Permit CITY OF TIGARD SITE WORK PERMIT
p
I I COMMUNITY DEVELOPMENT Permit#: SIT2015 00014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2015
Parcel: 2S111AB01000
Jurisdiction: Tigard
Site address: 14080 SW 93RD AVE
Project: WALTERS Subdivision: ELROSE TERRACE Lot: 7
Project Description: Erosion control and fill permit. Adding approximately 150 cubic yards to level out lot.
Contractor: JASON WALTERS Owner: WALTERS,JESSICA M&JASON A
OWNER 14080 SW 93RD AVE
14080 SW 93RD AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-501-6040 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control w/Development 10/26/2015 $80.70
Info Process/Archiving-Sm$0.50(up to 10/26/2015 $0.50
11x17)
Type of Use: SF Investigation Fee 10/26/2015 $90.00
Class of Work: OTR Investigation 12%State Surcharge 10/26/2015 $10.80
Project Valuation: $1,000.00 Permit Fee-Site Work 11/05/2015 $64.54
12%State Surcharge-Building 11/05/2015 $7.74
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: 150 cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Store Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $254.28
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
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
i ance, or if is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Cen Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUN y 50 .232.1987 or 1.800.332.2344.
Issued By: 4i Permittee Signatu ' Ar .-- '''C Call 503.639.4175 by 7:00 a.m.for the next available insp• tion 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.
k_____
' Building Permit Application
Site Work R w FOR OFFICE USE ONLY'
City of Tigard KNAN-Volc
Date/By: ry Permit No.: O t�j -oyy�
13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review �` /
1 ° Phone: 503.718.2439 Fax: 503.598.1960 t q 6 ` 015 Date/By: Other Permit:
Inspection Line: 503.639.4175 OC\ !r Date Ready/By: . Jung ® See Page 2 for
TIGARD U Notified/Method: Supplemental Information
Internet: www.tigard-or.gov 1���� nn
TYPE OF WOR
fit',/��G�1v`S1 REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Dein( ition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement gOther: Lr—,f,./)Cp(�p equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION ` work indicated on this application.
Z1-and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder WDther: /._.- r�'' \C(:j/),,,,c,� Number of bathrooms:
JOB SITE INFORMATION AND LOCATION 1 J Total number of floors:
Job site address: (y Dci V 1\...L) S\C A ,,,,,tJe New dwelling area: square feet
City/State/ZIP: --c- ,R�( et,�3 v-.` Garage/carport area: square feet
Suite/bldg./apt.no.: r,� rk
roject name: Covered porch area square feet
Cross street/directions to job site: ct\,'�(1 ,_ � b/telb Deck area: square feet
V�• J � 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(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF
WORK work indicated on this application.
Valuation: $ t O 0
0)1r6x Ott itx 0-(- IX A/y Jr,, LizA e1`"�
(DC loi , ( 1 50 -9&o Cy) f'1 t.L t s Zell- 6 ` y4e Existing building area square feet
New building area: square feet
a PROPERTY OWNER I 0 TENANT Number of stories:
Name: 1°'‘enn t jok.kx41 Type of construction: Awl'.,)S Q t ri-/ktk,,,,e6.af
Address: t..soup \w q1 4 4,,, Occupancy groups:
City/State/ZIP: -1-1-.. L 1. a l.L\ Existing:
Phone:(1O1 )3‘)1_tm00 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
�a`� �la C/3 under ORS 701 and may be required to be Ikensed in the
Address: Oil:tO \W R 3 tee 4+1.€ jurisdiction in which work is being performed.If the
City/State/ZIP: r 1d , C �� apply:
is exempt from licensing,the following reasons
PP l Y:
Phone:('Te\) csOl (4,0_110 Fax::( )
E-mail:
CONTRACTOR
Business name: .A OLA t- 2 BUILDING PERMIT FEES*
Address: 0C4 (Please refer to fee schedule)
City/State/ZIP: Structural plan review fee(or deposit):
Phone:( ) Fax:( ) FLS plan review fee(if applicable):
CCB lie.: Total fees due upon application: EI A(1
Amount 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: S�� ��` ��1 Date: �l (, * Fee methodology set by Tri-County Building Industry
�1(/ Service Board.
I:\Building\Permits\SIT-PermitApp.doc 10/01/09 4404613T(I1/02/COM/WEB)
1k - -
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) I (7 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.
1:\Building\Permits\SIT-PermitApp.doc 05/25/2012 2
A
City of Tigard
• COMMUNITY DEVELOPMENT DEPARTMENT
I
T I G A R D Building Permit Review — Residential
Building Permit #:
Site Address: 3 L (fb0 SW gird Ave.
Project Name: J -\- g Lot #:
(New dwelling= subdivision name;Addition or Alteration=last name of owner)
Planning Review I \
Proposal: grading only • no cons+y1k i o II
LV' Verify site address/suite#exists and active in permit syste .
River Terrace Neighborhood: ❑ Yes No
Site Plan Elements:
❑ hree(3)copies of site plan 12 Existing structures on site
Drawn to scale(standard architect or engineer scale) floor elevations
❑p orth arrow $L7tility locations(required for new,may apply for additions)
,tte address,project or subdivision name and lot number cation of wells/septic systems
Applicant information(name and phone number) rosion control(including drainage-way protection,silt fence
—Eliot dimensions and building setback dimensions esign,location of catch basin,etc.)
