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CITY O F T'O A R D SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT# : 04-00011
13125 SW Hall Blvd.,Tigard,OR 97223 (503! 6311-4171 DATE ISSUED -, 3 3/251!25!04
SITE ADDRESS: 09862 SW MURDOCK ST PARCEL : 2S111BD-01600
SUBDIVISION: ALDERBROJK FARM ZONING: R-3.5
_ BLOCK: LOT: 005 JURISDICTION : TIG
CLASS OF WORK: OTR PAVING?: RESO.NO:
TYPE OF USE: SF GRADING ?: VALUE: 1,100.00
EXCV VOLUME: cy LA'IDSCAPING?:
FILL VOLUME: 200 cy SITE PREP?:
ENG FILL.?: STORM DRAINS?:
SOILS RPT READ?: IMPERV SURFACE: sf
Remarks: Approximately 200 cu yd behind rockery wall less than 4"high. no surcharge. Wall is exempt from permit.
Owner: `—
_ _ FEES _
LUSK, JOHN D +GWEN E
9862 SW MURDOCK S7 Description Date Amount
_
TIGARD, OR 97224 [BUILD]Print Fee-Valu 3/25/04 $62.50
[TAX]Valu 8%State Sm 3/25/04 $5.00
Phone: [BUPPI,NI Pin Ck-Valu 3/25/04 $40.63
Contractor: Total ;118_13
OWNER
Phone:
Reg#:
Required Inspections
Final Inspection
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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 pla,iis. i nis 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
Lu requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
-a 952-001-0010 through OAR 952-001-0100. You may obtain r;opies of these rule- or direct questions to OUNC by
calling (503)246-6699.
Is4ped By:
Permittee Signature:
Call (503) X94175 by 7:00 P.M. for an Inspection needed the next business day
Sife Work
$uilding Permit Application
"ReceivedP.City of Tigal•d Pr1mi1 No
13125 SW tiall Blvd.,Tigard,OR 47223 '4APlan Review
Phone. 503.639.4171 Fax: 503.598.1960 Date/By. 011ier Permit.
Inspection Line: 503.639.4175 Date Ready/Ry: sass ® ties Paae z for
Internet wwv.ci,tigard.or.us Notified/MetMod: SapplemenhlIniormallan
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 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/atteration/replacentent Other equipment,materiPla,labor,overhead,and th-profit for the
work indicated p� -e r licauon.
CATEGORY OF CON9I`*JCTION .— ---
❑ I-and 2-family dwellingommC ercial/industrial Y �- � #r' °�{
00
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master but la,r ❑Other: Number of bathrooms: —
J6a srmtNFORMAIVON AND LOCATION Total number of floors:
Job A*addrala: m U(- �k v New dwelling area: square feet
CigY8tfWW: -, Garage/carport area: square feet
Suite/bldg./apt.no.: "eat tame: tx=sh �uHJ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
_ RF.QIrWD DATA:COMMERCIAL-139F.CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the va!ue of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parce rx3. equipment,materials,labor,overhead,!md the profit for the
work indicated on this application.
- + - -- d Valuation: $
\
J O 3 Uf Existing building area: square feet
1 ey Q New building area: square feet --
71;h Number of stories:
xrws.:
Name: Type of construction:
Address. 1$�Q — M�l.Q~�\+ f _ Occupancy groups:
City/SlatelZlP: __rc Existing:
Phone:( )� _ Fax ( ) New:
❑ APPLICANT Q CONTACT PERSON --
Business name: All contractors and subcontractors a, to be
Contact name: —i licensed with the Oregon Construction.. .tractors Board
IL under URS 701 and may be required to be licensed in the
Address: -- jurisdiction in which work is being performed.If the
~ City/State/ZIP: applicant is exempt from licensing,the following reasons
CO apply:
Phone:i —
E-mail:
Cal
--- — -
W Business name: , i > Fits.
t
Address: Please rrfn to fee schedule
city _--
- - Fees due upon application
--
--- ------ Amount received
CCB 1' ---
--- — Date received:
Au signature: This permit application expires If a permit Is not obtained
within 190 days after It has been accepted as complete.
Print name ,���� L�_>K 3�l,IOI f • Fee methodology set by Tri-County Building Indushv
Service Board.
i\Building\Perndu\SIT-PermitAppdoc 12/03 440-461IT(!!412/COM/wEn)
City of Tigard: Site Work Permit Checklist
Page 2-Supplemental Information
Commercial Multi-Family and One-and Two-Fam" Pweilin s:
Nc permit is required if fill is less th (5 d 1p truck loads), or less th feet deep
4nd will not be supporting a structure. Raiing ill be constructed on the fill, i!must be
et,ineered fill. If fill is in a flood plain, drainage ay,or wetland. the applicant must apply
for` sensitive lands review (SLR).
Please mplete all items below, unless otherw, se noted.
Excavation olume: 4� Y� cu. yds.
Grading Voiu
Soils report requt_d for>5,000 cu. ds. cu. yds.
Fill Volume:
(Fill exceeding 12"in d 9WMI be
co a ad to 90%of Y densit cu. yds.
Retaining structure? (Check on ❑ Rock
❑ CMIJ
[] Concrete
_ ❑ Other: _
*Total new impervious area includi g all
buildings, sidewalks and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit plication for site utilities bing work.
Plans Required: See"Site Wo r Permit Application -Plan Su 'ttai Requirements"
attached. The following must a om an thisplication: _
Site Plan with Vicinity Ma showing *Parking(inc lu ADA) and
ADA rom liance Li htin Plan
LJ Grading Plan and details *Landsca ing Plan
Erosion Control Plan and Oetails Soils Report if require
Retainirjg Structures _
*Does not apply to One- ar.4 Two-family dwellings.
i
Rbgaffid at
Iiiclude5 lVc ditions or Alterations Suhntittw
CommerciA 2
W
J
Multi-Family R-1 Occupancy 2
i:\BuildingTorms srr-Checklist.doc 12/29/03
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CITY OF TIGARD
BUILDING DIVISION PERMIT#: SIT2004.00011
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/25/2004
Phone: (503) 639-4171
Inspection Requests (24 Mrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/]/M TIME: 7:14AM PAGE: 124
SITE ADDRESS: 0%. 67 SW MORDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT#: 005 TYPE OF USE:
PROJECT NAME: LUSK
DESCRIPTION: Approximately 200 cu yd behind roctcery well less than 4"high, no surcharge. Wall is exempt from
permit.
OWNER: I-LISX, JOHN D+GWEN F, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
410 Fill 003576-J1 603624-8633 N
Corrections/Comments/Instructions:
14
PASS [] PARTIAL APPROVAL ❑ CANCEL _ ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1
Inspector: _ Date: . 0J� _ Phone #: (503) 718.