Permit CITY OF TIGARD SITE WORK PERMIT
1' '" DEVELOPMENT SERVICES PERMIT # : SIT2004 -00024
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/26/2004
SITE ADDRESS: 11710 SW WILDWOOD ST PARCEL : 2S110BD -00300
SUBDIVISION: SHADOW HILLS ZONING : R -2
BLOCK: • LOT: 001 JURISDICTION : TIG
CLASS OF WORK:.OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE: 3,500.00
EXCV VOLUME: cy LANDSCAPING ?: •
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Masonry rock retaining wall.
Owner:
FEES
GIESBRECHT, FRANK Description Date Amount
11710 SW WILDWOOD ST
TIGARD, OR 97224 [BUILD] Prmt Fee - Valu 8/26/2004 $81.70
[BUPPLN] Pln Ck -Valu 8/26/2004 $53.11
Phone: 503 - 620 -5615 [TAX] Valu 8% State Stu 8/26/2004 $6.54
Contractor: Total $141.35
OWNER
Phone:
Reg #:
Required Inspections
Final Inspection
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.
Issued By: lor4 / /` _
Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Work
P w
Building Permit • :e IlV FOR OFFICE USE ONLY
City of Tigard AA'' 11 � 2 5 2004 Received M
13125 SW Hall Blvd., Tigard, OR 9721� Plan Review M'' /w/
Phone: 503.639.4171 Fax: 503.598.1960 /4,100,..,%" I I +� Date/B , i Other Permit
r74 .�
Inspection Line: 503.639.4175 G ay OF TIGARD . a y,. i Date Ready/By: f � ® See Page 2 for
Internet: www ci.tigard.or.us BUILD DIVISION "- Notified/Method. fII/L�. Supplemental Information
TYPE °OF WORK t 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.
❑ 1- and 2- family dwelling ❑ Commercial /industrial
Valuation: $ 3 .3 - 0 C, . O cJ
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
- "JOB SITE INFORMATION AND LOCATION " " 4 '. Total number of floors:
Job site address: 1 1 7 1 f / 'u) ( Lb Lode, New dwelling area: square feet
City/State/ZIP: - L 0 � .Q 2 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: i Eia 6 C ti -- - Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED TAIiCOIGIMERCLAI! -USE CHECKLIST •
Subdivision: 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
. ;x' . 1 x = t _ _ DESCRIPTION O)E CORK ;'. , ; ,, , �. i. ms's U
3 work indicated on this application.
��il,'�' I t
tr,1 li 1 A _ _r Valuation: $
Existing building area: square feet
New building area: square feet
4 - g • j ' - EL PROEEkTY, OWNER ; , ; :,4 ."`,' .® TEN iNT - '? b Number of stories:
7.M" .L� -Us KS. Yxt-
Name: /:44,J lc a , £54/211-1/1--- Type of construction:
Address: 1/ 7/0 AA) to l e a wee. 7D Occupancy groups:
City/ State/ZIP: C
f^P/g2.1►) 02 / 72 :;'y Existing:
Phone: Oetill 6,94)_ 5 i, Fax: ( ) New:
' a . - - li/ ' AFFIICANT -, w%. , v - ` j` El CONTACT' 'PERSON . • . E ` ' NO TI C ' ,
� ie w .. • ,.. .
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:: ( )
E -mail:
' +
ry � -, ac ; � �` - CONTRACTOR,
R ,. . - .
1 : '
. y1� .` .r '�-S �.. R� . } � Y.' ,t.•1c �7/�- - '1� - ` n� s �.L.i�r; Y 4`
Business name: Dr� ` E K� , M `
'� � 1 # • �.�: '>3l�amn�lve� PERMIT FEES` *.
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lie.:
Date received:
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: ( A 40 e1 * Fee methodology set by Tri- County Building Industry
f Service Board.
1 : Butldmg\Pcrmits\SIT- PermitApp doc 12103 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 ❑ *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.
;:.> y It of Plans -
, P E OL tJB TTTAi _ Required
( Inc* idesw Addi io or Alterations) . r Submittal
Commercial 2
Multi - Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
i:\Building\Forms \SIT - Checklist.doc 12/29/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - " Business Line: (503) 639 -4171 MST
BUP
Received Date Requested C AM PM BUP
Location iUno g ws1- 1a1nJoeJ p ST Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT ?cry/ _0000 c'
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing ( AP'( 1-Amcr c _LA t" .r (A ) CAI 7 To -p t SEr'.E AM)
Insulation
Drywall Nailing 1FtTF�2 z-n.1 TI4 THE S r A i r geTA SN -sN4
Firewall
Fire Sprinkler - 1 -L 4 CRA, e2 p As - 13 LT- us - To
Fire Alarm LCC AT - rota QA) La -r AN LAe NHMA v2 p e'
Susp'd Ceiling
Roof
�/■w GC T F WA t! rr
•
(1:_7 PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
. Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 7-. o L I Inspector /AAA/ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL