Permit 711 4
CITY OF TIGARD SITE WORK PERMIT
° COMMUNITY DEVELOPMENT PERMIT # : SIT2008 -00022
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 11/10/2008
PARCEL : 1 S125DA -06600
SITE ADDRESS: 09625 SW 69TH AVE ZONING : R-4.5
SUBDIVISION: KINGS VIEW LOT: 052 JURISDICTION : TIG
PROJECT: HOAGLAND
Project Description: Retaining wall.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE: 2,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
DEAN HOAGLAND Description Date Amount
9625 SW 69TH [BUILD] Prmt Fee -Valu 10/28/2008 $62.50
TIGARD, OR 97223 [BUPPLN] Pln Rv -Valu 10/28/2008 $40.63
[TAX] Valu 12% State Surcha 10/28/2008 $7.50
Phone: 503 - 245 - 7079 Total $110.63
Contractor:
RONALD LOWELL ANDERSON
32855 NE OLD PARRETT MTN RD
NEWBERG, OR 97132
Contact #: PRI 503 - 708 - 3091
REQUIRED ITEMS AND REPORTS
Reg #: LIC 167422
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 = - 001 -0100. You may obtain copies of these
rules • • - , estions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/
sued By: `_/ ,// //� Permittee Signature: �� I il�;.
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.
. F din Permit Application
Site Work ; FOR OFFICE USE ONLY
City of Tigard
1 Y� Received /// 11. Re eiv : (/V � Permit No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 (� Plan Review
II I C . Phone: 503.639.4171 Fax: 503.598.196 tJ o 0 Date/By: 11.-6.01 Other Permit: /
T 1 G A It p Inspection Line: 503.639.4175 w , l. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov �` oti6ed/Method: II 11, „ 0,, Supplemental Information
TYPE OF WORK ,, . ` 9 REQUIRED DATA: 1- AND 2- FAMELY DWELLING
D'New construction ❑ Demo _ , ' ` 9��� 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 CONSTRUCTIO ' `1\ ,�`�` 9 ,\ • irk indicated on this application.
• G `\ 's ' Valuation: $ a (fl/C)
d 1- and 2- family dwelling ❑ Commercial/industrial ON eN J
❑ Accessory building ❑ Multi - family �� � � �� Number of bedrooms: j
❑ Master builder ❑Other: 0. Number of bathrooms: Z
JOB SITE INFORMATION AND LOCATION Total number of floors: ( t^•'/Q A,t_�AK --G�
Job site address: 1625 ,Sw (01=- PI/ New dwelling area: C` square feet
City /State /ZIP: T,GAR_ t) Oa_ q1-723 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: T hI i1 t..4) t..4) fs L t - Covered porch area: square feet
Cross street/directions to job sittc L FAZE Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL-USE CHECKLIST
Subdivision: ( ! / I Lot no.: 6r r 2..- Permit fees* are based on the value of the work performed.
Tax map /parcel no.: V Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
yy�� DESCRIPTION OF WORK work indicated on this application.
1[s=TPt li'V 105 Li A c.)UC 4 l C Valuation: $
J Existing building area: square feet
New building area: square feet
jal R PERTY OWNER ❑ TENANT Number of stories:
Name: j pC N . f-1-074� c ry c) Type of construction:
Address: q G 2 Cc S Lt., () f AU C- Occupancy groups:
City /State /ZIP: T1 cr la. () ! U o__ q ? --2..-L • Existing:
Phone: 933) Z(4 `) - 7CO.I( Fax: (y)3 ) 2C( 5 - 7 `7 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax:: ( )
E -mail:
1411.r eiV C N t C iy T % . /i/ , , -
Business name: BUILDING PERMIT FEES*
Address: so 5 NE 0 t �Gr/`� / I `-�' . vi refer to fee schedule)
City /State/ZIP:
I Fax: ( )
V I2 3� Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone:�t �� 9 _ 3
CCB lic.: 16 Total fees due upon application:
(....1/4___ Amount received: / 63
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: bC -tk.1ti G., i,._(.. (1—w13 Date: t() / p • Fee methodology set by Tri-County Building Industry
t Service Board.
