Permit 1
ili CITY OF TIGARD SITE WORK PERMIT
° COMMUNITY DEVELOPMENT PERMIT # : SIT2007 -00034
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 11/26/2007
PARCEL : 2S102DB 00500'
SITE ADDRESS: 08815 SW O'MARA ST ZONING : CBD
SUBDIVISION: FANNO CREEK PARK LOT: JURISDICTION : TIG
PROJECT: SENIOR CENTER REMODEL
Project Description: Site work for new addition.
•
CLASS OF WORK: ADD PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 28,000.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?:
' ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 1,062 sf
Owner: FEES
CITY OF TIGARD Description Date Amount
13125 SW HALL [BUILD] Prmt Fee -Valu 11/26/2007 $243.72
TIGARD, OR 97223 [TAX] Valu 8% State Surcha 11/26/2007 $19.50
[BUPPLN] Pln Rv -Valu 11/26/2007 $158.42
[ERPRMT] Erosion Control 11/26/2007 $80.00
Phone: [ERPLN] Erosn Pln Rv CWS 11/26/2007 $26.00
Contractor:
[EROSN] Erosn Pln Rv COT 11/26/2007 $26.00
KEL TEC BUILDERS Total $553.64
251 ARTHUR RD
MARTINEZ, CA 94553 •
Contact #: PRI 925- 229 -5508
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 - 4444
Reg #: LIC 164210
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 OUNC by calling 503.246.6699 or 1.800.332.2344. '
Issued By: A,/ Permittee Signatur - ,� ��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.
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Site Work
Building Permit Applic CEIVED m12 err lc„r vsl: c)N1.\
Received , , t `o.: _ rI /'.�
City of Tigard , , f 7 Dat• : :, / // o
13125 SW Hall Blvd, Tigard, OR ,
9 l 200 I Plan Review /� �
C / Other Permit:
_ one: 503.639.4171 Fax: 503 9 Date/B . r /�
Inspection Lane: 503.639.4175 (- I I Y o F T I G A R D Date Ready Ty: �: El See Pate 2 for
T I G AD
c u Internet BUILDIN DIVISIO xorified/Merhod: : www .tigard- or.gov t 1 � / 07 j5 ��
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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
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:'n''s� n s.9..._ - .. . _ -.:t _:.� s_ _ _ __ ,ni G work indicated on this application.
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❑ 1- and 2- family dwelling ® Commercial/industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other. Number of bathrooms:
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-==�= i1. - �:s �� -�� =� � ° - _ -: Total number. of floors:
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Job site address: 8815 SW O'Mara St. New dwelling area: square feet
City/State/ZIP: Tigard / OR / 97223 Garage/carport area: square feet
Suite/bldg./apt. no.: I Project name: Tigard Senior Center Add. Covered porch area square feet
Cross street/directions to job site: SW Hall Blvd, west on O'Mara to site Deck area: square feet
Other structure area: square feet
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Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax. map/ parcel no. 2S102DB / 00500
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equipment, materials, labor, overhead, and the profit for the
- : iarik �: a ` n , • 9 a ' - ; c" - ___ _ __ --.-'.. gg work indicated on this application.
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Interior remodel • of existing facility; addition of 854 sq. ft. Valuation: X300,000.00 0_45 )
Existing building area: 8,380 square feet
New building area: 854 square feet
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- = d - i"r' 5 ; _ • ; _ — --K - --�_ _� wr Number of stories: 2
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Name: City of Tigard - Public Works Type of construction: V -N
Address: 8777 SW Burnham Street Occupancy groups:
City/State/ZIP: Tigard / OR / 97223 Existing: A -2
Phone: (503)718 -2590 • Fax: (503)684 -7297 New: A -2
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Business name: LRS Architects a All contractors and subcontractors are required to be
Contact name: Peter Dixon licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe required to be licensed in the
Address: 720 NW Davis St. jurisdiction in which work is being performed. If the .
City/State/ZIP: Portland / OR / 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 265 -1570 I Fax: : (503) 221 -2077
E -mail: pdixon@lrsarchitects.com
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Business name: I
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Address: /7,o A r e . el5 f 5r.. .676 S iD li �' g. -ar ._:' =s t' ;
f f �j ( �� Structural plan review fee (or deposit):
City/State/ZIP: /1 - /t[ l r 2
Phone: " _ P 2 Fax: • ` , ii i / 3 FLS plan review fee (if applicable):
/� '2.-I Total fees due upon application:
CCB lic.: `
v 4- 4 ) Amount received:
Authorized signature: : 1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
[ Print name: P � T6-y D I XON Date: IO .. oct-o 7 • Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Petmits\SIT- PermitApp.doc 06/26/06 440- 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 062
buildings, sidewalks, and paving:
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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
►I1 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
IABui ]dingTemrits\SIT- PermitApp.doc 06 /26/06 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: S1T2007 -00034
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/26/2001
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 --
INSPECTION WORKSHEET FOR DATE: 4 /7/2008 TIME: 7:01AM PAGE: 37
SITE ADDRESS: 08815 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: FANNO CREEK PARK LOT #: TYPE OF USE:
PROJECT NAME: SENIOR CENTER
DESCRIPTION: Site work for new addition.
OWNER: CITY OF TIGARD, PHONE #:
CONTRACTOR: KEL TEC BUILDERS PHONE #: 925.229 - 5508
Inspection Request Scheduled For: Date: 4/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 067914 -01 360-721-8839 N
Corrections/Comments/Instructions:
f 1.41-1" C.- CL-5- "Mr
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a PAS '•ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL .- LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 0 Phone #: (503) 718 -5/7'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2007 -00034
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/26/2001
Phone: (503) 639 -4171 Itli ill l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/6/2000 TIME: 7:00AM PAGE: 16
SITE ADDRESS: 08815 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: F•ANNO CREEK PARK LOT #: TYPE OF USE:
PROJECT NAME: SENIOR CENTER
DESCRIPTION: Silo work for new addition.
OWNER: CrI1Y OF TIGARD, PHONE #:
CONTRACTOR: KEL TEC BUILDERS PHONE #: 325 - 229
Inspection Request Scheduled For: Date: 3/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # ► age
495 Misc. inspection 066204 -01 503.881 -5364 N
Corrections /Comments /Instructions:
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. 0E 2
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G _ - 1 J O . & .— L 4 .
4c( (2 — Ct) OE
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❑ PASS 4 PARTIAL APPROV;' ❑ CANCEL ❑ NO ACCESS
❑
FAIL - . • • - SP ECTION I] ADDITIONAL FEES ASSESSED
Inspector: - . Date: e O8 Phone #: (503) 718- Z‘g