Permit .- CITY OF TIGARD
SITE WORK PERMIT •
. , o DEVELOPMENT SERVICES PERMIT # : SIT1999 -00029
.. '- II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 -4 71 DATE ISSUED : 10/5/99 1G1N41, ADDRESS: 11705 SW 68TH AVE CEL : 1 S136DD -02600
SUBDIVISION: WEST PORTLAND HEIGHTS ING :
BLOCK: LOT: 009 JURISDICTION : TIG
CLASS OF WORK: ADD PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: N VALUE: $12,000.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: sf
Remarks: Site work permit for 800 sq. ft. addition
Owner: FEES
SMITH, DEAN W +
SMITH, JO ANN MONDELLI TRS Type By Date Amount Receipt
17880 SARAH HILL LN MISC BON 6/11/99 $37.00 99- 315902
LAKE OSWEGO, OR 97035 PLCK BON 6/11/99 $60.13 99- 315902
PRMT DEB 10/5/99 $92.50 99- 318864
Phone: 5PCT DEB 10/5/99 $6.48 99- 318864
Contractor: EROS DEB 10/5/99 $80.00 99- 318864
JOSEPH HUGHES CONSTRUCTION ERPU DEB 10/5/99 $26.00 99- 318864
7035 SW HAMPTON ERPC DEB 10/5/99 $26.00 99- 318864
TIGARD, OR 97223 Total $328.11
Phone: 620 -8134
Reg #: LIC 00045645
Required Inspections
Erosion Control Insp 844 -8444
Paving Insp
Strm Drain Insp
San Sewer Insp
Landscaping 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 0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Sig ature: l a_ �_ • go,_ N.
Issu d By: '1 �� �c.!.O�, /A...___
Call (503) 639 -4175 by 7:00 P.M. f• an inspection needed the next business day
N.
' CI TIGARD Site Permit Application Plan Check i4 " C
13125 SV1/ HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Recd B y IQ
Date Recd lD - -1 -I -
TIGARD, OR 97223 Residence: Complete SHADED areas Date to P.E. - 1 • 4 i
(503) 639 -4171 x304 Date to DST a q
Permit #'Tl°?'t.. "-v..,
Related SWR #
Print or Type Called 9, --1-i -
Incomplete or illegible applications will not be accepted
Project Name: _ _ • - Utilities (Complete all that apply)
Job :MOUNTAIN PACIFIC MACHINERY, INC...
Address ' Address Storm Sewer L ,it, --
11705 SW 68TH AVE,TIGARD,OR 97223. — 0 — Linear Ft.
Name Sanitary Sewer L.; do .'
- . DEAN AND JO ANN SMITH — 0 Linear Ft.
Owner Mailing Address- Fresh Water 11t• .T
• 17880 SARAH HILL •LN _ . 0 -- Linear Ft. • L t O SWEGO OR 97 62O -7349 Catch Basins 4fi
General Noma:, J PH HUGHES CONSTRUCTION, INC. Clean Outs
Contractor #
Prior to permit Mailing ddress Describe work to be done:
i ssp a o ala 70 SW HAMPTON ST New': AdditionIB Alteration': Repair': •
• licenses are ` / Phone Additional Description of Work:
required if 1( OR 972 �1`i 624 -7100 .
expired In COT State Const. Cont. Board Lic. # Exp. Date R-T7i1 JA goo I
database . CCB# 45645 •
Name Project •
DENNIS E. BATKE Valuation $ 12,000. . -
Architect Mailing Address Plans Required: See Matrix on back
1810 NW OVERTON The following, must accompany this application:-
City/State Zi Ph o,�te Site plan with Vicinity Map Parking (including
P OR 97209 242-9391 Showing ADA compliance ADA) & Lighting Plan
Name ' Grading Plan and details Landscaping Plan
TIM R.FROELICH CONSULTING ENGINEERS
Engineer Mailing Address Erosion Control Plan and Retaining Structures .
6969 SW HAMPTON ST • details including calculations
City/State Zip Phone Site Utility Plan and details Soils Report
TIGARD, OR 97223 624 -7005 . (showing connection to (if required)
approved system)
Excavation Volume 1 hereby acknowledge that I have read this application, that the
(Soils report required for >5,000 cu. Yards) information given is correct, that I am the owner or authorized
E t)1 11 cu. yds. agent of the owner, and that plans submitted are in compliance
with regon State laws.
FiII Volume Si ture of Ow ,r/Agent Date
(Soils report required for >5,000 cu. Yds.) ' (rr 1 6 -4 -99
cu. yds. ` OLAQA3
Will the fill support a structure Oontact Person N -It - Phone
(Engineer required if answer is yes) YESD NOR.. DEAN SMITH 1' - 639 -7635
KAREN JOSLIN
Retaining structure? (check one) DRock FOR OFFICE USE ONLY
A D CMU Notes: !
DConcrete /l 1 s ( Tt 1 1
DOther
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving 14 Sq. Ft.
i:.dstsVormsksite- app.doc 10/30/98 T _ '(f _ l) LA/. ' i
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COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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.. bmitte05
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 :ldsts\forms\rnatrxcom.doc 10/30/98
•
04/21/2000 Activities for Case #: SIT1999 -00029
2:34:42 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SITC005 Application received 06/04/1999 BON RECD No Hold BON 06/11/1999
SITC008 Permit Created 06/11/1999 BON DONE No Hold BON 06/11/1999
SITC010 Check for prcl. restrict. 06/11/1999 06/11/1999 06/11/1999 BON DONE No Hold BON 06/11/1999 Minor Modification letter
attached.
SITC013 Plans Routed to Plans Examiner 06/11/1999 06/11/1999 06/11/1999 BON DONE No Hold BON 06/11/1999
SITC015 Plan Rev. Ltr Sent to Ofc Svcs 06/21/1999 06/21/1999 NOTE No Hold RDP 06/21/1999 To Typing Pool 6/21/99
SITCO26 Plans approved by CPE 08/09/1999 08/09/1999 08/09/1999 RDP DONE No Hold RDP 08/09/1999
SITCO30 Reviewed plans routed to DSTS 08/09/1999 RDP DONE No Hold RDP 08/09/1999
SITC700 Erosion Control Insp 844 -8444 08/09/1999 08/09/1999 No Hold RDP 08/09/1999
SITC730 Paving Insp 08/09/1999 08/09/1999 N/A No Hold RB 03/09/2000
SITC740 Strm Drain lnsp 08/09/1999 08/09/1999 N/A No Hold RB 03/09/2000
SITC750 San Sewer Insp 08/09/1999 08/09/1999 N/A No Hold RB 03/09/2000
SITC760 Landscaping Insp 08/09/1999 08/09/1999 N/A No Hold RB 03/09/2000
SITC799 Final Inspection 08/09/1999 08/09/1999 03/08/2000 TLP FAIL No Hold RB 03/09/2000 See: BUP1999 -00237
SITCO32 DST Post - Review Completed 08/17/1999 BON DONE No Hold BON 08/17/1999 OK to issue per Mark Roberts
this date.
SITC080 (F) Ready to issue 08/17/1999 BON DONE No Hold BON 08/17/1999
SITC092 (F) Issue permit 10/05/1999 DEB DONE No Hold DEB 10/05/1999
SITC799 Final Inspection 04/17/2000 TLP PASS No Hold AKJ 04/17/2000
SITC800 Case Finaled • 04/17/2000 AKJ DONE No Hold AKJ 04/17/2000
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