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Permit CITY TIGARD SITE WORK PERMIT 4r� DEVELOPMENT SERVICES PERMIT # : SIT1999 -00020 --- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 6/10/99 SITE ADDRESS: X12655 SW 69TH AVE SS ! PARCEL : 2S101AA -09108 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : MUE BLOCK: LOT: 030 JURISDICTION : TIG CLASS OF WORK: NEW PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: $140,000.00 EXCV VOLUME: cy LANDSCAPING ?: FILL VOLUME: 800 cy SITE PREP ?: Y ENG FILL ?: Y STORM DRAINS ?: Y SOILS RPT READ ?: Y IMPERV SURFACE: 13.000 sf Remarks: New site and grading permit. Owner: FEES R & D PROPERTY DEVELOPMENT LLC 7991 SW MOHAWK Type By Date Amount Receipt TUALATIN, OR 97062 SWM BON 6/10/99 $1,034.09 99- 316049 SQWM BON 6/10/99 $1,428.03 99- 316049 • PRMT BON 6/10/99 $533.00 99- 316049 Phone: 624 -7100 5PCT BON 6/10/99 $26.65 99- 316049 Contractor: PLCK BON 6/3/99 $346.45 99- 315336 JOSEPH HUGHES CONSTRUCTION MISC BON 6/3/99 $213.20 99- 315336 7035 SW HAMPTON EROS BON 6/10/99 $80.00 99- 316049 ERPU BON 6/10/99 $26.00 99- 316049 TIGARD, OR 97223 ERPC BON 6/10/99 $26.00 99- 316049 Total $3,713.42 Phone: 620 -8134 • Reg #: LIC 00045645 Required Inspections Erosion Control Insp 844 -8444 .1 Fill Grading Paving Insp Strm Drain Insp Culvert/Catch Basin San Sewer lnsp ORIGINAL Manhole /Cleanout - PVT Domestic water line inspect. 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 Signature: Q ( / Issued By: ' r" / / // Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 1 -- f • Al Rec'd By i CITY - OF TIGARD Site Permit Application DateRec'd ma 13125 SW HALL BLVD. Commercial: Complete ENTIRE form Date to P.E. I • :? TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST /o (503) 639 - 4171 x304 Permit# 1 I li- - soul() Cap 1 Related SWR # 0 L- R \e . # lT1 - [mo -VU� Called le /0'91 Ink -AC Print or Type Lbcr V /l Rmay, Incomplete or illegible applications will not be accepted roject Name �� ` P v / Utilities (Complete all that apply) Job t �J 124 cr cc./ G '7 Address Address 9tozS . Linear Ft. - ame Q_ �� ary wer � Sa a ' D L C- - C- C. c � x Linear Ft. 112 Owner Mailin Fresh Water '7? 9 / 5 e 10® CtC Linear Ft. ity/State, c l eh r 7 Zip D`2 4,7,-/ Phone G ' Catch Basin tr r,ea # Z_ General Name Clean Outs / Contractor 74. + 4 c4VS f- # Prior to permit Mailing Address Describe work to be done: issuan alai - 70s r 541 ~ /raA) Ne Addition❑ Alteration❑ Repair❑ copy of all licenses are , .� C ' i it ty /State Zip Phone Additional Description of Work: required if / (o,y4 cm 1 77iZ) y t. v`'' / d?) expired in COT State Const. Cont. Board Lic. # Ex Date database �/_ T v / lL/ i, 042 Name ( � o_ Project 'Ter v - t'O (21 g.-,— 6 / Valuation $ / y ') Qvv Architect Mailing 91/ Address Plans Required: See Matrix on back r LJ / -a� --S The following, must accompany this application: i /Stat Zip Phone Site plan with Vicinity Map Parking (including 7 6 6 cf �J !.- 7, Showing ADA compliance ADA) & Lighting Plan • e Grading Plan and details Landscaping Plan li A r Erosion Control Plan and Retaining Engineer I n d� 9 Structures • 9 g 0 • q,- r details including calculations "leilve, ar, ity/State Zip Phone Site . Site Utility Plan and details Soils Report D j 46 � (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 cu. yds. agent of the owner, and that plans submitted are in compliance on State laws. Fill Volume sure of er /Agent Date (Soils report requiked for >5,00 c Yds.) E( / q / l v cu. yds. / Will the fill support a structure ontact Person Name P one (Engineer required if answer is yes) Ylk NOD gil r y c ci 6Sp-61 Retaining structure? (check one) ❑Rock IL- F OFFICE USE ONLY ❑ CMU Notes: ❑Concrete ❑Other Total new impervious area including all Lad U e Case # Map/TL# 3, buildings, sidewalks, and paving / Sq. Ft. 5 ) g ' 0,101 � j n bCk , / F �S z I �.2D G Oh 4k siteapp.doc 3/98 9 / - t / eet►� % -ib.yN vpA` ti,� • . COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX EIRM*1011100§§4§:019 :00 4. t signAtbrexiftho:*ipefiiikifj,bfgaitaidifedf43Viitiifigiig4(iilrtWa46Efd After plan revtew approval, Plans Examiner wdl contact the appltcant to request additional plan sets f�r distnbution purposes (Copy fr 4160,111111 Total # of ...... . KEY: 01400404% 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 NOTES: lAdsts\maxtrixtdoc 07/06/98 • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 Date Requested AM PM BLD /o2 5.5 Location � 5 (A.) / / T h Suite MEC Contact Person , Ddl /■'* /Ll Ph PLM Contractor Ph SWR DING Tenant/Owner ELC R ing Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: �p Slab & Beam SIT I /a �Z 0 Ext Sheath /Shear Int Sheath /Shear Framing Insulation /Z-4 7,SZOe X 1- L E ,R,9 _ Drywall Nailing �C ' Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -suiststa S aAI-- 7 IVtS+'� - �t� �a�2 ('Q>S5► . Roof Misc: Fin ASS) PART FAIL MBING 1 Molt / 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 1 Final PASS PART FAIL SITE 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 a Inspector — Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 qq BUP Date Requested G 9-Z l l AM PM BLD Location 12,SSI C / * Suite MEC Contact Person 6 (ep flL Ph g y ! -zOnq PLM IN ek Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab Post & Beam sir 1 l qq - Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall /27/9 /A/ 413 r & ' i / ' (//'v ? Fire Sprinkler - / Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL �CUM Post & Beam Under Slab Top Out Water Service nitaLV Sep• Rain Drains Fi PAS 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 SITE 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 reinspe ion RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date • Other = Inspector Ext Final PASS PART FAIL DO NOT R MOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested $ - �l 6 1 AM `Y PM BLD Location 1 iSS1 (D61` Suite MEC Contact Person Ph Rtiq - (q 3 PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: SIT lqqq— ��CYZQ Slab Post & Beam Ext Sheath /Shear Int Sheath/Shear Framing Insulation �j � Drywall Nailing / /11 4.c/ " gq- //ko j)ortia / Mc Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof c ct rt % 64.5 ( /u Misc: Final PASS PART FAIL k PLUMBING fig// / A./Gky 6 c' 7/eteti - f' 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 S PART FAIL /Grading San' •. Sewer [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date 2 nspector Ext PART FAIL DO NOT REMOVE this inspection record from the job site.