Permit o CITY OF TIGARD SITE WORK PERMIT
I COMMUNITY DEVELOPMENT Permit #: SIT2012 -00012
TI G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012
Parcel: 2S109AB14700
Jurisdiction: Tigard
Site address: 13369 SW OUZEL LN
Project: Alpine View, Lot 28 Subdivision: ALPINE VIEW Lot: 28
Project Description: Retaining wall
Contractor: D R HORTON INC PORTLAND Owner: DR HORTON INC - PORTLAND
4380 SW MACADAM AVE SUITE 100 ATTN MELISSA TRUNNELL
PORTLAND, OR 97239 4380 SW MACADAM STE 100
PORTLAND, OR 97239
PHONE: 503 - 222 -4151 PHONE:
FAX: 503 - 222 -1304
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 07/26/2012 $123.72
Plan Review 06/14/2012 $80.42
Type of Use: SF 12% State Surcharge - Building 07/26/2012 $14.85
Class of Work: OTR Info Process /Archiving - Sm $0.50 (up to 07/26/2012 $8.00
11x17)
Project Valuation: $4,500.00 Erosion Control 07/26/2012 $80.00
Erosion Plan Review CWS 07/26/2012 $26.00
Erosion Plan Review COT 07/26/2012 $26.00
Site Specifics:
Excavation Volume: 20 cu. yd.
Fill Volume: 8 cu. yd.
Impervious Surface: 1800 sq. ft.
Engineered Fill: No Soil Report Required: Yes
Paving: No Grading: Yes
Landscaping: No Site Prep: Yes
Storn Drains: Yes Retaining Wall: Yes
Fire Underground: No Accessible Parking: No
Fence:
Total $358.99
Required Items and Reports (Conditions)
1 Ersn Cntrl 503 - 639 -4175
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 -dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. ou may stai a copy of the rules
or direct quest• o • • C by calling 503.232.1987 or 1.800.332.2344.
Issued By: - � ��, /J Permittee Signature: '
Call 503.639.4175 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 oft project.
Approved plans are required on the job site at the time of each inspection.
•
, ,,3tiilding Permit Applicatio . 1; iLl
Site Work � � i FOR OFFICE USE ONI.l
City of Tigard J UN 14 2012 Received ® / Permit No.: /�/� t�)p/Z
DateB : J
° 13125 SW Hall Blvd., Tigard,OR 97223 e
Phone: 503.718.2439 Fax: 503.598.16 ®��IG`N® Date/B : Plan Revi /:'1�� Other Permit:
� - i � a Inspection Line: 503.639.4175 v Date Reams'• ' e ® See Page 2 for
Internet: www.tigard - or.gov BU!! DING DIVISION Notified/Method: �Z 444- J Supplemental Information
e -,0- /L ( 9-,2
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 (rotnded 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. co
❑ 1- and 2- family dwelling ❑ Comercial/industrial Valuation: $
m
❑ 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: /3 al AJ Du Z W New dwelling area: square feet
City/State /ZIP: -776/4 40 / • ev e qv-4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: /NLC7 i// e t () 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: Lot no.: L0 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.
RailiNIM' k mfa_ Valuation: $
/5G Existing building area square feet
New building area: square feet
i f PROPERTY OWNER ❑ TENANT Number of stories:
Name: DE /I27DN i NL Type of construction:
Address: 43c30 /i ( Jj3 7t /06 Occupancy groups:
f
City/State /ZIP: 1) 497244 � T � � Existing:
Phone: 60 ) 7ZZ.4/ J Fax: (5b3 )Z47- 'l? 4' New:
❑ APPLICANT IK CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 64/3/1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5 jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail: jai c* 0, c . itar , c - ,ut
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) - . : ( )
FLS plan review fee (if applicable):
Total fees due upon application:
CCB lic.: /
Amount received: / 80
Authorized signature This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date: ��!/ * Fee methodology set by Tri -County Building Industry
f � -` � Service Board
I: \Building'Permits\SlT- PermitApp.doc 10/01/09 440- 4613T(1l /02 /COM/WEB)
f
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: 21) cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) /`j cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum.density) ZIP cu. yds.
Retaining structure? (Check one) ❑ Rock
CMU
Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: !6 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 ❑ Fire Line '
*Does not apply to One- and Two - family dwellings. .
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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 $1,000.00 or
fraction thereof.
[:1Building\Permits\S1T- PermitApp.doc 05/25/2012 2
. , /33O? 4w 4 Li) .
I or a 8 4 L./ /�J£ o's)
0 ° Building Division
�iT� B pi/ A/C w
Development Code Provision Review
T I G A R D Residential Projects
Building Permit No: t T Oq 01P. -0001 4`-
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A
Routed Plans:
Original Plan Submittal Date: ( //
P `I y 12
1s Revision Submittal Date: ❑ Site Plan Only
- 2nd Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (1) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact JUN■ If / /
v 5 03 - 718 - a 1 /�� or @tigard-or.gov)
Land Use Case N Name N/ IfL. (/lam,✓
❑ Zoning k•-
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive ands Type:
Notes: iVre$ 16 C.bds fio /i — Vt.ed . /gtjreviSsiio
Original Plan: Approved 'a Not Approved ❑ Date: e - °-
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov)
,Er Actual Slope: i O
Notes:
Original Plan: Approved Not Approved ❑ Date: n '
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
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(Review Continues on Page 2)
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City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov)
/Street Trees
❑/ Protected Trees A
Notes: MD Li4� �,�� W/ Ttt Pvt,�e.44, 2,,,L 1.,/0 roj �Nr .r4 e ppr Om) •
Original Plan: Approved Liz Not Approved ❑ Date: 6 / /
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
•
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applican
Revision 2: Date Seat to App • ant
Okay to Issue Permit: Yes No ❑
Date Routed to Building:
Z/
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