Permit , , J +a CITY OF TIGARD u SITE WORK PERMIT
` ° ': COMMUNITY DEVELOPMENT Permit #: SIT2010 -00003 •
T (G AR LY 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2010
,,,,,,;• Parcel: 2S102CB03501
Jurisdiction: Tigard
Site address: 10040 SW GARRETT ST
Subdivision: Lot: 0
Project: Sorensen
Project Description: Relocate existing retaining wall from public right -of -way to private property..
Owner: FEES
SORENSEN, BROCK Description Date Amount
20 WALKING WOODS DR
LAKE OSWEGO, OR 97035 Permit Fee - Site Work 04/13/2010 $145.24
Plan Review 04/13/2010 $94.41
PHONE: 503 - 880 -3383 12% State Surcharge - Building 04/13/2010 $17.43
Contractor:
S2 CONTRACTORS INC
6860 S ANDERSON RD
AURORA, OR 97002
PHONE: 503 - 849 -2486
FAX: 503- 651 -4004
Type of Use: SF
Class of Work: ALT
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Yes Site Prep:
Storn Drains: Retaining Wall: Yes
Fire Underground: Accessible Parking:
Fence:
Total $257.08
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, • ' ".r• spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. ification Center. hos- les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direc questions to OUN
I' • x 3.246.6699 or 1.800.332.2344.
Issued = , • ��zu Permittee Signature: Mk _..,—„/.4.._j
1 % %
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application J` WO S' r3 - 7--W
Site Work - FOR OFFICE USE ONLY • -
Received _�� r /! O pc, Other Permit: doi
City of Tigard R ECEIVED Re eiv •: /0 Permit No.: 1
" 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
�� ��
Pr ill
Phone: 503.639.4171 Fax: 503.598.196�C � 3 �(�Tp Date/13 � �
TIGARD Inspection Line: 503.639.4175 C D Dale Ready /By El See Page 2 for
Internet: www.ngard or.gov Notified/Method. - , , O. s Supplemental Information
CITY OF TIGARD
TYPE OF$g :l LNG DIVISION REQUIRED DATA: 1- AND 2- FAMILY 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 OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ID Commercial /industrial 1
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder 'Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
.lob site address: L 040 ate ,,,,, Q I, New dwelling area: square feet
1
City /State /ZIP: -r t c,Al , or_ (_ L z. - Garage /carport area: square feet
Suite /bid /a t. no.: Project name: '
g P Project (7A � • �,(1r�Y 1-,,,,• 1 �+;);2ykGe3S Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
C.o.4C.r 0tJ G1n.trrE-1A c Are � -• 4 51S PT Sou r t-4 Other structure area: square feet
of 4(1E 1nir tscc T10N-) or' Gar2-r -rrr / 4 19 REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.: t S i 02 CG, 0 3 51) .■ equipment, materials, labor, overhead, and the profit for the
• DESCRIPTION OF WORK : • work indicated on this application.
.J-/...1s - ribs IA_ 4 ( L1 L C il -TC Valuation: $
C p. S - 1 NI - PLACE p ETP.1 NJ N C\ 1�A. (A— Existing bui; ; tg area: square feet
New building area: square feet
[PROPERTY OWNER. . . ❑ TENANT Number of stories:
Name: 'E. r o c la ‘:1;0rLn "i'., vN. Type of construction.:
Address: 1 pp,.{ O SW L� w.�re � • Occupancy groups:
City /State /ZIP: I-, �„1/4rGi , C r • Cf•7 '3 Existing:
Phone: (5 O 3) f ! -) — 73.3 c i , Ts Fax: ( ) New:
❑ APPLICANT [CONTACT PERSON NOTICE.
Business name: C 1 Ty d v T1 (.. )e.P._ All contractors and subcontractors are required to be
Contact name: VA, Ns 1 licensed with the Oregon Construction Contractors Board
E under ORS 701 and may be required to be licensed in the
Address: is 3 1 L vJ �4 A LA 1 . 7 1... N, 7 . jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: 1 g _ / 6 r_ • 9 -I Z7 -S apply:
Phone: (SG to 3 `l 4 1 "1 1 Fax: : (Ses3) 5 -4.6. (02.4I - d S"'
E-mail: va.,r\ x le c ---1 - - Cr r-
CONTRACTOR - / /)z
Business name: S- 2 CO314-4..^ c46 a-S / = n1G • BUILDING PERMIT FEES*
Address: ( 8 L D s . A ►J DEtiSO N (Please 'refer to fee schedule)
p ' Structural plan review fee (or deposit):
City /State /ZIP: f;\ u„...CtLA , 02. at -100 Z
FLS plan review fee (if applicable):
Phone: (5 3) e, 4 e t - 2-4 B(. Fax: (503) (0S - 4004
cCBlic.: �1 1 5 3 � � ( / if
Total fees due upon application:
.......42------' Authorized : ignature: J� �,; This permit applica expires if a permit is not obtained
• �" "' with 180 days after it has been accepted as complete.
Print name: VA N tv t J Q , y ,_ Date: v I I D * Fee methodology set by Tri- County Building Industry
7 Service Board.
1: \Building \ Permits \SIT- PermitApp.doc 10/01/09 440- 46131(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) n 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 n *Parking (including ADA) and Lighting
compliance Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details Lf 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 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 -1 Occupancy 2 510.76 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.
1.\ Building \ Permits \SIT- PermitApp.doc 12/27/06 2
City of Tigard MP PROOF J O U R N A L E N T R Y B A T C H P R O O F JE000204.DATA.ADMIN Page 3
TUE, APR 13, 2010, 12:08 PM - -req: KATHLEEN - -leg: GL JL - -loc: CITYHALL - -job: 217735 #J155 - -- -prog: GL450 <2.54>-- report id: GLJEBPOF
SORT ORDER: JEID
Rec OF Account Number Description Trns. Desc. Debit Credit
Posting Date: 04/13/2010
1 1 NY 2008000 -56005 Gas Tax Fund Capital Improvem Permit- Garrett 145.24 0.00
95008200 -140 Garrett St Sidew Construction
2 1 NY 2008000 -56005 Gas Tax Fund Capital Improvem Permit- Garrett 94.41 0.00
95008200 -140 Garrett St Sidew Construction
3 1 NY 2008000 -56005 Gas Tax Fund Capital Improvem Permit - Garrett 17.43 0.00
95008200 -140 Garrett St Sidew Construction
4 1 NY 2300000 -43104 Building Fund Building Permits Permit- Garrett 0.00 145.24
5 1 NY 2300000 -43106 Building Fund Building Plan Ch Permit- Garrett 0.00 94.41
6 1 NY 1003100 -24001 Community Develo State Building P Permit- Garrett 0.00 17.43
TTL 1000000 -10000 General Fund Claim on Cash AutoID: JE00020 17.43 0.00
TTL 2000000 -10000 Gas Tax Fund Claim on Cash AutoID: JE00020 0.00 257.08
TTL 2300000 -10000 Building Fund Claim on Cash AutoID: JE00020 239.65 0.00
Primary Entries 257.08 257.08
Inter Fund Offset 257.08 257.08
JE JE00407 TOTAL 514.16 514.16
GRAND TOTAL 514.16 514.16