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Permit (25) CITY OF TIGARD SITE WORK PERMIT 110 COMMUNITY DEVELOPMENT Permit#: SIT2017-00007 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2017 E '''' ' 9 Parcel: 1 S 136CB00202 Jurisdiction: Tigard Site address: 8025 SW THORN ST Project: Thorn Street LLC Subdivision: SHANNONDOW Lot: 1 Project Description: Erosion control for storm drain work on(3)lots: 8025,8035&8045 SW Thorn St. Contractor: N/A Owner: THORN ST PORTFOLIO LLC BY SHEPARD, CHRIS 2830 NW 29TH AVE PORTLAND, OR 97210 PHONE: PHONE: 360-772-6355 FAX: FEES Description Date Amount Specifics: Erosion Control w/Development 04/12/2017 $80.70 Type of Use: SF Class of Work: OTR Project Valuation: $1,200.00 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 $80.70 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 952-001-0090. You ma obtain a copy of the rules or direct questions to OUNC by callingn503.232.1987 or 1.800.332.2344. Issued By:(��\` X�/1 x Permittee Signature: /• 4111° • Call 503.639.4175 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 Site WorkFOR OFFICE USE ONLI Cityof TigardRece/B 7 eived REC�iu ED Dat L, �� Permit No.: , ./Tp.©I7-ev 13125 SW Hall Blvd.,Tigard,ORSC 31 0 �f11 7 Plan Review Phone: 503.718.2439 Fax: 50384-0940 U Date/B Other Permit: TI G A IZ D Inspection Line: 503.639.417 -�y /+ ry Date Ready/By: Juris: la See Page 2 for Internet: www.tigard-or.govLi I i OF Tt ttn� Notified/Method: Supplemental Information BUILDING DIVISION 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)of all 14 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. d ) ❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ // ?jw 0 Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 'ST'oZ� XO 3c gc,c(c to �-Lz,K New dwelling area: square feet City/State/ZIP: U I tet. ; ©/2_ Garage/carport area: square feet Suite/bldg./apt.no.: Project name: IA vrt. Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet V,QUI U R ATA) x, M►1MERCIAL-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 l'-' ' i» i. «st °.1" X'' If work indicated on this application. `- it ,> Valuation: $ fir.bu& �rv�1 I w �Cs(A&ltQ,►,. '> e46/ar3 Co/U i L ��g- i� �P iij Existing building area: square feet �" New building area: square feet ' ! , ANT Number of stories: � r ��_ �m : mss, Name: 1— LL.( Type of construction: Address: 7 L?�c iii 0 7 i7't-' Occupancy groups: City/State/ZIP: .p,,,4.4CjY1 '7214) Existing: Phone:(366) 7-7 2 6 3 j 5 Fax:( ) New: 0')1'u:•< AA CONT PERS ,-:. Business name: 5 L ,'L.c ro 4-A.-,,, I't�w � ,,.c..-z�- All contractors and subcontractors are required to be � Contact name: A'� 314.4.5,;„,( licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: Z:"i 3C 4 k 2-V1- jurisdiction in which work is being performed.If the City/State/ZIP: �� (� Z l applicant is exempt from licensing,the following reasons apply: Phone:(360 )772- b s S- Fax::( ) E-mail: ' '7al;t J Al , E? pq t 6454" Business name: " BUILDING 't' I FEES` Address: : �� (Please refer to ee schedule?, x,, Structural plan review fee(or deposit): City/State/ZIP: FLS plan review fee(if applicable): Phone:( ) Fax:( ) CCB lic.: IC(72,0`.) Total fees due upon application: �� Amount received: �g© •?d plete. Authorized signature: This permit application expires if a permit ted is as not obtained within 180 days after it has been ac epm Print name: Dater Z� '� * Fee methodology set by Tri-County Be uilding Induscotry Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 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 *Does not apply to One-and Two-family dwellings. Plan Submittal: Permit Fee: TYPE OF SUBMITTAL #of Plans 'ori;, *mit Fie. (New,Additions or Required of $.00 to$500.00 $51.09 minimum permit fee Alterations) Submittal t. $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. I:\Building\Permits\SIT-PennitApp.doc 08/02/2016 2