Permit CITY OF TIGARD SITE WORK PERMIT
i . • COMMUNITY DEVELOPMENT Permit #: SIT2013 -00014
T t GARL) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2013
Parcel: 2S110BC01201
Jurisdiction: TIG
Site address: 12300 SW BULL MOUNTAIN RD
Project: TROY PARK SUBDIVISION Subdivision: Lot:
Project Description: Retaining wall and fence spanning lots 1, 2, 3 & 4 in new subdivision.
Contractor: TIMBERLAND HOMES INC Owner: GOODLETT MARSHALL BUILDING & DEV.
12670 SW 68TH AVE STE 300 PO BOX 91551
TIGARD, OR 97223 PORTLAND, OR 97223
PHONE: 503 - 620 -8860 PHONE: 503 - 297 -1881
FAX: 503 - 598 -9081
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 06/26/2013 $328.16
Plan Review 05/30/2013 $213.30
Type of Use: SF 12% State Surcharge - Building 06/26/2013 $39.38
Class of Work: OTR Info Process /Archiving - Sm $0.50 (up to 06/26/2013 $10.50
11x17)
Project Valuation: $23,500.00
Site Specifics:
Excavation Volume cu. yd.
Fill Volume cu. yd.
Impervious Surface. sq. ft.
Engineered Fill Yes Soil Report Required: Yes
Paving: No Grading. Yes
Landscaping' Site Prep: Yes
Storn Drains: No Retaining Wall' Yes
Fire Underground No Accessible Parking: No
Fence' Yes
Total $591 34
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, or if work is suspended for more the 180 days. ATTENTION' Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification 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 direct questions to NC byL.calling 503.232.1987 or 1 800 332 2344.
Issued By: Li ' Permittee Signature:
--
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.
Bui11!!�i Permit A lica '
� PP t10 __
Site Work i �� C FOR 01. FILL I SE ONI,1
City of Tigard MAY 3 0 2013 R Da .C --7-
3a /3 :C=, Permit No 5,i 7;, i3 — f)O(J/I/
Plan vie
• 13125 SW Hall Blvd., Tigard, OR 97223 Pln Re C Q
Phone: 503.718.2439 Fax: 503.598 19 �. /, PI n Re '�� _ �(�� (3 Other penu 40200? QQ0//
Inspection Line: 503.639.4175 Yy 11 G a l�e � Date Ready ;y: f p qua ® See Page 2 for
I' G A R D Internet: www.tigard-or.gov ��� ��,�C �� "� � Vi �� Notified/Method 49 // /a 4 ` - 7 &' Supplemental Information
Rif ��
TYPE OF WORK QUIRED 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: V (A Irl,j N 4 ( I equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION ork indicated on this application.
q
- and 2- family dwelling ❑ Commercial/industrial iValuati �' 7 ( 6 -0 0 ' $
El Accessory building ❑ Multi- family Numb r of bedrooms:
❑ Master builder ether: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1230 V Sw 1t1 I tsthA, itei New dwelling area: square feet
City /State /ZIP: T; 0 gy14 , 0 R-. '1"11_24 Garage/carport area: square feet
Suite/bldg. /apt. no.: J Project name: , vo Vii. Vk 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 V4�k I Lot no.: '� 14 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.
131411 O V (,AT► INS I Q� ` 't1 V 1 r ftvtre Valuation: $
A `4 ti t411 a // Existing building area: square feet
-_` \ New building area: square feet
PROPERTY OWNER I 0 TENANT Number of stories:
Name: pbe s'h q 1 G l i V .es'�1 s , LL(_- Type of construction:
Address: Occupancy groups:
City/State/Z1P: Existing:
Phone: ( ) Fax: ( )
New:
%APPLICANT ❑ CONTACT PERSON NOTICE
Business name: iVCSTihG 1 Inv.( S ys 1,Lc All contractors and subcontractors are required to be
Contact name: Sor(xt, eon yam. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
0
Address: 'U SW (22,1"- A ` 1 S 3D O jurisdiction in which work is being performed. If the
City /State /ZIP: Tj 4,1,4( U 1 '1IA.,) applicant is exempt from licensing, the following reasons
5103 Phone: (503) 73 1. 1 apply:
I Fax:: ( )
E -mail: sit ye 14%t)t, /1d"a6` itoni cSslier
CONTRACTOR
Business name: m g.. - Tim Is mil' -t1/41.... Hot-1 ES t1U - BUILDING PERMIT FEES*
Address: 1 21,70 5 (A) 6 P ( , 4- E S7s 300 (Please refer to fee schedule) .
