Permit -a CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2010 00012
T t G i A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2010
Parcel: 2S114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Subdivision: Lot: 0
Project: Clean Water Services
Project Description: Site work for new Headworks addition and improvements.
Owner: FEES
CLEAN WATER SERVICES Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 Permit Fee - Site Work 08/04/2010 $2,192.34
Plan Review 06/22/2010 $1,425.02
PHONE: 503 - 547 -8177 12% State Surcharge - Building 08/04/2010 $263.08
Plan Review - Fire Life Safety 06/22/2010 $876.94
Contractor: Erosion Control 08/04/2010 $80.00
HARBOR PACIFIC CONTRACTORS INC Erosion Plan Review CWS 08/04/2010 $26.00
19628 144TH AVE NE - STE A Erosion Plan Review COT 08/04/2010 $26.00
WOODINVILLE, WA 98072
PHONE: 425 - 488 -7131
FAX:
Type of Use: COM
Class of Work: ADD
Site Specifics:
Excavation Volume: 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 $4,889.38
Required Items and Reports (Conditions)
1 SIT Ersn Cntrl 503 - 681 -4444
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
issua -, • 1 wor 1 - . •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti' Notification Center. •o • • les are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may o• ain a copy of the rules
or direct questions to OUN • cal in• •03.246.6699 or 1.800.332.2344.
Is ed By: /J ��I� ` / Permittee Signature: - � j G '11Ilf.A...4
• 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.
(Buildin2 Permit Application l u-i° 1 9 g q— 0000 3
Site Work . . 101( ()1 1 1( 1 l ltil t >yl
RECEIVED
City of Tigard Dateived izi
13125 SW Hall Blvd., Tigard, OR 97223 • Plan Review lb so . Permit No.: � ,,, }ir 1 a
I N
Phone: 503.639.4171 Fax: 503.598.1960 1 1 Other Permit:
DateB : r 4 31. A
`i. I G A R I Inspection Line: 503.639.4175 - Date Ready/By: • MI ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION .
. TYPE OF WORK . ' _ REQUIREDDATA :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
X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OE CONSTRUCTION • . ' _ work indicated on this application.
❑ 1- and 2- family dwelling 04Commercial/industrial Valuation: $
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
J OB SITE INFORMATION AND LOCATION _ Total number of floors:
Job site address: I t i' 5 1 �t ti , 4, c New dwelling area: square feet
7-7
City /State /ZIP: i t ,/ l D 7 7 2. 2 L/ Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name:1)405.O 3 /3/ Y 9, 161'fl46 g Covered porch area: square feet
t Cross street/directions t J
o job site: I Deck area: square feet
Jay -t h d pt 141 81 b G r ss D h r h y r-7 /PO f l Other structure area: square feet
We5f 5 /We.- d T S-- 4t, - •REQUIRED DATA: COMNtERCLAL.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
. DE SCRIPTION OF WORK.- , . • . work indicat on this applicatio On
I l Valuation: $ n 0 / g
P tet /r. r i /'oo'i -s I r•tp /9 « . 7 r 5 c r ee.,5. Existing building area: square feet
L New building area: square feet
Se ✓�o/ /C ‘ 000;30 ®rSLr•/pFtc•1 DT 61/1T
r PROPERTY OWNER ❑ TENANT Number of stories:
Name: G le,/ ti (4/4 - f t r s r"V,I (r s Type of construction:
Address: / d 06 O S hi Sst- Ave Occupancy groups:
/
City /State /ZIP: 7 Q r 0 /. / 7 2 2 1 Existing:
t,i Phone: (pi S y 7.- g/ 77 Fax: (5-03) s /7 •- g 196 New:
T .. ❑ APPLICANT:'... Pr CONTACT PERSON NOTICE
Business name: 47 , (44 /rr Ser ✓l1! rS All contractors and subcontractors are required to be
Contact name: . / o - / 8 a ' , e l f I-S licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / 6 o g j es 5 L1/ g- y -- ,4 I, jurisdiction in which work is being performed. If the
City /State /ZIP: / /; p D 4) 7 2 2
applicant is exempt from licensing, the following reasons
�r / q/ apply:
Phone: (( L 3) 3 �% 4' � 77 Fax: c5'63) 5•y .2 - 1 / / h
E -mail: bor lets i 0 4 1011 V f•r es, - 0 r
CONTRACTOR
Business name: r_. s, A A - / j _ .A BUILDING PERMIIT,FEES *.' ,
Address: ` I O - /� L� S / ' (Please refer to fee schedule) .
City /State /ZIP: W�vd l hJv t / L / 4 4- Q g" —1a Structural plan review fee (or deposit):
Phone: (4.- ) n - _ -7 / 3 r " Faax : ) FLS plan review fee (if applicable): q
CCB lic.: 9C// Total fees due upon application: *A 30�, o
` f Amount received: a 30 / . 90
Authorized signature: �( 4134,,r1.0„.20e ,
This permit application expires if a permit is not obtained
/ \ within 180 days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\SIT- PermitApp.doc 10/01/09 440- 4613T(1l/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 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 Valuation: Permit =Fee: •
(New,: Additions Required $.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.
1:1Building \Permits \SIT - PermitApp.doc 12/27/06 2
•
RECEIVED ( 3 uP42610 -oo 13
JAN 0 9 2012 PERMIT NO. S
CleanWater Services CITY OF TIGARD
Our commitment is clear. BUILDING DIVISION LOT S',
EROSION CONTROL INSPECTION REPORT
DATE / — 4 - 1 a INSPECTOR $"Z� R■vcIt SUBDIVISION 5; fe
OWNER/PERMITEE CL.nW QX -v ca-s. Attu/Lunt-Ks n dct.ka r. & J Irrpr- e∎Axly Ys'
SITE ADDRESS /0375 S, (.). Ss& Ave,
AppRovED
FINAL INSPECTION
THIS SITE MEETS THE POST - CONSTRUCTION
EROSION CONTROL REQUIREMENTS SET
FORTH IN CLEAN WATER SERVICES
RESOLUTION AND ORDER
NOTE: IF POST - CONSTRUCTION EROSION CONTROL MEASURES ARE STILL BEING
EMPLOYED ON THIS SITE TO MEET CRITERIA FOR AN APPROVED FINAL INSPECTION,
THE MEASURE(S) MUST REMAIN IN PLACE UNTIL LANDSCAPING IS COMPLETE
OR PERMANENT GROUND COVER IS ESTABLISHED.
A COPY OF THE FINAL EROSION CONTROL INSPECTION REPORT MUST BE
FORWARDED TO THE NEW OWNER, AT WHICH TIME NEW OWNER ASSUMES
THE RESPONSIBILITY FOR MAINTENANCE, REPAIR AND REMOVAL.
OTHER
THANK YOU FOR YOUR COOPERATION!
INSPECTOR S e_ Rv 47" PHONE C;Sp3) 6ePI— 57/?