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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 I -5/ / /3 ga Request st Permit Action E q ��EIV T rGA a D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- o�r TO: CITY OF TIGARD CITY OFTIGARD Building Division Services Supervisor BU1Lp 1 N GDN1S10N 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) NJ/ f. Mailing Address: City/State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( CANCEL /VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: tT p'{o /3- coo Site Address or Parcel #: /Jo A nD2ti. 5 5 /asi o .3 4.6 o5 " , 1 5 10 2. 96 o 6700 Project Name: (} 1 tJ e aT DJc2 Cior.J P /t21. , JC Subdivision Name: Lot #: EXPLANATION: CgAT - T / Pf-n3 ' E Kit" 6 o tJ Co T12-0 L PW l r To t 6 € P To `a. -7 ---boo /D . � t �2lti,r n�oi .etc2u-Lie_CD `a —b ov co 155 -L€T> y /A5/, Signature: L Date: 'VP- 3/ J / 3 Print Name: (MEg P e_ AnkMS km, I Refund Policy 1 The Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued pernuts d) not more than 80% of the building plan review fcc when an application is canceled before any plan review effort has been expended c) not more than 80% of the building permit fce for issued perrruts pnor to any inspection requests 2. Refunds will be returned to the onginal Payer in the same method in which payment was received Please allow 2 -4 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S s Admin: Date 4 ®®orisim Rte to Bld: Adrrun: Date ,5 < <i j p Refund Processed: Date ic/ ftj - By ,e1 Invoice Processed: Date By Permit Canceled: Date -WC By " Parcel Tag Added: Date By Receipt # Date Method Amount $ I: \ Building \Forms \RegPemutAction.doc Rev 05/25/2012 Miiilding Permit Application Site Work RECFI\/E FOIZ OFI ICL USE ONLY 5 R eceived City f Ti acct Permit No � g 2 201 Date/By y �� / 3 � T�o1.� ° 13125 SW Hall Blvd., Tigard,OR 97223APR 2 Plan Review C . Phone: 503 718 2439 Fax: 503.598.1960 Date/Byd Other Permit: T 1 G n R D Inspection Line. 503.639 CITY OF TIGARD Date Rea 1� June See Page 2 for Internet: www.tigard- or.gov Notified /tHod 1 Supplemental Information BUILDING DIVISIM' (o /i3 -6 TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rotnded 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: $ ❑ 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: New A}-b-0 LE5 New dwelling area: square feet City/State /ZIP: Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: )'"(f} -t lJ i € r 04.4.--1_101.4.D Covered porch area square feet Cross street/directions to job site: Polak, t,>cc. 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 (rotnded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. � V `fit 0 CO D r 2 C . 0)3 L)l Valuation: $ Existing building area square feet New building area: square feet p PROPERTY OWNER ❑ TENANT Number of stories: Name: L y 6 t 7 a#1-213 Type of construction: Address: `-`J Occupancy groups: City /State /ZIP: Existing: Phone: ( ) 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 Lensed 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: 1 CONTRACTOR Business name: of /r E K C t 1.........• BUILDING PERMIT FEES* Address: - 3 1 [p 7 (Please refer to fee schedule) l� Structural plan review fee (or deposit): City /State /ZIP: ( L Li, G J t Lei 0(Z_ 9 747 o Phone: (3'h ) 3 3 — p Fax: (5)5) 2.105 — 94) 4< $ FLS plan review fee (if applicable): Total fees due upon application: CCB lie.: ! 1.6 i Sh eIAil Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: Fee methodology set by Tri -County Building Industry Service Board. I:\Buildmg \Permits \SIT- PetmitApp.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 lessAhan 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 - 1 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.