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Permit - CITY OF TIGARD SITE WORK PERMIT I ' n ' „. COMMUNITY DEVELOPMENT Permit #: SIT2009 -00018 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10!02/2009 T�+GARI3. Parcel: 2S102AB05200 Jurisdiction: Tigard Site address: 9185 SW BURNHAM ST Subdivision: Lot: 0 Project: Scott & Hookland Real Estate Partnership Project Description: Parking lot re- striping. Owner: FEES SCOTT & HOOKLAND REAL ESTATE PAR Description Date Amount BY SCOTT, MICHAEL, 9185 SW BURNHAM ST TIGARD, OR 97223 Permit Fee - Site Work 10/02/2009 $51.09 Plan Review 10/02/2009 $33.21 PHONE. 12% State Surcharge - Building 10/02/2009 $6.13 Contractor: REMODELING & MAINTENANCE SERVICES PO BOX 231061 TIGARD, OR 97281 PHONE: 503 - 590 -7269 FAX: Type of Use: COM Class of Work: ALT 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 $90.43 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 uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit otification Center. ho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or irect Y ues ions to OU ■ ∎ by • 503.246.6699 or 1.800.332.2344. i q ssued By: ”( " / Permittee Signature: •cr > Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. / I Building Permit Application f Site Work RECEIVED FOR OFFICE USE ONLY City of Tigard OCT 02 2009 Date /Be ��®e Permit No.:t (� Q/��/ Ill O ther Permit. DvV " ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review' Phone: 503.639.4171 Fax: 503.598.196 OF TIGARD Date /Bv: TiGARD Inspection Line: 503.639.4175 Date Ready /By: ® See Page 2 for . Internet: www.tigard- or.gov BUILDING DIVISION Notified /Method: Mil Supplemental Information w w. z,e '�tt... ,.'� :e, � ",e�,�s`,'�:'�: *j�•��ws - , - ;:t H >:x1�,'_ aa: ;ark:.;sxv , ,. e:a a• 1.ILIIVG ,,,.r ..� % >E�" K -�� � AND:2= FAMI :t �, =RE UIRDtDATA. s- • F- V1' � RIC�,� Q :. .'' :T1'PE O r h 5r °"' :2's 4 a - - • r"4 ,5 � � _.....x.. .e, ht: .9: ` xfii # '` (.:{,: k'.., :;"ii "�r'Zx.'':. h� �`�. ..... o. a. ... �.d: Y . _ `. ; .1,.. . ,t'` '4' �! _ r . . , .j' .. h - J '. ❑ 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: equipment, materials, labor, overhead, and the profit for the +t s,•, ,. >' _ ,' ,X.: n :,ri •,: ..ss.�a,:: t, . ,r x. Rf` .9,. ,I,, - work indicated on this application. ° . `_:. 'i ; - : ,:� }ray 'CAI :EGORY 'OF''GONS CRUCTION F;c -., =r ., M 4a sTrnn" `i,�'..#,,.�'.. _"'r �:c : ....,,,....*;vh °ca+.t . ,...,.w - - :v 'F = `: •r^.r ' s , , . t r .z ❑ 1- and 2- family dwelling K Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: "£': _,,; :; _ , ,, 'a ,.v.,,.',.-:- ,::V. r .;, f : a- r "-: - .:r ' _� Total number of floors: ,,, , ;.: JOB. < SIT E INF,ORM * `' °' Job site address: s°' ,.. e-. New dwelling area: square feet City /State /ZIP: )( .s iLLa c-.9./L. `' ? 3 Garage /carport area: square feet Suite /bldg. /apt. no.: Project name: L Or 57 C mil 4 i.:3 i v Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet ��k =fi ....� ' t _H , n � �' a. ' � _� :mss -1 =lREQUIRED DA C ,USEMG Subdivision: 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 - < '. `;A : "a„ " «'i4 : V :51 iio E _ si e wk`, '' - ' .i' = ,', .1 r�, - e- p t ,: } i "''' :� i� ` � :� ,s",� "� ¢ �, ���'� '= ';''u'ra: = ., n 3 " k- .����,. work indicated on this application. . x gMt ". �'`.1Jai c DE SCRIPTIO " N { .,�OF WORK 314 , F. .,' . x I- 0 , 'r( 1 e / .A-01-, A•� �� Valuation: S Existing building area: square feet New building area: square feet `�,': 1e*? 53N.i: " z:�' '. � r ` _t ^ . r ..,. ;; .. r , - ,, ,:; a+ert4 ,' ,r :+.s'� -'A^` e��� r , , � r �a w s- ��k „ =� t� � " rcw : z _"^ P ii(1OW r ` , - , c:in, , .- , :r ., . . 4 r , .._ . ®'= ; PENAIVT.; ' i=, 3'P= . � -m..n., Number of stories: ��.i`:;x ...- }., .a`s:5.r�an!:, tas'n' -:', _ n%c4 +ir`��i"'ti �, .e F:l ti? +4 r:r .n , ' �R � s S '3 „ -_ , ' &. - x - " �. Name: 5 4J- I{-o cA,o /Z ` e_ S+ iii /- '¢A-4 $ Wt-7 Type of construction: Address: e/2 5 s 4 K ,A,1/4.44-4...-L. S + Occupancy groups: City /State /ZIP: 7-7G4-..... e9 .1L 5 l L Z J Existing: Phone: ( c' Fax: (Sb3) (p Zo Y3/S New: +ss' +fie - : ".