Permit CITY OF TIGARD SITE WORK PERMIT
. COMMUNITY DEVELOPMENT Permit #: SIT2010 -00017
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
T[ G A R. D Parcel: 1 S 133CA07800
Jurisdiction: TIGARD
Site address: 13568 SW ROSEMARY LN
Subdivision: VILLAGE AT SUMMER CREEK Lot: 1
Project: Village at Summer Creek
Project Description: Site grading and construction of gravel pads to prepare for construction of townhomes. Scope of
work covers all lots, 1 - 88.
Owner: FEES
CENTEX HOMES Description Date Amount
16520 SW UPPER BOONES FERRY RD 200
Permit Fee - Site Work 09/14/2010 $604.98
PORTLAND, OR 97224 Plan Review 09/14/2010 $393.24
PHONE: 503 -608 -3060 12% State Surcharge - Building 09/14/2010 $72.60
Erosion Control 10/01/2010 $140.00
Contractor: Erosion Plan Review CWS 10/01/2010 $45.50
BONES CONSTRUCTION CO Erosion Plan Review COT 10/01/2010 $45.50
3508 S 209TH AVE
ALOHA, OR 97007
PHONE: 503 -649 -5682
FAX:
Type of Use: SF
Class of Work: ALT
Site Specifics:
Excavation Volume: 1705 cu. yd.
Fill Volume: 1074 cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required: Yes
Paving: Grading:
Landscaping: Site Prep:
Stom Drains: Retaining Wall: No
Fire Underground: Accessible Parking: No
Fence:
Total $1,301.82
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
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 nter. 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 q ions to UNC b calling 503.246.6699 or 1.800.332.2344. •
Issue By: / Permittee Sig ture:
CaII 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.
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CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2010 -00017
TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1S 133CA07800
Jurisdiction: TIGARD
Site address: 13568 SW ROSEMARY LN
Subdivision: VILLAGE AT SUMMER CREEK Lot: 1
Project: Village at Summer Creek
Project Description: Site grading and construction of gravel pads to prepare for construction of townhomes. Scope of
work covers all lots, 1 - 88.
Owner: FEES
INTEGRITY DEVELOPMENT GROUP INC Description Date Amount
16280 NW BETHANY CT Permit Fee - Site Work 09/14/2010 $604.98
BEAVERTON, OR 97006 Plan Review 09/14/2010 $393.24
PHONE: 12% State Surcharge - Building 09/14/2010 $72.60
Erosion Control 10/01/2010 $140.00
Contractor: Erosion Plan Review CWS 10/01/2010 $45.50
BONES CONSTRUCTION CO Erosion Plan Review COT 10/01/2010 $45.50
3508 S 209TH AVE
ALOHA, OR 97007
PHONE: 503 - 649 -5682
FAX:
Type of Use: SF
Class of Work: ALT
Site Specifics:
Excavation Volume: 1705 cu. yd.
Fill Volume: 1074 cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required: Yes
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall: No
Fire Underground: Accessible Parking: No
Fence:
Total $1,301.82
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 wit ' 180 days of
issuan -, •r if work is su • : sded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ado..ted by the Ore. • n
Uti' Notification Center. Tho - rule - e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Y• . - • • 'n a copy of th= ru -s
• direct questions to OUNC by .= ing i3. • 6.6699 or 1.800.332.2344. /
-sued By: ■ / Permittee Signature: A 4 a 4 , 1 _ J
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 p eject.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2010 -00017
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1S133CA07800
Jurisdiction: TIGARD
Site address: 13568 SW ROSEMARY LN
Subdivision: VILLAGE AT SUMMER CREEK Lot: 1
Project: Village at Summer Creek
Project Description: Site grading and construction of gravel pads to prepare for construction of townhomes. Scope of
work covers all lots, 1 - 88.
Owner: FEES
INTEGRITY DEVELOPMENT GROUP INC Description Date Amount
16280 NW BETHANY CT Permit Fee - Site Work 09/14/2010 $604.98
BEAVERTON, OR 97006 Plan Review 09/14/2010 $393.24
PHONE: 12% State Surcharge - Building 09/14/2010 $72.60
Contractor:
BONES CONSTRUCTION CO
3508 S 209TH AVE
ALOHA, OR 97007
PHONE: 503 - 649 -5682
FAX:
Type of Use: SF
Class of Work: ALT
•
Site Specifics:
Excavation Volume: 1705 cu. yd.
