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Permit , -- °'' CITY OF TIGARD SITE WORK PERMIT 9 " COMMUNITY DEVELOPMENT PERMIT # : SIT2007 -00035 TIGA -RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 11/21/2007 PARCEL : 2S102BA -01100 SITE ADDRESS: 12220 SW GRANT AVE ZONING : I -P SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 058 JURISDICTION : TIG PROJECT: RED INK, INC. ADDITION Project Description: Site work for 600 sq ft addition. CLASS OF WORK: ADD PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: 2,060.00 EXCV VOLUME: 20 cy LANDSCAPING ?: FILL VOLUME: 20 cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: 720 sf Owner: FEES JOHN HADLEY Description Date Amount 12220 SW GRANT ST [BUPPLN] Pln Rv -Valu 11/7/2007 $45.27 TIGARD, OR 97223 [FLS] FLS Pln Rv 11/7/2007 $27.86 [BUILD] Prmt Fee -Valu 11/21/2007 $69.65 Phone: 503-906-1015 [TAX] Valu 8% State Surcha 11/21/2007 $5.57 [ERPRMT] Erosion Control 11/21/2007 $80.00 [ERPLN] Erosn Pln Rv CWS 11/21/2007 $26.00 Contractor: [EROSN] Erosn Pln Rv COT 11/21/2007 $26.00 JACOBS CONSTRUCTION 14011 SW ROY ROGERS RD. Total $280.35 SHERWOOD, OR 97140 Contact #: PRI 503 - 784 -1358 FAX 503 - 524 -3637 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 Reg #: LIC 3886 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: 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. s. . . ., .,,._ • •. g Permit Application k M7 �A rl�? -.000 P- --q Site Work , i FOR OFF USENLY h i Received City of Tigard y ` y Date /t : 1 1 67 R Plan Permit o.: ir 3 IIII 'I ° 13125 SW Nall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.19,11V 0 7 2007 Date • . r Other Permit: ? �� T 1 G A R D Inspection Line: 503.639.4175 Date • : 2T By: JT:j ' ® See Page 2 for .. Internet: www.tigard- or.gov �,/ Vl 1 y a 4 n Notified/Method: 7 i a Supplemental Information C1T i S �,, L ' ' I . ' 11 N �' DIVISION s IS • REQUIRED 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: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling Commercial /industrial Valuation: $ 111 Accessory building [1] Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 'JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 7a2�,; O J w c fa 1 / g ._. New dwelling area: square feet City /State /ZIP: 77--? ✓ � ©/ 9 7, - Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 4 ,5"p --ec f. /4 i ._ P 5- Covered porch area: square feet Cross street/directions to job site: //�� Deck area: square feet /V O -7(4.- )t e FO h N d (, - e e. /L Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CFIECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 02 5 /a , 8 i D,/ 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 applicatioi}, co g..it"a t -, ,? /a..e 4 c'..1 /. .ev✓ e c,, -47e ,€2/. Valuation: $ 470 e / ,/,� eta i i f r 0 Existing building area: 0 2 Urrc� square feet Y- T New building area: 6 square feet $JROPERTY OWNER ❑ TENANT Number of stories: Name: L a f A f 1 U ti a / r Type of construction: j- g Address: i A . .3 o S Lt.) C Si- Occupancy groups: • City /State /ZIP: ry „v2 , D t 9T / €/ Existing: Ij Phone: (663 ) go'_ /0/ 5 Fax: ( ) New: APPLICANT cg, CONTACT PERSON NOTICE Business name: / �d r0 6 (a ' u 5 Y- itt i 7 ...... All contractors and subcontractors are required to be Contact name: L e �,, Ti rG 6 S licensed with the Oregon Construction Contractors Board y under ORS 701 and may be required to be licensed in the Address: 1140 // C,C.) R e)? rs - jurisdiction in which work is being performed. If the City /State /ZIP: l- Q - applicant is exempt from licensing, the following reasons c� N.L✓ 4 /J e ^ 9 ' 7 ` ! 