Permit ':-.'%' ..::: CITY OF TIGARD
SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT # : SIT2008 - 00013
T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 5/29/2008
PARCEL : 2S112CD - 00701
SITE ADDRESS: 15950 SW 76TH AVE ZONING : R -12
SUBDIVISION: DURHAM ACRES LOT: 001 JURISDICTION : TIG
PROJECT: BLACKWELL
Project Description: Erosion control only.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
JAY & TRAC BLACKWELL Description Date Amount
15950 SW 76TH [ERPRMT] Erosion Control 5/29/2008 $80.00
TIGARD, OR 97224 [ERPLN] Erosn Pln Rv CWS 5/29/2008 $26.00
[EROSN] Erosn Pln Rv COT 5/29/2008 $26.00
Phone: 503 - 620 -6711 Total $132.00
Contractor:
ALL NATURAL LANDSCAPE INC
PO BOX 2815
CLACKAMAS, OR 97015
Contact #: PRI 503 740 - 7733
FAX 503 - 536 - 6535 REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #: LIC 8431
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By ,� 'ttee- Signature: -
�----' /E
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.
tg Permit Application
Site Work `� , 'j FOR OFFICE USE ONLY
CI of Ti ard� r1J�' Received Permit No.: .�
`J g Q�,V Q DateB : / l'j Gt O/
13125 SW Hall Blvd., Tigard, OR 97223 � 4 O Pl Review
III . Phone: 503.639.4171 Fax: 503.598.1960 JJ � O V Date/By: Other Permit:
T 1 G A R l7 Inspection Line: 503.639.4175 M P\ k, 1 D • to Ready /By: Juris B See Page 2 for
Internet: www.tigard or.gov � O G G XS
%' ified/Method: Supplemental Information
T � l V a
T YPE OF WORK � 0.,v1 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 gOther: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on is application.
p kI- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms.
J ❑ Master builder ❑ Other: Number of bathrooms:
Q JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /5"/ S 5!./ ?(O.pf P,Ve New dwelling area: square feet
City /State /ZIP: �G/LeO / 2 (. _ CJ7 7,2_,f Garage /carport .• ea: square feet
Suite/bldg. /apt. no.: Project name: '8 ‘Ae_k- (.viZ;L.- V Covered • .rch area: squ. • feet
'q Cross street/directions to job site: Dec area:- square feet
Q Other structure area: square feet
� REQUIRED DATA: COMMERCIAL -USE CHECKLIST
k Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
"V Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
AR F,Qo5 /o,t) do/ J n2OL. oAA. / Valuation: $
I Existing building . :.: s' • • e feet
� New building area: square feet
N il t1 ❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: './A.Y D 7 1e-AC,i 8LA h/6t Type of constructs. :
Address: / 5 9 5 b 5 eLJ '76 7}L /9 VE Occupancy ; oups:
City /State /ZIP: t 0, O lt - L.Zy E 'sting:
1� Phone: ( 503) (O 2.62 - (0 7 i / Fax: ( ) New:
, h ❑ APPLICANT ❑ CONTACT PERSON
A v NOTICE
Business name: - ^/A/yt.aL- t.>/c/Se•4,£ All contractors and subcontractors are required to be
Contact name: �r- licensed with the Oregon Construction Contractors Board
Q under ORS 701 and may be required to be licensed in the
Address: pct e 24,s jurisdiction in which work is being performed. If the
City /State /ZIP: C�GtG/LA #� Q� ' 7 O /S a a pplicant is exempt from licensing, the following reasons
v.1 apply:
Q Phone: (64t3) `) j_ 3 Fax: :(.'o -) 556^c, 5 3 5
cJ E -mail: biz-t-T A(( 4TU/r4( (a p -, ".. ze/Y
c� 1 CONTRACTOR
\o Business name: BUILDING PERMIT FEES*
evt Address: �20�0� rase refer lo fee schedule)
City /State /ZIP: — H / 1tt� SlJo Oa
. o�i ) a 6
Phone: ( ) Fax: ( ) ��Oh n _ ��
CCB Iic.: �� 3 1
/ / �'� t � ! o� . c' Amount received: �� "'
Authorized signature: /Aloe This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Is Act 16, ,,,,-/of"/ Dater S /Ltjek * Fee methodology set by Tri- County Building Industry
Service Board.
l: \Building\Permits \SIT - PermitApp.doc 12 /27/06 440- 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 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 ❑ *Parking (including ADA) and
ADA compliance Lighting 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.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
1: \Building \Permits \SIT- PermitApp.doc 12/27/06 2
ill ;2008 2'2:21 FAX 503 747 0054 CANUN:M.X700 4UU1 /U01
.. RECEIVED
MAY 2 9 2008
CITY OFTIGARD
BUILDING DIVISION
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