Permit (4) .A CITY OF TIGARD SITE WORK PERMIT
In DEVELOPMENT SERVICES PERMIT #: SIT2000 -00009
��I �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 4/6/00
SITE ADDRESS: 11540 SW PACIFIC HY PARCEL : 1 S136DA -00800
W
SUBDIVISION: FRUITLAND ACRES ZONING : C -G.
BLOCK: LOT: 001 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: $1,100.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: . sf
Remarks: Site work permit
Owner:
FEES
HIGH HAT RESTAURANTS, INC
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11530 SW PACIFIC HWY Type By Date Amount Receipt
TIGARD, OR 97223 PRMT KJP 4/6/00 $50.00 0001225
PLCK KJP 4/6/00 $32.50 0001225
5PCT KJP 4/6/00 $4.00 0001225
Phone: FIRE KJP 4/6/00 $20.00 0001225
Contractor: Total $106.50
OWNER OF BUSINESS
•
Phone:
Reg #:
Required Inspections
Misc. Inspection
Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952 - 001 -0080. Yo may o ain co • ies of these rules or direct questions to OUNC by
calling (503) 246 -1987. I
Permittee Signature:
Issued By: , O
,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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', Pla r
n Check # 7 "
CITY OF TIGARD Site Permit Application
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Recd s
TIGARD, OR 97223 Residence: Com lete SHADED areas D ate Recd 3
p Date to P.E. Date to DST 2 01:20%, WI Pp
(503) 639 -4171 x304 pA_I Permit #_flgetl!‘C22A
Print or Type 14--
Related SWR # /
Incomplete or illegible applications will not be accepted Called — (, - 2 - t
Project Name 1 tct'lap L.DcK ra., Key Utilities (Complete all that apply)
Job
Address Address 11540 61.4.) giclf - t (- t"1")41 Storm Sewer
n Y thaln tvz 51-7 ..-.
Linear Ft.
Name `RoGazi— , c en ea. Sanitary Sewer
Linear Ft.
Owner Mailing Address 11 S 7S 5 n.Qcr hr'c i-Loi Fresh Water
Q I I R IP Linear Ft.
City /State Zip Phone SD Catch Basins
T iel'2 ca 9
0 of 5 72 3 ( 77i6 #
General Nam , / Clean Outs
Contractor 1 ' tg #
Prior to permit Mailing Address Describe work to be done:
issuance, a New[ X1 Addition❑ Alteration0 Repair
copy of all ❑
licenses are City/State . Zip Phone Additional Description of Work: s i 'c o F I er4bft
required if it_Dr y T1 E Qo c. .IA35 - 1 c cM r.o'2A
expired in COT State Const. Cont. Board Lic. # Exp. Date w 1 C04.) cROTr - (4O5 Fag Let, z..4N17 loime
database
Name Project
Valuation $
Architect Mailing Address Plans Required: See Ma ix on back
The following, must accompan this application:
City/S Zip Phone Site plan with Vicinity Map Parking (including
r Showing ADA compliance ADA) & Lighting Plan
Name Grading Plan and details Landscaping Plan
Engineer Mailing Address Erosion Control Plan and Retaining Structures
details including calculations
City/State Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
information given is correct, that I am the owner or authorized
/ cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Grading Volume Sig - u _ o Owner /Agent Date
(Soils report required for >5,000 cu. Yds,) - O ,( f
cu. yds. / • /^, �til .1, 3 ,9t5 =cacn
Fill Volume ontact Person Name_ Phone
(Fill exceeding 12" in depth shall be compacted 4A/02E41 � / 6at3
To 90% of Maximum Density.) ^ 00 -9774
V cu. yds. .
