Permit > "s, CITY OF TIGARD
SITE WORK PERMIT
` ` :. COMMUNITY DEVELOPMENT Permit #: SIT2010 -00011
1 1:e Rp 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/05/2010
Parcel: 2S115AA01100
Jurisdiction: Tigard
Site address: 16005 SW 108TH AVE 101
Subdivision: WILLOW BROOK FARM Lot: 27
Project: Oak Tree 11
Project Description: Install 65 feet of sidewalk.
Owner: FEES
OT2 LLC Description Date Amount
633 NW 19TH
PORTLAND, OR 97209 Permit Fee - Site Work 05/05/2010 $112.96
Plan Review 05/05/2010 $73.42
PHONE: 12% State Surcharge - Building 05/05/2010 $13.56
Contractor:
KEYWAY CORP
7275 SW HERMOSO WAY
TIGARD, OR 97223
PHONE: 503 -684 -5100
FAX: 503- 684 -5500
Type of Use: CMS
Class of Work: OTR
Site Specifics:
Excavation Volume: cu. yd.
Fit 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 $199.94
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty •d- : a . all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is • •'sta 1-d wi y in 180 days of
issuance, o • • • spended for more the 180 days. ATTENTION: Oregon law requires you to follo e r ado.ted by the Oregon
Utility N. fication Center. T ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. iou obt• i a cop • e
or dire• questions to OUNC y ca 503.246.6699 or 1.800.332.2344.
Issue. :y: / / I/ � ( Permittee Signature: )(
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
' t Building Permit Application
Site Work < . 4 �, 4 ; # 4 .,;: 0It (l I Iell 1iSl 0 NI 1 .
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ri 'I . : 5 ` . Received L/I gg Permit No.:
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City of Tigard Date/By: ^7 % Tro1c /0 -f //
1 13125 SW Hall Blvd., Tigard, OR 1 • e• % 7 2010 Plan Review
-: I ' C.i \IL 12 7uris: ® ° Phone: 503.639.4171 Fax: 503. ` :.1`6(1" Date/By J y: / t+ ' 9 4G ' Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: j See Page 2 for
. , a= Internet: www.tigard- or.gov CITY OF T N.tifi jt a hod: J /D Supplemental Information
• G DIVISION /WiiTL� 1:1
TYPE OF WORK 'ffill QUIRED•DATA: 1 AND 2= FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are b. -. i (''N: f thqAasork performed.
Indicate the value (ii`, i''i to • eat9t do Iar) of all
(Addition/alteration / replacement ❑Other: equipment, materia ° , • • ": • e the a d and- the,profit for the
CATEGORY OF CONSTRUCTION work indicated on this ti T
❑ I - and 2- family dwelling ❑ Commercial /industrial
Number of bedrooht�:1 1 /��l-��
Valuation: $ r) 2010
❑ Accessory building ig Multi- family
OF TIGARD
❑ Master builder ❑ Other:
Number of bathr000' DING DIVISION
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11,00 5 31,3 ( wj — New dwelling area: square feet
City /State /ZIP: r R . Z - L Garage /carport area: square feet
Suite/bldg. /apt. no.: P roject name:
�fl ` D,4.' Um Covered porch area: square feet
- y �,.�
Cross street/directions to b site: ( 0 -- w A .pu- e1uAti,o 1 - Deck area: square feet
C44 `ti _ L .)ES S it)E.. 0 p j� 0 ( ± �P Other structure area: square feet
Jt)1"' SO (7 j - OF l)L VL.. 'RD. 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
DESCRIPTION OF WORK wor indicated o n thi application.
t i.7.5 6G. l•tt,�rlt _ Fz €r- OF 5i osc., ut _ Valuation: $ 3, Lop
Existing building area: square feet
New building area: square feet
IX PROPERTY OWNER . ❑ TENANT Number of stories:
Name: Or 2,.. LL.C.. Type of construction:
Address: g I e 4 Occupancy groups:
City /State /ZIP: c /510_ CR' 20q �7 ' P Existing:
.--
Phone: (50) Z2 '
— a Fax: -Z T '� - toc� New:
. .0 APPLICANT - • . AI CONTACT PERSON NOTICE .
Business name: C All contractors and subcontractors are required to be
Contact name: '�� %� licensed with the Oregon Construction Contractors Board
���ttt I —.) under ORS 701 and may be required to be licensed in the
Address: C— 6LAD t.� ,-p�,e{ ._SD LA-) jurisdiction in which work is being performed. If the
City /State /ZIP: G, j C OE �.2 L 1 -J applicant is exempt from licensing, the following reasons
apply:
Phone:) 6)&31 _a c0 I F ) — " )
E -mail: � � Vo, (_o. ,. G- 7 , (,zn - :z % f -
ONTIQCTOR
Business name: t 1.0A. G - BUILDING,PERMIT,FEES*
• (Please refer, to fee s chedule)
Address: -�'L743 S l>J Kaimaso IAA,t�
6A.CL (- e i �ZZ� Structural plan review fee (or deposit):
City /State /ZIP:
v L , _ ` FLS plan review fee (if applicable):
Phone: (5V1) —i _ S j PO Fax: 6z:a � ( sS C7 0
Total fees due upon application:
CCB lic.: I 23_6z ,
T /11 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`. L _ r 1 j. z Date:1.{( `_J 10 * Fee methodology set by Tri- County Building Industry
111111 '�'r'1 Service Board.
I: \Building\Permits \SIT - PermitApp.doc 10/01/09 440- 4613T(I 1/02 /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: s u. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) y 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
1 \ ft ❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: Z-( 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
❑ 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 . k of Plans Valuation:, - ' Fee:
(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 2 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 - Occupancy 2 $10.76 for each additional $1,000 or
fraction thereof, to and including
$25,000.00.
One & Two - Family Dwelling 2 $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.
I:\Building \Permits \S1T - PermitApp.doc 12/27/06 2