1:\Building\Permits\SIT- PermitApp.doc 12 /27/06 440- 4613T(11 /02 /COM/WEB) oti �r 66-
�r{t // Abial44 9-
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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 s 2
One- & Two - Family Dwelling 2
I:\ Building \Permits\SIT- PermitApp.doc 12/27/06 2
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: SIT2008- 00022
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11i1W2008
Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 - 4175 V11 .
INSPECTION WORKSHEET FOR DATE: 1112Q12008 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 09625 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: KINGS VIEW LOT #: 052 TYPE OF USE:
PROJECT NAME: HOAGLAND
DESCRIPTION: Retaining wall.
OWNER: HOAGLAND, DEAN PHONE #: 503 - 245-7079
CONTRACTOR: RONALD LOWELL ANDERSON PHONE #: 503 - 708 -3091
Inspection Request Scheduled For: Date: 11/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 078282 -01 503 -245 -7079 N '
Corrections /Comments /Instructions:
A s Qer I'\ ob. ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /35 Date: ;25.ddO Phone #: (503) 718- 2 "23
CITY OF TIGARD .
BUILDING DIVISION
A PERMIT #: SIT2008 00022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1111 0/2008
Phone: (503) 639 -4171 l
Inspection Requests (24 Hrs.): (503) 639 -4175 - "'I �
INSPECTION WORKSHEET FOR DATE: 11/18/2008 TIME: 7:01AM PAGE: 33
SITE ADDRESS: 09625 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: KINGS VIEW LOT #: 052 TYPE OF USE:
PROJECT NAME: HOAGLAND
DESCRIPTION: Retaining vuall.
OWNER: HOAGLAND, DEAN PHONE #: 503- 245.7079
CONTRACTOR: RONALD LOWELL ANDERSON PHONE #: 503 -708-3091
Inspection Request Scheduled For: Date: 11/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
215 Footing drain 078164 -01 850.324 -5707 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
"...,
Inspector: Date: /1- iA —ae Phone #: (503) 718 - Z4 -4,7)
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: SIT200ti -00022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2008
Phone: (503) 639 -4171 "W'
Inspection Requests (24 Hrs.): (503) 639 -4175 ° 'II-
INSPECTION WORKSHEET FOR DATE: 11/12/2008 TIME: 7:OOAM PAGE: 45
SITE ADDRESS: 09625 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: KINGS VIEW LOT #: Q52 TYPE OF USE:
PROJECT NAME: HOAGLAND
DESCRIPTION: Retaining wall.
OWNER: HOAGLAND, DEAN PHONE #: 503.2457079
CONTRACTOR: RONALD LOWELL ANDERSON PHONE #: 503.7013309 i
Inspection Request Scheduled For: Date: 11/12/2008 Pour Time: - 11:00
Code # Inspection Description Confirm # Contact # Message 1 /\
205 Footing 077923-01 503- 245 -7079 N 1/�/V� .
Corrections /Comments/ Instructions:
qer ilnurq 0(414tr P613 71 11 / / /AhYd 6
G k w acv . ; .
PASS ❑ PARTIAL APPROVAL .. \,..❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ' ADDITIONAL FEES ASSESSED
Inspector: OS Date: a,Vewa& Phone #: (503) 718 - ,2(4,93
CITY OF TIGARD • .. -.
BUI DIIIG DIVISION PERMIT #: SIT200 }3 -00022
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/10/20013
Phone: (503) 639 -4171 /�a 4I ifl
Inspection Requests (24 Hrs.): (503) 639 -4175 F_
INSPECTION WORKSHEET FOR DATE: 11/12/2008 TIME: 7 :OOAM PAGE: 44
SITE ADDRESS: 09625 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: KINGS VIt d LOT #: 052 TYPE OF USE:
PROJECT NAME: HOAGLAND
DESCRIPTION: Retaining wall.
OWNER: HOAGLAND, DEAN PHONE #: 503 - 245.7079
CONTRACTOR: RONALD LOWELL ANDERSON PHONE #: 503 - 7013.3091
Inspection Request Scheduled For: Date: 11/12/2008 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 077923 -02 503.2457079 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ns Date: /aAed08 Phone #: (503) 718- c2923