Loading...
Permit ym CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Permit #: SIT2010 -00009 ;TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2010 Parcel: 2S102BB01700 Jurisdiction: Tigard Site address: 12515 SW GRANT AVE Subdivision: Lot: 0 Project: St. Anthony's Church Project Description: Site work for parking lot expansion. Owner: FEES ST. ANTHONY'S CHURCH Description Date Amount 9905 SW MCKENZIE ST TIGARD, OR 97223 Permit Fee - Site Work 06/23/2010 $500.12 Plan Review 03/30/2010 $325.08 PHONE: 503 - 639 -4179 12% State Surcharge - Building 06/23/2010 $60.01 Erosion Control 06/23/2010 $80.00 Contractor: Erosion Plan Review CWS 06/23/2010 $26.00 GVS CONTRACTING Erosion Plan Review COT 06/23/2010 $26.00 700 N. COLLEGE NEWBERG, OR 97140 PHONE: 503 - 538 -2998 FAX: 503 - 538 -9829 Type of Use: COM Class of Work: ALT Site Specifics: Excavation Volume: 106 cu. yd. Fill Volume: 0 cu. yd. Impervious Surface: 15000 sq. ft. Engineered Fill: No Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Storn Drains: Yes Retaining Wall: No Fire Underground: No Accessible Parking: No Fence: Yes Total $1,017.21 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 set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to •UNC by c -Ili 503.246.6699 or 1.800.332.2344. Issued By: lv� Permittee Signature: ��� Sv' 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. w ' Building Permit Application l P earn 2- • Site Work RECEIVE FOR OFFICE USE ONLY City of Tigard . MAR `ii 0 r i DateB : ♦ Permit No.: 5 ,r • • SAO • 1312 SW H all Blvd., Tigard, OR 97223 Plan Review !IW Er Phone: 503.639.4171 Fax: 503.598.1960 Date /By: ® Other Permit. Inspection Line: 503.639.4175 /, 1 2_010 • r p for TIGARD CITY D ate Read y �+ ®See f Internet: www.tigard-or.gov P + y l od: / ur S � Supplemental Information TYPE OF WORK ' CCB lic.: ® New construction ❑ Demolition / /y� Authorized signature: .' / 5 , 7 ❑ Addition/alteration/replacement ❑ Other: � � CATEGORY OF CONSTRUCTION Print name: Z Z 5 c.-6 • /�' 1 • s ;66 El I - and 2- family dwelling ❑ Commercial /industrial REQUIRED DATA: 1- AND 2- FAMILY DWELLING Permit fees* are based on the value of the work performed. ❑ Accessory building ❑ Multi - family Indicate the value (rounded to the nearest dollar) of all 1:1 Master builder [E] Other: equipment, materials, labor, overhead, and the profit for the work indicated on this application. JOB SITE INFORMATION AND LOCATION Valuation: 54578AITOd` Job site address: ■ Z. C lis eJ ( Number of bedrooms: City /State /ZIP: Tigard, OR 97223 Number of bathrooms: Suite /bldg. /apt. no.: N/A Project name: St. Anthony's Church Total number of floors: Cross street/directions to job site: SW Grant Avenue /SW Johnson Street New dwelling area: square feet Garage /carport area: square feet Subdivision: N/A Lot no.: N/A Covered porch area: square feet Tax map /parcel no.: 2S102BB 01600/01700 Deck area: square feet DESCRIPTION OF WORK Other structure area: square feet Expansion of existing parking lot REQUIRED DATA: COMMERCIAL -USE CHECKLIST Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the work indicated on this application. ® PROPERTY OWNER ❑ TENANT Valuation: $ 1 15, t c,Z Name: St. Anthony's Church (Attn: Fran Avery) Existing building area: square feet Address: 9905 SW McKenzie Street New building area: square feet City /State /ZIP: Tigard, OR 97223 Number of stories: Type of construction: . , Phone: (503)639 -4179 Fax: (503)624 -2364 Occupancy groups: ❑ APPLICANT ® CONTACT PERSON Existing: Business name: Westlake Consultants, Inc. New: Contact name: Bernard R. Smith, P.E. NOTICE Address: 15115 SW Sequoia Parkway, Suite 150 All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board City /State /ZIP: Tigard, OR 97224 under ORS 701 and may be required to be licensed in the jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons Phone: (503) 684 -0652 Fax: : (503) 624-0157 apply: E -mail: bsmith @westlakeconsultants.com CONTRACTOR _ /� BUILDING PERMIT FEES* Business name: N/A � - 1/ S C CM/ - T � (/ /n/ tr (Please refer to lee schedule) Q Address: 7 N Co LL Structural plan review fee (or deposit): 30.5 , O v V City /State /ZIP: ,1/e/6 7 G- 172 97/0 C. -5-113Y0 FLS plan review fee (if applicable): Phonc: ) _5:34 ,9.9 l Fax: (serj)5:3k .9c 9 b/3// // I:\ Building \Permits \SIT- PermitApp.doc 10/01/09 440 4613T(11!02/COM /WEB) Total fees due upon application: Amount received: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. . I: \Building \Permits \SIT - PermitApp.doc 12/27/06 2 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: 104 cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) 3 lb cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) hA cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 1 i( 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 21 *Parking (including ADA) and Lighting compliance Plan IY Grading Plan and details E *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 5.00 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 $9 1.44 for the first $2,000.00 and Multi - Family R -1 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 . ( 3 ,"s-. .4. .. ► C? $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 \S1T - PermitApp.doc 12/27/06 3