Permit ir. CITY OF TIGARD
SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT # : SIT2007 - 00030
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 9/26/2007
PARCEL : 25101 BC - 02401
SITE ADDRESS: 12650 SW HALL BLVD ZONING : I -L
SUBDIVISION: LOT: JURISDICTION : TIG
PROJECT: SNYDER ROOFING POLE BUILDING
• Project Description: Digging post holes and trench for rain drain line.
CLASS OF WORK: ADD PAVING ?: U RESO. NO:
TYPE OF USE: COM GRADING ?: U VALUE: 2,000.00
EXCV VOLUME: 0 cy LANDSCAPING ?: U
FILL VOLUME: 0 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 2,304 sf
Owner: FEES
JFK PROPERTIES OF OR. LLC Description Date Amount
2017 RIVERKNOLL [BUILD] Prmt Fee -Valu 9/5/2007 $62.50
WEST LINN, OR 97068 [TAX] Valu 8% State Surcha 9/5/2007 $5.00
[BUPPLN] Pln Rv -Valu 9/5/2007 $40.63
[ERPRMT] Erosion Control 9/5/2007 $132.00
Phone: 503-657-4603 [ERPLN] Erosn Pln Rv CWS 9/21/2007 $26.00
Contractor: [EROSN] Erosn Pin Rv COT 9/21/2007 $26.00
[ERPRMT] Erosion Control 9/21/2007 $80.00
ECON 0 FAB BUILDINGS, INC. Refund - [ERPRMT] Erosion C 9/21/2007 - $132.00
14255 SW PARMELLE
GASTON, OR 97119 Total $240.13
Contact #: PRI 503 - 985 -1808
REQUIRED ITEMS AND REPORTS
Reg #: LIC 51042
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 reue,you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OA 91� 52 -00 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
A6.4 Issued By: Permittee Signature:
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.
r
' Building Permit Application
Sitt. WO'tk
RE ' • EN C FOR OFFICE USE ONLY
° I Received
City of Tigard Q Permit No.. J�
City g DateB : / 8 S �� / 00 30
13125 SW Hall Blvd., Tigard, OR 97 23. J
- 2O 1 Plan Rev 4 77711111W
RI 503.639.4171 Fax: 503.598�D966 - Date/B : AWL. �� Q Other Permit:
TI GARD Inspection Line: 503.639.4175 _� . Date Rearr:y: ' Juns HI See Page 2 for
Internet: www.tigard- or.govC r 1 ` ( r I lei A!��r-° Notified/Method: 1 04 Supplemental Information
. do o , ^JI ION Lv� w `�
QUIRED 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- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building 1=1 Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB.. SITE INFORMATION AND LOCATION Total number of floors:
Job site address:/ to 5 Ail fl 46,„/ New dwelling area: square feet
City/State/ZIP: Cit g � d Garage/carport y ��S VY �����".7�/ Gara % g arp t area: square feet q
Suite/bldg. /apt. no.: Project name: A/ /9u / /, /'q 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 profit for the
DESCRIPTION OF WORK work indicated on this application.
i Valuation: $ 0 006 4 it ' t /� G ■ Existing building area: - square feet
fl // l.:k I,W5e V'O� ,k p)f4P /L . • is
jf ile,5 iMd tr t�JVUE 4r ta/V dr4 i , . if Ave New building area: square feet
•
❑, PROPERTY OWNER ❑ TENANT /� Number of stories:
Name: cTFX f rop e r t/ /5 of Ore (9oru kit (, Type of construction:
Address: 0/7 � 4 L1� ,v' // 6 Occupancy groups:
City /State /ZIP 1 Aiit I1/ Or . C i B' Existing:
Phone: v , 0 .) < G 0 Fax: ( ) New: .
0 APPLICANT CONTACT PERSON NOTICE •
Business name: 'tJO pp L� `r oFt r ik .o of C5 & ) All contractors and subcontractors are required to be
Contact name: v V� �'CN"� " "- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: i2 Kb l , jurisdiction in which work is being performed. If the
City /State /ZIP: 11 tr - `` 0ILE l.k\) 1111 > applicant is exempt from licensing, the following reasons
`� _ 1 apply:
Phone: (al) b 20 - , 2 ' 7 I Fax: : ( r ,� - 03 (96 y 1 33/'®
E- mail: (�J'�1.D (: svIcI erro. a J Co. °
CONTRACTOR ,
Business name : -^ /. t — .j' ‘/lI r�CAIJ�$ f ) f/ (' - - BUILDING PERMIT FEES*
Address: /9 / s-s- 6 < ) R2 /ne ��P. v (Please refer fee schedule)
City /State /ZIP: L' �� < O� 9 5 / 9 Structural plan review fee (or deposit):
,_ _, FLS plan review fee (if applicable):
�
Phone: u- `1� te'` o ff Fax: ( )
CCB lic.: A✓6 I 4:7 v-p . (425l Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
D Q within 180 days after it has been accepted as complete.
Print name:
(;,0 5/ / "o * 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
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
(IncludesNew, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
l: \Building\Permits \SIT- PermitApp.doc 12/27/06 2
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