Permit CTY TIGARD SITE WORK PERMIT
• I r„ DEVELOPMENT SERVICES PERMIT # : SIT2001 -00010
�i' DATE ISSUED : 5/25/01
. + Lsr „ � __ -^4' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11560 SW 67TH AVE PARCEL : 1S136DD- 001-86
2-
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : MUE
BLOCK: LOT: 004 JURISDICTION : TIG
•
CLASS OF WORK: PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $120,000.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT REQD ?: Y IMPERV SURFACE: sf
Remarks: Site work permit for new office building.
Owner: FEES
GREEN, JOSEPH W
PO BOX 759 Type By Date Amount Receipt
PORTLAND, OR 97207 PRMT CTR 5/25/01 $822.30 27200100000
PLCK CTR 5/25/01 $534.50 27200100000
5PCT CTR 5/25/01 $65.78 27200100000
Phone: FIRE CTR 5/25/01 $328.92 27200100000
Contractor: Total $1,751.50
JOE GREEN INVESTMENT INC
PO BOX 759
PORTLAND, OR 97207
Phone: 503 - 678 -6266
Reg #: LIC 57652
Required Inspections
Erosion Control Insp 846 -8444
Excavation
Grading
Paving Insp
Strm Drain Insp
Culvert/Catch Basin
San Sewer lnsp
Manhole /Cleanout - PVT
Domestic water line inspect.
Landscaping lnsp
Final Report Eng'd Grading
Final Inspection
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 don n accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, o . w• suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by ! e Or-t• Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -1180. •; (ay obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signa re: 4.
Issue y: ARAM- - Cat IZ%.0
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.�_. �r i 2
B Permit Application
A Date received: s / 0/ Pemut no.:c5/ / -000 /0
r � iy? City of Tigard
- Project/appl. no.: Expire date:
` °
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
one: (503) 639 -4171 Date issued: By:. Receipt no.:
e. Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: c r.) k goon - / S 1 &2 family: Simple Complex:
TYPE OF PERMIT ,
0 1 & 2 family dwelling or accessory U Commercial/industrial 0 Multi - family New construction O Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: // Sire) 40 0 7 - 4 Bldg. no.: Suite no.:
Lot: I Block: (Subdivision: I Tax map /tax lot/account no.:
Project name: cmE A) n,K4 Cf. Oyu✓ `.V7A)
Description and location of work on premises/special conditions: /1 tape 411 —,
'OWNER . - ; FOR SPECIAL.INFORMIATION, USE CHECKLIST
Name: e -, (Floodplaii septic capacity, solar, etc.)
Mailing ito ,e 74- 1 & 2 family dwelling:
City: p f fit?!.,/ IS Q (ZIP: 0 7 Valuation of work $
Phone: ct9 ? j 7e2f, 'tIFax: cl t.-e_ I E -mailz , j ut . ING m
No. of bedroos/baths
Owner's representative: SA Aji , 1 Xetal number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT ' Garage carport area (sq. ft.)
Name: rho. Te.P/v/ Covered porch area (sq. ft.)
Mailing _ e Deck area (sq. ft.)
®ff I'�j Other structure area (sq. ft.)
hone:S'03 (7 b 2 Fax: c'q� E-mail: /ep,.1"6T j7VG Commercial/indus tri a1/multr family:
P c Valuation of work $ \ 2�c;c. i} <
,- ; _CONTRACTOR
�
- Existing bldg. area (sq. ft.)
Business name: tie 9l�ON� ..- dPJ /i.,60...- ���
Addres . 7c-9 New bldg. area (sq. ft.)
City. c f f � N _,/ 1s I ZiP y/ Number of stories
6L6(I Fax: , f 9,-e E -mail6 e /
Type of construction
Phone: SW Z 7
r�'''� 6 � • upancy group(s): Existing:
CCB no.: ,c74 2- S - -0/ Lr . New:
City/metro lit. no.: G j 1 Notice: All contractors and subcontractors are required to be
' ARClliTECT licensed . 'tensed with the Oregon Construction Contractors Board under
Name: f ,i Fpm UN' provisions of ORS 701 and may be required to be licensed in the
Address, 2;' . A r ■r� /` / e jurisdiction where work is being performed. If the applicant is
�m' .' j IP: _ exempt from licensing, the following reason applies:
Contact person: 47. , / - Plan no.:
Phone:So 3.2c/, , 3§ Fax5p3 -2ygdt -mail:
_ ENGINEER .:.
Nam: ( / orA i9 1/e'r Co l . ct pe Fees due upon application $
Address �, i e ... Date received:
•
/�1ZIAT Wal ZIP :. INI' Amount received $
Phone: So - 2/e. 0 '2 ! Fax: 'mail: Please refer to fee schedule.
I hereby certify I have • .. 4 d : amin:. , s application and the Not all Jurisdictions accept credit , please call jurisdiction for more information
attached checklist. All p . isi'ns of 1. 1 d ordinances governing this 0 Visa 0 MasterCard
work will be complied wi hether s ,':f ified herein or not yiy0, Credit card number / /
Expires
Authorized signature: !- Date: Name of cardholder as shown on credit card
$
Print name: - ( /
J
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6A0/COM)
c.
SITE WORK PERMIT CHECK LIST
Commercial and Multi - Family: Complete ENTIRE form.
Residential: Complete SHADED areas only.