Retaining structure? (check one) DRock FOR OFFICE USE ONLY
D CMU Notes:
{'
• Concrete 9 w tR - L _ DK 'i , ,_ C��
I' Other CO "� �,� ��y • , • Sr v./ ti 7 CO OW t� (u�'1n�
LI - l. - 2W0 aa� ti
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving 0 Sq. Ft. m YY 2c o-(x tx,
i:\dsts\forms\ste- app.doc 12/2/99
. J
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
a hcatlaa' `Foi a€ l :: r
After >plan review a ;:;:;'ro `l, Pl:::..'.> :; .:.,,:.:.;.:::.::,. wi ::.;.. .::.;::.:., , >;,::: >:: >::.;: :. >. :;: >:: >::::>
: :4Pwa , 00$ ami€te€� wig[ gootact t q ap l €cart to 51.9pg
... .. o ... �s r€b�€t€a>��::ii ;:::es <> >�� ': < >r�iar�r'�":: ` >•r> >::: >::1::: < > > < > > > > ><
:�:.:...::: �.::: �.::. .:::.::.'..:: ...:'.� i.i � T�alatir€ Slane F €rG flt l�£;'S�.'€I }. : :.>:.>:.»'; :::::::::.::::::::.: �:: :.::. s:.::.:: .:.>:::.:;;.>:.>:;:;•:;::;.s;.:
KEY:
mtt..
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
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....................................................................................... ...............................
'::¢ .::::: "i::: �# �ii' ��::i:: '::: ::: >:...i:f'�:: ..:.. ;; ...:':::::;;:::i:::::�: �5;;:222:iii::::::i.. ;•::;:: }i:;:;:;:::
NOTES:
;:: Shaded �r��� desk nat�, A�.T.suf�r��tafS �ry� .... °:.':: �.> �:::• �:�;::.:.,....::: ' : .�:.:.::::: >:::.�:::::
I: \dsts \fomts\matrxcom.doc 10/30/98
OVER- THE - COUNTER (OTC) PERMIT PLAN REVIEW
COMMERCIAL (STRUCTURAL) BUILDING PERMIT CHECKLIST
DESCRIPTION OF PROJECT: St,AZ Woc'
CLASS OF WORK: tJaoi FLOOR AREAS: EXTERIOR WALL CONSTRUCTION
TYPE OF US L: FIRST SQ. FT. N: S: E: W:
M
TYPE OF
CONSTR: SECOND SQ. FT. PROTECT OPENINGS ?:
OCCUPANCY GRP: THIRD SQ. FT. N: S: E: W:
OCCUPANCY LOAD: TOTAL SQ. FT. ROOF CONSTR: FIRE RET:
STOR: HT: FT: BSMNT: SQ. FT. AREA SEP. RATED:
BSMNT ?: MEZZ ?: GARAGE: SQ. FT. OCCU.SEP.RATED:
FIRE FIRE SMOKE HANDICAP
SPRINKLER: ALARM: DETECTOR: ACCESS:
COMMERCIAL INSPECTION ACTIONS FEE MENU
Foot/Found Post/Beam $ J am' Permit Fee
Masonry Framing $ SO Plan Review
Insulation Shear Wall $ 8% State Surcharge
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Firewall Gyp Board $ ZO FLS Plan Review
Suspended Ceiling Sprinkler Rough -in $ Add'I Permit Fee
Sprinkler Final Fire Alarm $ Add'I FLS Pln
Smoke Detector Approach /Sidewalk $ Inspection
iscellaneo G1' + $ MIS Fee
AD ' K4 rJ at ew•l).
FOR OFFICE USE ONLY:
TYPE OS USE OPTIONS (COM= commercial; CMS = commercial manufactured structure)
CLASS OF WORK OPTIONS FOR ALL PERMITS (NEW =new; Add = addition; ALT= alteration; ACS= accessory;FND- foundation;
OTR= other; DEM= demolition; REP= repair; FPS =fire protection system, NOTE: USE OTR FOR FENCES, RETAINING
WALLS, DETACHED DECKS, SIGNS, AWNINGS, CANOPIES)
I: \ovrcntr2.doc (DST) 9/99 - -
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP " min?
Date Requested S S I O AM PM cc BLD
Location 1 (S - /b P (, {{,� Suite MEC 2V ^ MEC
4i
Contact Person it Ph l0 - Z7 4 PLM
Contractor Ph SWR
ILDIN Tenant/Owner LOCH! Ku ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: � �- � p � G$�
Slab l: SIT - ctYXYcl
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
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Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
c:
;> PART FAIL
P u BING
Post & Beam
Under Slab
• Top Out
Water Service
Sanitary Sewer
Rain Drains •
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
gro
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other
Date I nspector 7 0 Ext
- PART FAIL DO NOT REMOVE this inspection record from the job site.