City /State /ZIP: T _ , 91-7 Structural plan review fee (or deposit):
Phone: (3) , , S q Fax: ( )
FLS plan review fee (if applicable):
CCB lie.: I Total fees due upon application: i t
Amount received:
Authorized signature: . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete. 44 Print name:S/('E � � , (� a u ■
Date: 5 .1,1 ' 13 * Fee methodology set by Tri -County Building Industry
1 V Service Board.
I \Bwlding\Permits \SIT - PermitApp.doc 10 /01/09 440- 4613T(I1/02 /COM/WEB)
IV
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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: 00 NC cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) S CG (414 1 tJ ( ? 1 - 4 1 - 1 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to 5
90% of maximum density) 7 cu. yds.
Retaining structure? (Check one) ❑ k
[ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit App i a n 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.
1:\ Building \PermitslSIT- PermitApp.doc 05/25/2012 2
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IN i
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Site Work Permit Application
Plan Submittal Requirements
T I G A R D Commercial, Multi- Family and One- & Two - Family Dwellings
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi -famil R -1
occupancies. A site work permit is required for excavation, fill, grading, pavin retaining walls,
fire hydrants and fire department access on private property for work on indivi u ots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
locati n labeled with:
A. map & tax lot # 'project name [site address !1° .uite number
zoning Er applicant name Rlpplicant phone number
B. orth arrow. ✓
C. Scale (architectural or engineering only).
D. Street names. ✓ I
E. Building pads (drawn to scale) with project location. 141
2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing.
1) Silt fence locations.
2) Bio -filter bags /other approved barrier material surrounding catch basins.
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(:\Building \Permits \SIT- PennitApp.doc 05/25/2012 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb. /sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
1: \ Building \Permits\SIT- PerrnitApp.doc 05/25/2012 4
Building Division
Development Code Provision Review
T c n li Residential Projects
Building Permit No.: S / 3 - 000/ 9
Project /Subdivision Name: 772i P , Lot #:
Site Address: A.2 3 0 -SA) witw "to u v ,,J faeN .
CWS Service Provider Letter:
Required: Yes ❑ No ❑
Received: Yes ❑ No ❑
Plans Routed:
Original Plan Submittal Date: ���A3 Routed By: A•
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2n Revision Submittal Date: ❑ Site Plan Only Routed By:
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 check items along left only if approved.
Planning Review (contact /4f at (503) 718 -, 1 4D or 4114/° @tigard-
or.gov)
Land Use CaA No. `3W/ ,2)007 //
Zoning , l
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height: Actual Building Height
❑ J?isual Clearance
Easements
❑ Sensitive Lands Type:
❑ Street Trees
❑ Protected Trees
r I
Notes: /if W G1,6( P.J
Original Plan: Approved IV
Not Approved ❑ Date: //
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
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Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard- or.gov)
H' Actual Slope: MP?
Notes:
Original Plan: Approved .0 Not Approved ❑ Date: 6/ /f, 3
Revision 1: Approved ❑ Not Approved ❑ - Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
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Permit Coordinator Review (contact Albert Shields at (503) 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
•
Original Plan: Date Sent to Applic t:
Revision 1: Date Sent to Ap • nt
Revision 2: Date Sent to A nt
Okay to Issue Permit: Yes) o ❑
Date Routed to Building:
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