Permit r
CITY OF TIGARD SITE WORK PERMIT
II Q • 7 COMMUNITY DEVELOPMENT Permit #: SIT2009 -00010
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/22/2009
Parcel: 2S102AC01101
Jurisdiction:
Site address: 12562 SW MAIN ST
Subdivision: Lot: 0
Project: MAX'S BREW PUB IMPROVEMENTS
Project Description: Construct water quality facility.
Owner: FEES
TWO G'S REAL ESTATE LLC Description Date Amount
18395 WOOD THRUSH ST Permit Fee - RES 06/03/2009 $62.50
LAKE OSWEGO, OR 97035 Plan Review 06/03/2009 $40.63
PHONE: 12% State Surcharge - Building 06/03/2009 $7.50
Plan Review - Fire Life Safety 06/03/2009 $25.00
Contractor:
OWNER
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Site Specifics:
Excavation Volume: 0 cu. yd.
Fill Volume: 0 cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall:
Fire Underground: No Accessible Parking:
Fence: No
Total $135.63
Required Items and Reports (Conditions)
1 Pln Gen REMOVE CONCRETE BLOCK PAVING:
2 Pln Gen SUBMIT FRANCHISE HAULER LETTER
3 Pin Gen SUBMIT REVISED LANDSCAPE PLAN
4 Pin Gen INSTALL TREE PROTECTION FENCING
5 Pln Gen SUBMIT JOINT USE/MAINTENANCE AGREEMEI
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all .
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started with' • 80 . - s of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules • • •pted bi e Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You m. •btain a of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
c o `/`
Issued By: c�4— '��� Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busi
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.
iu liling Permit Application JO, ,A 4 6
Site Work FOR OFFICE USE ONLY
City of Tigard Dateivea kiMIININI Permit No.:
tea
I N
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 DateB : , 0.... / [M ii��JJ
TIGARD
Inspection Line: 503.639.4175 Date Ready 7. Ju ' A ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: ( / . 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 all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El I- and 2-family dwelling Valuation: $
y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ® Other: WQ FACILITY Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12562 SW MAIN STREET New dwelling area: square feet
City /State /ZIP: TIGARD, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: SAME411PiDDRESS S"'4X15 p Covered porch area: square feet
Cross street/directions to job site: SW MAPLEWOOD DR /bet it) it D Deck area: square feet
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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
CONSTRUCT WATER QUALITY FACILITY Valuation: S 1 MO
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: TWO G'S REAL ESTATE, LLC. - CONTACT: RUSS GODDARD Type of construction:
Address: 18395 WOOD THRUSH STREET Occupancy groups:
City /State /ZIP: LAKE OSWEGO, OR 97035 Existing:
Phone: (503)684 -0550 Fax: (503)620 -5583 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: SAME AS OWNER 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: ( ) I Fax:: ( )
E -mail:
CONTRACTOR
Business name: TBD _OW �\ N/ BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
Amount received:
Authorized signs I AggeAdir This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: L .�1�� • ��� • Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\SIT- PermitApp.doc 12 /27/06 440- 4613T(ll /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: 540 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 0 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) 0 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: 0 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
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