Permit CITY TIGARD SITE WORK PERMIT
44. ,. DEVELOPMENT SERVICES PER # : SIT2004 -00002
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 3/12/04
SITE ADDRESS: 12703 SW 67TH AVE PARCEL : 2S101AD -01000
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : MUE
BLOCK: LOT: 033 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 26,000.00
EXCV VOLUME: . 399. cy LANDSCAPING ?: Y
FILL VOLUME: 0 cy SITE PREP ?: Y
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: N IMPERV SURFACE: 1.817 sf
Remarks: Site work including grading, utilities, parking, landscaping for 2310 sf one story office building
Owner:
FEES
EQUITY GROUP FUND ONE, LLC Description Date Amount
[BUPPLN] Pln Ck -Valu 1/27/04 $583.66
[FLS] FLS Pln Rv 1/27/04 $360.12
[BUILD] Prmt Fee -Valu 1/27/04 $290.80
Phone: [TAX] Valu 8% State 3/12/04 $23.26
Contractor: [FLS] FLS Pin Rv 1/27/04 $116.32
BEACON HOMES NORTHWEST [ERPRMT] Erosion Cntl 1/27/04 $72.64
PO BOX 407 [ERPLN] Ersn 3/12/04 $26.00
WILSONVILLE, OR 97070 [EROSN] Ersn 3/12/04 $26.00
[WQUANT] Wtr Quant 1/27/04 $275.00
Phone: 503 - 570 - 8828 [BUPPLN] Pln Ck -Valu 1/27/04 $189.02
(additional fees not listed here)
Reg #: LIC 151251
Total $1,019.04
Required Inspections
Ersn Cntrl 681 -4444
Paving Insp
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 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.
Issued By: da,t,zazta....
•
Permittee Signature: alpj At „I - JRL
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
rr Site
•
Buillk erm it Application FOR OFFICE CSE ONLY
City of Tigard Day/ _27.0q J"/, Penult No.: 5/ T1eoy -0000Z
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
,Allhi
Phone: 503.639.4171 Fax: 503.598.1960 ' ' I` i +� Date/By:3. -Oy /DV Other Permit SPA 200 3 - 0001/
Inspection Line: 503.639.4175 . e1 1 Date Ready/By: luris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE _.OF WORK RLQtFIRPMATA N4D 2 FAMIL Y DWELLING
n 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
CAT
ECORtY Olt :',CON : I V ?EON work indicated on this application.
❑ 1- and 2- family dwelling Comercial /industrial Valua • • $
m
El Accessory building El Multi-family Number o • rooms:
❑ Master builder ❑ Other: Number of bathroo
do» SIDE INFORMATIO)4 s.ND £OC.4TY01!i Total number of .ors:
Job site address: 1 03 sw ( -n L N I New dwelling area. square feet
City/State/ZIP: ■ . . O � , ITT Q �
7 Garage /carport area: squ: : feet
i
Suite/bldg. /apt. no.: f� Project name: ms's " V . y .' V overed porch area: square fe
Cross street/directions to job site: S W c - 7 ... C 7 Cr Deck area: square feet
, = i• ■ tr. k C ∎i 1 •. E ■ M '*J • ■ • Other structure area: square feet
REQUIRED I ATA.- COMM RCIAL -USE CHECKi.IST -;: get
IIID
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2�j 1 D 1 ODO Indicate the value (rounded to the nearest dollar) of all
1 equipment, materials, labor, overhead, and the profit for the
DE�IiOI►i OF WOIij °° work indicated on this application.
I * � tsg , / / Valuation: $ �, 000 5
Existing building area: 1Q square feet
New building area: 23 ` O square feet
PROPERTY OWNS i EN
ANT' Number of stories: Nj'
Name: — 4.. � A l A x �,�! Type of construction: V .. N4
Address:c � I� �i 1 (� a f'�► Occupancy groups:
City / State/ZIP: ( : ►, .. ` r �7 E xisting: ---6-3---..
Phone: Imo) 70 , t,.�i : r Fax: ( 6 A (' ` it j New: IS
b . %1PI.:I;C.ANT : .° O13T
- CACT PE iOTICE
Business name : - }�� IN 'TT 4 As ,,,, � G J All contractors and subcontractors are required to be
Contact name: '" j n Fi 5 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: ?.2 2 (&j /e-"tY 4 1 jurisdiction in which work is being performed. If the
City /State/ZIP: reiz_m ` D I t` . 17 � eT applicant is exempt from licensing, the following reasons
4;713s apply:
Phone: (5-0) 2260 - t f 1 Fax :: (t +"4 . �� I I
Email
55 �� e Gt,V'Gt,G 1'` G,1,
CONTRACTOR
Business name: / coyj f ?
$UILDINIG PERMIT FEES
Address: 7
/� %' ' Please refer to fee schedule
City/State /ZIP: - 1L� .. �'
• Fees due upon application
Phone: (Q ) • , 11,_`, Amount received
CCB lic.: 5 mrs 44111111M1111111I�
t. Date received:
Authorized signs • / Wee ' This permit application expires it a permit is not obtain'
/ within 180 days after it has been accepted as complett
Print name: i� _ A i, -1-, jps a* Date: . - D - * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Pemrits\SIT- PenuitAoo.doc 440- 4613T(I1/02/COM/WEB) "
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
BUP
Received u/ p X Date Requested /7, ?' O AM PM BUP
Location /2-76 7A, Suite MEC
Contact Person Ph ( 'o 5 - V) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
• Crawl Drain
Slab Inspection Notes: SIT 2a,p 1 /-oddd
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
Framing
Insulation
Drywall Nailing OW/ ` `� I /ice" S
Firewall - � j i .
Fire Sprinkler ' • •
Fire Alarm _ r- P I alb ! -
Susp'd Ceiling I. w w w
' _
Roof
Other:
Final
PASS PART FAIL
PLUMBING , •
Post & Beam Alp '
Under Slab _ • I J
Rough -In II "'ilk - W
Water Service -
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: '
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In �.� /I 41
Low Vot Voltage t � ®• /����,�
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: Unable to inspect - no access
Fire Supply Line •
ADA
Approach/ ide� Date Inspector Ext
Othe
ink DO NOT REMOVE this inspection record from the Job site.
•ART FAIL -