Permit •
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CITY OI TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT PERMIT # : SIT2008 -00010
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 3/27/2008
PARCEL : 2S102DD -01100
SITE ADDRESS: 13635 SW HALL BLVD ZONING : R -4.5
SUBDIVISION: EDGEWOOD LOT: 007 JURISDICTION TIG
PROJECT: TANAKA
Project Description: Erosion control only permit.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
TORU TANAKA Description Date Amount
22857 SW NORTON AVE [ERPRMT] Erosion Control 3/27/2008 $80.00
SHERWOOD, OR 97140 [ERPLN] Erosn Pln Rv CWS 3/27/2008 $26.00
[EROSN] Erosn Pln Rv COT 3/27/2008 $26.00
Phone: 503 - 317 -2970 Total $132.00
Contractor:
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.
Issue By: A // , �l i / Permittee Signatur J
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 L.
Building P App lication
Site work 1 :_ : FOR OFFICE_USE ONLY r .
City of Tigard Date/By: 0'7 ,)' Permit No. d l Oc�V
l I: ° 13125 SW Halt Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
•
T L GAR D Inspection Line: 503.639.4175 Date Ready /By: Jur /� ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 (j , Supplemental Information
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 (rounded to the nearest dollar) of :II
❑ Addition/alteration /replacement ❑ Other: equip . •laterials, labor, overhead, and the pra it for the
CATEGORY OF CONSTRUCTION ' work indicate. c. this application.
Et I- and 2- family dwelling El Commercial /industrial Valuation: $
ID Accessory building ET Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I 3 6 35 ` 5w Hal.. 5LVP . New dwelling area: quare feet
City /State /ZIP: qa►N p 2 g 2= 3 Garage /carport.: ea: squ:, e feet —
Suite/bldg. /apt. no.: d Project name: 1 A Covered p.• ch area: square
Cross street/directions to job site: !� Deck ... • 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 val e (rounded to the nearest dollar) of all
equipment, mate •als, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on is application.
Valuation: $
Ebe Ca vA I.J f'+nA PAR tC.1J •
Existing building area: q■ are feet
New building area: square feet
D PROPERTY OWNER ❑ TENANT Number of stori.
Naive: l o J` H " fC [.L Type of cons n:
Address: 2,2.. g p 5,.." ^ Jo r e f-p p A VE , Occupanc • - oups:
City /State /ZIP: r ,t "5 e, a `[ d f2• 7-) '4/4) Existing:
Phone: (y-b3) i z ?g 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
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply: {�
Phone: ( ) Fax:: ( )
f2oslolJ pt 4E0 .°°
E -mail: g405. )14,1 (4d - Co — .
CONTRACTOR /e0 P L 1 2A) - e BUJ 2 / . 60
Business name: C - BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit): • '
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): ______..----•
CCB lie.: a
Total fees due upon application: �--
Amount received: H' 3 -
Authorized signatur i ��_� This permit application expires if a permit is not obtained
t within 180 days after it has been accepted as complete.
Print name: ip Ta,H Q_ K 4i Date: ., 2 9 - p * Fee methodology set by Tri- County Building Industry
Service Board.
l: \Building\Permits \SIT- PermitApp.doc 12/27/06 440- 4613T(II/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 plumliirig
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 ❑ *Landscapingplan
❑ 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
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