• tot area,building coverage area,percentage of coverage and NJStreet names
Impervious area(applicable if R-7,R-12,R-25&R-40) EStreet tree size,type and location
Property corner elevations(2 foot contour lines if more than -Existing trees to be retained with drip line,and tree
4 foot differential) protection measures
Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
/Required: Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No
gin Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified lNo Applied For: ❑ Yes ❑ No,stop intake
and Use Case#:
zoning: R-q.5
$Setbacks: Front Rear Side Street Side Garage
$Landscape Requirement:
&Lot Coverage Maximum:
$Building Height: Maximum Height Actual Height
- Visual Clearance
$ Easements
"Sensitive Lands: i Yes ❑ No 1 vpe -lab i i-cci-
4E1- Urban Forestry Plan
-9—Conditions "Met"prior to issuance of building permit
Notes: /
\
Approved By Planning: L TI fr -41 A CLA() Date: p 2.6
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
1:\Bui(ding\Forms\BldgPermitRvw_RES_0709I5.docx
Building Permit Submittal
Original Submittal Date: /a/a2 4-3"--
Site Plans: # 5
Building Plans: # nl//�"
Building Permit#: �7 Enter building permit#above.
Workflow Routing: —Planning ° Z^gine w^^
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
❑ Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: tA2A..t/.J - it. -' (yG( 044 GcxJ� c.K 1 !� o-1' /55}Q- - �-ed- �Cv�
By Permit ec ician: _ /.t `J Date: /0/�9/�
Iu�I� rr
Engineering Review
❑ Slope at building pad:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-i _• ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: • Yes ❑ ►•
LIDA Facility on lot: ❑ • • No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date:
Revisions (after Buildin• :ubmittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent t. •pplica :
Revision Notice 2: Date S-- to Applicant:
Revision Notice 3: Dat= ent to Applicant:
❑ SDC Fees Entered: , ash Co Trans Dev Tax: • es ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
-Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermit R vw_RES_070915.doc x
Debbie Adamski
From: Debbie Adamski
Sent: Thursday, November 05, 2015 9:33 AM
To: 'Jason Walters'
Cc: #Building Permit Technicians
Subject: RE: Permit # SIT 2015-00014
Jason,
Thank you for sending these. I have printed these approved documents from CWS and added them to your file. There
are additional fees due of$72.28 for the fill portion of the permit that did not get collected when you first applied for
your permit. Originally you were only assessed fees for the erosion control. You can pay these fees online if you would
like. Here is the link to building page: http://www.tigard-or.gov/city hall/community development/building.php ,
there is a Quick Link list on the lower right of the page, click on Online Payments. When that page opens, scroll down
and in the lower left hand side of the page, under Building, click on Search Permits/Pay Fees, then enter the permit
number in the Record Number box. The permit record will be displayed, click on the arrow next to Payments and it will
display the fees due and you can proceed with making the payment. Once the fees are paid we will receive a
notification and I can take the permit off hold. I can then reprint and mail the permit and plans to you or if you prefer
you can come in to the office to pay the fee and pick the permit and plans. Our office hours are Monday through
Thursday from 8:00 am to 4:30 pm. Let me know if you have any questions.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503-718-2450
From: Jason Walters [mailto:jwalters2l @gmail.com]
Sent: Wednesday, November 04, 2015 9:57 AM
To: Debbie Adamski
Subject: Re: Permit # SIT 2015-00014 •,,
Here is the service provider letter from clean water.
On Mon, Nov 2, 2015 at 7:44 AM, Debbie Adamski <DEBBIC@tigard-or.gov> wrote:
Jason,
Thanks for the update. I will add this information to your permit file and we will wait to activate your permit until you
have the approval from Clean Water Services.
Debbie Adamski
Senior Building Permit Technician
1
•
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
From: Jason Walters [mailto:jwalters2l(agmail.com]
Sent: Friday, October 30, 2015 12:42 PM
To: #Building Permit Technicians
Subject: Permit # SIT 2015-00014
Here is an update to where Fm at.
I was in Monday to apply for erosion control permit and a fill permit. I was told I needed to get an service
provider letter from Clean Water. I applied for that and they got back to me saying that based upon their review
I may be within 200 feet of Sensitive areas. In order to continue I needed to submit a Sensitive Areas Site
Certification form. I have done all this, and am waiting to here back from them.
Thanks,
Jason Walters
14080 Sw 93rd ave
Tigard, OR, 97224
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative'Rules"City General Records Retention Schedule."
2
CleanWater Services
November 03, 2015
SPL expires on November 2, 2017
WALTERS, JESSICA M &
WALTERS, JASON A
14080 SW 93RD AVE
TIGARD OR 97224
RE: Grading
CWS file 15-003472 (Tax map 2S111AB Tax lot 01000)
Clean Water Services has received your Sensitive Area Certification for the
above referenced site. District staff has reviewed the submitted materials
including site conditions and the description of your project. Staff concurs that
the above referenced project will not significantly impact the existing Sensitive
Areas found near the site. In light of this result, this document will serve as your
Service Provider letter as required by Resolution and Order 07-20, Section
3.02.1. All required permits and approvals must be obtained and
completed under applicable local, state, and federal law.
This letter does NOT eliminate the need to protect Sensitive Areas if they are
subsequently identified on your site.
If you have any questions, please feel free to call me at (503) 681-3639.
Sincerely,
G�
/---/Q444;
Laurie Laurie Harris
Environmental Plan Review
Attachment(1)
2550 SW Hillsboro Highway • Hillsboro,Oregon 97123
Phone: (503)681-3600 • Fax: (503)681-3603 • cleanwaterservices.org