Permit .'4.. CITY OF TIGARD SITE WORK PERMIT II
_'- COMMUNITY DEVELOPMENT Permit#: SIT2014 00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2014
TIGARD g Parcel: 1S136 DC04402
Jurisdiction: Tigard
Site address: 11860 SW 72ND AVE
Project: TLB LLC Subdivision: FRUITLAND ACRES Lot: 31
Project Description: Erosion control only for 11860 SW 72nd Ave, 11930 SW 72nd Ave, 11990 SW 72nd Ave,and vacant adjacent lot.
Contractor: KERR CONTRACTORS OREGON INC Owner: TLB LLC
PO BOX 1060 PO BOX 25716
WOODBURN, OR 97071 PORTLAND, OR 97298
PHONE: 971-216-0050 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only-Eng 10/22/2014 $322.80
Type of Use: SF
Class of Work: OTR
Project Valuation: $0.00
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 $322.80
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 Notifi ation—Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. ou may obtain a copy of the rules
or direc uestions to U y calling 503.232.1987 or 1.800.332.2344.
Iss d By: /A 11 / Permittee Signature: /�
Call 503.639.4175 by 7:00 a.m.for the next available inpction d e.
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
1
Site Work FOR OFFICE USE ONLY
• Received Gj � ,.,�
City of Tigard xN1x DateB : / Permit No.:
q 13125 SW Hall Blvd.,Tigard,ti�: 'F.!3 Plan Review '" /k_` l
Phone: 503.718.2439 Fax: 50.=°9-6: Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juri s: El See Page 2 for
Internet: www.tigard-or.gov P i 2p14 Notified/Method: 6 Supplemental Information
SE
TYPE OFgW vitiv>v���IAp �roe REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction CI .1,l:'io,i2_' Permit fees*are based on the value of the work performed.
tit:, Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement d 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: $
❑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: %/06 0` //73.0 1 ///70 -7 Z""J A4 v-e. New dwelling area: square feet
City/State/ZIP: rl J,,,,—,/ 7 0R/ 7 Zj. 'Z"L 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: YARD 6..L cov0 u P Covered porch area square feet
Cross street/directions to job site: .1) • /K,zt_7T'y( G EL(,,....rroy,_, /.44 4..S Deck area: square feet
Other structure area: square feet
I5131 7(' )9/490 /5/3 e)y / REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /e/3&Dwq 360 t /5/ % e alL _t 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.
.51.-c e--/t-Pi/e- /Aig I.,/ ( c1-/t.iaK' 60.>^5-p ip,n Valuation: $
i.,-7-7S,z,,r-/ ^ /-5- . L!G ,\ cif/1-6,21-15 �■ -I-0 Existing building area square feet
--F.//C)w v P 4, 97,46e-ES New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
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 lcensed in the
rAddress: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax: :( )
Cil E-mail:
t
CONTRACTOR
Q. Business name: Ke- f-r ej, ,rf e-- &--)-p rf' BUILDING PERMIT FEES*
• Address: 9 5 54,,,,,,; to ati Ln /1J : (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP: e�c�0,41,4 Fr /0/2 / l 7 4)-54 1
Phone:(''y}O 2 /6 - c>6 $o Fax:( ) FLS plan review fee(if applicable):
Total fees due upon application:
CCB lie.:
1 Amount received:
Authorized signature: .
�YYYY This permit application expires if a permit is not obtained
Pat within 180 days after it has been accepted as complete.
M
Print name: .L 4,11 Date: q_$-/y * Fee methodology set by Tri-County Building Industry
Service Board.
1:\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
❑ 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 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.
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.
s I:\Building\Permits\SIT-PennitApp.doc 05/25/2012 2
1