Permit CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2012 -00017
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 1 S126DB06700
Jurisdiction: TIGARD
Site address:
Project: Montage Subdivision: MONTAGE Lot: 33
Project Description: Erosion control only
Contractor: Owner: NW AREA INVESTMENTS LLC
11150 SW RIVERWOOD RD
PORTLAND, OR 97219
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control w /Permit - Ping 08/28/2012 $75.00
Type of Use: SF
Class of Work: OTR
Project Valuation: $0.00
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $75.00
Required Items and Reports (Conditions)
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
issuanc- or i wo • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0091 You may obtain a copy of the rules
or d ect questions to OUNC b ng , 03.232.1987 or 1.800.332.2344. / r
Iss ed By: 0 //4/ Permittee Signature: C •
- Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Permit Application
pE E EIVED
Site Work
A',i 8 �.r: Received
City of Tigard 8 , , 6 Date/By: / Permit No.: ap/ 0 00,
w 13125 SW Hall Blvd., Tigard,OR 9 vn Plan Review
II Phone: 503.718.2439 Fax: 503.n c OFTIGARD Date/By: Other Permit:
Inspection Line: 503.639.4175 13 �iG'D Date Ready/By: Jung: ® See Page 2 for
T l G A R D p 11`! Notified/Method: Su pp Information
Internet: www.tigard- or.gov 1 � PP
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 (romded 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.
CI 1- and 2- family dwelling El Commercial /industrial Valuation: $
ID Accessory building 1:1 Multi-family Number of bedrooms:
ID Master builder 1:1 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: � a-e T New dwelling area: square feet
City /State /ZIP: er A-/Lyj ( 4 2 c 72-P" 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: fie) A / - E_ 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: �1 I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: / J/ a( 0 sf t5 GP 7000 Indicate the value (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
\ DESCRIPTION OF WORK work indicated on this application.
Ea
_C) n) C.G J �ZO L Pto-1lT 2 Less Valuation: $
.' J / A-C ,Lt Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
,Name: (4 y e‘ k. C, I y' a N i / -C to /Q it id e it ra ' p of construction:
Address: I"' y t f S
- ,iv, tf / � (544.) . a) tat Ihtweribi2 Occupancy
City /State /ZIP: -to 4 •t PT c3.12—q-7 ?q_ 7 Existing:
Phone: (S d ) 7. 7 _'7 TA7 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 !'tensed 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: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
Phone:
( ) I Fax: ( )
CCB lit.: Total fees due upon application:
Amount received: 1 75' c O
Authorized signature: ( - /".„.; /1/4.)---- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:su 45 H c . a ra n` ..� Date: / 8 2g' i .._.,1 * Fee methodology set by Tri- County Building Industry
1 / Service Board.
I:\Building\Permits \SIT - PermitApp.doc 10/01/09 440- 4613T(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 ADA ❑ *Parking (including ADA) and Lighting
compliance Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures ❑ Fire Line
*Does not apply to One- and Two - family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL # of Plans Valuation: Permit Fee:
(New, Additions or Required at $.00 to $500.00 • $51.09 minimum permit fee
Alterations) Submittal $500.01 to $2,000.00 $51.09 for the first $500.00 and
$2.69 for each additional $100 or fraction
Commercial 3 thereof, to and including $2,000.00.
$2,000.01 to $25,000.00 $91.44 for the first $2,000.00 and
Multi - Family R - Occupancy 3 $10.76 for each additional $1,000 or
fraction thereof, to and including
$25,000.00.
One & Two - Family Dwelling 2 $25,000.01 to $50,000.00 $338.92 for the first $25,000.00 and
$8.06 for each additional $1,000.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $540.42 for the first $50,000.00 and
$5.38 for each additional $1,000.00 or
fraction thereof; to and including
$100,000.00.
$100,000.01 and over $809.42 for the first $100,000.00 and
$4.49 for each additional $1,000.00 or
fraction thereof.
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CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2012 -00017
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 1 S126DB06700
Jurisdiction: TIGARD
Site address:
Project: Montage Subdivision: MONTAGE Lot: 33
Project Description: Erosion control only
Contractor: Owner: NW AREA INVESTMENTS LLC
11150 SW RIVERWOOD RD
PORTLAND, OR 97219
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control w /Permit - Ping 08/28/2012 $75.00
Type of Use: SF
Class of Work: OTR
Project Valuation: $0.00
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $75.00
Required Items and Reports (Conditions)
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
issuanc- or i wo • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0091 You may obtain a copy of the rules
or d ect questions to OUNC b ng , 03.232.1987 or 1.800.332.2344. / r
Iss ed By: 0 //4/ Permittee Signature: C •
- Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
•