Permit � CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SIT2007 -00005
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 2/6/2007
PARCEL : 2S103DC -01100
SITE ADDRESS: 11075 SW GAARDE ST A ZONING : R -3.5
SUBDIVISION: LOT: JURISDICTION : TIG
Project Description: This permit is for erosion control only, per requirement of CWS.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
FIRST BAPTIST CHURCH OF Description Date Amount
TIGARD, THE [ERPRMT] Erosion Control 2/6/2007 $80.00
11075 SW GAARDE [ERPLN] Erosn Pln Rv CWS 2/6/2007 $26.00
TIGARD, OR 97223 [EROSN] Erosn Pln Rv COT 2/6/2007 $26.00
Phone: Total $132.00
Contractor:
CITY OF TIGARD
13125 SW HALL BLVD
TIGARD, OR 97223
Contact #:
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #:
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 plans. This 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 requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: 5
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.
r
Site Work
.� Building Permit Application,. Er YE " FOR OrFICE USE ONLY
City of Tigard R eceived - Permit No.: •
`J g Date/B , ".l I . 1. 4
lilq
a 13125 SW Hall Blvd., Tigard, OR 97223 P lan Review
C ' Phone: 503.639.4171 Fax: 503.598.1960 FL; 0 200 Date/By Other Permit.
l l C A R D Inspection Line: 503.639.4175 lo a Ready/By: Juris: ® See Page 2 for
. Internet: www.tigard - or.gov a In ( f dr 1 • ''.bfied/Method: Supplemental Information
,
TYPE OF k ow i o `i � t )1\
REQUIRED DATA: I- 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
• dwelling Valuation: $
❑ 1- and 2-family g ❑ Commercial /industrial
11 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: // O 7 5 [, t ) rte. � c A ..., , `s)"' New dwelling area: square feet
City /State /ZIP: , t ` Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 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: 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
- DESCRIPTION OF WORK work indicated on this application.
• Crx n `S' 6 CO y. � Valuation: ' $ ;Q�
tl Existing building area: ^� square feet
New building area: square feet
. l PROPERTY OWNER ❑ TENANT Number of stories:
Name: \ 5 cN \ CX,1 ^(-- 0\r_ J Type of construction:
Address: 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 licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: C, \-- 0 r T \3 % � rtk BUILDING PERMIT FEES*
Address: 1 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
CCB lic.: Total fees due upon application:
A Amount received:
Authorized signature: C� , ' . T his permit application expires if a permit is not obtained
�dt within 180 days after it has been accepted as complete.
Print name: ,f7-. lac, //4)74! Date: * Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\Permits\SIT- PermitApp.doc 06/26/06 440 -4613T(11 /02 /COM/WEB)
r
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.
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 ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and details ❑ *Landscaping Plan
El Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
# of Plans
- TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
I:\Building\Permits \SIT - PermitApp.doc 06/26/06 2
tr __.,..._
REv E Vr_ If )
. _
FEB 06 2007
. C11 Ut ilUaKb
m .1.63.• f I f
179
I -
]_____ j_f_ BT II TypVT 7117.16)\
i (----- P i 1
-_-
80
PAg' ‘
. .. ---- -------- ---- 1 ------- T ----. ' N \ I''
...
i 1
Et
,
- 1
ir_Tri .81-e.cirr\,
tY: (
wa d ks
,--1.
.....
i 82
. 1 „ 56 1
L..
r-<------___--- lit . -a - 11 ..,
_ __L______ - -- - ---- - ---T-------_- _-_
''''''"''''''*":'''''''''Qi/"Z''''Ir':"'*'''".''''`'''V4'''M''',<,.,,,,,tl..,,,-:::::::'::W:'t::::..::::::::----f::f.,::,.:.i:'4;■,;::Vn,:z.,.•:'k•,••••,,;:::;,.;::::,::og m,:,,z.,,,t4,,,,.,,,,,v4:,,,,
I 1 5
,,....,, 0,, .4 -4 14
. ._------
53
5 - -..,
.......
1 ,..-
__)-- „,„
1
1
.________
.,.....
-..
.... ..
..,.
....„..,
A
, )
. , , I • : ' . , , .
. . .
/
I -
I • q \ , CD e
Vs 1 : 1 3 4 I • g
CD cp Ca.
N . .
- R.... ‘,
R.1