Permit IL CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2021-00006
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/10/2021
Parcel: 1 S 135ACO2900
Jurisdiction: Tigard
Site address: 10620 SW 95TH AVE
Project: FOREIGN MISSION FOUNDATION Subdivision: ASHBROOK FARM Lot: 17
Project Description: Erosion control only:Stockpiling for TVWD waterline improvements.
Contractor: MAGNA CONSTRUCTION SERVICES INC Owner: FOREIGN MISSION FOUNDATION
13023 NE HWY 99 STE 7- 138 108758 SW 89TH AVE
VANCOUVER,WA 98686 TIGARD, OR 97223
PHONE: 360-977-9004 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only 03/09/2021 $472.80
Info Process/Archiving-Sm$0.50(up to 03/09/2021 $0.50
Type of Use: SF 11x17)
Class of Work: ALT
Project Valuation:
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 $473.30
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
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. 2344.
Issued By: ' d 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.
1
Building Permit Application
Site Work ` " '
City of Tigard RECEIVED r/>]ztmrlclelsl:o L�
Date v�d
IN • 13125 SW Hall Blvd.,Ti Dace/By. 3)5� ,617.... Permit No.: 7r- _ ti; y l j_
s_ , Tigard,OR 97223 Plan Review L(vLNYJ
Phone: 503.718.2439 Fax: 503.598.1960 FEB 9 t- 2021 Date/By: AlfOrherPermit:
1I G A R II Inspection Line: 503.639.4175 Date Ready/By: >ti<ti. ®See Page 2 for
Internet: www.tigard-or.gov Notified/Metbod: Se emeetei Information
CITY OF'11GARG 3 , 7 t, PPt
,gr um.. ws k:y ,,A.'.; ,. - - U+mx
' `r.'�`�s` I TYL,'fi) e: '.s s l:ED DATA:1-AND 2-C''' IkWET LING
❑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
0 A.ddition/afteration/replacement 1: Other: 5\001?)U ( c x6Re.. equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION h work indicated on this application.
❑ 1-and 2-fanulydwelling ❑Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 154 Other: if „ 15a4 Number of bathrooms:
JOB SITE IN FORNIATJON AND IA/CATION l Total number of floors:
03�� SttvS ��Q .
Soh site address: C\ New dwelling area: square feet
City/State/ZIP71190d e4 O 2_ C\-ill' , Garage//carport area: square feet
Suite/bldg./apt.no.: Project name.""W eYtv1vp � Covered porch area: square feet
Cross street/directions to job site:C.,k k' CQ 1.se xk I (�`a��1 _ Deck area: square feet
' Cr `D UP 10
G n ' IQ �O` - {W 1P Other structure area: square feet
.] r "l V 6.1IRED DATA:COILLVIERCIAL-L SI CHECKLIST
CS Subdivision:
��C0O��OI:CY� Lot no.:i���� �Penny,fees*are based on the value of the worn performed.
Q Indicate the value(rounded to the nearest dollar)of all
�. Tax map parcel no.:
(3 SACS vl>00 equipment,materials,labor,overhead,and the profit for the
i . DESCRIPH'O(_N OF WORK 1 Z , : . work indicated on this application.
S car- M U�111` f\-* elrwi`)c Valuation: $ / 77 3w—'s
W c7
to ( Exis' building area: square feet
c�v\ mc���r�.t o� 1o\n �1�-��, � S ,�rne• +erg g
^� Vew building area: square feet
�.PROPERTI^O`ER ❑ TENANT. Number of stories:
�?.�a. Name: - 1JA\)IS Type of construction:
I'.1 Address:,p ko 20 c\s- f\ ,e, Occupancy groups:
( City/State/ZIPTITQ A r I L,2 (V 7 7.2
_ Existing:
►taw Phone:(SO )jc •so Z Fax:( )
New:
APPLICANC. N CONTACT PIILSO4 Business name:SYvriv\ct !�_,5�„ )_!•Do C _c J`Lp t I C . All contractors and subcontractors are required to be
Contact name:i rruJ (W L+� t t(at J� licensed with the Oregon Construction Contractors Board
Address: ^� ?L�� under ORS 701 and maybe required to be licensed in the
'307�� `�+� C�1 soap jurisdiction in which work is being performed.lithe
City/State/ZIP:V r �t applicant is exempt from licensing,the following reasons
tli.lft(OL frl�i 1-t)`A Q CJ(A
apply:
Phone:(2) p) Ckl'1 -q 001 -1 Fax::(Rat))fi41-t ol.__
F-maih aJ
�ov� C �',mc l -00'i ,,CDV\A an . 9 p'
ma wae0� crw
CONTRACT() -
Business name:'( (�,� ,
C �L��` �� {/}�ADVN SQ,�AIVCPS \V\C . ';",BULLRING PERMIT FEES*
Address: 'St7 -1`7 �A�ITY� ' (Please refer(flee schedule)
City/State/ZIP: , �1 y,sv . G ��� Structural plan review fee(or deposit):
Phone:(3to0)q 7..C( 04 Fax:(3�)5< 11_C( 0 t FLS plan review fee(if applicable):
CCB lie.:V\ACi�r C2FV►�, ��7�2 --yx / o�� q/ Total fees due upon application:
' \��tl l �]t:'�. r S- .7 V ` ff/ Amount received:
Authorized signaturee p..._�
This permit application expires if a permit is not obtained
Print name:_Nev., �U r * within 180days after it has been accepted as complete.
IDa41 ,2(Z021
.__ '® Fee methodology set by Tri-County Building Industry
Service Board.
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