Permit -
/' CITYOFTIGARD �
DEVELOPMENT PERMIT Nowa ~=�~�n�"���" "�"~~"�" SERVICES PERMIT # • SIT97-0018
s��r �!:. 13125 SN/ Hall BAvd., Tigard, OR97223 (503) G39-4/7l DATE ISSUED: 07/14/97
PARCEL: 25104BD-07500
SITE ADDRESS...: 12810 SW 135TH AVE
SUBDIVISION ~ HANDY ACRES ZONING: R-6
BLOCK..........: LOT ~32 JURISDICTION: TIG
CLASS OF WORK..:NEW : PAVING?.........: N RESO. NO.:'
TYPE OF USE ^SF : GRADING? • Y VALUE...$: 6000
EXCV VOLUME: 0 cy LANDSCAPING? ^ N
FILL VOLUME: 0 cy SITE PREP? : Y
ENG FILL?......: N STORM DRAINS?...: Y
SOILS RPT REQD?: Y IMPERV SURFACE: 10354 sf
Remarks: Site work re: MLP96-0013
Owner: FEES
- __
BETTY SARICH type amount by date recpt
12860 SW 135TH AVENUE PLCK $ 0.00 BON 05/20/97 97-294766
TIGARD OR 97223 PRMT $ 56.50 B 07/14/97 97-207058
PLCK $ 36.73
Phone #: 5PCT $ 2.83 B 07/14/97 97-207058
EROS $ 80.00 B 07/14/97 97-207058
Contractor: ERPC $ 26.00 B 07/14/97 97-207058
OWNER ERPC_$ 26.00 B 07/14/97 97-207058
Phone #: $ 228.06 TOTAL
Reg #..:
------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control __
Tigard Municipal Code, State of Ore. Specialty Codes and all other Grading Insp
applicable laws. All work will be done in accordance with Strm Drain Insp
approved plans. This permit will expire if work is not started Final Inspection
within 180 days of issuance, or if work is suspended for more ___ ___
than 180 days. ATTENTION: Oregon law.reqoires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-001-0010 through DAR 952-001-0080. Your may ___
obtain copies of these rules or direct questions to OUNC by calling
(503)246-9187.
�
Issued by: '
� � l � �� / �
Ik��'y v�klJ���[����'�---- Permittee Signature:���
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++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
. .
CITY OF TIGARD Site Permit Application Plan check x —Ids
Rec d By go
13125 SW HALL BLVD. Private Grading, Paving, Site Accessibility Date Recd -ZO -q
TIGARD, OR 97223 Retaining Structures, Utilities and Related Work Date to P E. x5-3 -
(503) 639 -4171 x304 Date to DST 65 -�_ q
Permit # .,1 r q
Called
Print or Type
Incomplete or illegible applications will not be accepted
:5 ,- / 5 t-i? m te. -Iv ; ag e.
Project Name Utilities (Complete all'that apply)
Jo b 13,17_51' 41/(0 d 4 _f&I.J..4-./1,.\,, --,......_ s
Address Address Storm Sewer r�
.
/a. JO ,C / 36 if (/.4 -' Linear Ft.
Name - Sanitary Sewer
tZosiC- 1c 5 R tr;F- 1�L3earFt.
Owner Marling Address Fresh Water
l of P eo S CV. (3.c- 029 -2'
., e'.
Linear Ft.
City/State Zip Phone Catch Basins a
•
•
2 -f 4 ? J 9 '7A13 Sd (F� Joo7 # `' if
Name Clean Outs
General /K ®,S'rGf 14 CART ,- #
Contractor Mailing Address Describe work to be done:
Issuance e c 3 - �/.3-- Newk Addition❑ Alteration0 Repair0
suan
{ applicant must City/State Zip Phone Additional Description of Work:
provide all 7 9 .2.2. S o2 (4 ' - qcc) P . •
all contractors State Co • 1 t. Board.Lic. # Exp. Date
1 license 00 ' C "/q l
:nformanon in COT Business Tax or Metro # Exp. Date
COT catabase)
Name Project $ (
�' J USA G Valuation
Architect Mailing Address Plan Submittal: (3) sets containing each of of th
/ f // $ 4 /74;4 S=f� _ a. _ following, must accompany this application:
City/State Zip Phone I Site plan with Vicinity Map I Parking (including
Cl/f- A',4 1( /1 /4..C' O/ & (17016-
f o! S I � P.SoZ '- /Iv& I Showing ADA compliance ADA) & Lighting Plan
Name . Grading Plan and details Landscaping Plan
-1Al2
Engineer Mailing Address Erosion Control Plan and Retaining Structures
details including calculations
City/State Zip Phone + Site Utility Plan and details I Soils Report
• (showing connection to VES I (if required)
acproved system)
/ yes
scavation Volume : herecy acknowledge that { have read this application, that the
_oils report required for >5,000 cu. Yards information given is correct. that or,authonzed
i cu. yds. agent of the owner„ and "that.p{ans t:eii�arerin�compliance
V , eg with Oregon_ a ' ".- " '--------., =iii Volume r _ "',late ; laws -. ' ,�.:�---- . > *_,•' _, . '.�7, , �
6 b Signature of'Owner /Agent Date ',
Soils report required for >5.000 cu. Yds.) A f - I cu. yds. � / ) ,\ • _ t'•i'i! the fill support a structure ; Contactp rson`'' a'e Phone I
