Permit y
•
.,. a CITY OF TIGARD SITE WORK PERMIT
.` COMMUNITY DEVELOPMENT PERMIT # : SIT2008 - 00005
TIGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 5/20/2008
PARCEL : 1S136DC -04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO ZONING : C -G
SUBDIVISION: PP1995 -013 LOT: JURISDICTION : TIG
PROJECT: WINCO
Project Description: Reconfiguring existing parking spaces to 90 degree angled parking spaces and installing new
landscaping. Includes building expansion - see SDR2007 -00002
CLASS OF WORK: ADD PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 182,400.00
EXCV VOLUME: 167 cy LANDSCAPING ?:
FILL VOLUME: 167 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
WINCO FOODS INC. Description Date Amount
650 N. ARMSTRONG PL [BUPPLN] Pln Rv -Valu 3/5/2008 $590.21
BOISE, ID 83704 [FLS] FLS Pln Rv 3/5/2008 $363.21
[BUILD] Prmt Fee -Valu 5/16/2008 $56.07
[BUPPLN] Pln Rv - Valu 5/16/2008 $569.15
Phone: 208 [TAX] Valu 12% State Surcha 5/20/2008 $105.07
Contractor: [FLS] FLS Pln Rv 5/16/2008 $350.25
[ERPLN] Erosn Pln Rv CWS 5/20/2008 $26.00
ENGINEERED STRUCTURES INC [EROSN] Erosn Pin Rv COT 5/20/2008 $26.00
12400 W OVERLAND RD Refund - [BUPPLN] Pln Rv -Va 5/16/2008 - $590.21
BOISE, ID 83709 Refund - [FLS] FLS Pln Rv 5/16/2008 - $363.21
(additional fees not listed here)
Contact #: PRI 208- 362 -3040 Total $1,212.54
FAX 208 - 362 -3113 REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681-4444
Reg #: LIC 77160
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 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B -! j`_ . - _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
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Site Work U l V CP/
Building Permit Applicatio s *� ' , „ . , f s, ,, , I OR O f I I C US O \L '
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City of Tigard � � Permit No.: •
i `' 13125 SW Hall Blvd., Tigard OR 97223 �1�� �' �11�t�flxfl' Date /B : ` ,I j . "At — . .
yc - an evew
{ p 1 >I Other Permit: c,
P hone: 503.639.4171 Fax: 503.598.19, 1aetotie N Date i ��Iiv / /tJ54
Inspection Line: 503.639.4175 C3� 1 Date Read /B
TIGARD r, Ins i 4175 p Ready /By: j tuns: I_lSee Page 2 for
,r _. Internet: www.tieard- or.gov Notified /Method: �( . t r �i J Supplemental Information
en ' ( e e7 ,
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 ❑ Other: - , equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1 and 2 family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of Floors:
Job site address. 7501 SW Dartmouth Street New dwelling area: square feet
City /State /ZIP: Tigard, Oregon Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Tigard WinCo Parking Lot Improvements Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area square feet
REQUIRED 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 an
Tax map /parcel no - 1 S 136CD04300, 1 S 136DC04500 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1 A wv0.
Reconfigure existing parking spaces to 90 degree angled parking spaces and install valuation: I9 -1 O.G0 --
new landscaping Existing building area square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name. WinCo Foods Inc.; Dave Van Ettan Type of construction:
Address: 650 N Armstrong Place Occupancy groups:
City /State /ZIP: Boise, ID 83704 Existing:
Phone: ( 208) 672 -2017 Fax- ( ) New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: WRG Design, Inc. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: Chris Negelspach under ORS 701 and may be required to be licensed in the
Address: 5415 SW Westgate Drive, Suite 100 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: Portland, OR 97221 apply:
Phone: ( 503 ) 419 -2500 Fax:: ( 503 ) 419 -2600
E mail chris.negelspach @wrgdesign.com
CONTRACTOR
Business name: To be determined � , . I _i - _t i �` f BUILDING PERMIT FEES*
r (Please refer to fee sehedul
Address: /?�te%) G(( ✓l1 Structural plan review fee (or deposit): 1("596 21
City /State /ZIP: XJs /�28 -?7°"
1 ! 1 FLS plan review fee (if applicable): # 3
Phone: (Doir) 4 3(`3�o Fax: (ot '3C d__....3 //
CCB lic.: 77/6 Total fees due upon application: p is-3.42_
Amount received:
Authorized signature: c- , J This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Chris Negelspach Date: 02/26/08 * Fee methodology set by Tri- County Building Industry
Service Board.
1:Building \Pennits \SIT - PermitApp.doc 12/27/06 440- 4613T(11/02 /COM/WEB) 0p 17/9'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: S!T2008-0000S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/20/2008
Phone: (503) 639-4171 Ato
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/21/2008 TIME: 7:00AM PAGE: 31
SITE ADDRESS: 07601 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: PP1995 LOT #: TYPE OF USE:
PROJECT NAME: WINCO
DESCRIPTION: Reconfiguring existing parking spaces to 90 degree angled parking spaces and installing new
landscaping. Includes building expansion - see SDR2007-00002
OWNER: WINCO FOODS INC., PHONE #: 208-672-2017
CONTRACTOR: ENGINEERED STRUCTURES INC PHONE #: 208-362-3040
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
406 Excavation 070200-01 208-484-2878
Corrections/Comments/Instructions:
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•
&I6-,
El PASS .
TIAL APPRONPI El CANCEL NO ACCESS
LIJ FAIL lig CALL FOR INSPECTION Li ADDITIONAL FEES ASSESSED
Inspector: Date: Z--/ C Phone #: (503) 718- 249V