Permit •t CITY OF TIGARD SITE WORK PERMIT
s = `',- COMMUNITY DEVELOPMENT Permit #: SIT2010 -00025
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010
Parcel: 2S105DD01600
Jurisdiction: Tigard
Site address: 14825 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. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if we not started within 180 days of
issuance , v. is suspended for more the 180 days. ATTENTION: Oregon law requires you to •Ilow t e ules adopted by the Oregon
Utility otification Cent . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 - 9090. Yo, .y obtain a copy • t - rules
or di ect quest'ons to OUN by in• 503.232.1987 or 1.800.332.2344.
Issue• = : , / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio. d. e.
This permit card shall be kept in a conspicuous place on the job site until . .letion of the pr••
Approved plans are required on the job site at the time of a inspection.
Building Permit Application
Site Work FO U ONLY
City of Tigard (} Date /Bea /Z ri / D ...../ Permit No.: (6,ri X40_ �'
- q 13125 SW Hall Blvd., Tigard, OR 97223 DE Y 20 0 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: ,
I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris. El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
RUII DING DIVISION
TYPE OF WORK REQUIRED DATA: l- 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: $
111 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: / S 440 au /JP-15f A-A.i , New dwelling area: square feet
City /State /ZIP: - fl 6, -t , p q. ZZ3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Sth�9.4Se L..err4E 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.
6;20 Valuation: $
Existing building area: square feet
New building area: square feet
, ',PROPERTY OWNER' ❑ TENANT Number of stories:
Name: Solt‘ set Lie NIVINTUIMI L1 Type of construction:
Address: 241°14 C1JOUP- f ' IVuarN4 bra.. Occupancy groups:
City /State /ZIP: west- (.wN 01L 9"'0be, Existing:
Phone: (t9D3 ) t --T5 5 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: r424 1;7,,j C-4_QpitN E 'Me1/4rt?Z. rn7L. BUILDING PERMIT :FEES*
Address: 110K 5011 Structural refer to fee schedule)
City/State/ZIP: Structural plan review fee (or deposit):
In�t(FpnlVtu.e., cit. °l"10`jO FLS plan review fee (if applicable):
Phone: ( 56;) 6$ Z - 042 Fax: ( )
CCB lic.: Total fees due upon application:
Amount received:
Authorized signature:
Print name: .../1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
- Date: * Fee methodology set by Tri- County Building Industry
/ Service Board.
I:\Building \Permits\ - PermitAppy 10/01/09 440- 4613T(11 /02 /COM/WEB)
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 ADA ❑ *Parking (including ADA) and Lighting
compliance • • Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion ControlPlan 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 $25,000.00 591.44 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.
$50,001.0016 $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