• 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 "TAN" 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 Parking (including ADA) and
showing ADA compliance Lighting Plan
Grading Plan and details Landscaping Plan
Erosion Control Plan and details Retaining Structures
Site Utility Plan and details Soils Report (if required)
(showing connection to approved
system)
i : \dsts \forms\sitecheddist.doc 12/21/00
r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2001••00010
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5!25/2001
Phone: (503) 639 -4171 tact
Inspection Requests (24 Hrs.): (503) 639 -4175 `'f L
INSPECTION WORKSHEET FOR DATE: 7/12/2006 TIME: 7 :05AM PAGE: 14
11560 SW 67TH AVE
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 044 TYPE OF USE:
PROJECT NAME: GREEN OFFICE COMPLEX
DESCRIPTION: Site work permit for new office building.
OWNER: PHONE #:
CONTRACTOR: JOE GREEN INVESTMENT INC PHONE #: 503-678-6266
Inspection Request Scheduled For: Date: 7/1712006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 032993-01 503 - 806 -3004 Y
Corrections /Comments /Instructions: r E
tip a
----- 1 Ilf:i■ &Mr
---7- .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • CALL FORINSPECTION ❑ ADDIT NAL ES ASSESSED
0■4 �'}
Inspector: , I : Date: v Phone #: (503) 718 - Z/
CITY' OF TIGARD ��
BUILDING DIVISION PERMIT #: z 1 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 „.. „.. ' J --.
INSPECTION WORKSHEET FOR DATE: c2(Z7 ® T IME: PAGE:
,
SITE ADDRESS: t ( <co / CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT ON:
DESCRIPTION:
OWNER: (�� PHONE #:
E ��
CONTRACTOR: ' ( t � PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
4qc S tre_ Foi& —
Corrections /Comments / Instructions:
j l l2( Fe_ Ft "-- LO • • '.: Ts" /. Pcv. (' FO-c EU &-U _el>--1 kig--
i' ori 1.0,,E
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
_ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
1
j741r
CITY OF TIGARD 24 -Hour
o BUILDING • Inspect lire: (503) 639 -4175
INSPECTION DIVISION . Business Line: _ (503) 639 -4171 MST
BUP
Received //__ Da at �--
teRequested 1 1 AM PM BUP
Location _// & 0 Oi) ( 7 444- u Suite MEC
Contact Person t& • a/M-4/ Ph (_,) k 9 (3 3'4 PLM
Contractor �..- Ph ( ) - SWR
BUILDING Tenant/Owner - ELC
Footing /I
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: IT 1 — 00 LO
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
•
Framing w-= =��=
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof a / / A • — �
Other: `
Final
PASS PART FAIL
PLUMBING
Post & Beam -
Under Slab
Rough -In 61 ' - ` ` / dliv
Water Service
Sanitary Sewer
Rain Drains
Catch B- sin / Manholl , --
• -r *an rAi 11 5 .1 ■‘ffMr vP
Other:
Fi
PART FAIL
ANICAL Zit
Post •& Beam
Rough -In j;/ / /"
Gas Line
Smoke Dampers _ -
Final .
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab -
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd:
PASS PART FAIL .
SITE ❑ Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO I OT REMOVE this inspection record from the Job site.
PASS PART FAIL •
CITY OF TIGARD 24 -Hour
•
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: i (14639 -4171
MST
BUP
Received Date Requested -.AS AM PM BUP
Location / /.c& /I 4ve Suite MEC
Contact Person �'►�l�" Ph (Ce cr ) SD3 SD7— 8'33 PLM
Contractor q•/• ' - pc.-44 Ph ( ) SIAM
.Te a nt/O C wner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain • Cp 2D D/ - D OO! O
Slab Inspection Notes:
Post & Beam
Shear Anchors /
Ext Sheath/Shear t 1 eCk% t '
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
•
Fire Sprinkler
Fire Alarm ! -
��
Susp'd Ceiling — — /�
—
Roof
Other: -
Final
PASS P T FAIL
Beam - -
Under Slab
Rough -In
Water -- • ' --
'am Drains
Catch Basin / Manhole y e c
Storm Drain
Shower Pan
Other:
Final c eo
PASS FAIL
MECHA AL -
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL .
ELECTRICAL
Service -
Rough -In
UG /Slab -
Low Voltage
Fire Alarm . -
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PA RT FAIL
SITE 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approa /Sidewalk Date ?5/6:3 Inspector Ext
Other. S
Final - DO NOT REMOVE this inspection record from the Job site. _
PASS PART FAIL -
ITY OF TIGARD 24 -Hour ` '
. BUILDING Inspection Line: (503)639 -4175 • _ •
INSPECTION Business Line: - (503) - 4171 MST
BUP
Received Date Requested 9-26) AM PM BUP
Location 11 ( CO ALL Suite MEC
Contact Person 2"r ! JJ �rt vt 4/1. Ph ( 50 ' cS v 7 — F3 3 5`PLM
Contractor �� c `vt.(,�d'1•Ph ( ) SWR
BUILDING Tenant/Owner ELC
•
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SI f — 05 QC) 1 C�
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation �j /
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling .0" '' i � �
Roof
Other: `L L 21 11 l i
� i/ ii/
Final
PASS PART FAI
• UMBIN `1' i1 ' ; ;;% !' j i►��� /I
Post & Beam
Under Slab
Rough -In
Water Servic t
unitary Sewer,
Rain I •' ,
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PART FAIL
'CHANICAL
Post& Beam
Rough -In -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service -
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Li Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date w i Inspector 0 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL