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Permit (11) CITY OF TIGARD SITE WORK PERMIT = COMMUNITY DEVELOPMENT Permit#: SIT2022-00022 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/18/2022 Parcel: 2S 111 BA05000 Jurisdiction: Tigard Site address: 14125 SW 97TH AVE Project: Villarreal Subdivision: SOLARCREST Lot: 2 Project Description: Leveling 3,360 sq ft of front,back,and side yard and adding gravel. Contractor: OWNER Owner: VILLARREAL, HERMELINDA VILLARREAL, MONICA 14125 SW 97TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Erosion Control Only 08/18/2022 $322.80 Info Process/Archiving-Sm$0.50(up to 08/18/2022 $0.50 Type of Use: SF 11x17) Class of Work: OTR 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 $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 et forth In OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a. .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 qe5 ' Site Work OONLY City of Tigard RECEIVED Received �] �^ Date/By: � 13125 SW Hall Blvd.,Tigard,OR 97223 .� 6A y 20etel Plan Review �vW C Phone: 503.718.2439 Fax: 503.598.1960AUC7 Date/By: Other Permit Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for CITY T�GARG Internet: www.tigard-or.gov I OF Notified/Method: Supplemental Information V VISION TYPE OF R1uQUIItED DATA:I-AND 24AMILY DWELLING ❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY,' 07 CONST RUC"i WAI work indicated on this application. ❑ 1-and 2-family dwelling ❑Commercial/industrial aluation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB'$ INFORMATION.Al'+tl) LOCATibIV Total number of floors: Job site address: W U Q New dwelling area: square feet City/State/ZIP: Q �Y Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 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: Lot no.: 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 ESCRII'[ION.flF WORK work indicated on this application. loaC Valuation: $ Q Y' OA, ` Existing building area: square feet New building area: square feet =PROPERTY O'W'NER ❑ TENANT Number of stories: Name: e '� 1Pr7� Type of construction: Address: 1.� ' Occupancy groups: City/State/ZIP: AY A © Existing: Phone:(5413)%110- 51 ?3 Fax:( ) New: APPLICANT CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: l�0- Y ecx l licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 14 4 jurisdiction in which work is being performed.If the City/State/ZIP: applicant is exempt from licensing,the following reasons apply: Phone:(��O _ Fax::( ) E-mail: CONTRACTOR (� Business name: e 1 W`l _ 1 BUILDING PERMIT FEES* Address: lease refer tofee schedule City/State/ZIP: Structural plan review fee(or deposit): Phone:( ) Fax:( ) FLS plan review fee(if applicable): CCB lic.: Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained t h within 180 days after it has been accepted as complete. Print name: Date: Q * Fee methodology set by Tri-County Building Industry Service Board. 1:ABuilding\Pennits\SIT-PennitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB) F City of Tigard: Site Work Permit Checklist Page 2- Supplemental Information Commercial Multi-Family and One- and Two-Family Dwellings: No permit is required if fill is less than 50 yards (5 dump truck loads),or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If fill is in a flood plain, drainage way, or wetland,the applicant must apply for a sensitive lands review (SLR). Please complete all items below,unless otherwise noted. Excavation Volume: cu. yds. Grading Volume: (Soils report required for>5,000 cu. ds.) cu.yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 90%of maximum density) cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the Plumbing Permit Application for site utilities plumbing work. Plans Required: See"Site Work Permit Application- Plan Submittal Requirements"attached. The following must accompany this application: ❑ Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting compliance Plan ❑ G ading Plan and details ❑ *Landscaping Plan ❑ Erosion Control Plan and details ❑ Soils Report if required) ❑ Retaining Structures *Does not apply to One-and Two-family dwellings. Plan Submittal: Permit Fee: TYPE OF SUBMITTAL #of Plans Valuation: Permit Fee: (New,Additions or Required at $.00 to$500.00 $51.09 minimum pennit fee Alterations) Submittal $500.01 to$2,000.00 $51.09 for the first$500.00 and $2.69 for each additional$100 or fraction Commercial 3 thereof,to and including$2,000.00. $2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and Multi-Family R-1 Occupancy 3 $10.76 for each additional$1,000 or fraction thereof,to and including $25,000.00. One-&Two-Family Dwelling 3 $25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and $8.06 for each additional$1,000.00 or fraction thereof,to and including $50,000.00. $50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and $5.38 for each additional$1,000.00 or fraction thereof,to and including $100,000.00. $100,000.01 and over $809.42 for the first$100,000.00 and $4.49 for each additional$1,000.00 or fraction thereof. 1.•\Building\Pennits\SIT-PennitApp.doc 08/02/2016 2 r Site Work Permit Application Plan Submittal Requirements Commercial, Multi-Family and One- & Two-Family Dwellings A site work permit is required for all commercial projects including new buildings, additions, accessory buildings larger than 120 square feet, modular structures and multi-family R-1 occupancies. A site work permit is required for excavation, fill,grading, paving,retaining walls, fire hydrants and fire department access on private property for work on individual lots not covered under the subdivision development. Note: A separate "plumbing"permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. Please see the Site Utilities - Plumbing Permit Application for plan submittal requirements. 