Permit CITY OF TIGARD SITE WORK PERMIT
0 COMMUNITY DEVELOPMENT Permit #: SIT2010 -00019
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 2S111 BA01700
Jurisdiction: Tigard
Site address: 14325 SW 97TH AVE
Subdivision: TIGARDVILLE HEIGHTS Lot: 32
Project: Mitchell
Project Description: Erosion control only.
Owner: FEES
MITCHELL, MICHAEL AND PATRICIA Description Date Amount
14325 SW 97TH AVE
TIGARD, OR 97224 Erosion Control 10/05/2010 $80.00
Erosion Plan Review CWS 10/05/2010 $26.00
PHONE: 503 - 620 -3203 Erosion Plan Review COT 10/05/2010 $26.00
Contractor:
OWNER •
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Stom Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $132.00
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 aril 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 off rules/
or direct questions to OUNC by calling 503.246.6699 or 1.80! ! - .4.
Issued By: 4 Permittee Signature: "A giadi
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.
Building Permit Application
Site Work t1Ni
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City of Tigard I�c�u c>r� ic1: �!()Nix 22 jV Received /��_ Permit No.: 2d t o _coo)
Date/By: i D /5- lb `-�/ / l
I
a 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
C Phone: 503.639.4171 Fax: 503.598.196 241 Date/By: Other Permit:
T G n it �� Inspection Line: 503.639.4175 10C1 Date Ready/By: ruris. ® See Page 2 for
Internet: www.tigard - or.gov PR9 Notified/Method: . /,ii Supplemental Information
Cl � N REQUIRED TYPE OF W q u, Slo DATA: 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
❑ Addition/alteration/replacement ® Other: seeding yard equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $500.00
❑ Accessory building ❑ Multi- family Number of bedrooms: 1
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: I
lob site address: 14325 SW 97th New dwelling area: 0 square feet
City/State/ZIP: Tigard, OR 97224 Garage/carport area: 0 square feet
Suite/bldgJapt. no.: Project name:y.41Rlr /Yl j -C1 • Covered porch area: 0 square feet
Cross street/directions to job site: 97 Ave. north of Murdock Deck area: 0 square feet
Other structure area: 0 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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
DESCRIPTION OF WORK work indicated on this application.
Have tilled most of the 1.2 acre lot in preparation of seeding a new lawn. Valuation: $
Lot is partially seeded and covered. Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Michael and Patricia Mitchell Type of construction:
Address: 14325 SW 97th Occupancy groups:
City/ State/ZIP: Tigard, OR 97224 Existing:
Phone: (503)620 3203 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: home owner All contractors and subcontractors are required to be
Contact name: Michael Mitchell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14325 SW 97 Ave. jurisdiction in which work is being performed. If the
City/ State/ZIP: Tigard, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 3203 Fax:: ( )
E -mail:
CONTRACTOR
Business name: home owner BUILDING PERMIT FEES*
Address: same as above (Please refer to fee schedule)
City/ State/ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax; ( ) FLS plan review fee (if applicable):
Total fees due upon application: t I �
Sl
CCB lic.:
Amount received: v ), --
Authorized signature: ' % f a411/4/ This permit application expires if a per tt is not obtained
within 180 days after it has been accepted as complete.
Print name: MICHAEL W. MITCHELL I Date: 10/05/2010 • Fee methodology set by Tri-County Building Industry
Service Board.
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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: 0 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 4000 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 0 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
® Other: NONE REQUIRED
*Total new impervious area including all buildings,
sidewalks, and paving: 0 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.
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