\Buildmg \Permits \SIT - PermitApp.doc 05/25/2012 2 . LEGEND j-1\ , 11 154 EXISTING 1' CONTOUR LINE 0 © ` i �; � APR - 155 $ . J EXISTING 5' CONTOUR LINE 2 1 2 V 01 6- 3 11-154 2 �3 c © f1 tc 2 154 PROPOSED 1 ' CONTOUR LINE 15 8 .8 EG t 1 55 X PROPOSED PROPOSED 5 SED CONTOUR IMENT FENC LINE I T 1 y y9 FENCING 5 OHP A CITY/1C 0 HP \�- + . - ,1-1-1 "� "•_r"lo - ' • 158 :1 \ p TINA 19 PROPOSED SLOPE AND ( _ / _) ., ," ', =. =' " =' = ''" • '.158.5 ., 57.1 EG VI DIRECTION OF FLOW ARROW CRUSHED AGGREGATE BASE TO BE 0 H P 0 H P " G ..:........... ...•.:: . s SI p N ® O PROPOSED INLET PROTECTION - - _ � e l COMPACTED TO 95Z T-99 158.10 A i 158.25 AC � � "►' r 157.47 �. V 1 158.4 E� 158.5 EG lc) ►�i 15g �►�i AC GRAVEL CONSTRUCTION • h� O ENTRANCE ON TENSAR BIAXIAL GEOGRID c 3:1 1.09 1 y 157.11 EG EXISTING GROUND ELEVATION OR APPROVED EQUAL '`S9 . ass 15798 AC C8 8 p GRAVEL TRANSITION SECTION 158.5f 157.96 IIii 156. EG 157.10 AC PROPOSED PAVEMENT ELEVATION N. T. S. 58.6± EG 158.1± EG o I AC ', _ al 155.22 SW PROPOSED SIDEWALK ELEVATION 0 155.40 DWY PROPOSED DRIVEWAY ELEVATION -. 157.54 AC ' 157.49 AC 156.9-: 1 AC -4111111 �, CONC. CONCRETE 157.8 EG w -- us I 1 .7.07 157.11 AC FC FACE OF CURB co 3:1 of 157 8869 I 2:1 \ 0 / 15 '. 3 AC N 1.09 r AC ( G.B) I I I 0 TC TOP OF CURB �`' s 156. - ` d r y � .I C/L CENTERLINE 156.9.3 .f) �1` iII 5 156. ■ % 6.9 AC 155.6 EG X7.0 AC PT. POINT 156.86 AC AC AC 69 AC ' 7 156.8. AC I EROSION CONTROL NOTES: (ANGLE PT) 15 20 AC 156.63 1 - 6.18 AC i• � INSTALL SEDIMENT FENCING. SEE SHEET D6 AC 1 i AC ID PT) II' FOR DETAILS 7.. EG N 157.24 AC AC 155.82 AC - ( ) £ f 156. AC I 156.40 AC 155.94 AC (HPT) / I O/ O INSTALL B10- BAG INLET PROTECTION. � II 154 EG SEE SHEET D6 FOR DETAILS g (G. B. , 156.40 SW (HPT) '111° © , 0 . 3 GRAVEL CONSTRUCTION ENTRANCE. SEE I 3 SHEET D6 FOR DETAILS 3:1 6 v 1 55.45 h6 156 / of 0 , ^ " 1 5.78 A� � y � � AC I �'[� , �° ,� O GRAVEL TRANSITION AREA. 200 SFf /4 CY±). 156.9 G I I ' °°""" " °° °°° °°i °" I I 156.49 AC . I I } cs / 4h SEE DETAIL THIS SHEET. ri 1.59 ©, - � s � 77 ,�hh ►.11 O 3:1 5O VEGETATED AREA SFt /5 WITH ). FINAL TO 1 5 / 156.40 S I we= I II 15 Mg ® illittfil BE VERIFIED IN FIELD DURING CONSTRUCTION. 5. 0 � ��� 156.04 d AC 6 SLOPE GRAD /NG TD DAYLIGHT 2 a ° a 75 `\ -! 155 ✓ O 155 V 0 1 0 1 ° a { f . + 15�5.0 ��� ° 86 a X15'4! 36 AT • ° ° 3. B7 MA C 4 • • • 15 ° 4 ► ° .*.. ° SW 154. MATCH . , 4. / r" :.. a e • . d" ° e a ' • .. n ► 154.96 MATCH a s , r • S 6 /3 F S, - � • n ° g e :. P' o 1 ° _7CH• : a a ° a e; _ - � � 154 MATCH v _ - • , . , Q I -4 _ . !fl � ° ° ° ,, ° ' �� I N Z �, 6 - ' ss \ � ° a �� �■�_ j l. V. i�� ' ® a ° / a c� w 4,392 4 9 g( 154.17 7c __�J�I 152.4 FC [11 W.A..,l: 1 6 N 153.58 TC 0 + 'n' 3p N 9b9 �" v s; BURNHAM ST 153.63 FC 3.36 FC 153.18 FC �0 y SARAH 153.69 TC 1 .42 TC 153.24 TC b 3 ( LIP) %4" LIP) ( LIP) / / !EXPIRES: 12/31/1i_ : HALL BLVD. R Description e • Revisions and Addendum's MAIN No. By DmeioN S HEET » - PUBLIC WORKS DEPARTMENT M A i N STREET L3 V ; SCALE. 1 - 20' : 13125 S.W. 1st - t "=1 nGARD, OREGON 97223 OFFSTREET PARKING LOT 3 OF ° E VOICE- 503 -718 -2466 r' FAX: 503 -624 -0752 15 20' 10' 0 20' Z'IGARD . WWW.TIC RD- OR.GOV FILE NO a. GRADING /EROSION CONTROL PLAN 97019 DESIGN: ✓RP I DRAWN: ✓RP ICHECK: KM PROJECT NO: 97019 Standard Erosion Control Notes For Sites Less Than One Acre: Filter Fabric Use Stitched Loops 60" Toll Posts Material Over 2 "x 2" Posts Angle Both Ends Of 10' On Center 1" X 75" i Filter Fabric Fence To _�:�:� ; ;n� � Fabric Fence Heavy Duty 1. During periods of rainfall and runoff, doily inspections of the erosion sediment controls _� Filter Fabrics / Assure Soil Is w . � Staples E and discharge ()offal's must be provided by someone knowledgeable and experienced in Material � ._ T rapped 48 Orange ¢'", (5 ea) • the principles, installation, and maintenance of erosion and sediment controls. �1 36" Wide Ro 1 = ems `' Synthetic . '' ; r48" Orange 2. Construction activities must avoid or minimize excavation and creation of bore ground ,�� y• /�e Inte rlock and Attach 2 - , ,= Fobnc Fen `` -c, 4 Synthetic from October 1 through May 31 each year. ` "= ''.r- L 3. During wet weather period, temporary stabilization of the site must occur at the end of I 6' Max. Spacing' I I aI 2 ° x 2 Posts At S :_e.