Permit / ,
CI TY OF TIGARD SITE WORK PERMIT
2:411*. l� DEVELOPMENT SERVICES PERMIT #: SIT2006 -00005
°7 I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED : 5/30/2006
PARCEL: 1S135BD - 00200
SITE ADDRESS: 09785 SW SHADY LN ZONING : C -
SUBDIVISION: LOT: JURISDICTION : TIG
Project Description: Add ADA sidewalk. No new impervious area.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 1,900.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
STAN NORED Description Date Amount
1650 NW GARFIELD AVE [BUILD] Prmt Fee -Valu 5/25/2006 $62.50
CORVALLIS, OR 97330 [TAX] Valu 8% State Surcha 5/25/2006 $5.00
[FLS] FLS Pin Rv 5/25/2006 $25.00
Phone: 503 - 689 - 1702 Total $92.50
Contractor:
PLAYPROS INC
1650 NW GARFIELD AVE
CORVALLIS, OR 97330
Contact #: PRI 541 - 689 - 1702
FAX 541 - 463 - 0741 REQUIRED ITEMS AND REPORTS
Reg #: LIC 140881
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 Permittee Signature: 1 i i A 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 au P 9-60 5 -z)000 a-
YI uilding Permit Application A FOR OFFICE, USE ONLY
City of ® Tigard � �
•
Permit No.: r, do •-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review...
Phone: 503.639.4171 Fax: 503.598.1960
AIR pr . Date/B . J • i'06 Ili Other Permit:
Inspection Line: 503.639.4175 J_ i Date Ready/By. . n See Page 2 for
Internet: www.ci.tigard.or.us J Notified/Method * I a. 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.
12 I -and 2 -family dwelling El Commercial /industrial Valuation: $
1:1 Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AM) LOCATION Total number of floors:
Job site address: 9235- ,c- . (A / i s h� .4t, L New dwelling area: square feet
City /State/ZIP: 7 . p a rid I o X ( 7 Z J Z 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: e(6129,3 PA-g, K 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.
Q
/" tJ r a u..r...-( w Valuation: $ ( 77cD , 0 0
Existing building area: square feet '
New building area: square feet
PK OWNER ❑ TENANT Number of stories:
Name: s Aco Y` Type of construction:
Address: / 6SD A( (U 6A-g.'. ( 4- ("Q Occupancy groups:
City /State/ZIP: eatroaLA, 3 f Q /f ?7330 Existing:
Phone: (y() 6 Es ?..- i ?Q Fax: (5 (() K 3 - 07 c f r New:
❑ APPLICANT CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: . 574A) C e - 4 L 5 671/ - Z,3 1 - /999 ' 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
applicant is exempt from licensing, the following reasons
City / State/ZIP: apply:
Phone:( ) I Fax::( )
E -mail:
!, CONTRACTOR
Business name: (�jj BUILDING PERMIT FEES*
6s �
Address: AKe _ V 6 / ' el
Please refer to fee schedulj�
City /State/ZIP: �(jCel e j COX 775 rJ �I / , S
� Fees due upon application f7 l �
Phone: ( !/ ) 6,9f• [?o _ I Fax: (Sn 1(63 -- (�
Amount received
' CCB lie.: / = r al/44K
Date received:
Authorized signatu This permit application expires if a permit is not obtained
,/ within 180 days after it has been accepted as complete.
' Print name: . 5 7 7 - 79 / y- 14(62 re... I Date: 57 6 • Fee methodology set by Tri County Building Industry
` Service Board.
i:\ Building \Pennits\SIT -PennitApp•doc 12/03 4404613T(1I /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 JiA
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
i:\Building\Forms\s1T- PermitApp.doc 1/13/04 2
•
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CITY OF TIGARD -- � ti - 11 606o
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 jell
Inspection Requests (24 Hrs.): (503) 639 -4175 ^, _
INSPECTION WORKSHEET FOR DATE: 1.1, / 0 (4 TIME: PAGE:
SITE ADDRESS: D1 1 D 6 c J L "/Ci'V CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /C ments /Instructions:
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Npf PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V6,' ci Date: 1 7-774 6 Phone #: (503) 718- 2).(24
______
CITY OF TIGARD , .�
BUILDING DIVISION PERMIT #: SIT2006 -00005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/30/2006
Phone: (503) 639 - 4171.
Inspection Requests (24 Hrs.): (503) 639 -4175 J 'IL
INSPECTION WORKSHEET FOR DATE: 12/26/2006 TIME: 7:00AM PAGE: 15
SITE ADDRESS: 0978F, SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RAINBOW PARK & PLAYGROUND CO
DESCRIPTION: Add ADA sidewalk. No new impervious area.
OWNER: NORED, STAN PHONE #: 503-689-1702
CONTRACTOR: PLAYPROS INC PHONE #: 541.689 - 1702
Inspection Request Scheduled For: Date: 12/26/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
495 Misc. inspection 041509 -01 503-968-7230 N
Corrections /C mments /Instructions:
A ' D 4-6- 1 I ri-edtAr A k
iot6aSS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \ /i < ' ' Date: 11 /0 #: (503) 718- 2 / 2r
CITY•OF TIGARD -
BUILDING DIVISION . PERMIT #: SIT2006.00005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/30/2006
r Phone: (503) 639 -4171 Vq I In spection Requests (24 Hrs.): (503) 639 -4175 - —
INSPECTION WORKSHEET FOR DATE: 9/20/2006 TIME: 7 :01AM PAGE: 60
SITE ADDRESS: 09785 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RAINBOW PARK & PLAYGROUND CO
DESCRIPTION: Add ADA sidewalk. No new impervious area.
OWNER: NORED, STAN PHONE #: 6603 -(H9 -1702
CONTRACTOR: PLAYPROS INC PHONE #: 541-N39-1702
Inspection Request Scheduled For: Date: 912012006 Pour Time:
Code # Inspection Description Confirm # Contact # Message tV/, CO --
499 Final inspection 036829 -01 503-968 -7230 Y L a', co
Corrections /Comments /Instructions:
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❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: OW Date: ` 26 CG Phone #: (503) 718