`zi,sfw e,: NY3^,>.` r4 - 'A:-+":: ',ill ^' _ " " ,.;,r i. ' ^ ..,..�,cr' i '' `;i , k, : _ _ _ _ ;•f'i :.��.. 4�ir %�; �4 �;, ',�. " °�'', ''�°�z�k, >., .s �';. �_<°� -..a` . -�.e� �,.�,�:,,,.. , _ +t= �:rs -;�;*a`u� v,.r,'r , +s°:; . °a` �,� � ^: �.. c„ �i, =: �r�r f � ' ,. `.c , Vin :�_:�;.. �:.: �,.. ,�, "�:r: ` b� ^ � ' 'I nc •,; , ,: ,. AP PLICANT,.- <Az Aq `5 ;: .. ,,.. s ,,.® C.ONTACT .PERSON" ` *°jz`" , t rtt ,' .,x: ' �: 4 s'N .: 5' }:, :`+_ r. . .. °` d, :gab. :_y L. i a :1 : h . , r „ ,. °, ,..,,. ICE w,. -t,`. rri' sn ,: 'N�..., ;. �z;�, ;�.�•€`��.�,. tt:Fe�t�::��'�_av5,�€"as.:- ` '�,r:� , psi :;.�•sMeAk „�r_�x''�'��r���H � - Krad`....; "� r "�5 Business name: i SCz,• 1 4•-' - S f ' All contractors and subcontractors are required to be Contact name: •� licensed with the Oregon Construction Contractors Board V V "'�"ti� L— ' (.9--.., f � unde OR 701 a nd m be required to be licensed in the Address: p LO. GC) �3 i 0 6, r jurisdiction in which work is being performed. If the City/State/ZIP: ( n applicant is exempt from licensing, the following reasons Cit y L. ,r +`.:J c � `j ? Z� / apply: Phone: (5 J) 3 3 J 7 z_6,- ,) Fax: : (S`v 1.3 ) S 7 5 3 y•o / . E -mail: CV,�,s ca ; C3 1` e ,,I 4 - .t- f':5%'c 5"''' r:•+51.',.;'<; : 4 `.as .;,:':i!3 `i -V" : <, ^;,.:ik < "a .:`�;a,-: � s^;�•w;. : 7,�' •..... ,�. . � :::: .�:�. ` P'a,°' .YT S. ''Y ' ' � :h Ya . k. * t _ a r �: ? u°�" `='COIVTRAC,T,ORy;� " �',.:: "�;( , ��� � ; �' `�'� : zip.:, �, �i:.m u•. �1..-' �. cx�:- E.`:.'-` �- �: h��e: �d.. �.. rox_ � sx';, a. �.*. u=. r-., �n�f .,x�;:,?u.:?.._J.+�€- Y�;.... +- 3�``.`"'S'a % as" °te Business name: i ,,.., 5 S Yz--� i #;6 vi` a ry t t:fliW t'w tt : v BUILDING .P.ERMIT:FE•S�- =- �..�,� ��,, , �- .c,cy lc_ ' , :' §'b+ «' .: ; u r n: • Vol _ ; x 061 -, t•. >�5., ? w #r' �_ s u(Plea`se:refer fe'e schedule tR F . >a..SI Address: ; �� - /�'�)" 2 --`; i 0 C; j ' 457-'9 . City /State /ZIP: 77 (�./i,A,.r? C-5." 9 ? L�1 /� p an r view ee t ): 35. At Phone: (s'c, f) 3 5,3 7 Z(, 7 Fax: (5) 3)s ? i 3 ,. /of (Q. l 3 lie.: G G' e3 p Amount received: U 96.9 3 Authorized signature: f Po--h, v., This permit application expires if a permit is not obtained y � within 180 days after it has been accepted as complete. Print name: /� ®� �(, fJ °z•a ,/� Date: �� /N 9 * Fee methodology set by Tri- County Building Industry ` Service Board. 1:\Building \Permits \SIT- PermitApp.doc 10 /01/09 440- 4613T(I1/02 /COM /WEB) City of Tigard: Site Work Permit Checklist P 2 - Supplemental Information Commercial, Multi- Family and One- and Two- Family Dwellings: No r ck loads), or less than 3 feet deep and will permit is required if fill is less than 50 yards (5 dump t u p P q ( P not be supporting a structure. If a building will be constructed on the fill, it en 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. .tea -�.- „�,. ' °> >:� ��ra.}'c"e°i;.rr..., ..;; a 's .4 - :i a `�s•'t , �',� �. ,� 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: uTY�I'E;OF`x`SIJB ;�' i� #.of,Pl`ans� x�Valuat><on. � .��� Per �,Y•�;�`:�:���_�:. •}= x (New, Addl`t Oii or Required,:at $.00 to $500.00 _ $51.09 minimum permit fee aka ,, :AlterationS)� �,t ,, ., .Submittal $500.01 to $2,000.00 $51.09 for the first $500.00 and $2.69 for each additional $100 or fraction Commercial 2 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 2 $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 \S1T - PermitApp.doc 12/27/06 2 /1/ . . V 7 . . . Applovect OF TI 4__ ___ OCT 0 2 2009 - . RECEIVED Conditionally APProved..... I I' CITY OF TIGARD S ee Letter to: FOI/OW••■■•0•4004plumeasees ( I BUILDING DIVISION • .,,, ; ". I .. I f°1 e re 1.•7 .=•c• Pt, rut c.6. Permit • 11 1A. 10- ' lorc-plz..t.-ie 11.4t, RCM PIP.P.t. .r.' A. i.A.LirrEkel 0 YPelaic.:-1 1'4 .4 i 1 , -LS NI • , '-z.siz.. . _ : - -- (Coil .•-11.;-'7 - 1," ....,_ . _ ___ _ if Date: bleffir , -77 .0H. (1 C ' 4 ") DY: .- / 21 4‹,,M C... HI 1 . 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