1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic location labeled with: A. ❑ map &tax lot # ❑ project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name ❑ applicant phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads (drawn to scale) with project location. 2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only. All details listed below shall be incorporated into the plans: A. Site plan showing: 1) Required parking spaces and driveways. 2) A route, accessible to persons with disability, leading from the public way to an accessible building entrance. 3) Accessible parking spaces and adjacent access aisle connecting with the accessible route. 4) Curb ramps along the accessible route, curb, sidewalk and gutter. 5) Finish grade elevations along the accessible route. B. Topographic survey plan showing grade elevations crossing the entire site. C. Overall grading plan. D. Utilities plan showing: 1) Fire hydrant location and pipe size if on private property. 2) If the building is to be protected with an automatic fire sprinkler system, show location of the water service vault and the fire department connection (FDC) within 70 feet of a fire hydrant. 3) Size of underground water service for the sprinkler system. E. Erosion control plan complying with the requirements of the Clean Water Services (CWS) agency showing: 1) Silt fence locations. 2) Bio-filter bags/other approved barrier material surrounding catch basins. l:\Building\Permits\SIT-PermitApp.doc 08/02/2016 3 3) Illustrations detailing the correct installation of the silt fencing and catch basin protection. 4) Any other measures to ensure compliance with CWS standards. F. Landscaping plan. 3. ADDITIONAL REQUIREMENTS: A. Soils (geotechnical) report. A soils report is required for new buildings and additions to contain the following: 1) The report shall address the potential of soil liquefaction and instability (OSSC Sec. 1804.2). 2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1). 3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805). B. Fire flow and hydrant worksheet. C. Plan review deposit based upon project valuation. 1:ABuilding\Pennits\SIT-PennitApp.doc 08/02/2016 4 rsCity of Tigard COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review - Residential Building Permit #: ��" Site Address: (�( ZS 6LA) R7 7 �i Ay� Project Name: Walk- Lot #: Land Use Case: - Zone: 5 - Required Submittal Elements ,if3 copies of sii� plan. fished scale s'North arrow , c1 # , P ' wiiltreet tree labelled Street names = � ° i� ���ww�y= ov+�n end dimensioned ae _ o Basemen s itions) .dimensipns' s )alExisting structures on site g I_- efld 19*"Ver@no parrpntage p -ErncinP cnnlrnl + MW 06..0lms ',W ntours if > 4' dffferen�ial) Z \/icinn clearance triannlA -LcL1yn Planning Review *Verify address / suite # active in Accela. ❑ Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995) Required: ❑ Yes �o Received: ❑ Yes ❑ No ❑ Public Facilities Improvement (PFI) Permit: Required: ❑ Yes "'�o Applied For: ❑ Yes ❑ No, stop intake ❑ Sensitive Lands: ❑ Yes ❑ No Type: a (Housing Supplemental Sheets Completed ❑ Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad ❑ Courtyard Units C&O (1 site, 1 per building) ❑ Rowhouse ❑ Cottage Cluster Type II (1 per unit) ❑ Small Form Residential / ADU ❑ Courtyard Units Type II (1 per building) ❑ River Terrace Addendum ❑ Conditions met prior to issuance of building permit Approved By Planning: 91�� Date: T) 10 ZZ _ Notes Revision 1: ❑ Approved ❑ Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: I:\Building\Forrc\BldgPerrmtRvw_Res_070722.docx Building Permit Submittal Original Submittal Date: 02�J2� 'y Site Plans #: 1?1 Building Plans #: 2 Building Permit #: 'T1 Building permit # entered on page 1 Workflow Routing: —=Nanning TT?ermit oor in for Workflow Sign-off: Sign-off for Planning (include notes from planning review) Route Documents: , >x pl-AS, an rus a ai Permit Technician: ate: ` L Notes Engineering Review ❑ Slope at building pad verified Slope: ❑ Conditions met pr issuance of permit ❑ Easements (encroach men er engineering conditions of approval and ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lie ❑ Yes o Assess Water Quantity Fee in-lieu: ❑ No LIDA Facility on lot: ❑ Yes No Add Fee: ❑ Yes ❑ No ❑ Final Plat Recorded ❑ NOT Approv Date: Notes Approved By Engineering: Date: Revision 1: ❑ Approved ❑ Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: ermit Coordinator Review ❑ o ns met prior to issuance of permit ❑ Approve , Released: notified applicant: ❑ ENG Revisions Re d: _Date notified applicant: ❑ SDC Exemptio , ❑ Received not apply ❑ SD ntered: Wash Co Trans Dev Tax. Yes ❑ N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes ❑ N LIDA ❑ Yes ❑ N/A ❑ OK to Issue/Approved by Permit Coordinator: Date: Revision 1: ❑ Approved ❑ Not Approved Date: Revision 2: 11 Approved 0 Not Approved Date: Property Owner Statement RECEIVED Regarding Construction Responsibilit AUG 2012 OF 11202ZG Oregon Law requires residential construction permit applicants who are not lirfL(ftIhn Construction Contractors Board to sign the following statement before a building perm) c PN- issued. (ORS 701.325(2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not *ubmit this statement. This statement will be filed with the permit. Please check the appropriate box: ❑ I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date ❑ I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. �4tj � �c3. rint Name of Permit Applicant e�rv�n ��nda ) l\(fir e0.1 ❑4 /a4 2.2 Signature of Permit Applicant Date Permit M Address: Issued by: Date: This Copy for Permit Offices Information Notice to Owners About Construction Responsibilities (ORS 701.325 (3)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to http://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.aov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD PO Box 14140, Salem,OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address:www.oreaon.gov/ccb f/property owner adopted 9-23-08 This Copy for Permit Applicant