Permit CITY OF TIGARD SITE WORK PERMIT
to COMMUNITY DEVELOPMENT Permit#: SIT2012 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 1S125DC06200
Jurisdiction: Tigard
Site address: 9700 SW 74TH AVE
Project: AP Pacific Subdivision: ASH CREEK GATES Lot: 4
Project Description: Erosion control only.
Contractor: DP EXCAVATING INC Owner: AP PACIFIC
PO BOX 1362 800 NE TENNY RD STE 110 -423
HAPPY VALLEY, OR 97086 VANCOUVER, WA 98085
PHONE: 503 - 710 -7565 PHONE: 360 - 967 -4303
FAX: 503 - 710 -7565
FEES
Description Date Amount
Specifics: Erosion Control 03/29/2012 $80.00
Erosion Plan Review CWS 03/29/2012 $26.00
Type of Use: SF Erosion Plan Review COT 03/29/2012 $26.00
Class of Work: ALT Info Process /Archiving - Sm $0.50 (up to 03/29/2012 $0.50
11x17)
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 $132.50
•
Required Items and Reports (Conditions)
1 Ersn Cntrl 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 foll the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001- 0090.0 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2 • /
Issued By: ./. � Permittee Signature: Q- - ) 1 - ----------
Call 503.; •..175 by 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.
t 'building Permit Application
Site Work ®�� l cili of l lce USE c)NL.l
City of Tigard '�� rkOt Received
DateB , Permit No.:
!Al g 13125 SW Hall Blvd., Tigard,O 0 % Plan Review
Phone: 503.718.2439 Fax: 503. "? \V Date/By: Other Permit: f ToO i j__(....-69 /.L
i - i R D Inspection Line: 503.639.4175 `� ' .` \C? ` 4 J -' Date Ready/By: twia: ® See Page 2 for
Internet: www.tigard or.gov \\`��`` o � � y � Notified/Method: p Supplemental Information
TYPE OF WO \\.) � REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (roinded 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 1- and 2-family dwelling Valuation: $
y g ❑ CtimmerciaUindustrial
❑ 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: fq 7 ^ a 0 c 14/ - Zit fl al/ e^ New dwelling area: square feet
City/State /ZIP: t /a� `4 - 0 Garage /carport area: square feet
Suite/bldg. /apt. no.: /� Project name: Ap 1046.6 r 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: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rotnded to the' nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
�± r Valuation: $
17 - ON) <d■thrat c)n1 \ 7 .
Existing building area square feet
. New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
PLICANT ❑ CONTACT PERSON NOTICE
Business name: 561, , 4 S 10A) 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: p /_ g. V--ti A 1 �A . BUILDING PERMIT FEES*
I Address: kab g f 6. a d e (� ' �1 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State /ZIP: N V,„ GLe ok 3 ?D $ i6
/' ^7 ` FLS plan review fee (if applicable):
Phone: (5029 7/0 76 6 Fax: (.5pZ,) 7/ D / J 6 5—
3e J V
./ -V 3 Total fees due upon application:
Amount received: / b_ i
Authorized signature: This permit application expires if a per it is not obtained
/, within 180 days after it has been accepted as complete.
Print name: D / h 4 Lc Dater / / ,2 ' ' • Fee methodology set by Tri-County Building Industry
Service Board.
I: \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 - 1 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.
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