Permit (7) iiii CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2023-00012
Date Issued: 6/1/2023
T'I G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 • (61y ,. parcel: 1 S 134CA05200
l
V. Jurisdiction: Tigard
Site address: 11775 SW BURLCREST DR
Project: Bean Subdivision: BURLWOOD NO.2 Lot: 25
Project Description: Erosion control only. 6/5/23: REPRINT Revised to add Erosion Control note.
Contractor: OWNER Owner: BEAN,JAMES R&DEBRA A
11775 SW BURLCREST DR
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only 06/01/2023 $322.80
Type of Use: SF
Class of Work: OTR
Project Valuation:
Site Specifics:
Excavation Volume: .02 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 $322.80
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 f r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Thos rules r set forth in AR 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.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.
4
Building Permit Application
Site Work FOR OFFICE USE°NEN'
City of Tigard „R„tCFR'''''"'
_ ,,..„„:.:, ;'1 ',2-,,,,',,, Received
Date/B : Ce I,.
74 4.177.11MEP6. 11.
Ill m II 13125 SW Hall Blvd.,Tigard,OR Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ,,?..1 Date/B : Other Permit:
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: Juris: lia See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
C;Pc
firp'Ipy, ' ' .;I ' OfV181011 ' , 7'.:, :e-,,' 17*1 `, REQUIRED a:44 AND 2'-21,ililliin
/ - N . .. ' ',,, ....,F. 7 ,,.,.,..L.;,. .. ,„. ....„. :A.,1.
El New construction 1=1 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
El Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
.''' ',.i'W' "7'-`,„': ..';'''. ,f' ,''' '....' work indicated on this application.
',. .:''' AL.'Or;ifAtg*,:: ',4.,
Valuation: 0 z...
0 1-and 2-family dwelling El Commercial/industrial
Number of bedrooms:
Ej Accessory building 1=1 Multi-family
Number of bathrooms:
1=1 Master builder El Other:
itilkiliE,,i ,4 illilfir''fiCialb:I ,C. ::t 1. :: 41 Total number of floors:
6, - z:•7„. il V,. ..,,,'•*,,, .;,,I,7',,: ,,eorAti:Arc "e., ee,e, eeZe 'ee
Job site address: /i 71 5 $IA"'Bt-vIcits 1 dr New dwelling area: square feet
City/State/ZIP: Te1/47a t d OR 972a Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Z e A r\ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Bt-te their 0-3 fas fr Other structure area: square feet
CHECKUST
Subdivision: 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.:
equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
6 t Valuation: $sX CA.V4 fiV---1 o ZGve, .70 t -41 t-9
-$0° 15-' P-fr Existing building area: square feet
New building area: square feet
— — .... .
-PROPEAW OWNtat..4,:.. ';1!' '1'.' 1:''"ffil.31Ni.,1P'1:10Y7 ,.V Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( ) New:
'.'64,4,,c1Eisiii+i ,i.:.2 ' ' ,„:,,..1* iil'.,.'::*•,,' :Ati .',,,;•:?; /40TICE,..
Business name: ,lc,14, e S c_c,../1 All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: 1 c%444, .--1 under ORS 701 and may be required to be licensed in the
Address: j I' I S- 4.4.i 1914/ (c_f C 1 1 d r jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: —7-1 ctrd o A `t1Zz I apply:
Phone:(5 0 3) CI 3i- 1(0 9 3 Fax::( )
E-mail: j i C q b i 4 F'e Ve,C tjtc ?µI.a; (• C 61 0-'--1
ibisiTRAtt6i .'.; ...l.t,::- , ,A,:,
— '... `7 , r:.'''' ' ' , :
Business name: 01A,,,,e,( ::-',/'''' A'tf*trtsioPEltMIMEstv
A.;.?..ritiiiikOreferrofeeseWaile)
Address:
Structural plan review fee(or deposit):
City/State/ZIP:
FLS plan review fee(if applicable):
Phone:( ) Fax:( )
Total fees due upon application:
CCB lie.:
Amount received:
Authorized signature:
- A - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ot,44 A Bea.,7 Date: (0/I fro a,)
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PennitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB)
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.yds.) 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 pavm : sq.
