Permit „ CITY OF TIGARD
SITE WORK PERMIT
g A. COMMUNITY DEVELOPMENT Permit #: SIT2010 -00023
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
TIARL? Parcel: 2S104BC01200
Jurisdiction: Tigard
Site address: 14504 SW FERN ST
Project: Moon Subdivision: Lot: 0
Project Description: This permit is for erosion control only. The fill material does not exceed 6” in depth at any point. The fill is being
placed under the power transmission line and does not appear to impact any trees. Copy of Service Provider letter
in file.
Contractor: OWNER Owner: MOON, STEVE AND CALLIE
14504 SW FERN ST
TIGARD, OR 97223
PHONE: PHONE: 503 - 579 -3201
FAX:
FEES
Description Date Amount
Specifics: Erosion Control 11/19/2010 $80.00
Erosion Plan Review CWS 11/19/2010 $26.00
Type of Use: SF Erosion Plan Review COT 11/19/2010 $26.00
Class of Work: ALT
Project Valuation: $500.00
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 $132.00
Required Items and Reports (Conditions)
1 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 r if work is s. .ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Th - -. are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -009. You y obtain a copy of the rules
or di ct questions to OUNC by c- ing 503 32.1987 or 1.800.332.2344.
Iss ed By: A 4 % - Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Nov 16 10 08:10a Agent Plumbing Inc 971- 250 -2568 p.1
Building Permit Application
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,
Site Work ! EcFlvE, - '
1 4
City of Tigard p � a nee `: l Ito ,lL� Pem."°.: a� /0- ,Q3
: . t: .1 13125 SW Hall Blvd., Tigard, OR 97223 NOV V 1 6 2010
A omen Permit
Phone: 503.639.4171 Fax: 503.598.1960 / I
� ,
T 1Ci A R D , Inspection tigard or gov7S CITY OF TiGAI C� ( o � // / & /0 y/ Supplemental Information
BUILDING DIVISION
• TYPE OF WORK REQUIRED DATA: I- 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. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application_
1- and 2- family dwelling ❑ CommerciaUindustrial Valuation: $ fxr .n
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other- Number of bathrooms: 7
JOB SITE INFORMATION AND .LOCATION Total number of floors: L
Job site address: 1' Say �4\1 -7-E 4,, : -- New dwelling area: — square feet
City/ State/ZIP: k i n u - 47 Garage/carport area: .— square feet
SuitcJbldgJapt no.: Project name: Covered porch area: — square feet
Cross street/directions to job site: peck area: — square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL - 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
., DESCRIITION OF WORK work indicated on this application.
G into fkr,i 1'6 1 ( , o c r Valuation: S
%Dal &irk, . - SK-` Of Existing building area square feet
-P'fkt to 64k-7 E;20610,3 0_0 - ten (. .4,Qcy * New building area: square feet
la PROPEY OWNER 0 TENANT Number of stories:
Name: . i* yi6_ i .1.,t ;.> 6 /N L, I. , le 1,6, 0 0 },, Type of construction:
Address: - c - , -- _( :\ - fvyh N `To ; `-,1 .j Occupancy groups:
City / State/ZIP: Existing:
Phone: (7(73) 5-741 4. 3/0 1 Fax: ( ) New:
4 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: - 1/4-\\/\! ; - `'r7 vT j Nsi c..5,1\9\:1, - ✓ All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under OILS 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: ( ) Fax:: ( )
E- mail: (.j ' r\r."0p \--,.` t_ -,ry- ,l,t'1 • c_o r\--)
CONTRACTOR
Business name: N L C / BUILDING PERMIT FEES'
Address:
` Me ee refer rota se�teduir
Structural plan review fce (or deposit):
City /State/ZIP: •
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
CCB lie_:
Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
/t, within 130 days after it bas been accepted as complete.
Print name:
(.1,) ( ` 1VV Bale: ∎ 1 . : Fee methodology set by Tri- County Building Industry
Service Board.
1:1 Building \Permits'SIT- PermitApp.doc 10 /01109 440 - 4613T(11f02 /COM/WEB)
Nov 16 10 08:10a Agent Plumbing Inc 971 - 250 -2568 p.2
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: l „
(Fill exceeding 12" in depth shall be compacted to j s)
90% of maximum density) / SO 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 dwelling.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL # of Plans Valuation: Permit Fee:
(New, Additions or Required at $.00108500.00 $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.
52,001101 to $25,000.00 $91.44 for the first $2.000.00 and
Multi - Family R -1 Occupancy 2 $10.76 for each additional $1,000 or
traction thereof, to and including
825,000.00.
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 51,000.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to 8100,000.00 $540.42 for the first $50,000.00 and
$538 for each additional 51,000.00 or
fraction thereof, to and including
$ 100,000.00.
5100,000.01 and over $809.42 for the first $100,000.00 and
$4.49 for each additional $1,000.00 or
fraction thereof.
1:' Bui lding \Permits\S IT-Perm itApp.doc 12/27106
❑ This Service Provider Letter is not vend unless CWS approved site plain(s) are attached,
❑ The proposed activity does not meet the definition of development or the lot was platted after 9!9.95 ORS 92.040(2). NO SITE
SSE ORSER c, Roy /iDEg LErT R 18 REQUIRED.
Reviewed By G . Data: if
2550 aW tillsboro iighrar• KlisOoru, Oregon 97123
Phone: M681-5100 • Fax: (50 681 -4439 . •runv dearwamr:rvias.orG
Rarhod: May q MC
w . y i �o f,
.- . _. r .. . i _ • NOV 2010 "
OFFICE COPY
CITY OF TIGARD N
r,. -." ' - - BUILDING DIVISION
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CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: - ) "Z
PLAN ING DIVISION:
Required -tbacks: 0 Approved ❑ Not Approved
Side: Street Side:
Front. Garage: Rear:
Visual Clearance: Iii • p oved ❑ Not Approved
Maximum Building Heigh feet
CWS Service Provider .•tter Requi E. Yes ❑ No
►` i eceived(DM
13): Date:
ENGINEER' ' DEPARTMENT:
Actual Slop _% ❑ Approved ❑ Not Approved
Site Plan ❑ Approved 0 Not Approved
By: Date:
Notes:
W — � J
' � J
CITY T • ► - 5IT)E REVIEW
BUILDING PERMIT N +•
0 App
Street Trees: ❑ Not A9proved
Protected Trees: 0 , , 0 Not Approved
g Dete