4� apply: Phone: ( 5 ? g `k. / 35 Fax:: ( 5 5---,,_ , `t" ` ,j ;Z I E -mail: // f 2 ` �o65 &l e QA /. r CONTRACTOR Business name: \ d .- ( - Sr a_ , `, _ BUILDING PERMIT FEES* � Address: Q (Please refer to fee schedule) City /State /ZIP: `,`'r`( Structural plan review fee (or deposit): 5—.X7 FLS plan review fee (if applicable): 7 g . Phone: ( ) Fax: ( ) CCB lic.: 3 084 7- / - 0q Total fees due upon application: ��/ Amount received: 'f 3- z Authorized signature: / il� _o This permit application expires if a permit is not obtained L �� within 180 days after it has been accepted as complete. Print name: L f! To_ e .6..s Date: / 1/41G -07 * Fee methodology set by Tri- County Building Industry Service Board. L \Building \ Permits \SIT - PermitApp.doc 12/27/06 440- 4613T(I1/02 /COM/WEB) S .4 & d 1 ^ ' M 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: 7, 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 ❑ 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' l: \Buildin \Permits \SIT- PerrnitApp. 12/27/06 2 100 YEAR FLOODPLAIN / (APPROX� E)/ / AREA OF ADDITION Al - - _ _ / _ _ I' 100 YEAR ,, EXISTING FLOODWAY (APPROXIMATE) J_ 1 O FFICE - , ■ ' �I EXISTING ORAG BUILDIING • ‘?) ( SHED — — — ti/ C c , - -----..A . , , 5 yoga 43 _. � - 41 -- '�� City of Tigard ewe• Plans , B l ep Date ,.,, „_, . t(' --z_i (0 r . de it4.:,.. A ki i \ ----,__, � �� -SFr � _._._._., • ___ 0 . ' CN EOGE OF CR . • _r_-- -______ . . .... . ,.... . ..„...„, ----_________, . _, __ ____________, �q OFFICE COPY srrE PLAN NORTH gel SCALE::We' = 1' -0' ����~�� ��������������� CITY, BUILDING DIVISION PERMIT #: 0T2007-00035 | 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/21/2007 Phone: (5O'4038-4171 ' |napoo(ion'Roquesta(24Hnoj:(S03)G39'4175 INSPECTION WORKSHEET FOR DATE: 3U8/3008 TIME: 7:00AM PAGE: 28 SITE ADDRESS: 12220 SW GRANT AVE CLASS OF WORK: SUBDIVISION: NO. lOGARONLLE ADDITION AMEND LOT #: 058 TYPE OF USE: PROJECT NAME: AG SPECIALTIES DESCRIPTION: Site work for 600 o9 ft addition. OWNER: HADLEY, JOHN PHONE #: 503-806'1015 CONTRACTOR: JAC0BSC0N3TRUCT\ON PHONE #: 503-784'1358 • Inspection Request Scheduled For: Date: 3V18/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 499 Final inspection 066868-01 603-784-1358 N Corrections/Comments/Instructions: ASS . n PARTIAL APPROVAL CANCEL pi NO ACCESS | | FAIL | I CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: �// � Date: 3 t/Y—co,a— Phone #: 8503\ 718- CITY �~�����U�������� ��nm � n�,�~ mn�m��wm�� ^ _ _ BUILDING DIVISION PERMIT #: SIT2007-00035 13125SVV Hall B|vd.. Tigard, DRQ7223 DATE ISSUED: 11/21/2007 Phone: (SD3)G39'4171 • Inspection Requests (24Hnoj:(5O3)83Q~4175 ^4 ^t INSPECTION WORKSHEET FOR DATE: 3/7/2008 TIME: 7:00AM PAGE: 53 SITE ADDRESS: 1222OSW GRANT AVE CLASS OF WORK: SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 058 TYPE OF USE: PROJECT NAME: AG SPECIALTIES DESCRIPTION: Sito work for 600 sq ft addition. OWNER: HA[D'EY.JC)HN PHONE #: 503-906-1015 CONTRACTOR: JACOBS CONSTRUCTION PHONE #: 503-7841360 Inspection Request Scheduled For: Date: 3V7y2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 495 Final inspection 085249-01 503.784'1358 N • Corrections/Comments/Instructions: PASS F RTIAL APPROVAL ' ri CANCEL fl NO ACCESS Fri FAIL rj CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED ~�, ^r�~� �`�/ / 408 / Inspector: Oa� �� ^- / Phona #' (583) 71B' . . �` (503)