Permit CITY OF TIGARD SITE WORK PERMIT
11 ' COMMUNITY DEVELOPMENT Permit #: SIT2010 00021
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 2S112DB00700
Jurisdiction: Tigard
Site address: 15245 SW 74TH AVE
Project: Comcast Subdivision: Lot: 11
Project Description: Site work to construct equipment building for new service hub.
Contractor: LEGACY WIRELESS SERVICES INC Owner: HUEWE, ERIC J & JENNIFER E
15580 SE FOR MOR CT 1199 FAIRWAY RD
CLACKAMAS, OR 97015 LAKE OSWEGO, OR 97034
PHONE: 503 - 656 -5300 PHONE: 503 - 968 -5450
FAX: 503 - 656 -5305
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 04/15/2011 $177.52
Plan Review 04/15/2011 $115.39
Type of Use: COM 12% State Surcharge - Building 04/15/2011 $21.30
Class of Work: NEW Erosion Control 04/15/2011 $200.00
Project Valuation: Erosion Plan Review CWS 04/15/2011 $65.00
1 $10,000.00 Erosion Plan Review COT 04/15/2011 $65.00
Water Quality - Corn / Multi family 04/15/2011 $225.00
Water Quantity - Conn / Multi family 04/15/2011 $275.00
Site Specifics:
Excavation Volume: 80 cu. yd.
Fill Volume: 65 cu. yd.
Impervious Surface: 896 sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall:
Fire Underground: No Accessible Parking: No
Fence: Yes
Total $1,144.21
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 . ork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to • low the rules adopted by - Oregon
Utility Notifica Center. , ose ru -s are set forth in OAR 952 - 001 -0010 through OAR 952-001-00•• You may obtain a copy o • - rules
or direct que ion to OUNC by c lli . 503. .1987 or 1.800.332.2344.
Issued By: Permittee Signature:
■
Call 503.639.4175 by 7:00 a.m. for the next available inspection d.• e.
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 RECEIVED Oa / 00/0 - 0400
Site Work iOi :O1IIt l l - ∎∎vI1
NOV 3 201'Li �
City of Tigard 3 /p n Pami Na : (5, 7 - 40/0 0 44,2 /
1 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIG ' 3:m '''
T� efin
Phone: 501639.4171 Fax: 503.598.1960 �� ..: l i Other Permit:
i t Inspection Line: 503.639.4175 BUILDING DIVIS 0 Rea ,, a See race 2 tic. Tv
Internet www.tigard-or.gov Notified/me t od. ' ,� 3)1 0 49 S.pptase.w td r.a6..
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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ® Commercialfmdustrial
Valuation: S
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder 0 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15245 SW 74th Avenue New dwelling area: square feet
If
City /State/ZIP: Tigard, OR Garage/carport area: square feet
3 Suite/bldg. /apt. no.: I Project name: Comcast Tigard Hub Covered porch area: square feet
Cross street/directions to job site: SW 74th Avenue N. & SW Durham Road Deck area: square feet
Other structure area: 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.: Wash Co 2S1 12D6 700 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.
Construction of a +/- 896 SF unoccupied CMU block and metal roof equipment Valuation: t>►vS;006(00' 40
building with HVAC units, in a gravel and fenced compound also containing Existing building area: square feet {
Z backup power generator and fuel tank for Comcast service to area. New building area: 896 square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: .
Name: Ric Huewe Type of construction:
4 . Address: PO Box 2026 Occupancy groups:
City /State/ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503) 968 -5450 Fax: (503)598 -5474 New:
- ►t APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Legacy Wireless Services, Inc. All contractors and subcontractors are required to be
Contact name: James Kramer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15580 SE For Mor Court jurisdiction in which work is being performed. If the
City/State/LIP: Clackamas, OR 97015 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 804-9202 I Fax: : (503) 656 -5305
E -mail: jkramer(legacy- wireless.com
CONTRACTOR
5 Business name: Legacy Wireless Services, Inc. BUILDING PERMIT FEES*
Address: 15580 SE For Mor Court
(Meese refer r fee sekellsd0
City/State/Z1P: Clackamas, OR 97015 Structural plan review fee (or deposit):
Phone: (503) 656 -5300 Fax: (503) 656 -5305 FLS plan review fee (if applicable):
CCB lie.: 150432 — Total fees due upon application Vg/
9.t? .410
I Amount received I
Authorized signature* I 4 This permit application expires ifs perait is not obtained
Print name: James Kramer I Date: 10/28/10 within 180 days after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry
Service Board.
-, '1+
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi - Family and One- and Two-Family Dwellines:
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: 80 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 145 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 65 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: +/ - 896 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-1 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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