Permit C ITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SIT2006 - 00013
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 5/31/2007
PARCEL : 1 S134AB -03300
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD ZONING : R -12
SUBDIVISION: LOT: JURISDICTION : TIG
PROJECT: MUSLIM EDUCATIONAL TRU
Project Description: Site work to place (3) modular classrooms.
CLASS OF WORK: NEW PAVING ?: RESO. NO: ->`
TYPE OF USE: CMSGDM GRADING ?: VALUE: 9 a a 000.64
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 9,982 sf
Owner: FEES
MUSLIM EDUCATIONAL TRUST Description Date Amount
PO BOX 283 [BUPPLN] Pln Rv -Valu 8/22/2006 $165.43
TIGARD, OR 97223 [FLS] FLS Pln Rv 8/22/2006 $101.80
[ERPRMT] Erosion Control 5/31/2007 $80.00
Phone: [ERPLN] Erosn Pln Rv CWS 5/31/2007 $26.00
[EROSN] Erosn Pln Rv COT 5/31/2007 $26.00
Contractor: [BUILD] Prmt Fee -Valu 5/31/2007 $254.50
NW FALCON INC. Total $653.73
PO BOX 146
14845 SW MURRAY - SCHOLLS DR #1
BEAVERTON, OR 97007
Contact #: PM 503 - 490 -5555
FAX 503 - 579 - 1188 REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 - 4444
Reg #: LIC 166350
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 rul - _ _ -- •rth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli _ 03.246.6699 or .:00 • 344.
Issu : d By: _ i i/L Permittee Signature: / ■ _
Call 503.639.4175 by 7:00 a.m. for an inspection that s day.
This permit card shall be kept in a conspicuous place on the job site u • mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
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Site Work
/o33D 56(-) ' °.--iC. O //r .1-e4 .
i : Buildfni Permit ApplicatioI4ECEIVED r()li O,. LiSI:
City of Tigard Received
: U G 2 e6 gap_ D to . 5 Permit No.•� / (Q -0
13 125 SW Hall Blvd, Tigard, OR 9722 2006 Ran Review
Phone: 503.639.4171 Fax: 503.598. Date/13 Other Pemut.
TI c. n ii p Inspection Line: 503.639.4175 �Y O TIGARD Date Ready/By �' ® See Page 2 for
• Internet: www.tigard- or.gov �UILD DIVI I Notified/Method Supplemental Information
�LeP Poo� • Ot3 � 3
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: S
❑ 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: (0330 5(.3 5C 1. c'eeR. 't -C) New dwelling area: square feet
City /State/ZIP: 1"; Qr d l / OR c aa3 Garage /carport area: 6 square feet
Suite/bldg. /apt. no.: 1 l Project name: I E ( Cl aSSt`oo n.S Covered porch ar as square feet
Cross street/directions to job site: Deck area: square feet
�r Nni Raa4 Kogo Oar' 0 SS ' C.on2ST �
0CcQ SIe_4' Otherstru area: square feet
1 1 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 3 C f TL 38OQ 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.
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P(4cemen-r OC 3 r - ■OCI u Inc- [Nut (Ainy 5 0r\ 41,P Valuation: s aa� 000 S ire ca 2 C.(a C e r oOw►s , t Existing building area: square feet
New building area: < 3r( (9 square feet
. jirPROPERTY OWNER I ❑ TENANT Number of stories: I
Name: y1[T A{(•N• (JAI SA•p • _. �of'f/QYI a Type of construction:
Address: 10330 5w Scrods CGQ(Zk oA.h ' UPO Qox D83) Occupancy groups:
City/ State/ZIP: ";C QrcJ I op_ c('rl 2. 3 -- Existing:
Phone: ( ) s99- ((0 2 ( Fax: ( 583) 59(y-O20( New:
❑ APPLICANT Et CONTACT PERSON NOTICE
Business name: SA rv,e NS 46 a 4 E 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
applicant is exempt from licensing, the following reasons
City /State ZIP: apply:
Phone: ( ) I Fax: : ( )
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E -mail:
CONTRACTOR
Business name: N W rA 1 C O ,J t ^c• 400: f A tt J - 1 - 4 \1 AO BUILDING PERMIT FEES*
Address: P.n. Q o 1i.� t (-Ig4S Su IYlyrrc - S OR (Ff rq/ertofe rkedufe)
Structural plan review fee (or deposit): /66
City / State/ZIP: Q eflvgyz 1 0R S uN 110
Phone: ( �) A 0 - SSSS Fax: (st 3 ) to 0 -19 - I in FLS plan review fee (if applicable): �D/ •
i (0350 (Geneva1 �.ot\. racka� Total fees due upon application:
CCB lic.: l
Amount received: . ,96 7. 2-3
Authopzei ►
• • . ' r ip
\
\\ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: „ £ " / . Date: :07.2 O 6 • Fee methodology set by Tri-County Building Industry
-al■ - -
Service Board.
I.\Building\Permits\SIT- PermitApp.doc 0626/06 440 -4613T(II /02 /COM/WEB)
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City of Tigard: Site Work Permit Checklist
Page 1- 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),'ot 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 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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I:\Building\Permits\ .SIT - PermitApp.doc 0626/06 ° 2 ti %
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CITY OF TIGARD 1��-�l�
BUILDING DIVISION PER
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5--i 3 i / o -
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . ,' � 'I I ..
INSPECTION WORKSHEET FOR DATE: FrA TIME: PAGE:
SITE ADDRESS: l U '5 - 6 O 0-v✓p �t -t-'S )y
CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: � _ / f �,
DESCRIPTION: faj (//y /�C.¢,i7 'Y � � ��J °611.6 2�
OWNS . � � PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: D . Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments/ Instructions:
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41i' ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
i .)
Inspector: _ Date: 6 ii D6 Phone #: (503) 718- Z-69