�� _ �_.� .�� - . each work day. f ront View . Top View 4. Sediment controls must be installed and maintained on all down gradient sides of the NOTES Side View construction site of all times during construction. They must remain in place until . SEDIMENT ORANGE FENCE permanent vegetation or other permanent covering of exposed soil is established. 1. Sediment fencing consists of o geotextile fabric usually 36" in FENCE NTS 5. All active inlets must hove sediment controls installed and maintained at all times width with regular spaced pockets of supporting posts. 1 ". 2 Wooden Stokes during construction. Unless otherwise approved, a surface mounted and attachable, 2. Sediment fence must be trenched at least 6" into the ground. The SPACING ON (2 per bag) u-shoped filter bag is required for all curb inlet catch basins. use of a "ditch witch" or other mechanical means is helpful SLOPES 6. Significant amounts of sediment which /eaves the site must be cleaned up within 24 3. Sediment fence must be stretched tight between the posts. Do Slope Spwwing .. hours and placed back on the site and stobilized or properly disposed The cause of not allow The fence to sag or break away from the fence posts. 109 or ` Fencing Flatter r ° ` °' %' : '::' 300 ft a o .,:o :: \ : : : : :. the sediment release must be found and prevented from causing a • recurrence of the 5. More that one row of sediment fence may be required. , m m g Q dischor a within the same 24 hours. Any in- stream clean up of sediment shall be . 9 Y P should be Locatedi no more than 100' from the upper edge of a > 109 or 150 ft y /• i "i performed according to the Oregon Department of State Lands required time frame. disturbed area. Space silt Fencing in rows no greater than 100" <15% 7. Sediment must not be intentionally washed into storm sewers, drainage ways, or water 6. Sediment fences ore effective only in sheet flow conditions and > 159 or 100 ft SECTION VIEW c.rx bodies. should not be Installed across streams or other concentrated flows <20% NOTES 8. Sediment must be removed from behind all sediment control measures when it has 7 Posts to be fir, pine, or steel Posts to be installed on uphill side >20% or 50 ft 1. Embed Bio -bags 3 Below Ground reached a height of one -third the barrier height, and prior to the control measures of slope. <309 Surface. Shovel Excavate for Contour Fit removal. 8 Compact both sides of filter fabric trench. >30% or <50% 25 ft To Ground 9. Cleaning of all structures with sumps must occur when the sediment retention capacity • 2. Drive Stakes Minimum 12 Into Ground has been reduced by fifty percent and at completion of project. SEDIMENT FENCE > 509* 25 ft* Surface 10. Any use of toxic or other hazardous materials must include proper storage, application, NTS * stockpile slope RIO-BAG SEDIMENT BARRIER and disposal. May Be Used Short Term , Catch Basin Grate NTS 11. The permittee must properly manoge hazardous wastes, used oils, contaminated soil, with Utility Work And with concrete waste, sanitary waste, liquid waste, or other toxic substances discovered or Phasing Of Development „ , 1 111111 "' ( '° generated during construction. -- 71-5 "4 12. The application rote of fertilizers used to reestablish vegetation must follow (:!! Suspension o� Flow 's:: Flow ti manufacturer's recommendations. Nutrient releases from fertilizers to surface waters " "r • Cords /Rods �� Q°�c j j/ E MM I nu• m ust be minimized. Time release fertilizers should be used and core should be made nu ' uwi ii iifi ' ' . �� ," � ,• , • ..... h Q Q g j in application of fertilizers within any water way riparian zone. I'i!:;' ' "!!:!11!:7 ;nil ;l ;lij =j,;l;' C a t c x' W 14. Prior to any land disturbing activities, the boundaries of the clearing vegetated � nl;,r Basin - . • Filter Sock •• 0 3 - a o �� P `' :4:;'44-. SO• 9 limits, ve 9 = == = _ - :: =i'° s : �...t••, , ,,49. �.. g buffers, and an sensitive areas shown on this plan shall be clearly delineated in the - __=_ _ _ _____ _= gi Q �f•!