Permit J
`t 4 CITY OF TIGARD
SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SIT2007 -00014
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 4/13/2007
PARCEL : 1S135DA -01000
SITE ADDRESS: 08530 SW PFAFFLE ST ZONING : C -P
SUBDIVISION: METZGER ACRE TRACTS LOT: 020 JURISDICTION : TIG
PROJECT: DALTON'S CATERING
Project Description: Site work for 970 sq ft addition.
CLASS OF WORK: ADD PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 7,500.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
DAVID DALTON Description Date Amount
8530 SW PFAFFLE ST [BUPPLN] Pln Rv -Valu 4/9/2007 $78.07
TIGARD, OR 97223 [FLS] FLS Pln Rv 4/9/2007 $48.04
[BUILD] Prmt Fee -Valu 4/13/2007 $120.10
[TAX] Valu 8% State Surcha 4/13/2007 $9.61
Phone: 503 - 639 -7211 [ERPRMT] Erosion Control 4/13/2007 $80.00
Contractor [ERPLN] Erosn Pln Rv CWS 4/13/2007 $26.00
[EROSN] Erosn Pln Rv COT 4/13/2007 $26.00
WAYNE S RANDALL CONSTRUCTION
20259 SW 70TH AVE Total $387.82
TUALATIN, OR 97062
Contact #: PRI 503- 544 -3523
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #: LIC 95917
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: 4AP �4 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.
\l
' Site Work
- Bu ldin Permit Applica GEW E FOR OFFICE USE ONLY
II a City of Tigard APR 2°V D 0 O/ Permit No.:� i '�60!
13125 SW Hall Blvd., Tigard, OR 9T123
Phone: 503.639.4171 Fax: 503.5 *��F TtG ?T® p ® y/ Plan Revie . ��''
Dat .. AJ �m� Other Permit:
TI G A R D Inspection Line: 503.639.4175 ne m rin VIS' n Date Ready . y: ® Se
Internet: www.tigard or.gov w* Notified/Method: /al Supplemental age 2 In formation
TYPE OF. WORK REQUIRED DATA: AND_2- FAMILYDWELLING .
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
NI Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
'CATEGORY OF CONSTRUCTION • work indicated on this application.
El I- and 2- family dwelling &Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. . - ' JOB SITE INFORMATION AND LOCATION ' Total number of floors:
•
Job site address: P 660 . W. pl'a F F V a gr . New dwelling area: square feet
City /State/ZIP: Ti L.A l2. b ogodnoN 11223 Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: bALto?S GATE 0.I N Li Covered porch area: square feet
Cross street/directions to job site: 1-lAGL p 5 Gyb 4 . pFA p rL�_ 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.: ;, 5 b A r 00 equipment, 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.
q /D 6.f: N N Af7.ol rvbt.4 Valuation $ 1 50b
Existing building area: i, 2' 1 square feet
• New building area: 9 " a square feet
... A -. PROPERTY. OWNER I CI TENANT ' . Number of stories: I
Name: bAvl 0 bALra N Type of construction: v .e,
Address: g r 3 t7 , I4• p viii r I~ Ll, S•r. Occupancy groups: 13
City /State/ZIP: 101 1.1614,11.b C1R 911.2 3 Existing: 13
Phone: (5 use! '1 - .1 2.11 Fax: ( ) New:
. ® APPLICANT ,. = .CONTACT PERSON _
Business name: 1.,1 1 , 0 f 1 51.4 (7t t N sr`2.I NA , IN ( All contractors and subcontractors are required to be
Contact name: Jim A1y D 12 *1.4 J licensed with the Oregon Construction Contractors Board
�°` under ORS 701 and may be required to be licensed in the
Address: rep. X 2 s1 oi 4- jurisdiction in which work is being performed. If the
City /State/ZIP: '"1 L A 12-b OP. q 7 2 to applicant is exempt from licensing, the following reasons
f apply:
Phone: (6'& CP so - 2 0 6 & Fax: : (5 0 A4' 3 , 31',,
E -mail:
. - CONTRACTOR l -95 I�I5 o , gre Fa mi ,
Business name:
. BUILDING PERMIT FEES*
Address: (Please refer tojee schedule)
Structural plan review fee (or deposit): 9e. C 7
City /State/ZIP:
Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable): 'Yg. ey
CCB lic.: Total fees due upon application:
11 b C e�tse. Amount received: 24, O/ Authorized signature: This permit application expires if a permit is not obtained
Print name: �� Date: � N 7 • within 180 days after it has been accepted as complete.
' 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)