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
❑ Grading 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 V a a : '
(New,Additions or Required at $.00 to$500.00 $51.09 minimum permit 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:A Building\Pennits\SIT-PermitApp.doc 08/02/2016 2
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #:
Site Address: <<1? S S-1/0 D(/✓I Cral Pr. XI-Verified in Accela
Project Name: f3ectn &1te, wait- Lot/Unit #:
Proposal: goo a qr4Ort ,ao - Zone: S—i�
Housing Type:/SFR(Single Detached 0 Duplex 0 Triplex 0 ADU)0 Rowhouse❑Cottage Cluster 0 CYU❑Quad 0 Other
Re uired Site Plan Elements:
2
3 copies of site plan on maX17r"
Zf Drawn to standard scale l t_.___, ip line/ tree protection
Z'North arrow rees shown / labeled
rd'Site address, project name, lot # ca cu a i tree canopy at maturity
Street names (N/A for SFR)
,Applicant name and phone # - --eoui lycn d Pec.langle dimensioned (if applicable)
Lot mensi angle
E ruc ures &square ootage easements
Q-Fuotpnnt of new structure and FFE <EittrprertrCOTfferetevations
Toned A > s nce)
rea an ercentage
Required Elevation Plan Elements:
SFR: calcs needed only on street-facing) Summary table with calculations for:
rawn to standard scale 0 Total fa a
❑ But ' height dimensioned window and door area
❑ Facade di ioned
❑ Windows and door " ension
❑ Garage doors dimensio
Required Floo n Elements:
(Not re for SFR) ❑ Summary includes
ach story dimensioned 0 Total floor area
❑ Each story floor area calculated 0 Floor area per story
Planning Review
The following standards have been met:
Setbacks 0 Front: Rear: Side: Min/Max Street Side: / Garage:
Height 0 Max. Height: Propose. -eight:
❑ es 0 N/A Landscape
❑ Ye 0 N/A Screening (Quad • y)
❑ Yes ■ /A % Window Co -rage
❑ Yes 0 N ' Garage (SF• Only) Parking (Other Res)
❑ Yes 0 N/A Entranc, SFR, Rowhouse, Quad only)
❑ Yes 0 N/A •the Building design standards (Rowhouse only)
❑ Yes 0 N/A A, essory Structure Standards
❑ Yes 0 No •u- ifying pre-existing unit exempt from standards (Cottage unit only)
Additional - andar. for Courtyard Units, Cottage Clusters, Rowhouses,and Quads:
❑ Yes ❑ A Unit Co,nt:
❑ Yes r N/A Lot Width -nd Size
❑ Y-_ 0 N/A Pathway
A. itional standards for Co, yard Units and Cottage Clusters only:
z Yes 0 N/A Unit Area:
❑Yes 0 N/A Floor Area (per sto
❑Yes 0 N/A Courtyard
0 Yes 0 N/A Fence
❑ Yes 41 ❑N/A Clean Water Services - Service Provider Letter(lot platted prior to 9/10/1995)
❑ Yes 0 No /A Public Facilities Improvement (PFI) Permit:
Required: 0 Yes ❑ No
Applied For: 0 Yes 0 No, stop intake
,O'Sensitive Lands: ❑ Yes "Flo
/''Main Land Use Case #s: ❑ Conditions met
❑Applicant notified of land use expiration date:
Approved By Planning: Date: 2I i /23
Notes N d cetyvc7tUeS °
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: ell/A-5
Site Plans #:
Building Plans #:
Building Permit #: ET-Building permit # entered on page 1
Workflow Routing: 11,,P4anning ❑ Enyiuefr1i1 0 PerVearbrdinator 0 Building
Workflow Sign-off: lgn-off for Planning (include notes from planning review)
Route Documents:
unit original plan review Coy sting farm -
p ans, building plans, engineer and!
u a ions nd trust details, if applicab e, e c.
Permit Technician: Date: / 2_3
Notes:
Engineering Review
❑ PFI Permit:
❑ Slope at building pad: ok
❑ Conditions met prior to issuance of permit
❑ Easements (encroachments) per engine:, ng conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality --e in-lieu: ❑ Yes ❑ No
Assess Water Qu.• ity Fee in-lieu: 0 Yes 0 No
LIDA Facility • lot: ❑ Yes 0 No Add Fee: 0 Yes ❑ No
❑ Final Plat Recorded
❑ NOT Appro -d: Date:
Notes:
Appr• ed By Engineering: Date:
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
❑ Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
❑ SDC Exemption: ❑ ied for ❑ Received 0 Does not apply
❑ SDC Fees Entered' Wash Co Trans Dev Tax: 0 Yes 0 N/A
Tigard Trans SDC: 0 Yes 0 N/A ❑ Deferred
Parks SDC: 0 Yes 0 N/A 0 Deferred
LIDA ❑ Yes ❑ N/A
❑ OK to Issue/Approved by Permit Coordinator: Date:
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: ❑ Approved 0 Not Approved Date:
Property Owner Statement `tiry
Regarding Construction Responsibilities 731 3
Oregon Law requires residential construction permit applicants who are not licerrpst,withithe, r,
Construction Contractors Board to sign the following statement before a buildirpg permit-ca
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
submit 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.
Of
K1I 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.
Print Name of Permit Appl' nt
� l I �z3
Sign re of Permit Applicant Date
Permit#:
Address:
rtrlq ;►4
Issued by: Date: • t i-1'•
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.gov.
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.oregon.gov/ccb
f/property_owner adopted 9-23-08 This Copy for Permit Applicant