jt/ r , -7
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 Z,���,J2.
Site WorkRECEIVEDC
City of Tigardeceived `, / //��
FEBE 10 Date/By: c/`l/21 ,f3CL Permit No.:s,7 1 �` oe3
III 13125 SW Hall Blvd.,Tigard,OR 97223 2�2 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit'
Inspection Line: 503.639.4175 i TY of TIGARu Date Ready/By: inns
tl,,Attt) L1tJ+ ady y: 7 �j ,` 0/ S SeePage2for
Internet www.tigard-or L DING DI�Pc Ft'''.g Notified/Method�,id/'L ( Supplemental Information
k771/,4-1 L C2-I r
TYPE PE OF WORK I ( REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction 0 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 CONSTRUCTION RUCTION work indicated on this application.
❑ I-and 2-family dwelling Valuation: $ i Zr e C 0 S`CC�
❑Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms: 6M471- '
❑Master builder Number of bathrooms:
Other:
err vewa . X4!rtSiorl
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 72/Z U 56t) SU,' -iiev CkeS t- i1 r New dwelling area: square feet
City/State/`LIP: r)9 el yd / t2 ic. _! 1223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: gr ,, .i C/r ail S18:'t Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
/ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: fU MP y 1]ti((`� f t r ._.. Lot no.: Z 3 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
- ---.----_,- equipment,materials,labor,overhead,and the profit for the
Dk SCRIP"rlON OF WORK work indicated on this implication.
�~ r Valuation: $
C_,¢ 04.57 fi4 O -ppQ.. /S irM UY!✓•e r,,-'+T y'/ 4,-/(I ..-74,..40 _._
-e4 / Xl f (L.r•/Vtirw1y «i�= / /c/ r� Q Existing building area: square feet
t filly)A C C✓v- 6 , t/e. ,v�7 l Mi - New building area: square feet
L PROPERTY OWNER !' ❑ 'TENANT Y�.v Number of stories:
_� d
Name: as (f l2lj/J Type of construction:
Address: (2.16 U .Sw .51.1/2l
•f2/JE'Y ei-,2dt- 0 r. Occupancy groups:
City/State/ZIP: Tr','
T 47 a' a k g72Z'-? Existing:
Phone.(V O cf ) 7( 1- /1'fJ Fax:._(._ ) New:
re APPLICANT 0 CONTACT PERSON
Business name: All contractors and subcontractors are required to be
Contact name: /r4r S (' , Aj J/' licensed with the Oregon Construction Contractors Board
/ under ORS 701 and may be required to be licensed in the
Address: /it 2.0 L I r i1 . C 1-�r • jurisdiction in which work is being performed. I f the
City/State/ZIP: '7 6.rd Q. er 7 Zi applicant is exempt from licensing,the following reasons
apply:
Phone:(y'of' ) _7/ /-9 8 Fax::( )
E-mail:
L 0 IRAC roc:
Business name: .f 14 AA/, �t-.7 ' -4E73 M C. BUILDING PERMIT FEES*
Address: /0 0 v / . fPf¢rrsv rv(< ja r e x�clsxeda/
City/State/ZIP: C er,9,e.E L L ji-S L�/2- 9'70/y
Structural plan review fee(or deposit):
( r'^ 4,Cis t� GGS- FLS plan review fee(if applicable):
Phone: G' 7 d d Fax:( )
CCB lie.: . . 9 v.3 /y_/��1/ 'Total fees due upon application:
/ ! Amount received:
Authorized signature: �. This permit application expires if a permit is not obtained
/ / within 180 days after it has been accepted as complete.
Print name: �.. ll,S / J!l' Date: 21/0/2,( * Fee methodology set by Tri-County Building Industry
Service Board.
CIBuilding\Perm its\SIT-Perm itApp.doc 08/02/2016 440-461 3T(1 1/02/COM/WEB)