Permit I
_ a
CITY OF TIGARD SITE WORK PERMIT
r m • COMMUNITY DEVELOPMENT Permit #: SIT2009 -00011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/21/2009
Parcel: 2S102DB00500
Jurisdiction: Tigard
Site address: 8815 SW OMARA ST
Subdivision: Lot: 0
Project: Fanno Creek Trail Enhancement
Project Description: Construct Fanno Creek Trail Segment
Owner: FEES
CITY OF TIGARD Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 Permit Fee - COM 08/20/2009 $1,785.20
12% State Surcharge - Building 08/20/2009 $214.22
PHONE: Erosion Control 08/20/2009 $80.00
Erosion Plan Review CWS 08/20/2009 $26.00
Contractor: Erosion Plan Review COT 08/20/2009 $26.00
/ Additional Plan Review 08/20/2009 $1,108.38
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
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Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Yes Soil Report Required: No
Paving: No Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: No Retaining Wall: Yes
Fire Underground: No Accessible Parking: No
Fence: No
Total $3,239.80
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Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ' ation Center. ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or ' ct questions to OUNC •y - 'ng 503.246.6699 or 1.800.332.2344.
I sued By: ' / - / !j � 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.
Q f<_. 1 A4 C J t 1 e 6.
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1
.,....Building Permit Application 0 M ( 41 1.6
D S ite Work RECEVE FOR OFFICE USE ONLY
Received
City of Tigard Date/B : ' J Permit No; 0 • • - 0106
q 111 II 13125 SW Hall Blvd., Tigard, OR 97223�UN 0 4 2009 Plan Review \
Phone: 503.639.4171 Fax: 503.598.19 60 Date/B : OEM Other Permit: - _ _.
Inspection Line: 503.639.4175 Date Ready /By: g El Page 2 for
T I G A R D Internet: www.tigard- or.gov CITY OF DVI fied/Method: v / �/ I ( Y Supplemental Information
BUILDING - 1/M
TYPE OF WORK REQ D 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: Stream work equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $500 El 1- and 2- family dwelling El Commercial/industrial
,O00.
El Accessory building El Multi-family Number of bedrooms:
1:1 Master builder ® Other: stream work Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: Fanno Creek Park X8/5 L.k) Q • HA -69.. New dwelling area: square feet
City /State/ZIP: 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Fanno Creek Enhancement Covered porch area: square feet
Cross street/directions to job site: Fanno Creek at Hall Blvd. Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S102DB00500 • 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.
Fanno Creek channel remeande bank repairs Valuation: $0
C,.--(A 4'-' G- a 1 s h e. 5 q t 5 uvn Me r r Q 1 W 0 ri! ' Existing building area: square feet
tz _ rvt-e &v e.T „ - t - . -- ( work' is su✓nrne( 10 New building area: square feet
® PROPERTY OWNER I 0 TENANT Number of stories:
Name: City of Tigard Type of construction:
Address: Occupancy groups:
City /State/ZIP: ' ' Existing:
■
Phone: ( ) Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Clean Water Services All contractors and subcontractors are required to be
Contact name: Peter Guillozet licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2550 SW Hillsboro Hwy jurisdiction in which work is being performed. If the
City/State/ZIP: Hillsboro, OR 97123 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 681 -4470 •E--- I Fax: : (503) 681 -3603 See attached
E -mail: guillozetp @cleanwaterservices.org
CONTRACTOR !f- - 't-1
Business name: Clean Water Services / t3 Iv / J BUILDING PERMIT FEES*
Address: same as above 0 flit\ -krCL.0 O r / 1 t to T d 0 , (Please refer to fee schedule)
C Structural plan review fee (or deposit):
ity /State/ZIP:
1 � p S 0 1 1 j J I e , �� J � FLS plan review fee (if applicable):
Phone: ( ) l �tt �� )
CCB lic.: 111 Total fees due upon application:
Amount received: It 3 p5f. gr
Authorized signature: This permit application expires if a permit is trot obtained
within 180 days after it has been accepted as complete.
Print name: Peter Guillozet I Date: 6/1/09 * Fee methodology set by Tri -County Building Industry
Service Board.
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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 cciplete 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
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
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