Fill Volume: 1074 cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required: Yes
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall: No
Fire Underground: Accessible Parking: No
Fence:
Total $1,070.82
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 Notifica ' • - en er. - • e rule are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct • . -stions to OUNC by mg r .. 6.6699 or 1.800.332.2344.
Issue. By: , r A Permittee Signature:
CaII 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.
N. auildine Permit 01.1.1(,1.; Applicati
Site Work EC EIVEp FOR u
l: (),vl.1
O Received G / O ,
City of Tigard SEP 2010 Reeiv T • / /o —''149/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - 7. �/ Q r % 12211
Other Permit:
Phone: 503 Fax: 503. O F r Date : 11 1
Inspection Line: 503.639.4175 VV l RD Date Ready : y: Jung ® See Page 2 for
'I I L. i1 It D Internet: www.tigard - or.gov BUILDING DIVISION B Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
New construction 0 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 ov
cl CATEGORY OF CONSTRUCTION work incl - .. i is application.
Valuation: $
- r
❑ 1- and 2- family dwelling 0 Commercial/industrial
❑ Accessory building '' Multi - family o e
4 ❑ Master builder El Job Number of bathrooms:
1 JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: square feet
City /State /ZIP: -1-74,440 OR_ 77 3 Garage /carport area: square feet
Suite/bldg./apt. no.: I Project name: WOW I ,7f0/01(ZZ 1 _ Covered porch area: square feet
Cross street/directions to job site: ( ii j" ) ` 3/� B 1-- �1(,�S Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
, li,
a Subdivision: UWW,, *-7,44/1*_. t Z 4 _- I Lot no.: 1....190 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
i Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
I
Z-1 0/ /) , fi3 Valuation: $
! y 4/7k._ N [/� Existing building area: square feet
New building area: square feet
l PROPERTY OWNER ❑ TENANT Number of stories:
q Name: ,Cjih id 1-4577 Type of construction:
Address: J/ 49 v A gyer /2.0 Occupancy groups:
City /State /ZIP: cwirt.00.49 77_,Li �— Existing:
Phone: (53) Fax: (9j) 3
New:
(` ❑ APPLICANT CONTACT PERSON NOTICE
=• Business name: R j=ZS, All contractors and subcontractors are required to be
Contact name: 110 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /[9Ltiyfj //(/ jrle -otA C/t4719 ..."-- jurisdiction in which work is being performed. If the \'
City /State /ZIP: L'(J/�� ,// �L 7O(`�� applicant is exempt from licensing, the follow re q
,y 7 �7 apply: PEQ#-t t 1' ' 09 • [ ff
` Phone ) �(S 7615 Fax: J W - 09/ �g
J 7 /fff, /? La RA R.�J 9:34'
E -mail: LO , " 1 - 7:4x CONTRACTOR
Address: Business name: .{, Ce5W �� V/ V BUILDING PERMIT E, *Le , 07
(Pkare refer to fee schedule) :
Structural plan review fee (or deposit):
City /State /ZIP: &(J
/6,57f2__ 7 Q[ � / ' FLS plan review fee (if applicable):
Phone:3) 6ef I Fax:) gig ! — /7 '
I' Total fees due upon application:
CCB lie.: 73
Amount received:
Authorized signature. / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: r s te: 0 Fee methodology set by Tri -County Building Industry
%18'x`
Service Board.
w ilding \Permits\SIT- PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB)
r r
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: 1701;5 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacte to /
90% of maximum density) 6' o7q 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 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 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.
I:\Building\Permits \SIT - PermitApp.doc 12/27/06 2
I G-
Ili
a Site Work Permit Application
Plan Submittal Requirements
- 1 GI \ I& D Commercial, Multi- Family and One- & Two - Family Dwellings
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi- family R -1
occupancies. A site work permit is required for excavation, fill, grading, paving, retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing.
1) Silt fence locations. .
2) Bio -filter bags /other approved barrier material surrounding catch basins.
I:\Building\Permits\SIT- PermitApp.doc 12/27/06 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb. /sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
•
I: \Building\Permits\SIT- PermitApp.doc 12/27/06 4