Permit If CITY OF TIGARD SITE WORK PERMIT
111 slt , ` COMMUNITY DEVELO PMENT Permit #: SIT2011 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011
Parcel: 1 S133CA06000
Jurisdiction: Tigard
Site address: 11297 SW HALLMARK TER
Project: Barrows Road Estates, Lot 9 Subdivision: BARROWS ROAD ESTATES Lot: 9
Project Description: Increasing height of existing retaining wall.
Contractor: RENNER TRUCKING & EXCAVATING INC Owner: FOSTER FINCH
228 SW WALNUT ST 7235 SW NEWTON PL
HILLSBORO, OR 97123 PORTLAND, OR 97225
PHONE: 503 - 793 -1172 PHONE: 503 - 292 -1671
FAX: 503 - 846 -1354
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 03/09/2011 $123.72
Plan Review 03/09/2011 $80.42
Type of Use: SF 12% State Surcharge - Building 03/09/2011 $14.85
Class of Work: ALT Info Process /Archiving - Sm Sheet (up to 03/09/2011 $8.00
11x17)
Project Valuation: $5,000.00
Site Specifics:
Excavation Volume: 30 cu. yd.
Fill Volume: 230 cu. yd.
Impervious Surface: 40 sq. ft. /
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall: Yes
Fire Underground: Accessible Parking:
Fence:
Total $226.99
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 - rules a.- %ed by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. m. o.. a spy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: i/
Call 503.63'.5 by 7:00 a.m. for the next available inspecti 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.
- Building Permit Application
S to Work ��1 FOR OFFICE USE ONLY
City of Tigard ' c De B : , do,s Permit No mw 1 4. i , h`
13125 SW Hall Blvd., Tigard,OR 99., 4 N. `c
Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 � V 5 DateB : , Other Permit: �_
/ ..
IA G A R D Inspection Line 503.639.4175 � Date Ready/By: El See Page 2 for
Internet: www.tigard- or `A4 (- Notified/method: t 11 i a iM Supplemental Information
& r -n- r,
TYPE OF WORK 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 El Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
CI 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
1:1 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: ' 1 ,29 7 5 IA/ HA//M Ark TCi'r. New dwelling area: square feet
City/State /ZIP: T'& kr-d 0 •-7 . G 7 A.2_3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: C3(Arer tv s /2 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.
Tax map /parcel no.: Indicate the value (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
R ,,1 Valuation: $ 5"7o
J Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Fps -e r F C- Type of construction:
Address: 72_35 S k/ //e.g./1 pi._ Occupancy groups:
City /State /ZIP: 1O d 0 - 7 . q 7 a XS' Existing:
Phone: (s-03 zet 2.- — ! 6 7 / Fax: (5 '3) .2.'? 5 f 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 'tensed 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: )Ze_nn e y - LGlcin c 4_ R$Cal/ ' At , BUILDING PERMIT FEES*
Address: 6 1,41 Ai& 1/1144- S f •J (Please refer to fee schedule)
City /State /ZIP: ji/ /Ser / 0 Y. q 7 / , 3 Structural plan review fee (or deposit):
Phone: (5 7 q 3 � / / 7 Z Fax: ( 5 irc/6 _ l 3 ,S I/ FLS plan review fee (if applicable):
CCB lit.: / �3Ss Pp 5-/ Total fees due upon application:
, � Amount received:
Authorized signature: '!
This permit application expires if a permit is not obtained
1, r within 180 days after it has been accepted as complete.
Print name: �i M F ¢ "� `� Date: 3 — fS� j
/ * Fee methodology set by Tri County Building Industry
Service Board.
I: \Building\Permits\SIT- PermitApp.doc 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: "3 0 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 1 0 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 30 cu. yds.
Retaining structure? (Check one) ❑ Rock
• CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 140 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 3 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 3 $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 fust $100,000.00 and
$4.49 for each additional $1,000.00 or
fraction thereof.
1: \Building \Permits \SIT - PermitApp.doc 03/03/2011 2
1 1 1 111 ' B uilding Division
Development Code Provision Review
T i G n iz ° Residential Projects
Building Permit No: _ 577 / /mod 00 r
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑
Routed Plans:
Original Plan Submittal Date: 3/ C ?)
1St Revision Submittal Date: ❑ Site Plan Only
2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact ' "CE- E'c-k at 503 -718- 2(3 or @tigard- or.gov)
Land Use Case No. r 4 r 2 1. 5 Name gm?, )s E: i 3
Er 1L" zS
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitiy., Lands Typ -: / ' . / / " I
Notes: ` ► L
t-- . 'pv..... • . . c • I -'L • '-' ...• c '` 9 ' °K C
LA- 6 • • r" A' ONAl''s -' ' i A if _ I MIC LWiNIf:. ._7 5 (e - biz
C ' 0---14' ' ' I ' 1 /Q ,
Original Plan: Approved 1 Not Approved ❑ Date: 9 — 4 G-15 ��
Revision 1: Approved � Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope: %
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2