Permit •
C ITY OF TIGARD SITE WORK PERMIT
PERMIT # : SIT2006 - 00015
4 �1( DEVELOPMENT SERVICES DATE ISSUED : 9/14/2006
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL : 2S1026D - 01900
SITE ADDRESS: 12910 SW PACIFIC HWY ZONING : C -G
SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION : TIG
Project Description: Site work for enviromental compound & parking lot.
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 10,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
HENDERSON, MARILYN DOROTHEA Description Date Amount
JENSEN HUDSON TRUSTEE [BUILD] Prmt Fee -Valu 9/14/2006 $139.30
11795 SW KATHERINE ST [BUPPLN] Pln Rv -Valu 9/14/2006 $90.55
TIGARD, OR 97224
[TAX] Valu 8% State Surcha 9/14/2006 $11.14
Phone: [FLS] FLS Pln Rv 9/14/2006 $55.72
[ERPRMT] Erosion Control 9/14/2006 $80.00
Contractor [ERPLN] Erosn Pln Rv CWS 9/14/2006 $26.00
[EROSN] Erosn Pln Rv COT 9/14/2006 $26.00
MARLAND HENDERSON CONST. Total $428.71
12950 SW PACIFIC HWY #225
TIGARD, OR 97223
Contact #:
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 - 4444
Reg #: LIC 70266
•
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 b e Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. o • opies if these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. 952-001-0100.
Issued By: � Perm' :e nature �//
t rAillIPPW-1. VILA."
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.
Site Work RECEIVED
4.
Building Permit Application role orrlcl: t si: ()Nix
City of Tigard S E P 0 5 2006 Received • - O 7 Permit No.: S 11 (000 lS
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review._
Phone: 503.639.4171 Fax: 503.598.1969 OF TIGARD 7 Dat�B / / . QG 5,� Other Permit: TIGARD
Inspection Line: 503.639.4175 BUILDING DIVISION / %1 1 la See Page 2 for
Internet: www.tigard- or.gov Date fied/Method 7 /� 6 ��/ f ` ' • l i J" Supplemental Information
` -) aC--A-' W/\ VI( \4?rfL
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- and 2-family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFOR TION AND LOCATION Total number of floors:
• Job site address: / di F e X ied / New dwelling area: square feet
City /State/ZIP: a /� /164 p 7 p2 9 7 %) 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: 1 Project name: 4 411-X4 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: 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.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK n _ l /..PD indicated on this application.
. 6l1i /e/.. /2 g /i /2/26,L4 �,Jr, C'n
t, U /.. Valuation: $ /e #
a- PAkit-11.1 1 1 /-67:- Existing building area: square feet
I New building area: square feet
".PROPERTY OWNER I ❑ TENANT Number of stories:
Name: / li fie_ L- 13 /'I z'NUe, X50/3 Type of construction:
Address: 11 VI�lt`��2t � �� Occupancy groups:
—
City /State/ZIP: R la -,-, a, g 7 x .9-3 Existing:
Phone: (5 d -" 2, y f Fax: (53) 1P3/ 31010 3 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) I Fax::( )
• E -mail:
CONTRACTOR
Business name: 1'14 p_ L 1 , y r, H . , (�� BUILDING PERMIT FEES*
Address: 1 ac75 h t_3 ` ile 1 F4 C N U7\Y .Ir ga's (Please rejerm fee schedale)
� Structural plan review fee (or deposit):
• City /State/ZIP: ` ! /Co A (21-) C) R c a
Phone: ( 5c) b 59 - 37 Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: 7 a l Total fees due upon application:
`C � � Amount received:
Authorized signattu . 4 This permit application expires if a permit is not obtained
4/ within 180 days after it has been accepted as complete.
. Print name Date: 470 i • Fee methodology set by Tri-County Building Industry
Service Board.
l:\ Building \Permits\SIT- PermitApp.doc 06/26/06 4404613T(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
(Includes New, Additions or Alterations) Submittal
• Commercial 2
Multi - Family R -1 Occupancy 2
•
One- & Two - Family Dwelling 2
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