Permit Building Permit Application J b I VE U ' ,, "
Site Work EXPIR
/� p FOR OFFICE USE ONLY
l �� AR 2 0 ZOUB Received ��� f/
CI Of Permit No.:
g Date/B.:_ L� /� •_ �.lf/q �
• 13125 SW Hall
Blvd.,Tigard,ard,O OF TIGARD Plan Revie
��� ,(
r 0 Phone: 503.639.4171 Fax: Sa DateB : � 11 Other Per"Ff�n nt O -0 0
a•
T It Alm Inspection Line: 503.639.4175�Li _
G DIVISION Date Rea.':y: tyc:�/ El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: l SupplemeahlInformation
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(rounded to the nearest dollar)o
r Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the -. ofit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling *Commercial/industrial Valuation: S
❑Accessory building ❑Multi-family Numbcr of bedroom
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of I•ors:
5
Job site address: 9450 Sal. MA,12 wyyk l.L?A' New dwelli.1 area: square feet
City/State/ZIP: `I`f eD ' O�• 2-24-
Gazag arport _ _ sq•. e feet
Suite/bldg./apt.no.: Project name:1i4AL,t,�I4 WNGI�/� -�� Co• e• porch area: square -et
Cross street/directions to job site: 0 F T NT'1C,14)rrAi T4ns Deck area: square feet
4 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 fro: the
DESCRIPTION�OF WOJR,K work indicated on this application. 006
A ,et-Liieti �4U(df int, • Valuation: S
Existing building area: square feet 6
New building area: square feet
. __..4
.PROPERTY OWNER ❑ TENANT Number of stories:
Name: t47i_/ a te,J Gn u ned �= Sk7Y � Type of construction:
91 Address{�4 Q/vC ' , 'jl, etwil,„ evil D
4 v/I is„r 5S c1 "r , Occupancy groups:
City/State/ZIP: •'fl 1 G .411 2-7-4- Existing:)
w
' Phone:(N3 L z4--• /j5 Fax:( ) New: W lit APPLICANT ❑ CONTACT PERSON NOTICE
�13usiness name:Y�� � UN nom J -•L C All contractors and subcontractors are required to be
) Contact name: v 5 C...Gi e' I , 4,�i�3 licensed with the Oregon Construction Contractors Board
*� under ORS 701 and may be required to be licensed in the
ddress:I 2G`1 15 V. )5 g)63124> ' 5I jurisdiction in which work is being performed.If the
°j City/State/ZIP: 1`'�) 't,A Ai . p , q ZZ?J applicant is exempt from licensing,the following reasons
Phone:(55 ) 'f _ 34 O Fax::'($5 ) , apply:
E-mail: ��gi,�j U'[e 3 V r r,(.the-1-
A/ T S CONTRACTOR
L-1.- Business name: BUILDING PERMIT FEES*
Address:
(Please refer to fee schedule
Structural plan review fee(or deposit): f, 4.20
City/State/ZIP: —
FLS plan review fee(if applicable): 74.•if
Phone:( ) Fax:( )
Wb CCB lic.: Total fees due upon application: 0(3 IS
Amount received: v`��
Authorized signature: ' S This permit application ezpires if a permit is oot obtained
within 180 days after it has been accepted as complete.
Print name: i(`�.,� :5/ze/o;
Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 12/27/06 440-4613T(I1/02/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: 41,,,I cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) //f/q - cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
MU
� /E3 Concrete
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: 4 2 Q LJ sq. ft.
Site Utilities Plumbi Work:
Complete the Plumbing '-rmit Application for site - 1 sties plumbing work.
Plans Required: See "Site ork Permit A.• 'cation- Plan Submittal Requirements"
attached. The following must . comp. • • this application:
❑ Site Plan with Vicinity Ma. •owing ❑ *Parking(including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and .• ails ❑ *Landscaping Plan
❑ Erosion Cont : 'Ian and details ❑ Soils Report(if required)
❑ Retaining b tructures
*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
1:\Building\Permits\SIT-PermitApp.doc 12/27/06 2