Permit 1
, . _ CITY OF TIGARD SITE WORK PERMIT
v
s - ; '' COMMUN DEVELOPMENT Permit #: SIT2010 00024
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010
1 TIGARD Parcel: 2S105DD01700
Jurisdiction: Tigard
Site address: 14775 SW SUNRISE LN
Project: Sunrise Lane Subdivision: Lot: 0
Project Description: Erosion control only.
Contractor: BRIAN CLOPTON EXCAVATION INC Owner: SRL 79 LLC
P 0 BOX 509 2694 COUER D'ALENE DR
WILSONVILLE, OR 97070 WEST LINN, OR 97068
PHONE: 503 - 682 -0420 PHONE: 503 - 657 -3402
FAX:
FEES
Description Date Amount
Specifics: Erosion Control 12/01/2010 $80.00
Erosion Plan Review CWS 12/01/2010 $26.00
Type of Use: SF Erosion Plan Review COT 12/01/2010 $26.00
Class of Work: OTR
Project Valuation: $0.00
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. =.-cialty Codes and all • -r
applicable law. All work will be done in accordance with approved plans. This permit will expire if work of ailed within 180.ays of
issuance is suspended for more the 180 days. ATTENTION: Oregon law requires you to folk t - ru 1 adopted by tre Oreg.
Utility otification Cente T : rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You ma obtain a copy . f the les
or d ect questions to OUNC calli g • 232.1987 or 1.80 .332.2344. •
Iss ed B ( �'�� .�,� `I/ Permittee S ignature: . •
Call 503.639.4175 by 7:00 a.m. for the next available inspection d- -
This permit card shall be kept in a conspicuous place on the job site until co ion of the pry -ct.
Approved plans are required on the job site at the time of each ' .ection.
Building Permit Application
Site Work RECENED FoR.orFicy list: ONLY
City of Tigard (` �O 1 10 Received
II q DateB : fat / / O Permit No.:a Ti, 0/0 ...e45,5,_ ...e45,5,_ 13125 SW Hall Blvd., Tigard, OR 97223 DE-kJ Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 - `IGAR° Date/B : Other Permit
i rcin l�
Insp Line: 503.639.4175 CITY o � is: ® Se e Page 2 for
li �Q�� Date ReadyBy: Jur
Internet: www.tigard- or.gov g � o �p1NG DIVISION Supplemental Information
TYPE OF WO RK . REQUIRED 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: 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: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (L1/ 7 75 , 'Oh 3 t 6-4..} , New dwelling area: square feet
City /State /ZIP: - Ti �tPC +, \ O 2 c-1 Zz-3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: She, Ly E Covered porch area: square feet
Cross street/directions to job site: Deck 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
i;...L'5%/6 A.) 0 i1.li" Valuation: $
Existing building area: square feet
New building area: square feet
gPROPERTY OWNER. ❑ TENANT Number of stories:
Name: SoNSi✓ Likr4e N i l..L.L.. Type of construction:
Address: 2.-CAA CO u L i t D . Occupancy groups:
City/State /ZIP: LJGgt" ` 1.,..),,j ` op- 9106e Existing:
Phone: (5b$ ) Togy ---rs5 Fax: ( ) 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: ( ) Fax:: ( )
E -mail:
. CONTRACTOR .
Business name: 7(24 AT4 C.'- PR N EXc t kr.it /or_ . . - BUILDING PERMIT FEES* . .
Address: ] �K g li (Please refer to fee schedule)
City/State /ZIP: �. �p,7� Structural plan review fee (or deposit):
i tho�V6uro FLS plan review fee (if applicable):
Phone: ( 50 6c3 2. . Og2JD Fax: ( )
CCB lic.: Total fees due upon application:
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: l Date: * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\ - PermitApp» 10/01/09 440- 4613T(11/02 /COM/WEB)