Permit CITY OF TIGARD
SITE WORKPERMT
COMMUNITY DEVELOPMENT PERMIT #: SIT2008 -00002
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 2/1/2008
PARCEL : 2S102CB -00100
SITE ADDRESS: 12850 SW GRANT AVE ZONING : R -12
SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION : TIG
PROJECT: CHARLES F TIGARD RUNNING TRACK
Project Description: Installation of 5,000 sq ft running track. This permit is for erosion control only.
CLASS OF WORK: UNK PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 5,000 sf
Owner: FEES
WACO SCHOOL DISTRICT NO. 23 Description Date Amount
6960 SW SANDBURG ST [ERPRMT] Erosion Control 2/1/2008 $80.00
TIGARD, OR 97223 [ERPLN] Erosn Pin Rv CWS 2/1/2008 $26.00
[EROSN] Erosn Pln Rv COT 2/1/2008 $26.00
Phone: 503 - 431 -4017 Total $132.00
Contractor:
OWNER
Contact #:
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws
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 than 180 days ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OU NC by
calling 503 246 6699 or 1 800 332 2344
Issued y Permittee Signature: \C
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
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Building Permit Application e , . r 4 , x ,1HOR OFFICE U SE ONLY - �� ' . p 4.1 Y „ :
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C l t Permit No �(
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y of Tigard Received g Date /B � 4 i o e / i ��U •-•°41/110 p„: 1 3125 SW Hall Blvd., Tigard, OR 97223 P lan Review
Phone 503.639.4171 Fax: 503.598 1960 D ate /13 , Other Permit
TCG Inspection Line 503 639 4175 Date Ready/By 0 See Page 2 for
w Internet www.tigard - gov Notified /Method t =L � Supplemental Information
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® 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
r - - h ' et t . r,, °,. _ �, : v work indicated on this application.
:s.... _;. .• '_ GATEG Y OF C QNSTRU. e TIQ Na rc •,.. , ,T. " ", : „:4 •_ :u Ax.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ® Other: Number of bathrooms:
r,- w, > - - tea- = Total number of floors.
`" * , . r i . ;3oB`aSIT INFpRMATIOl AIV D.7 OGATI®N - � ` , ._ . Il i- 3
Job site address- 12855 SW Crant St Nev: dwelling aiea: square feet
City /State /ZIP Tigard Or, 97224 Garage /carport area: square feet
Suite /bldg. /apt no.: Project name: CF Tigard Track Covered porch area: square feet
Cross street/directions to job site: Deck area square feet
Other structure area: square feet
4 REQtUIRED DAB A COMN USE CFIECKI IST.
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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
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` -s" - = # >'4 ' ° ;=:'- D ESCl2IPTI®NO _ - _ . = F = ro • , 0;- .° i work indicated on this application. _
Build all weather track
Valuation: $
Existing building area: square feet
New building area: square feet
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,:iv al ® -- I - ?®WNE - - - °, 0-w4 - ' p T ENA. N _-_,:.,,,,v,' .> °` , -- Number of stories:
Name Tigard School District Type of construction:
Address: 6960 Sandburg St Occupancy groups -
City /State /ZIP• Tigard Or, 97224 Existing:
Phone (503)431 -4017 Fax: (503)431 -4020 New -
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Business name HBII Engineering All contractors and subcontractors are requited to be
Contact name Dave Boatman licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address 20015 SW Pacific Hwy Suite 101 jurisdiction in which work is being performed II the
City /State/ZIP. Sherwood Or 97140 applicant is exempt from licensing, the following reasons
apply
Phone: (503) 625 -8065 Fax: : (503) 625 -1531
E -mail: DBoatman @hbh- consulting.com
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Business name• Owner gf' i v' = `:BUILDING PERSTIT;FEES' , `� ; z ,
!- ?...a Ple rc ee,"ich i& , "' `" m`"
Address:
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Structural plan review fee (or deposit):
City/State/ZIP-
Phone ( ) Fax. ( ) FLS plan review fee (if applicable) -
CCB lie Total fees due upon application
6 �' �� Amount received.
Authorized signature This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Pont name nes.� L t Jat.tiv. Date ' -3 ( -0s -, Fee methodology set by Tri- County But khny Industry
Sci vice Board
I \Building \Permits \SIT- PermrtAppdoc 06/26/06 440- 4613T(II/02/COM /WEB)
x1 . •
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: 32 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 32 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: Rubber Track
*Total new impervious area including all
buildings, sidewalks, and paving: 5000 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 a•plication:
❑ 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.
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Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
I \ But lding \Permits \SIT- PermttApp doc 06/26/06 2