Permit }'•: , .1 CITY OF TIGARD SITE WORK PERMIT
2 ° COMMUNITY DEVELOPMENT Permit #: SIT2012 -00014
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 1 S136DB02400
Jurisdiction: Tigard
Site address: 11642 SW PACIFIC HWY 160
Project: Amazing Auto Detailing Subdivision: AZOIC TERRACE Lot: 1
Project Description: Site work for auto detailing shop
Contractor: HALS CONSTRUCTION INC Owner: CHAMPION, RONALD V & ROBERTA E
20666 S HWY 213 16449 LEXINGTON CT
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97034
PHONE: 503 - 656 -4999 PHONE: 503 - 997 -1608
FAX: 503 - 656 -5961
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 10/03/2012 $371.16
Plan Review 10/03/2012 $241.25
Type of Use: COM 12% State Surcharge - Building 10/03/2012 $44.54
Class of Work: OTR Info Process /Archiving - Lg $2.00 (over 10/03/2012 $4.00
11x17)
Project Valuation: $28,016.00 Erosion Control w /Permit - Ping 10/03/2012 $100.00
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required:
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking: Yes
Fence:
Total $760.95
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 •
issuance, . • 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 -0090. You may obtain a copy of the rules
or dir . t questions to OUNC b - 503.232.1987 or 1.800.332.2344.
0),
Issue. By: / /.Il L �� _ / Permittee Signature: / �/
y .,
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.
•
- " 1BuildingPermit Applicatio D
Site Work JUL_ 1 7 2012 FOR OFFICE LJ ONLY
City of Tigard ��ry C Deceived /7 I - ! Permit No : i I Ago.-0,9/41 ` ' ° 13125 SW Hall Blvd., Tigard,OR 9 2 y Oi �GA Plan Review 1,0 YHDA/ ,i— e04007
Phone: 503.718.2439 Fax: 503. 1 ZING DIVISION Plan Re : 0 .5_. 17.----Other Permit:
TI G n F D Inspection Line: 503.639.4175 Date Ready/ y: Juris: fll See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ ew construction
i ❑Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition/alterafion / replacement Other: equipment, materials, labor, overhead, and the prbfit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building
❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMAT ON AND LOCATION Total number of floors:
Job site address: / </_ "i - ' -�� r / New dwelling area: square feet
City /State /ZIP: - / 7 a o�-/ Garage /carport area: square feet
Suite/bldg. /..r 1,d) /VII 'roject name: � Covered porch area square feet
Cross street/r trections to job site: ,W,WMFA �; %/ Deck area: square feet
/ / .,I i IA I �i t&Pl 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 2- 6/6 .. o27
Existing building area square feet
New building area: square feet
.ROPERTY OWNER I ❑TENANT Number of stories:
Name: , b , / • ,_ j j _ T . i f / Type of construction:
'`ddress: // / Occupancy groups:
� /1 ✓.1/ — *AG i P y g P •
City /State /ZIP: �r��/%�/ i /� / ,��/ 6/ Existing:
Phone: 5r uo 0 g i ax. ( ) , New:
APPLICANT ❑ CONTACT PERSON NOTICE
■
Business name All contractors and subcontractors are required to be
Contact name: y t 1 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: 2 n Fax:: applicant is exempt from licensing, the following reasons 1S,
Phone: �jC,
) !/ /At I ( ) apply:
r
E -mail:
CONTRACTOR
Business name: H L. tS % "e1 / BUILDING PERMIT FEES*
• Address: # , If A._ ,� (Please refer to fee schedule)
gr/ y � r — �,'�� Structural plan review fee (or deposit):
City /State /ZIP: � �i. , J �j
Phone: / '7 (J
_�� Vt� 09 7.7 FLS plan review fee (if applicable):
Z Fax:
CCB lic.: Total fees due upon application:
< Amount received:
Authorized signature: -- /// r / �� ,./,, ..... --6:1"--. Thi permit application expires if a permit is not obtained
' � within 180 days after it has been accepted as complete.
Print name: o 1 // , 4 D ate: a * Fee methodology set by Tri- County Building Industry
— Service Board.
I: \Building \Permits \SIT - PermitApp.doc 10/01/09 440 -4613T(I1 /02 /COM/WEB)
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi- Family and One- and Two - Family Dwellines:
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
El 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.
4 . $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.
1:\Building\Permits \SIT - PermitApp.doc 05/25/2012 2
/ / l ig 640 119-e/ Ny
AM4zl1.)6 AuTo 4 -
II Building Division
Development Code Provision Review
T c n ° Commercial Projects with Approved Land Use
Building Permit No.: l �OO / 4 't -DOc / L
Land Use Casefile No.: H ('.n Sb (2 — 61040 7
Routed Plans:
Submittal Date: /7 9-
Submittal Date: 2 30 /c.2— / S #-"
Submittal Date:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies
to the Building Division. Only checked (/) items are approved. Items not approved and those listed in the
notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed
above each section.
STAFF: please only mark those items on the left side that are approved.
Planning Review (contact Jaw /a at 503 - 718 -zY)" or ,ja�jnt @tigard- or.gov)
• Land Use Approval V
❑ Building Plans Match Approved Plan: Yes ❑ No ❑
❑ Maximum Building Height
❑ Conditions Met ak
Notes: o"
Original Plan: Approved ❑ Not Approved (Ec Date: —/ 1
Revision 1: Approved Not Approved ❑ Date: '-- -- ad- /1
Revision 2: Approved Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard- or.gov)
,lEr Actual Slope: 7
❑ PFI Permit #
❑ Conditions Met
❑ tes: G� NEED ' - kj - 1 °j/1C J `✓- P� (of,
QUj 'r ® r - /LS /N "1 /-) 7 i1C) 'i
Original Plan: Approved ❑ Not Approved O. Date: f3 1 (p---
Revision 1: Approved A Not Approved ❑ Date: 6 3 0, /
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved) Not Approved ❑ Date: 7 u " •
Revision 1: Approved UI Not Approved ❑ Date: )— »'r2 NIP
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit
❑ Engineering Okay to Issue Permit
Notes:
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes•'/ No ►`
Date Routed to Building:
•
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Page 2 of 2
ZTec ENGINEERS, INC. IEVLuJIAi Lul
3737 SE 8th Avenue
PORTLAND, OREGON 97202 -3701
DATE.? � / ,. JOB NO.
(503) 23\5-8795 ATTENTION
1
TO � F L- '-vim -1 I� RE: ) I !p b c LJ P1 C TU w
C \ j 2X T 1 6 r
RECEIVED
JUL 2 6 2012
CITY OF TIGARD
WE ARE SENDING YOU Attached ❑ RI ENGINEERING the following items:
❑ Shop drawings Prints ❑ Plans ❑ Samples ❑, Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
I
2_6V r s &-.,o
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
. XFor your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
(31-7,t__. 7 /°C A/G EA/6_ 1 6 '.ems; co_
i
l j (9-v/ L 000/ Y
COPY TO
SIGNED:
If enclosures are not as noted, kindly notify I. t once.