Permit , CITY OF TIGARD SITE WORK PERMIT
'� 2 ' ', COMMUNITY DEVELOPMENT Permit #: SIT2009 -00013
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.A Date Issued: 07/22/2009
Parcel: 1S 135CA00600
Jurisdiction: Tigard
Site address: 11200 SW GREENBURG RD, UNIT# 1
Subdivision: AUTUMN OAKS APARTMENTS Lot: 0
Project: Autumn Oaks Apartments
Project Description: Installation of sidewalks, green spaces, parking spaces and parking lot renovations.
Owner: FEES
AUTUMN OAKS PROPERTIES LLC Description Date Amount
6036 SW MADISON CT
PORTLAND, OR 97221 Permit Fee - COM 07/22/2009 $784.90
Plan Review 06/30/2009 $447.01
PHONE: 12% State Surcharge - Building 07/22/2009 $94.19
Plan Review 07/22/2009 $63.18
Contractor: Erosion Control 07/22/2009 $80.00
SHANNON CONTRACTING LLC Erosion Plan Review CWS 07/22/2009 $26.00
2065 NW MILLER RD #415 Erosion Plan Review COT 07/22/2009 $26.00
PORTLAND, OR 97229
PHONE: 503 - 913 -1339
FAX: 503 - 690 -5868
Type of Use: COM
Class of Work: OTR
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $1,521.28
Required Items and Reports (Conditions)
This permi ' suedsubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
appli le law. All work-%A0 be done in accordance with approved plans. This permit will expire if work is not started wit 'n 180 days of
is ance, or if work is suspe ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adc.ted by the Oregon
ility Notification Center. Tho es r- set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may ..tain a copy of the rules
1( r direct questons to OUNC b (ling '3.246.6699 or 1.800.332.2344.
ssued By: 0 / Permittee Signature: 6 d2A4A- � 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.
t
Building Permit Application
Site Work - FOR OFFICE USE ONLY
a
of Tigard 1Cd Received / ' zt:v
City g I Date/B 7 Oa B Permit No.: (
u 13125 SW Hall Blvd., Tigard, OR 9722 O9 Plan Review "�,1, �1
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : d�.�� ® Other Permit: •
T I G ARD Inspection Line: 503.639 Date Rea" Juris: See Page 2 for •
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- 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.
❑ I- and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB' SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 8:/80 z, y Agiil h, 4 Rd New dwelling area: square feet
City/State /ZIP:
1; / 4 977Z9. Garage /carport area: square feet
Suite/bldg. /apt. no.: ` Proj name: 7 Covered porch area: square feet
Cross street/directions to job site: 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.
Tax map /parcel no.: • Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the proft for the
DESCRIPTION OF WORK . work indicated on this application. Mb L ry
��77 `` ,,�� - Valuation: $ 6 % rain '--
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: 4 m j Ogg' ad. gel/ Type of construction:
Address: d / �L/ Occupancy groups:
City /State /ZIP `� Existing:
Phone: ( .03) 6 3y O 707 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 9 d.41 Lk All contractors and subcontractors are required to be
Contact name: KL - 4//4 4rnC10 i licensed with the Oregon Construction Contractors Board
� under ORS 701 and may be required to be licensed in the
Address: 9o&s NUJ - A/ s 7 15 jurisdiction in which work is being performed. If the .
CitylState /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: 51/81pmcp..1 C ht, ..T-, Lt.. BUILDING PERMIT FEES *"
i
Address: / 0, + fCd (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:7' a��® / ® N 9'722
�� FLS plan review fee (if applicable):
`
Phone: ) �/ 3 _a Fax: (SO ) 6 e`5 94':17
CCB lie.: Total fees due upon application:
` Amount received:
Authorized signature: i4.1
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ha 4vm Date: f
O Fee methodology set by Tri -County Building Industry
Service Board.
L\ Building \Pennits \SIT- PennitApp.doc 12/27/06 440 -461 T(11 2/COM /WEB)
City of Tigard: Site Work Permit Checklist vil 1 s`
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: 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.
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.
# 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- PermitApp.doc 12/27/06 2
1( �63
Building Permit Application 11-1 - c F -000 (2, /Y A0o 7
; y��;
' Site Work RECEIVED FOR OFFICE USE ONLY?
City of Tigard ��N 3
. 0 2009 Received J _ O Permit No.: � ( �� -061
D ate /B (fJ
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revief'�11�
A IIINgi . Phone: 503.639.4171 Fax: 503.598.1960./ TIG�D Date /B : ( Ilk Other Permit:
TIGARD Inspection Line: 503.639.4175 Cl b �F Date Ready ® See Page 2 for
Internet: www.tigard- or.gov BU1LD1NG DIVISION . 'Notified/Method: r9 Supplemental Information
•
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.
1:1 1- and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building III Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
0
Job site address: //? 0 o Std /1 y h ��,l New dwelling area: square feet
City/State /ZIP: oA/�/ZO' / C T ?722...g Garage /carport area: square feet
Suite/bldg. /apt. no.: , / Project name: , Covered porch area: square feet
Cross street/directions to job site: 2Lt 6dQ Rol Deck area: square feet
I
5w 0a(2. 0 t , ( Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
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, o head, and the profit for the •
DESCRIPTION OF WORK work indicated on this app ion.
oxa �1
�' Valuation:
(Ws � �'-'
,{Cl titt(� St ot,.,�141,l(g /
Existing building area: square feet
( New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: fii.r; 00K-s LC C. Type of construction:
Address: �vtt .0%c" 6q �40 /St e/ Occupancy groups: ( _
an - 7 - 44 „,,
City /State /ZIP: Q ? ) t''
Phone: (S (a - O 7 5 1) F / E/l ) Existing: New:
❑ APPLICANT ❑ CONTACT PERSON • NOTICE
Business name: J/ I01,,w,pV CO.J.1.1-(677c C 1 All contractors and subcontractors are required to be
Contact name: elj`� NNi�� licensed with the•Oregon Construction Contractors Board
-G\j t under'ORS 701 and may be required to be licensed in the
Address: c2OG Nw MtLL R rit #efts jurisdiction in which work is being performed. If the
�� / applicant is exempt from licensing, the following reasons
City/State /ZIP:
�MK_( 2p JD O( 7QN/ ' 7Z2.? apply:
Phone: (53 ) q( _ 3 39 Fax.: ( )
E -mail: (.< l:oN� ("1 sr,' , C,m
CO NTRACTOR
Business name: SH aN1N10.1 a frACT 7.,r- (-1-- (Z. . BUILDING PERMIT. FEES* � V
Address: .2(1(2-5- Ntj rug ft p J (Please refer to fee schedule)"
City /State /ZIP: Structural plan review fee (or deposit):
p o r�1 q 2Z
` "ivy L ` FLS plan review fee (if applicable):
Phone: (5 ) C _ - (3 3 °i Fa. " )
CCB lie.: 1 5 9 ({ • �4 1 Total fees due upon application: 1 /17. 1 /17. 0 l
Amount received:
Authorized signature:
_9 T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: C -� ( A &i Date: * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building \Permits \SIT- PermitApp.doc 12/27/06 440- 4613T(II/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: 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.
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 required) •
❑ 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
I:\Building\Permits \SIT - PermitApp.doc 12/27/06 2