� . field unless otherwise approved. No disturbance is permitted beyond the clearing limits. - _- °--_-° `` ^:I�•r Au°-•• •., 0 0 , ,_, •� -. � 1 The contractor must maintain the delineation for the duration of the project. Note: - 60 ° •/ soo • 8 Vegetated corridors to be delineated with orange construction fence or approved equal C atch Basin. Area Drain. / • ,. •.'��,fi Insert Sack - Front View O /�� >•, - ms s` ,- ,, ,'?o!ta , 15. Prior to any land disturbing activities, the BMPs (Best Management Practices) that must . .;� .t. ���� iEii � be installed are grovel construction entrance, perimeter sediment control, and inlet 25" Min Radius . ::s; a� o' g protection. These burp's must be maintained for the duration of the project. Iiiiii {r1liai i Flow Subgrode Reinforcement Q`° a ,�r of ct 16. If vegetative seed mixes are specified seeding must take place no later than ,' °I��• 1 " Rebor For Geotextile �� y g \�' a September 1st; the type and percentages of seed in the mix are as identified on plans , °` F/ ow Ditch Catch Bog Removal 10 " -12" Min. ■Depth 4 c A a ecified o or as s b Y 9 en the design engineer. l 1 ,1111 . Izil P 9 �•• ;uunnu r •f�•.. ' B asin 1 17. Watertight trucks must be used to transport saturated soils from the construction site L , th cation usin , i _ O Bottom \ l 2"x2"4" *20' Min. For Single Family And Duplex Residential T d An approved equivalent is to drain the soil on site of a designated log :-. � Rubber Blocks a ;:: ! ! H! I Expansion GRAVEL CONSTRUCTION ` pumping 0 4 appropriate BMPs; soil must be drained sufficiently for minimal spillage. gli ;,; Storm 18. All of sediment laden water must be discharged over an undisturbed, 6" Min. Bags ; , il . ; ;; P g g . (typ) ' Pipe Restraint E i preferably vegetated area, and through a sediment control bmp (i.e. Filter bog). =- S _ Filter Sack ENTRANCE 19. The ESC plan must be kept onsite. All measures shown on the plan must be installed Eknt Section NTS 3 ,, properly to ensure that sediment laden water does not enter a surface water system, Pitch Inlet � p � )C � ss I Sack Sid Vi V � N� roadway, or other properties. Note � �cy� �G I N392 �� �0 0 20. The ESC measures shown on this plan are the minimum requirements for anticipated 1. Additional Measures Must Be Considered V `v 14 'p y site conditions. During the construction period, these measures shall be upgraded as Depending On Soil Type. Note: 41:\i • r 2a. needed to maintain compliance with all regulations. 2. Bio - filter Bogs Shouldl Be Staked Where Recessed curb inlet must be blocked when N k 21. Written ESC logs are suggested to be maintained onsite and available to district Applicable Using (2) 1 Wooden Stokes using filter fabric inlet sacks size of filter ,7 Jt ^'/ % ;'' inspectors upon request. Or Approved Equal Per i Bag. fabric inlet sacks to be determined by 0 +N A a� 22. In areas subject to wind erosion, appropriate BMPs must be used which may include 3. When Using 30" Bio -bogs To Protect A manufacturer. ''T 30. �9� v ° 2 = the application of fine water spraying, plastic sheeting, mulching, or other approved Catch Basin You Must - Have 4 Bogs And `fit y + 4..°4 measures. They Shall Be Overlapped By 6". FILTER FABRIC INLET SAW - 23. All exposed soils must be covered during wet weather period. BIO° FILTER BAGS TEMPORARY PROTECTION 11 NTS I NTS p MAIN STREET' ° 2 Revisions and Addendums +.3; SHEET E � Description . Date No. By ,I.:-.1.;. %` - PUBLIC WORKS DEPARTMENT 06 - k . � s ,. 13125 S.W. HALL BLVD ®1 STREET PARKING L ®T 15 . , III : T/G4RD, OREGON 97223 OF e o� ' *- " ' f `^�" VOICE 503- 718 -2466 E - l g ..? FAX: 503 -624 -0752 15 s ` 'IG_ II u wwwnGaeD- oR.cov EROSION CONTROL DETAILS 9701 FILE N DESIGN: JRP 1 DRAWN: JRP I CHECK: KM PROJECT ' NO: 97019