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Permit
CITY OF TIGARD SITE WORK PERMIT 1111 E, : COMMUNITY DEVELOPMENT Permit #: SIT2011 -00012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011 Parcel: 2S103DC01100 Jurisdiction: Tigard Site address: 11075 SW GAARDE ST A Project: Grace Point Church Subdivision: VIRGINIA ACRES NO.2 Lot: 15 Project Description: Erosion control only permit. Contractor: OWNER Owner: FIRST BAPTIST CHURCH OF TIGARD, 11075 SW GAARDE ST TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Erosion Control 11/08/2011 $80.00 Erosion Plan Review CWS 11/08/2011 $26.00 Type of Use: COM Erosion Plan Review COT 11/08/2011 $26.00 Class of Work: OTR Project Valuation: $0.00 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 $132.00 Required Items and Reports (Conditions) 1 Ersn Cntrl 503 - 681 -4444 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800 Issued By Permi'ee Signature: Call 503.639.' .y 7:00 a.m. for the next available inspection date. 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. Building Permit Application Site Work RECEIVED E F OR OFFICE USE ONLY City of Tigard Received Permit No.: 13125 Hall lvd., Tigard, OR 97 223 ' Datc/B : / O ai, , • _ :� 0, l _ t � Review R . Phone: 503.718.2439 Fax: 503.598.196 0 8 2011 Plan Plan y: Other Permit: T IGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information 1I , JON Nip - TYPE OF WORK REQUIRED DATA:.1 -AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (romded to the nearest dollar) of all A ❑ Addition /alteration/replacement C Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2 -famil dwellin Valuation: $ y g ❑Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: 4) ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: New dwelling area: square feet \ City /State /ZIP: I + 077 s ti , c gi© -E Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 1^' y /ACS po i 1.,, - c iAokcL . Covered porch area square feet Cross street/directions to job site: C�AC„2i7� t# (V - f Blvt r Deck area: square feet 0 a Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (romded to the nearest dollar) of all (;;Ialebitg. equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK �> work indicated on this application. r Qcr� ''- s- 3 A 5 p�.A L.-T 'F teem" Gta$€12 `D i• i-tt W 1 Valuation: $ .4 4 V-t OLA-Gi'Ll GJ t . ` b I- j - 1 - t- c---c-5 ) St+fr ✓A S Existing building area square feet (p AJ _4 i'f- 2. EX i3 t i u1 L. pa�+d-SCiz1 or_ z 4. 1 -g-i - ,j New building area: square feet .. PROPERTY OWNER ❑ TENANT Number of stories: Name: 7r CC,IMihlu0 t'4 `( t� ) 12-GN Type of construction: (- ,Ft�Cc� PO i i Address: ( l O 75 � . GApcI_ 0 e �-t Occupancy groups: City /State /ZIP: — G rA ..--,1_ O� e 7 2Z9- Existing: Phone: (503 �03 — 3 /� Fax: (5Q3) _ �oFl - e7 s New: CA' lkX l ❑ APPLICANT ❑ CONTACT PERSON NOTICE 3r 73 B usiness n ahte: 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 City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone:( ) Fax::( ) . i E -mail: CONTRACTOR Business name: i / k 67 BUILDING PERMIT FEES* (Please rejer.to fee schedule) Address: Structural plan review fee (or deposit): City /State /ZIP: FLS plan review fee (if applicable): O, Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: Amount received: Authorized signature `/ ;�/� This permit a expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name.J y „ t S 4 , J f fSpsi_) Date: /'/ „ 6- ._ // * Fee methodology set by Tri -County Building Industry Service Board. L\Building\Permits \SIT- PermitApp.doc 10 /01/09 440 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. 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 - Occupancy 3 $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. I:\Building\Permits \SIT- PermitApp.doc 03/03/2011 2 CleanWater Services November 03, 2011 Expires: November 2, 2013 JIM WILSON GRACE POINT COMMUNITY CHURCH 11075 SW GAARDE ST TIGARD OR 97224 RE: Convert 1,040 s.f. old asphalt driveway to landscape area CWS file 11- 004181 (Tax map 2S103DC Tax lot 01100) Clean Water Services has received your Sensitive Area Certification for the above referenced site. District staff has reviewed the submitted materials including site conditions and the description of your project. Staff concurs that the above referenced project will not significantly impact the existing Sensitive Areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT eliminate the need to protect Sensitive Areas if they are subsequently identified on your site. If you have any questions, please feel free to call me at (503) 681 -3639. Sincerely, L ? s. , --- t tt " c- tc-- /, - 44Ws---- ---- Laurie Harris Environmental Plan Review Attachment (1) 2550 5W Hillsboro Highway • Hillsboro, Oregon 97123 Phone: (503) 681 -3600 • Fax: (503) 681 -3603 • cleanwaterservices.org