Permit SITE WORK PERMIT
INCITY OF TIGARD
z..'- COMMUNITY DEVELOPMENT Permit#: SIT2017 00008
Date Issued: 05/08/2017
T[ ash D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S109DD11500
Jurisdiction: Tigard
Site address: 15716 SW GREENFIELD DR
Project: Zarrini Subdivision: BELLA VISTA Lot: 45
Project Description: Erosion control only for installation of artificial turf.
Contractor: N/A Owner: JOSH ZARRINI
15716 SW GREENFIELD DR
TIGARD, OR 97224
PHONE: PHONE: 330-697-0574
FAX:
FEES
Description Date Amount
Specifics: Erosion Control w/Development 05/08/2017 $80.70
Erosion Control Reinspection 05/08/2017 $96.84
Type of Use: SF
Class of Work: OTR
Project Valuation: $480.00
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 $177.54
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
applicabl- work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issu-. ce, or if work is uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ity Notification Center. Those lesre set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to OUNC b ing 5 .2.1987 or 1.800.332.2344.
sued By: ` i / Permittee Signature: F/— —
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.
r Building Permit Application
Site Work RECEIVED FOR OFFICE USE ONE\'
City of Tigard �,1 Received 0
/ Permit No.: 6�e90/07 O
514 - 13125 SW Hall Blvd.,Tigard,OR 972�18AY 8 2017 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q p Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: inns: Ea See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. /\
Valuation: $ `TevV. G O
❑ 1-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
4,
Job site address: i S7 t 6 SW a LD New dwelling area: square feet
,i"Gr�
City/State/ZIP: Iko ®UA. . Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: `24.24A it) Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
11 {QQJIRED DATA:COMNIERCAISE CH QST
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
DESCRIPTIQ OF WORK , -, , 4 work indicated on this application.
r e0 5/et \ N1 t�G L 0,(11,/V Valuation: $
SCJ Existing building area: square feet
4A) P e / 4-e New building area: square feet
0, .PER • ' r,: E- ., Number of stories:
Name: 3, '2 4 LL)I Type of construction:
Address: 1 S'714, St,,, G e....crio P i i Lb Occupancy groups:
City/State/ZIP:fci 6#02 0 Da. Existing:
Phone:(s30) tol 7 Os-7A Fax ( ) New:
.4. 44, APPI:rcANT il, ci.t CONTA ON ''`;3 , ' e CE ,,.; a s
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 licensed in the
Address: jurisdiction in which work is being performed.If the
Ci /State/ZIP: applicant is exempt from licensing,the following reasons
City/State/ZIP: apply:
Phone:( ) Fax::( )
E-mail:
1114' 1, CTOR 0
Business name: ! r[iL- BUILDINGP * '
Address: (Please rfer of .h. ' ,'. re.,
Structural plan review fee(or deposit):
City/State/ZIP:
FLS plan review fee(if applicable):
Phone:( ) Fax:( )
CCB lic.: Total fees due upon application: ii (j
Amount received: 7'7 7. s
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 4 a Date: 5-.g.i-? * Fee methodology set by Tri-County Building Industry
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 com. ete all items below,unless otherwise noted.
Excavation Vo me: cu.yds.
Grading Volume.
(Soils report requir:. for>5,000 cu. yds.) cu.yds.
Fill Volume:
(Fill exceeding 12" in •: 9th shall be compacted to
90%of maximum density cu.yds.
Retaining structure? (Check one) Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including • ildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit :pplication for s utilities plumbing work.
Plans Required: See"Site ork Permit Applicati•'. -Plan Submittal Requirements"attached.
The following must acco ',any this application:
❑ Site Plan with Vici► ty Map showing ADA a. *Parking(including ADA)and Lighting
compliance lan
❑ Grading Plan a•d details ❑ andscaping Plan
❑ Erosion Cont .1 Plan and details ❑ So s Report(if required)
❑ Retaining St ctures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SU 3MITTAL #of Plans Vai
(New,Additions or Reqquired 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.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15716 SW GREENFIELD DR, TIGARD, OR, June 29, 2017 at 7:10:03 AM
97224
Record Type: Record ID:
Residential - Site Work SIT2017-00008
Inspection Type: Inspector:
499 Final inspection David Young
Result:
FA I L
Comments:
Provide approved initial and final erosion control inspections prior to SIT final inspection.
Violation Summary:
Inspector Contractor