Permit CITY OF TIGARD .k+ /.. SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2009 -00002
T I C A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/25/2009
Parcel: 2S102CB03101
Jurisdiction:
Site address: 12950 SW PACIFIC HWY
Subdivision: Lot: 0
Project: HUDSON PLAZA
Project Description: Remove 4 parking stalls; remove & replace handi -cap space w /van accessibility; construct egress
to sidewalk; filling w /planter parking area that was removed
Owner: FEES
HENDERSON, MARILYN DOROTHEA Description Date Amount
JENSEN HUDSON TRUSTEE, 11795 SW Permit Fee-- COM 03/25/2009 $62.50 •
KATHERINE ST Plan Review 03/09/2009 $40.63
PHONE: Tax - 12% State Surcharge 03/25/2009 $7.50
Plan Review - Fire Life Safety 03/09/2009 $25.00
Contractor: •
MARLAND HENDERSON CONSTRUCTION •
12950 SW PACIFIC HWY #225
TIGARD, OR 97223
PHONE: 503 - 639 -5537
FAX: (503)639 -3663 ,
Type of Use: COM
Class of Work: ALT
•
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: Soil Report Required: No
Paving: Yes Grading: No •
Landscaping: Yes Site Prep: Yes •
Storn Drains: Retaining Wall: •
Fire Underground: Accessible Parking: Yes
Fence:
• Total $135.63
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a • o
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not starte+ ithi 181 days •f
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the ryl-s ado9 d b, 0 ego
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You obtaf a copy of • - rules
Issued By: �('� �, V■./3 Permittee Signature: _..4111;111 _..4111;111 I��a3U V'` �-�
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.
•
i zctio St) C (4
Building Permit Application
Site Work FOR OFFICE USE ONLY
: Received �g
City of Tigard RWv+� DateBy: PermitNo.: f / f�69- �
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Resew -
0 i 7, ` Other Permit: i`
Phone: 503.639.4171 Fax: 503.598.196 Date/B : . /MIL 4i - -( -OG�3
Inspection Line: 503.639.4175 Date Rea. ': y: El See Page 2 for
G N
r I G n It D AR 0 9 2009 ��
Internet: www.tigard- or.gov OF ,��. T r No [ified/M �od � � � ENI Supplemental Information
CITY _ GL , 7?M NMP, - .,
TYPE OF ■ I I , g .' REQUIRED DATA: 1- AND 2- FAMILY DWELLING
w 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 ommercial/industrial Valuation: $
❑ 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: ( qs-D - j31 C , tkLo ( New dwelling area: square feet
City/State /ZIP: 1 1 (� A L 0 O e, C t 2 2 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ! 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK ` work indicated on this application.
A4 I ter.- Valuation: $ ...2, CYO . ' • D-
e'� cq-�(e � o A c ces 5 � f �
f2E •w5 Existing building area: square feet
. New building area: square feet
OPERTY OWNER ❑ TENANT Number of stories:
Name: AAA- A - a C A kk (, ( • • C TSJ Type of construction:
Address: 1 ( S S (.U. - t �2( kc$ se r, Occupancy groups:
City /State/ZIP: 1 (- A. Q 0 P. � 9 Existing:
Phone: ( D3) So- � ° ^ e / Fax: ( 019 639 .._..3 6 6 3 New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Os) ( (A VI- i ( � All contractors and subcontractors are required to be
Contact name: d1 Ap licensed with the Oregon Construction Contractors Board
1 V under ORS 701 and may be required to be licensed in the
Address: I T. S S L4.-' , (C �'tkc° p ( BC ! jurisdiction in which work is being performed. If the
City/State /ZIP: C_-7 4-1 p ` -! ) -2-5 applicant is exempt from licensing, the following reasons
apply:
Phone: (t)3 )51.O. 1 7 I Fax: : ( C3'► 6 - 3
E -mail: in •64 C b &C ® l40 Lc —C-3 —C-3 rl /t
CONTRACTOR
Business name: j�/ � rD K 5 /� BUILDING PERMIT FEES*
G
Address: r , / S73 - 5 - 45-t:. t (-kat) t- Z -zsr-- (Please refer ro fee schedule) -
City/State /ZIP: ---n C 4 Lc) OE, Structural plan review fee (or deposit):
Phone: --/) ,, .' _ s, - I Fax: ( 6 - 56,-t5 FLS plan review fee (if applicable):
CCB lie.: 6
IIIIP Total fees due upon application:
� / -/ Amount received: .
Authorized signature: .��i/
,� This permit application expires if a permit is not obtained
I , t w ithin 180 days after it has been accepted as complete.
Print name k- Ar �iS �C I Date: n 3 0,-.....c& ■ Fee methodology set by Tr -County Building Industry
L Service Board.
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I 4
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi- Family and One- and Two - Famil Dwellings:
No permit is required if fill is less than 50 yards (5, 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
0 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 ❑ *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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