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Permit ? / /y /% cr2j CITY OF TIGARD SITE WORK PERMIT 11 • COMMUNITY DEVELOPMENT Permit #: SIT2010-00015 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2010 Parcel: 1 S125DB10800 Jurisdiction: Tigard Site address: 9495 SW SHADY PL Subdivision: Lot: 0 Project: ONeal Project Description: Replace wood driveway with concrete driveway. Owner: FEES ONEAL, LAUREN Description Date Amount 9495 SW SHADY LN TIGARD, OR 97223 Permit Fee - Site Work 09/10/2010 $285.12 Plan Review 09/01/2010 $185.33 PHONE: 971 - 409 -7851 12% State Surcharge - Building 09/10/2010 $34.21 Erosion Control 09/14/2010 $80.00 Contractor: Erosion Plan Review CWS 09/14/2010 $26.00 ANDREW JAY MILLER Erosion Plan Review COT 09/14/2010 $26.00 11252 SW 105TH TIGARD, OR 97223 PHONE: 503 - 784 -4442 FAX: Type of Use: SF Class of Work: ALT Site Specifics: Excavation Volume: 3 cu. yd. Fill Volume: 55 cu. yd. Impervious Surface: 651 sq. ft. Engineered Fill: Yes Soil Report Required: Paving: Yes Grading: Landscaping: Site Prep: Yes Storn Drains: Yes Retaining Wall: Yes Fire Underground: Accessible Parking: Fence: Yes Total $636.66 Required Items and Reports (Conditions) 1 MST 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 la All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issu , or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon U ' ity Notification Center. Those les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules r direct ques ions to OUNC • ca li • . 503.246.6699 or 1.800.332.2344. Issued By: X it 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. V CITY OF TIGARD SITE WORK PERMIT .11 • COMMUNITY DEVELOPMENT Permit #: SIT2010 00015 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2010 Parcel: 1S125DB10800 Jurisdiction: Tigard Site address: 9495 SW SHADY PL Subdivision: Lot: 0 Project: ONeal Project Description: Replace wood driveway with concrete driveway. Owner: FEES ONEAL, LAUREN Description Date Amount 9495 SW SHADY LN TIGARD, OR 97223 Permit Fee - Site Work 09/10/2010 $285.12 Plan Review 09/01/2010 $185.33 PHONE: 971 - 409 -7851 12% State Surcharge - Building 09/10/2010 $34.21 Contractor: ANDREW JAY MILLER 11252 SW 105TH TIGARD, OR 97223 PHONE: 503 - 784 -4442 FAX: Type of Use: SF Class of Work: ALT Site Specifics: Excavation Volume: 3 cu. yd. Fill Volume: 55 cu. yd. Impervious Surface: 651 sq. ft. Engineered Fill: Yes Soil Report Required: Paving: Yes Grading: Landscaping: Site Prep: Yes Storn Drains: Yes Retaining Wall: Yes Fire Underground: Accessible Parking: Fence: Yes Total $504.66 Required Items and Reports (Conditions) ahte.r 41- 6(240v1 r.10 I rJsp£ crio rJ r2EPo2r E►Q&5 1On) eo,.) hhp1, /p,(SPt 3T'ok) 3 - 68i- gyiy 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 OUNC by calling 51 . - - • • • : : • 32.2344. � ( Issued By: � Permittee Signature " P- Call 503.639.4175 by 7:00 a.m. for an inspection that business day. GS AL , l This permit card shall be kept in a conspicuous place on the job site until completion of the project. J Approved plans are required on the job site at the time of each inspection. Building Permit Application _ v -0 Ex Pp.,7 ! - Site Work roFOR OFFIC i: UsUSE oN F1ECEIVED Cit of Ti and Received Tigard DateB : 9 / /O Permit No.: ,§i ( ext,/ 13125 SW Hall Blvd., Tigard, OR 97223 Q Phone: 503.639.4171 Fax: 503.598.1960 S E P 0 1 2010 nate/B riew � 7 b other Permit: T G A ii Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for 1 Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: G I ' 3 / 0 _ :"?(' Supplemental Information BUILDING DIVISION (t}, 1-14 TYPE OF : WORK RE Q D DATA : 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: -7(Y . Y equipment, materials, labor, overhead, and the profit for the .. CATEGORY OF CONSTRUCTION • " - .j. work indicated on this application. 10 1- and 2- family dwelling ❑ Commercial/industrial • Valuation: $ J (200 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder • ❑ Other: Number of bathrooms: -• . - JOB S1TE • INFORMATION AND LOCATION'.. : , . . - Total number of floors: Job site address: cliicr 5 5, ll„e , pi New dwelling area: square feet cit I I j jp (9 q 7 L Z � ,� Garage/carport area: square feet Suite/bldg. /apt. no.: J "t/�. Project name: Oil e.4.1 `pry a ;/eyt "0-�/ Covered porch area: square feet Cross street/directions to job site: o i4 �haa h4 / Deck area: square feet Other structure area: square feet I REQUI.'REDDATAs C ,6*LERCIA,L -USE CH 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.: 5 ' 5 equipment, materials, labor, overhead, and the profit for the DESCRIPTION ' O1 WORK' "z•,...,. .. ::"; '% c' " `i'• - . . • , work indicated on this application. MQ. i� 14/1 0C d ,/} 4t°i w (R/ / Valuation: $ el C � / 0-„ Va4 /A . Existing building area square feet Cx9 ccc///��� �'� "' /"/ New building area: square feet ` 11 PROPERTY :OWNER '. _ _ Q_, TENANT- Number of stories: Name: `i:A,) (ems 0 a1ea, Type of construction: Address: i K g 5 s, A t 1o< Q 1 Occupancy groups: Cit `"F o O (4--) "Z. 2-3 Existing: Phone: all ) lip 785/ Fax: ( ) New: r.''. ' .. ' -. i ,APPL'ICAN' ❑ eTTACT PERSON- �. , . • /� i i ` . l�o�tcE Business name: ! r � l l tv.ch', All contractors and subcontractors are required to be Contact name: ,Q,� )41111e/r" licensed with the Oregon Construction Contractors Board 7 under ORS 701 and may be required to be licensed in the Address: 112.62 X5 w. A05Th A 0 I jurisdiction ;n which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons g -- ` © Zz3 ap Phone: (5)3) WA/ — 110/2, Fax: : ( ) E -mail: 0 .44 d Y Oa.) e z ,,, J.7 di , t I e t- GO °'I � tr ✓l o C.A � "'" CONTRACTOR Business name: *hi (.er dl f rac. f., i „ 4, BUILDING PERMIT FEES* , Address: y e( ��� (Please refer to tee schedule) Structural plan review fee (or deposit): City/State/ZIP: Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable): ti li d l fees due upon application: CCB lit;.: / 57 clog /r iy /.p ( ISJS 3 Amount received: Authorized signs / (��� This permit application expires if a permit is not obtained t within 180 days after it has been accepted as complete. / J/ ' Date: -lb * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\SIT -Penn tApp.doc 0/01/09 440- 4613T(11 /02/COM/WEB) City of Tigard: Site Work Permit Checklist Page 2 - Supplemental Information Commercial, Multi -Familv 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: 3 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) 6.5 cu. yds. Retaining structure? (Check one) ❑ Rock CMU Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 1 / 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 Fees • (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 tind $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. 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