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Permit
ti CITY OF TIGARD SIT WORK PERMIT . - 2 -- COMMUNITY DEVELOPMENT Permit #: SIT2009 -00005 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/08/2009 Parcel: 2S 104 B D 10000 Jurisdiction: Tigard Site address: 12631 SW 135TH AVE Subdivision: ALEXANDER PARTITION Lot: 2 Project: Alexander Project Description: Moving utilities into easement. Owner: FEES ALEXANDER LIVING TRUST Description Date Amount BY MARION /DOMINIQUE ALEXANDER TRS, Permit Fee - RES 05/08/2009 $62.50 12645 SW 135TH AVE Tax - 12% State Surcharge 05/08/2009 $7.50 PHONE: Erosion Control 05/08/2009 $26.00 Erosion Plan Review CWS 05/08/2009 $8.45 Contractor: Erosion Plan Review COT 05/08/2009 $8.45 MARIN NITA 16015 SE OATFIELD RD. MILWAUKIE, OR 97267 PHONE: 503 - 209 -0941 FAX: Type of Use: SF Class of Work: ALT 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 $112.90 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 the rules adopted by the Oregon Utility Notification Ce ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules Issued By: -� / //� U feA Permittee Signature: 1104-10-66? O o '` � �, Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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 Site Work RECEIVED FOR OFFICE - USE ONLY City of Tigard ate' Received Permit No.: ° 13125 SW Hall Blvd., Tigard, OR 97223 MqY 0 8 2009 Plan R view • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI G A RD Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: lurk ® See Page 2 for Internet: www.tigard- or.gov IVISION Notified/Method: 1 \G Supplemental Information BUILDING D 't 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 $K Addition/ teration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ," CATEGORY..OF C ONSTRUCTION .. work indicated on this application. m 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ oo ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION LOCATION Total number of floors: Job site address: \ a (n ` ,1 \ —) LJ h A- v e New dwelling area: square feet City /State /ZIP: � Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: A lQec� nd(c— Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: • square feet REQUIRED DATA: COMMERCIAL - USE Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 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. MC) lC ■ : Ce . LAA l \ \ \--i,er," - Valuation: $ Existing building area: square feet New building area: square feet IX PROPERTY OWNER , ' _ . ` TENANT , . Number of stories: o Name: M Ct 1 t r■ 42,1C0 In (-k ,Q r Type of construction: Address: 1'2 c q t j 3 I �� Occupancy groups: City /State /ZIP: `, C,01 r A t , Existing: Phone: (5 ) B o i4 ©� Fa '(563) 3 O 1 141 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 ,. , . X Business name: / 'T , I V . C© x- S7 ic2. c , 7 i - BUILDI PERMIT FEES* Address: // 0 l' 5 m �-I' [ 2-i �L 24 , . ' v e'refer" to jee schedule) City /State /ZIP: `{� 5 Structural plan review fee (or deposit): re( n12 q� 2.6 7 ,5O) 2 r— © 4 ( Fax: ( ) FLS plan review fee (if applicable): Phone: ( >t CCB lic.: CJ ©" Z c.9, O • � •QQ Total fees due upon application: � Amount received: 1 2 , 9 0 X Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: 5 _ 6 0( * Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits \SIT - PermitApp.doc 12/27/06 440- 4613T(11/02/COM /WEB) , ., City of Tigard: Site Work Permit Checklist Page 2 - Supplemental Information 3 ' 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. $ 7 ' 7 .J _s r r`Y. _ ` -- . t, r _ 4 :a' 2 _ 'S , f . :F , " '` 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 ❑ *Parking (including ADA) and ADA compliance Lighting 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. :e of Plans TX,PT OF SUBMITTAL , I2equ><red at (Includes New, A or Alterati(ns) Submittal .y Commercial 2 Multi- Family R -1 Occupancy 2 One- & Two - Family Dwelling 2 I:\Building \Permits \SIT- PennitApp.doc 12/27/06 2 • . II 7 1 . . . Site Work Permit Application Plan Submittal Requirements T1GARD Commercial, Multi- Family and One- & Two - Family Dwellings A site work permit is required for all commercial projects including new buildings, additions, accessory buildings larger than 120 square feet, modular structures and multi - family R -1 occupancies. A site work permit is required for excavation, fill, grading, paving, retaining walls, fire hydrants and fire department access on private property for work on individual lots not covered under the subdivision development. Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. Please see the Site Utilities - Plumbing Permit Application for plan submittal requirements. 1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic location labeled with: _ A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name ❑ applicant phone number B. North arrow. . -- C. Scale (architectural or engineering only). ._. D. Street names. E. Building pads (drawn to scale) with project location. 2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only. All details listed below shall be incorporated into the plans: A. Site plan showing: 1) Required parking spaces and driveways. 2) A route, accessible to persons with disability, leading from the public way to an accessible building entrance. 3) Accessible parking spaces and adjacent access aisle connecting with the accessible route. 4) Curb ramps along the accessible route, curb, sidewalk and gutter. 5) Finish grade elevations along the accessible route. B. Topographic survey plan showing grade elevations crossing the entire site. C. Overall grading plan. D. Utilities plan showing: 1) Fire hydrant location and pipe size if on private property. 2) If the building is to be protected with an automatic fire sprinkler system, show location of the water service vault and the fire department connection (FDC) within 70 feet of a fire hydrant. 3) Size of underground water service for the sprinkler system. E. Erosion control plan complying with the requirements of the Clean Water Services (CWS) agency showing: 1) Silt fence locations. 2) Bio- filter bags /other approved barrier material surrounding catch basins. I:\ Building \Permits \SIT- PermitApp. 12/27/06 3 • 3) Illustrations detailing the correct installation of the silt fencing and catch basin protection. 4) Any other measures to ensure compliance with CWS standards. F. Landscaping plan. 3. ADDITIONAL REQUIREMENTS: A. Soils (geotechnical) report. A soils report is required for new buildings and additions to contain the following: 1) The report shall address the potential of soil liquefaction and instability (OSSC Sec. 1804.2). 2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1). 3) Foundation and lateral pressures exceeding 1,500 lb. /sq. ft. (OSSC Sec. 1805). B. Fire flow and hydrant worksheet. C. Plan review deposit based upon project valuation. I:\ Building \Permits \SIT - PermitApp.doc 12/27/06 4 dt'D0 ° wy " g, 1 \q e i r \ \ ,,../ \ /,..‘ _.., \,. ,, ,. .., ,.>. , _ ,' \ q `\ \ t f / . .-:1\t.b\ \ \\ ti\ \ • A \ \. ''--• P , . - 1 W . LOU \ . . \ . \ f / 2 8A O z 1 10100 rft4 • 51VO - L 1 V ,-- ,-- D r /„. ,, / ) 7 , .,.,,, , , ,, .., . .. i 3 in - , . . . ,,.-- Z „ < ./ \ /, .... .___,‘ . \ , 34.28 ;4.. LJ_j # , i „ , _ 0.) i -1 2-134- L .. 2 \ 0, N ________-7' \o„6 r .....e , / , / EAS EM ENT 144411 • N 0 _,,-- : \ / 1 A Ft \ / 83-514c° 0