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Permit (54) CITY OF TIGARDIII SITE WORK PERMIT 1. COMMUNITY DEVELOPMENT Permit#: SIT2018-00018 ) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/14/2018 T I 'A ft� g Parcel: 2S110DD10600 Jurisdiction: Tigard Site address: 10940 SW HIGHLAND DR Project: HAYWOOD Subdivision: SUMMERFIELD NO.6 Lot: 322 Project Description: Erosion control only permit for retaining wall and landscaping area over 500 sf. Contractor: J CHAVEZ DESIGN BUILD Owner: HAYWOOD, CHARLES W 1991 REVOCABL 1327 SE TACOMA STREET#180 WIEST-HAYWOOD, G 1999 REVOCABLE PORTLAND, OR 97202 TRU 10940 SW HIGHLAND DR TIGARD, OR 97224 PHONE: 503-833-2433 PHONE: FAX: FEES Description Date Amount Specifics: Erosion Control Only 06/14/2018 $322.80 Type of Use: SF Class of Work: OTR Project Valuation: $10,000.00 Site Specifics: Excavation Volume: cu.yd. Fill Volume: cu.yd. Impervious Surface: sq.ft. Engineered Fill: Soil Report Required: Paving: Grading: Landscaping: Site Prep: Storn Drains: Retaining Wall: Fire Underground: Accessible Parking: Fence: Total $322.80 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 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 cop of the rules or direct questions to O NC by calling 503.232.1987 or 1.800.332.2344. Issued By: f `�l Permittee Signature: _de Call 503.639.4175 by 7:00 a.m.for the next available ins, ction date. This permit card shall be kept in a conspicuous place on the job site til completion of the proj-ct. Approved plans are required on the job site at the time of each inspection. 1 Building Permit Application , , , Site Work '�.• • FOR OFFICE LSE ONLY City of Tigard 4V 1 4 ?�� ReceivDate/Be: Cr, IV �d 4.1r42. Permit No.f/7a/f..- 7 /,.2 III Iii 113125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19 y�� Date/B : Other Permit: T 1(;A R p Inspection Line: 503.639.4175 E etc .i 1 i1' Date Ready/By: Juris: ® See Page 2 for Internet www.tigard-or.gov ��jj riA{� r fl y' yy rgg( Notified Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND E;FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement aOther: „cs i 2A-' mir ,ry equipment,materials,labor,overhead,and the profit for the �� work indicated on this application. ���� � !*"' �: CATEGORY OF CONSTRUCTION `; - Valuation: $ Igo-and 2-family dwelling 0 Commercial/industrial 1 � ❑Accessory building ❑Multi-family Number of bedrooms: ElMaster builder 0 Other: Number of bathrooms: " ::. pB SITE INFORMATION R 1. LOCATION ' Total number of floors: Job site address: tool q 0 4 V1/ tilt)), 1 eiy� p r . New dwelling area: square feet City/State/ZIP: ‘i ti i q 7 2 Garage/carport area: square feet Suite/bldg./apt.no.: j Project name: Illit, Covered porch area: square feet Cross street/directions to job site: Deck area: square feet 1 )t— 141 slk1 v 5" L4i,, 114 Other structure area: square feet f 77 REQUIRED DATA ©, i k'd„µ„,IAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the ,„ "ti*, igi 1 to ` s '6 RK s1* work indicated on this application. � ..max. r $� I / Valuation: $ ��J, �� Existing building area: square feet New building area: square feet `X f:$11/4 PROPERTY OWNER a '- 0TENANT v` Number of stories: Name: Clow`1 ti ror ) f Type of construction: Address: LQ el Li, 6 5' t I L (o. 0 1/ Occupancy groups: City/State/ZIP: �(t1)�^ a 'I 1--- el 1 2 t' Existing: Phone:(tf ,L/ r,'`` 7 ik, Fax: ( ( ) New: APPLIC'::::,..7.:7-,- , 0 "ACT P:�:c ON NOTICE 41, Business name: �� a � ��� c v,(� p sj`�yv I,._ l t�� d All contractors and subcontractors are required to be Contact name: J 7 1 licensed with the Oregon Construction Contractors Board ' `” '� ^ under ORS 701 and may be required to be licensed in the Address: i) .7 .5 ( L sr. t �1 jurisdiction in which work is being performed.If the City/State/ZIP:` pe,,,, � � 5 / r2 ' applicant is exempt from licensing,the following reasons �l ! apply: Phone:(0.) c/3 3 21.3> Fax::( ---1-..---- E-mail: ) C(401,l./e_ 4r17C1/fr ,' Al------1-..----- ..,6 ( r f%�h-t -r14.. ,CO OR Business name: , BUILDING PERMIT FEES*'fss. Address: eat refer to fee scl% wl _ City/State/ZIP: S 4,-i 3 - Structural plan review fee(or deposit): FLS plan review fee(if applicable): Phone:( ) J Fax:( ) CCB lic.: O • Total fees due upon application: /,/�� 411111 Amount received: � Authorized signature: This permit application expires if a permit is not obtained Print name—(moi C Date: / / , * within 180 days after it has been accepted as complete. 1 J (,) Fee methodology set by Tri-County Building Industry ((( Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 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 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. u 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 *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 3 $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. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2