Permit (43) 7,1 CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT
Permit#: SIT2016-00011
Date Issued: 07/28/2016
T GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AC14300
Jurisdiction: Tigard
Site address: 12976 SW HILLSIDE TER
Project: Miller Subdivision: HILLSIDE ESTATES Lot: 8
Project Description: Erosion control only permit.
Contractor: OWNER Owner: MILLER, MELISSA&SCOTT
SCOTT&MELLISSA MILLER 12976 SW HILLSIDE TER
12976 SW HILLSIDE TERRACE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 971-275-0341 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Info Process/Archiving-Sm$0.50(up to 07/28/2016 $0.50
11x17)
Erosion Control Only 07/28/2016 $322.80
Type of Use: SF
Class of Work: OTR
Project Valuation: $0.00
Site Specifics:
Excavation Volume: 60 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 $323.30
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t, follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OA0 through OAR 952-00144•0. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1 87 or . 00.3 344. /
Issued By: � +rte►
P- ittee Signature: (,
Call 503.639.41 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Site Work FOR OFFICE: USE ONLY
Received
City of Tigard Date/B : 7 �= Permit No.: ', ii. v if
• 13125 SW HIIIall Blvd.,Tigard,OR 972 1" i p;` X; Plan Review Other Permit
Phone: 503.718.2439 Fax: 503.598.1960 . Date/B : 1 _d'
Inspection Line: 503.639.4175
Internet: www.tigard-or.gov Date Ready/By: y . See Page 2 for
I I G A RD JUL 11 2016
Not Supplemental Information
` TYPE O 4 � t\ltd$oN . REQUIRED DATA:
L AlsID 2 FAMILY WELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
';',/
xCATEGOEY OF CONSTRUCT N A
work indicated on this application.
Valuation: $
p1-and 2-family dwelling ❑Commercial/industrial
❑Accessory buildingMulti-family Number of bedrooms:
0
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I2_617g 5o Hill Sic{c. 1-e ir. New dwelling area: square feet
City/State/ZIP: • ��^f Oar, C17l z.3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 13 3(6 e 11)�a t v►v ' Deck area: square feet
Other structure area: square feet
REQI)IRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
, x
H. SCRUUTION"'OF WORK work indicated on this application.
Valuation: $
CAA irti 64? a/�s O.�f .11 A;rv-
Existing building area: square feet
New building area: square feet
PROPERTY OWNER Q TENANT: -"`" Number of stories:
Name:
I/-r 4 //he/,‹sc o
� lit/rte Te of construction:
Address: I 217 s j /tit sr„/e_ kr, Occupancy groups:
City/State/ZIP: 'j ckfc cog_ q722,3 Existing:
Phone:(<17/ ) 2_75 03 y/ Fax:( ) New:
GIC T L ONTACT PERSON
AIS' � A�1" hIOTILE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
5Cs>� i'ti .‘,Aer under ORS 701 and may be required to be licensed in the
Address: t��},s,�t� '^�cr_ jurisdiction in which work is being performed.If the
�2''l'7E+ S
applicant is exempt from licensing,the following reasons
City/State/ZIP: ,-T, ".,1 C.rt ct7 LZ. apply:
Phone:(Cf7I) 2...)5" C>j if/ Fax::( )
E-mail:
, °r C9PT,TRAcTPR.'.' 0 -6,
Business name: enV/ ie- i BUI ING PERMIT FEES* ,
,.0k<..: � , (PleaserefertsJee schedule) .
Address:
Structural plan review fee(or deposit):
City/State/ZIP:
FLS plan review fee(if applicable):
Phone:( ) Fax:( ) q?
Total fees due upon application: )3 3
CCB lic.:
Amount received:
Authorized signature: -1____-... This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .i"'r— frkAtixi Date: * Fee methodology set by Tri-County Building Industry
Service Board.
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.411
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: 610 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.
z,r
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
ualtion r�P�>f` it +ee,
(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 3 $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.
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