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Permit (198) CITY OF TIGARD SITE WORK PERMIT I. COMMUNITY DEVELOPMENT Permit#: SIT2017-00015 Date Issued: 07/24/2017 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134D603900 Jurisdiction: Tigard Site address: 11185 SW 109TH AVE Project: Tamura Subdivision:AHAN'S ADDITION TO THE CITY OF TI Lot: 1 Project Description: Erosion control only Contractor: N/A Owner: TAMURA,WAKAKO L 11185 SW 109TH AVE TIGARD, OR 97223 PHONE: PHONE: 503-277-9714 FAX: FEES Description Date Amount Specifics: Erosion Control w/Development 07/24/2017 $80.70 Type of Use: SF Class of Work: OTR Project Valuation: $500.00 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 Notificati. Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direc estions to •• C by c. ing 503.232.1987 or 1.800.332.2344. Iss •d By: ( / Permittee Signature: " 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 Work ������� FOR OFFICE USE owLv City of Tigard Received 7 0"1 S 17 A Permit No.: ITaO!?- !S IN - 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.5J_962 4 2017 Date/B Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: Ea See Page 2 for Internet: www.tigard-or.gov CITY OF TtGARD Notified Method: Supplemental Information BUILDING DIVISION, TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all 0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ E.Y2ItveZ ❑ 1-and 2-family dwelling ❑Commercial/industrial 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:///B$ 4010 /69-e-4, j4LA . New dwelling area: square feet City/State/ZIP: T7ard , bi _ 9 722J Garage/carport area: square feet Suite/bldg./apt.no.: llroject name: T!�/�(,(I-a Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet A REQUIRED DATA:COMMER IAL-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 DSCRIPTIO F 'PORI work indicated on this application. �-�2oc. c vo L���� �� Valuation: $ E./203i6A) (,� Existing building area: square feet New building area: square feet OPER'I ow x 7°< -, ;TENANT Number of stories: Name: toair4.0 zijq 700.71,,frvi Type of construction: Address: //lac 4 ) l d Arm Occupancy groups: City/State/ZIP: 7t,et / e f? 72-2-3 Existing: Phone:( 1 ) 2_77- ? / ;C. Fax:( ) New: i- PLICA '' ❑ 4, t PERSO 'A,, C .. x fit=. *,, - . ., ---, ,. ,:;,- Business mBusiness 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 City/State/ZIP: applicant is exempt from licensing,the following reasons, apply: Phone:( ) Fax::( ) E-mail: Affi ter Business name: ( /Q� ' 1 F���."° BU4:1 a qTERIvoirkg Address: z.� 4 (P ,' 'rtofee schediriei, : . Structural plan review fee(or deposit): City/State/ZIP: Phone:( ) Fax:( ) FLS plan review fee(if applicable): Total fees due upon application: CCB lic.: Amount received: S© •?d Authorized signature: This permit application expires if a permit is not obtained �� L" n within 180 days after it has been accepted as complete. Print name: Gi(/L�( 4,4.-0 74/,,7,,, `Y Date: 7�2�C.-`'/ * Fee methodology set by Tri-County Building Industry C / Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(ll/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) [II 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 Valu io <t Pere .y_ (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. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2