.Egineer required if answer is yes) YESL NOI, i ;,
.. _:.- -
Retaining structure? (check one) [Rock • - "FOR'OFFICE USE ONLY
1 Q p CMU Notes; , .
Concrete
niOther
I Total new impervious area including all Land lisp se # Ma /TL# C
buildings. sidewalks. and paving Sq. Ft. 1 3 I � 9/°`1 `j � I
1:'asts siteaop.doc
3/06
00�
Perm # A9count Description `°/ ' Amount Amt. Pd. Bal. Due
ue --
Build. Permit N (BUILD) sv <P76
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT)
State Tax (TAX) ZJ3 a •R3
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check -
Build: (BUPPLN) �--
Plumb: (PLMPLN)
Mech: • (MECPLN)
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Commercial TIF (TIF -C)
Industrial TIF (TIF-1)
Institutional TIF (TIF -IS)
Office TIF (TIF -O)
Mass Transit TIF (TIF -MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT) gD
Erosion Planck/USA (ERPLAN) 2G
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS) //
TOTALS: c 79 p .73 a �. S�
044,
Permit #: 5 ll - (7d( i
OF
% ~'' t255L 0 5� ( - 5 -44 " -
Address:
N 1 . :** ri': z q
1 Issued by: v- Date: 7- IL/ '_ / 7
1859
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
,.' 1. I own, reside in, or will reside in the completed structure.
/ 1j 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
LEI before or upon completion.
...q 3A. My general contractor is 13 Li /y 9 c -n,C, , P/
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
E 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners abo Construction Responsibilities on the reverse side of this form.
a; 0 7 /4 /T
(Signature of permit app scant) (Date)
(White copy to issuing ag per file,
pink copy to applicant)
•
~ ,,'oti~e to Property Owners
. A � PI bout ConstrucUon Co nesK��`0���^b�D@�es
~
This Information Notice to Property Owners about Construction Responsibilities
was 'developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new hom or make a substantial i to an exi i structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
ENPLUVER RESPONS1BILMES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residentiarstructure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you mus withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
Unemployment insurance tax: As an employer, you are required to pay a tax fo unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, ad must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject toponolbouundwi)\hcliuhlefora||c\udo'ooxtoiCnoenfyouzeooployeeoiui jured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.8.IIntwonmQ Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829'1040.
OTHER RESPONSBUTES ANO AREAS 0 CONCERN:
Code compliance: As the permit holder for this project, ynuareccspnnujhleforoconlvinguoybdlnrohunnuctuodeccgu>/eou:nto
that may be brought to your attention through inspections.
Liability and property dam -.Lainsurance: Contact your insurance agent to see if you have adequate insurance coverage for
accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to s e employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building offkials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (P0 Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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NOTE: This is to ff)
F E R \ ' —r—
lo I inform you of,and ,-
to correct a tranposition.
P1eAse note this
CD O correction in your
15 0 IC) r'') records.
CO
Ln
`~ 12810 SAAR I CH
CD - MLP96 -0013
N 12860 2 S 10413D - 03200
. In ro f NG
f ,A111 I
06/08/2000 Activities for Case #: SIT97 -00018
3:12:15 PM
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
`
SITA700 Erosion Control lnsp 844 -8444 JD 05/28/1997
SITA720 Grading lnsp JD 05/28/1997
SITA740 Strm Drain Insp JD 05/28/1997
SITA799 Final Inspection MEMO JT 07/17/1997 Memo to file - See Soils
Engineer Report on footings
and fill required for wet
conditions. Look for this at MST
Application - Bob P
SITA005 Application received 05/28/1997 05/20/1997 BON PASS JD 05/28/1997
SITA008 Permit Created 05/28/1997 05/28/1997 JSD PASS JD 05/28/1997
SITA010 Check for prcl. restrict. 05/28/1997 05/28/1997 JSD PASS JD 05/28/1997 See MLP96 -0013
SITA011 DST /mail Land Use Condition Lt 05/28/1997 05/28/1997 JSD PASS JD 05/28/1997
SITA013 Plans Routed to Plans Examiner 05/28/1997 05/28/1997 JSD PASS JD 05/28/1997
SITA030 Reviewed plans routed to DSTS 05/29/1997 05/29/1997 RDP PEND RDP 05/29/1997
SITA032 DST Post - Review Completed 06/06/1997 GEO PASS GEO 06/06/1997 Needs owner responsibility
form and application signature
at issuance
SITA080 (F) Ready to issue 07/01/1997 B MEMO BON 07/01/1997 needs construction
responsibilities form signed.
SITA092 (F) Issue permit 07/14/1997 B PAS BON 07/14/1997
SITA750 San Sewer lnsp 07/17/1997 MEMO JT 07/17/1997 sewer issued at WACO. COT
will inspect. See notes on
voided sewer permit. Jeanne
T.
SITA180 Expired by limitation 05/15/2000 HAP DONE No Hold AKJ 05/15/2000
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