Permit iii CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT # : SIT2007 -00015
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 6/4/2007
PARCEL : 2S102DA -00400
SITE ADDRESS: 13125 SW HALL BLVD ZONING : CBD
SUBDIVISION: LOT: JURISDICTION : TIG
PROJECT: TIGARD SKATE PARK
Project Description: Site work
CLASS OF WORK: OTR PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 0.00
EXCV VOLUME: 350 cy LANDSCAPING ?: Y
FILL VOLUME: 200 cy SITE PREP ?: Y
ENG FILL ?: Y STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 0 sf
Owner: FEES
TIGARD, CITY OF Description Date Amount
13125 SW HALL [BUILD] Prmt Fee -Valu 6/1/2007 $738.83
TIGARD, OR 97223 [TAX] Valu 8% State Surcharg 6/1/2007 $59.11
[FLS] FLS Pln Rv 6/1/2007 $295.53
Phone: [ERPRMT] Erosion Control 6/1/2007 $80.00
[ERPLN] Erosn Pln Rv CWS 6/1/2007 $26.00
Contractor: [EROSN] Erosn Pln Rv COT 6/1/2007 $26.00
DREAMLAND SKATEPARKS LLC Total $1,225.47
960 SE HWY 101 PMB 384
LINCOLN CITY, OR 97367 -2622
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Contact #: PRI 503 - 577 -9277
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #: LIC 152121
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those . - . - in OAR 952 - 001 - 0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
cal • g 50 3.246.6699 8r<1 .800. 32.2344. / 4 . _ . , 2_ _ _ , _
I.sued By: A l I/ i t
kJ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Si Work / 3 / 5 - - c$A-) W L. L _ 6
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Buildid Permit Applicatiody r _ FORAFFICI� USE ONLY
`� ` Rece ived Pe rmit No. 4
City of Tigard Dazer6 -7 p 7 a - !
13125 SW Hall Blvd., Tigard, OR 972 n - 9 2007 Plan Review
M ' ' Phone: 503.639.4171 Fax: 503.598.1 Y Date/By. ,, "O 7• ` j Other Permit
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TIGARD Inspection Line: 503.639 y�p� Date Ready :y: ®See Page 2 for
Internet: www.tigard- or.gov CITY Y ®� TIGARD Notified/Method: �� Supplemental Information
BUILDING DIVISION
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 ► i Other: s4 4. 9 v equipment, materials, labor, overhead, and the profit for the
. CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ►�I Commercial /industrial
1:1 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: ' ?. 1.2 fit..) 4 A p..,; ,„‘A New dwelling area: square feet
City /State /ZIP: uAfd ` 0e. 0 \ - 2 z3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ,v\t\S:c14„ 141em r Covered porch area: square feet
Cross street /directions to job site: ` 1 j r 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 an Ideation. A /
d t 4 Pox tL Valuation: $ p9 t
Existing building area: square feet
New building area: square feet
h PROPERTY OWNER ❑ TENANT Number of stories:
. Name: e...;.1.1 o £ T, 9 ... , Type of construction:
Address: 1-11 25 S W l{Pd...l.. 1::m,, A Occupancy groups:
City /State /ZIP: 'Txckn.>t'A I d� \ i 222, Existing:
Phone: ( ) Fax:( ) New:
El APPLICANT ® CONTACT PERSON NOTICE :
Business name: -j ok- ", q ocr All contractors and subcontractors are required to be
Contact name: — 5. � S licensed with the Oregon Construction Contractors Board
'I under ORS 701 and may be required to be licensed in the
Address: t31Zsj s w t g,vtl jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
y �ic.i aafr, l G5 7 2. apply:
Phone: ( ) I Fax:: ( )
E -mail:
CONTRACTOR
Business name: ' flt ., cos , 1'r�it0 koNA'e PQ,t'ks 1.. L. C.
BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
O s E 4 (.4 � 1 Q M g 3% 4 Structural plan review fee (or deposit):
City /State /ZIP: L \,,c1c.11, mil} OR.. 9`1 (D 1 - Z (o 'Z7
7 t FLS plan review fee (if applicable):
Phone: ( 503) 51 1 - ' 2.1 l Fax: ( )
A c9 /,q / / Total fees due upon application:
Amount received:
Authorized signature:
// (( / /�� - 1 7 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: T,tzo1 A /r1E4p s Date: 5 /9/6'7 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits \SIT- PermitApp.doc 06/26/06 440- 4613T(II/02 /COM/WEB)
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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: 3 5o cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) %t t-) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) aco cu. yds.
Retaining structure? (Check one) ❑ Rock
® CMU
❑ Concrete
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: O 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:
E Site Plan with Vicinity Map showing 0 *Parking (including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and details ❑ *Landscaping Plan - • •
O 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
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One- & Two - Family Dwelling 2
1:\Building \Permits \SIT - PermitApp.doc 06/26/06 2 ' • '
CITY OF TIGARD c ol_ 00®
BUILDING DIVISION PERMIT #:
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 '� t
Inspection Requests (24 Hrs.): (503) 639 - 4175 "'f I
INSPECTION WORKSHEET FOR DATE: I V /®7 TIME: PAGE:
SITE ADDRESS: . 7 t I VA CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT TION: ) � � 4v&ic—t n DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # • Contact # Message
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Corrections /Co /I structions:
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Vt-pAss- ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " /66\ L/ Date: �A Phone #: (503) 718- 1/4 (2, &70