Permit CITY OF TIGARD SITE WORK PERMIT
s. COMMUNITY DEVELOPMENT Permit#: SIT2014-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/24/2014
Parcel: 2S110AD03410
Jurisdiction: Tigard
Site address: 10639 SW MURDOCK ST GAR
Project: KENNEDY Subdivision: LANG HILL Lot: 29G
Project Description: Wheelchair ramp to front door.
Contractor: OWNER Owner: KENNEDY, PATRICIA L
PATRICIA KENNEDY 10639 SW MURDOCK ST
10639 SW MURDOCK ST TIGARD, OR 97223
TIGARD, OR 97224
PHONE: 503-620-1488 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 02/24/2014 $51.09
12%State Surcharge-Building 02/24/2014 $6.13
Type of Use: SF
Class of Work: ALT
Project Valuation: $500.00
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 $57.22
Required Items and Reports(Conditions)
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 adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 9 1-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 • .800.332.2344'"
Issued By: 4`�'`/ a ittee Signature: i A....001111111111
Ca;-t"." -•(. 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.
Building Permit Application gYACYAVYJD
Site Work I Int O1 I l(1. l til: O\I.1
City of Tigard 014 ReCe1VCd Permit�' g cEg 2 4 2 Date/B : �k 1k 7. old- -
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 �1! A ��i. Other Permit:
T I G A R D Inspection Line: 503.639.4175 ON OF V Ready/By: kris ® See Page 2 for
Internet: www.tigard-or.gov Q[t��^%� DIVIS ed/Method: 7(a Supplemental Information
TYPE OF WORK
/St I, V 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
dition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
�� CATEGORY OF CONSTRUCTION work indicated on this application.
L�'1-and 2-family dwelling ❑Commercial/industrial Valuation: $
El Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10&3 9 Sal M U,yo 0e . 1— New dwelling area: square feet
City/State/ZIP: 1761,4[�- e 1-/b z Z'f Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: K, i-04 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.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(romded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
n Valuation: $ c
0 W Lt ti —AA IV YN 0 i-i,-", } a 06 Y- Existing
building area square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: a rr(m & 4-coin 1(/\ Type of construction:
Address: 1 04 3 W A l v &4.. S ` Occupancy groups:
City/State/ZIP: 'l 4.4,pal. 0 (Z— 11 2L 4 Existing:
Phone:(SU3) tiA - its/ Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 1A.« 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:
CONTRACTOR
Business name: oul/IJcr BUILDING PERMIT FEES*
-
Address: (Please refer tole schedule)
Structural plan review fee(or deposit):
City/State/ZIP:
FLS plan review fee(if applicable):
Phone:( ) Fax:( )
CCB lie.: Total fees due upon application:
4kafp.--- Amount received: 5 7. }�_Authorized sigma 1_,, This permit application expires if a permit is not obtained
Print name: PQ L Date: , 'r * within 180 days after it has been accepted as complete.
1 rf of i,(-V1 hl d N 2 -! -f - ( Fee methodology set by Tri-County Building Industry
J Service Board,
L\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
El Concrete
El 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 El *Parking(including ADA)and Lighting
compliance Plan
El Grading Plan and details El *Landscaping Plan
El Erosion Control Plan and details El Soils Report(if required)
El _ Retaining Structures El 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\Permits\SIT-PermitApp.doc 05/25/2012 2
;7 ■ Site Work Permit Application
Plan Submittal Requirements
T I G A R D Commercial, Multi-Family and One- &Two-Family Dwellings
A site work permit is required for all commercial projects including new buildings,additions,
accessory buildings larger than 120 square feet, modular structures and multi-family R-1
occupancies. A site work permit is required for excavation, fill,grading,paving, retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map &tax lot # ❑ project name El site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability,leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing:
1) Silt fence locations.
2) Bio-filter bags/other approved barrier material surrounding catch basins.
I:\Building\Permits\SIT-PermitApp.doc 05/25/2012 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
1:\Building\Permits\SIT-PermitApp.doc 05/25/2012 4
Building Permit Number: 517.7014- (xlcx)3
III Building Permit Review
Residential Projects
1I(jAR1)
Site Address: 1 o 3'1 6t,) Mu, duck- 54.
1erify site address is valid.
Project Name & Lot #:
Clean Water Services-Service Provider Letter: (lot platted prior to 9/10/1995)
Required: Yes ' No Received: Yes ❑ No ❑
Site Plan Elements:
Site plan must be on 8-1/2"x 11"or 11"x 17"paper Errhree(3)copies of site plan
cgtDrawn to scale(standard architect or engineer scale) regNorth arrow
Lu1Map and tax lot number,site address,project or subdivision Footprint of new structure(including decks)with finished
name,lot number,and zoning floor elevations
i$Applicant information(name and phone number) Xot and building setback dimensions
roperty corner elevations(2 foot contour lines if more than )2tot area,building coverage area,percentage of coverage and
4 foot differential) impervious area.
,, TUtility locations giLocation of wells/septic systems.
'Existing structures on site Jurface drainage
Street names ,Street tree size,type and location
%Erosion control(including drainage-way protection,silt fence JZt xisting trees to be retained with drip line,and tree
design,location of catch basin,etc.) protection measures
Planning Review
Land Use Case Number: NI A
EV Zoning. it-1a-
ySetbacks:
Front O Rear 0 Side 0 Street Side O Garage v
''Landscape Requirement:
ff Lot Coverage Maximum: iyo
I'll ,Z Building Height: Maximum Height Actual Height
j21°Visual Clearance
'Easements
Sensitive Lands: ❑ Yes Type
�II A ,'Urban Forestry Plan
%Conditions Satisfied
Approved by: C £C A AU►y Date: -DWI -14
Notes: i_eet se4-b act. because Co•-■A 6i k Pn 'a. ra rv,19 '1J on
—}Mo r w,r3 ?el re.-1-) 0 earl vi(+ t..l -'1'i;h C d ,rvAm a_v-�AJ .
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
I:\Building\Forms\BldgPermitRvw_RES_123013.docx
Building Permit Submittal
Original Plan Submittal: Date: d't By: ��-
Site Plans: #
Building Plans: #
Create Case Record#: er case#aboovv or Building Permit Number.
Workflow Routing: SE--P1 g Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: i -off for Planning staff,including notes from planning review(page 1)
Route Application Documents: ❑ En ' g: (1) copy of permit application, (1) site plan, (1)building plan and
origin p review routing form.
❑ �� original permit application,site plans,building plans,engineer and
am lations and trust details,if applicable, etc.
Reviewed By: /41,4(1 Date: 2/,,.f//f
Notes: /Vic r- 77, Cm.".7fr-✓ ,j c v l y
engineering Review—reviewed by:
Actual Slope:
❑ Conditions Satisfied
Notes:
Approved by: Date:
Revisions (after Building Sub I • -al only) Reviewer Date
Revision 1 Approved PIP Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent • Applicant:
Revision Notice 2: Date t to Applicant
Revision Notice 3: I. e Sent to Applicant
Okay to Issue Permit- Date:
I:\Building\Forms\BldgPermitRvw_RES_123013.docx
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical,and plumbing per mits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
r
will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
� �c1, ‘c-- LI 1 k ,ehvlewi
Pint Name of Permit pplicant
rtfrik_jir z z2/_ ,4, ,
Signature of P rmitApplican Date
Permit#: I 'aCi11 00003 1
Address: 10 6 31 5L1 "412/0c4,51
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Issued by: A--- Date: ?4ui/j4/ I7-
This Copy for Permit Offices