Permit CITY OF TIGARD SITE WORK PERMIT
' •:. COMMUNITY DEVELOPMENT Permit #: SIT2009 00004
Date Issued: 07/13/2009
TIGARD. 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Parcel: 2S113BA00200
Jurisdiction: Tigard
Site address: 7800 SW DURHAM RD
Subdivision: Lot: 0
Project: Jackson Business Center
Project Description: Add (10) parking stalls
Owner: FEES
METZGER VENTURES, LLC Description Date Amount
PO BOX 400
SHERWOOD, OR 97140 Permit Fee - COM 04/27/2009 $134.00
Plan Review 04/27/2009 $87 10
PHONE. Tax - 12% State Surcharge 04/27/2009 $16 08
Erosion Control 07/13/2009 $80 00
Contractor Erosion Plan Review CWS 07/13/2009 $26 00
BRIAN CLOPTON EXCAVATION INC Erosion Plan Review COT 07/13/2009 $26 00
P 0 BOX 509
WILSONVILLE, OR 97070
PHONE 503 - 682 -0420
FAX
Type of Use: COM
Class of Work: ALT
Site Specifics:
Excavation Volume 50 cu yd
Fill Volume 50 cu yd
Impervious Surface 1587 sq ft
Engineered Fill. No Soil Report Required No
Paving: Yes Grading Yes
Landscaping No Site Prep: Yes
Storn Drains: No Retaining Wall. No
Fire Underground No Accessible Parking No
Fence. No
Total $369 18
Required Items and Reports (Conditions)
1 SIT 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 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 Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules_
or direct questions to OUNC by calling 503.246 6699 or 1.800 332 2344
Issued By: g� np j/� L l Permittee Signat er"-_
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.
Site Work 7 4 �
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Building Permit Application n � I� r'' FOR OFFIC USE ONLY
City of Tigard qq q Received 1 I 2 r� ' c I Permit No lT 2 y��� o 111 �;
IIII
- w !d 13125 SW Hall Blvd., Tigard OR 9722AP I ZOOS _ ' _
Phone 503 639.4171 Fax. 503.598.1960 D a te B evie _ t / Other Permit rn , `t: • c o
Inspection Line• 503.639.4175 GlTY OF TIGARD Date Rea∎ /B ■ See Page 2 for
TIGARD Internet. www.tigard or.gov Notified/Method 7. L 3 O l Supplemental Information
BUILDING DIVISION ��tt
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.
Valuation. $
❑ 1 and 2 family dwelling ❑ Commercial /industrial
Number of bedrooms:
El Multi -famil Accessory building ❑ Multi-family
❑ Master builder 0 Other Parking Lot Addition Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address. 7800 SW Durham Road New dwelling area: square feet
City/State /ZIP: Tigard, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name. Durham Elementary - Metzger Parking Covered porch area: square feet
Cross street/directions to job site South of Durham Road and East of Durham Elementary 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 an
Tax map /parcel no - 2S113BA -00200 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application
Valuation: $ 12,000.00
Addition of 10 parking stalls
Existing building area N/A square feet
New building area N/A square feet
el PROPERTY OWNER ❑ TENANT Number of stories: N/A
Name. David Metzger Type of construction: Parking Lot Addition
Address. P.O. Box 400 Occupancy groups: N/A
City/State /ZIP Sherwood, OR 97140 Existing N/A
Phone: ( 503) 804 -0507 Fax- ( ) New:
N/A
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name: CardnoWRG All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: Tony Roos under ORS 701 and may be required to be licensed in the
Address: 5415 SW Westgate Drive, Suite 100 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: Portland, Oregon 97221 apply:
Phone: ( 503 ) 419 -2500 Fax. ' ( 503 ) 419 -2600
E mail tony.roos @cardnowrg.com
CONTRACTOR
Business name: T be determined C60 (�,,[}��� ,�C,
of BUILDING PERMIT FEES*
� �
R Cy (Please refer to fee schedule)
Address: V� `� . $0
6 �� /l � Structural plan review fee (or deposit): $ 87.10
City /State /ZIP: L t \,,SO n v l , \ _Q `J
�� • FLS plan review fee (if applicable): N/A
t
Phone. _.);; � (Q 8, . 04 2-0 Fax ( )
CCB lic.:
-����` ? Total fees due upon application: $ 87.10
l O Amount received: $ 237.18
uthorized signature: - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name• Tony Roos Date: *7/05 * Fee methodology set by Tri -County Building Industry
`� Service Board. i "Z _ v°
I:Building \Pennits \SIT - PermitApp doe 12/27/06 440- 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: < 50 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) < 50 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) < 50 cu. yds.
Retaining structure? (Check one) n Rock
❑ CMU
n Concrete
n Other:
*Total new impervious area including all
buildings sidewalks, and paving- 1,587 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 followin t must accomsany this a. • lication:
►/ Site Plan with Vicinity Map showing *Parking (including ADA) and
ADA com . Hance Lighting Plan
/ Grading Plan and • /.1 *Landscaping Plan
1 Erosion Control Plan and details Soils Resort if re • uired
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi - Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
1: \Building\Permits \SIT - PennitApp.doc 06/26/06 2