Permit CITY OF TIGARD SITE WORK PERMIT
p
8 , COMMUNITY DEVELOPMENT Permit#: SIT2013-00027
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 10/22/2013
Parcel: 2S110BB04000
Jurisdiction: Tigard
Site address: 12165 SW AMES LN
Project: Peterson Subdivision: ARLINGTON RIDGE Lot: 17
Project Description: Installation of retaining wall
Contractor: THE EXCAVATORS LLC Owner: PETERSON, BRYCE D&KRISTI A
PO BOX 690 12165 SW AMES LN
YAMHILL,OR 97148 TIGARD, OR 97224
PHONE: 503-869-0910 PHONE:
FAX 503-662-3513
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/22/2013 $419.52
Plan Review 10/16/2013 $272.69
Type of Use: SF 12%State Surcharge-Building 10/22/2013 $50.34
Class of Work: OTR Info Process/Archiving-Sm$0 50(up to 10/22/2013 $9 50
11x17)
Project Valuation: $35,000.00 Erosion Control w/Permit-Eng 10/22/2013 $100.00
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* Yes
Fire Underground. Accessible Parking-
Fence.
Total $852 05
Required Items and Reports(Conditions)
I 11
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State • 0' S.eci- y Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire P wo is not -tailed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION' Oregon law requires you to folio, the ru-s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091. ou a obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
'---Tz::,5::e "-------
Issued By: < 7.....‘,./,,.;,...ye...._, Permittee Signature: AA
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 of the project.
Approved plans are required on the job site at the time of each inspection.
'Wine Permit Application
,d . Site Work FOR OFFICE USE ONLY
City of Tigard EN Received
11 ii Date/By f0 /te /3 Permit No /rav(3-006;7
° 13125 SW Hall Blvd,Tigard,OR 99EJJJ1 Plan Review
C: Phone 503 718 2439 Fax: 503.598.1960 Date/By 1`
L t Other Permit
T I G A R D Inspection Line. 503.639.4175 0 CT 1 2013 Date Ready/By: / tuns ® See Page 2 for
Internet. www tigard-or.gov .ti . ethod• /0/9"-Pi 3 ' Supplemental Information
GAS `i, )
TYPE O`���'iii GDN1 ' ` /' ;QUIRED A:1-AND 2-FAMILY DWELLING
` Permit fees*are based on the value of the work performed.
❑New construction ■ Demolition p
Indicate the value(rourdcd 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.
Valuation:
❑ 1-and 2-family dwelling El Commercial/industrial Commercial/industrial 3 3-t uo J
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder 1:1 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /IR / S SLtJ ��ngs L1 • New dwelling area: square feet
City/State/ZIP: t//- 44-1 0 t '7 7 ,)3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: r Tt sa-SG l 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: J 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.
n-e/141„.45 f v 44 L L- Valuation: $
Existing building area square feet
New building area: square feet
❑ PROPERTY'OWNER ❑ TENANT Number of stories:
Name: 8lydC Pelt-x. Type of construction:
Address: 447/Cc 5,,t/ ;-, _j 4� Occupancy groups:
City/State/ZIP: T� 1 mf JJ f7A'J Existing:
Phone:( ) ✓ Fax:( ) New:
■ APPLICANT NTACT PERSON NOTICE
Business name: ,te6/64 Gib' eob1/e.4 '.r . All contractors and subcontractors are required to be
�
d y ore) , licensed with the Oregon Construction Contractors Board
,
Contact name:
� under ORS 701 and may be required to be licensed in the
c
Address: ! $ 4(3 St„, ,t'ee,,✓b49,to w rq-y 11075"-- jurisdiction in which work is being performed.If the
City/State/ZIP: RYwae 6,4 02 f Inds' applicant is exempt from licensing,the following reasons
apply:
Phone:(3P23 ) 9?'S —6600 I Fax::( )
E-mail: --D(-eXS e.,vN.spi . Corvt
CONTRACTOR --
Business name: The e r,, _• iv)At)A-rOa-6 1-LC BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State/ZIP: Structural plan review fee(or deposit):
Phone:UD) ) 86'9 ‘-‘20 O I Fax:( ) FLS plan review fee(if applicable):
CCB lie.: /15-9.;33 7/-4/tit Total fees due upon application:
Amount received: a-'2a .4'7--
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:
/0`/' /3 * Fee methodology set by Tri-County Building Industry
Service Board.
l:\BulldingWermlts\SIT-PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
Ari
■■
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
❑ ncrete
:
*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
❑ Sion Control Plan and details ❑ Soils Report(if required)
Retaining Structures ❑ Fire Line
*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
1•\Building\Pennits\SIT-PermitApp doc 05/25/2012 2
f
III
" Building Division
Development Code Provision Review
T I GA RD Residential Projects
Building Permit No.: i T"aQC / 5- Coo a--?
Project/Subdivision Name: N-r-f k So , Lot #:
Site Address: 1 a 1 Las ca 03 PI-1,4i-S
CWS Service Provider Letter: Pk.), - , e e-name- — .,_ J) _0
Required:Yes ❑ No 5p,....4,02,,,,_ L.o/ `�- ,A,21 .4 S i
Received:Yes ❑ No la � i\ 0
Plans Routed:
Original Plan Submittal Date: /0///,//3 Route _y:--7--
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2nd Revision Submittal Date: ❑ Site Plan Only Routed By:
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 (✓) 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. (�/C,
Planning Review (contact Jo A n rya at (503) 718-a 70` / or @tigard-
or.gov)
Land Use Case No. `-
Zoning
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height: Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved L4' Not Approved ❑ Date: /v /7,3
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
_C\CURPLN\Masters\Development Code Provision Review\DCPR_RES.doc_Rev 01/16/13
AT
Engineering Review(contact Mike White at 503-718-2464 or MikeW @tigard-or.gov)
V Actual Slope: fc
Notes:
Original Plan: Approved Not Approved ❑ Date: ID fr(
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 Applica
Revision 2: Date Sent to Ap. :cant
Okay to Issue Permit: Yes d■ No ❑
Date Routed to Building:
/Q oZ/// Arr.--
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_RLS.doc Rev.01/16/13
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