Permit v
CITY OF TIGARD SITE WORK PERMIT
°. COMMUNITY DEVELOPMENT PERMIT #: SIT2008 -00011
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 3/28/2008
PARCEL : 1S125DB - 05800
SITE ADDRESS: 07190 SW SHADY LN ZONING : R -4.5
SUBDIVISION: SHADY DELL NO. 2 LOT: 031 JURISDICTION : TIG
PROJECT: JOHNSON
Project Description: 4' foot high retaining wall with fill.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
TOM JOHNSON & JAN GASPAR Description Date Amount
7190 SW SHADY LN [TAX] Valu 12% State Surcha 3/28/2008 $7.50
TIGARD, OR 97223
[BUILD] Prmt Fee -Valu 3/28/2008 $62.50
[BUPPLN] Pln Rv -Valu 3/28/2008 $40.63
Phone: 503 - 320 - 4898 Total $110.63
Contractor:
SKM EXCAVATING INC
19476 SW BUTTEVILLE RD NE
AURORA, OR 97002
Contact #: PRI 503 - 789 - 8427
FAX 503 - 678 -7852 REQUIRED ITEMS AND REPORTS
Reg #: LIC 174241
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 • . ec q - - '•ns to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu: d By: / �� 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.
-
Building Per mit ; Applicatio n
Site Work FOR OFFICE USE ONLY
'
Received n Q g r /f�1
City of Tigard Date/By: : At O Ob Permit No.: frA I. (� V
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 : Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGAR
Inspection Line: 503.639.4175 Date Ready/By: Jur ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: ra Supplemental Information
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.
r
1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ q On , CDQ
❑ 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: 1 I Sv s W s H 1 L� • New dwelling area: square feet
City/State /ZIP: � % � cillci ) OR q 1 2 z'1 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 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: 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 application.
• y 6Y1 674 ad Aid, Gc)ALL w/ /�i LL .
Valuation: $
Existing building area: square feet
New building area: square feet
XPROPERTY OWNER � ❑ TENANT Number of stories:
—
Name: O m 0 h io -S o h) 3 u .. ('y'S? 0.'04 Type of construction:
Address: - i C ) S , ,j�. S I , i ') Occupancy groups:
City /State /ZIP: I/ ct 0 R. • e i 1 2,Z Existing:
Phone: (5 .3 .. 8' Fax: ( ) 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: ( ) Fax:: ( )
E -mail:
CONTRACTOR }� /� ' /fi n 1
Business name: S E' ( a Utt +1Vl) _ bPJ/ ,II 1 1 3 G � 1{, t • BUILDING PERMIT FEES*
Address: ICI 4 '� (� b VT� V 1 i l a reps r �J (Pl ease reler to fee schedule)
�"r review fee (or eposit): 6 , ,.>2)
City /State /ZIP:
� n -ua,/ , . Or a1 0vz y . 1P3 -
Phone: (� l gel. d�'d17 Fax: ( 7 b �g"'1 7—
CCB lie.: ( riM' k 1 x 2 8 dam/ Total £e' s fine upon 7.pplication: 7. 5 v
l Amount received: r! 0 , 6 3
Authorized signature: _ �+ Thi perm application expires if a permit is not obtained
1 'M IA -10CNASO within 180 days after it has been accepted as complete.
Print name: ikon ' i _ ` - Date: 3 - fl Q • p 2 * Fee methodology set by Tri- County Building Industry
0 Service Board.
I:\Building \Permits \SIT- PermitApp.doc 12/ 7/06 440- 4613T(I1 /02 /COM/WEB)
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1. 1
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
(:\Building \Permits \SIT - PermitApp.doc 12/27/06 2
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Client: G-r 1
ENGINEERING, INC. Job No.: C 7 '1j - a 9 Date: 3/ 7-3/015
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9025 SW Center Street - PO Box 23784 Tigard, Oregon 97281 • Phone: (503) 620-2nRR • FRY: (nn RRLS -AR.1A
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CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.: L " __,,,
PLANNING DIVISION: ,
Required Setbacks: Approved ❑ Not Approved
Side: S eet Side: .
From. Garage: Rear:
Visual Clearance: ❑ Approved ❑ Not Approved
Maximum Building Height feet
`., CWS Service rovider Letter Required: ❑ Yes ❑ No
�, ❑ Receiv d
B : Date: ,c) / / 6
ENGINEERING DEPARTMENT: .
Actual Slope: _% ❑ Approved ❑ Not Approved
Site Plan: V ❑ Approved ❑ Not Approved
By:
Date:
Notes: -
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CITY OF.TIGARD . .
BUILDING DIVISION PERMI0 /004 //
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 It# 3/),049-
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /960 C9(161/W CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: .\/ �-�c7 PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Ins ection Description Confirm # Contact # essage
C ctia ns /Comments /Instru o s:
ASS ❑ PA' L APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL OP L FOR T 1 SP -AWN : DITI NAL F S ASSESSED
Inspector: Date Phone #: (503) 718-