Permit 4 % ; CITY � TIGARD
SITE WORK
DEVELOPMENT PERMIT m��
m�m��w�n���w "�om�nmw SERVICES PERMIT # ^ SIT96-0055
3;i ��� 13125 SW Hail ��'��d�����������
--''=' `---" DATE ISSUED: 12/20/96
PARCEL: 2S101AA-09000
SITE ADDRESS...: 12570 SW 69TH AVE
SUBDIVISION.....: MLP95-0013 ZONING: C—P
BLOCK ^ LOT ^001
TYPE OF WORK: COM PAVING? • Y RESO. NO.:
EXCV VOLUME: 0 cy GRADING?...:-..,..: N VALUE...$: 56400
FILL VOLUME: 0 cy LANDSCAPING?'' • Y
ENG FILL? • Y SITE PREP? ^ Y
SOILS RPT REQD?: Y STORM DRAINS?...: Y
. IMPERV SURFACE: 14008 sf
Remarks: Site and grading permit for an 8,200 sq ft office building on a site
which is developed with a single family residence.
Owner: FEES
J T ROTH JR ' type. amount by date recpt
12540 SW 68TH AVENUE PLCK $ 197.60 JH 10/30/96 96-285911
STE B . � .. ��' SWM, $ 955.09 BON 12/20/96 96-288052
TIGARD OR 97223 SWM $ 530.61 BON 12/20/96 96-288052
Phone #: 639-2639. PRMT $ 304.00 BON 12/20/96 96-288052
5PCT $ 15.20 BON 12/20/96 96-288052
Contractor: ERPC $ 80.00 BON 12/20/96 96-288052
S & N EXCAVATION ERPC $ 26.00 BON 12/20/96 96-288052
ASGER M NIELSEN ERPC $ 26.00 BON 12/20/96 96-288052
2070 RIDGE POINTE DR
LAKE OSWEGO OR 97034
Phone #: $ 2134.50 TOTAL
Reg #..: 047745
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control
Tigard Municipal Code, State of Ore. Specialty Codes and. all other Fill Inspection
applicable laws. All work will be done in accordance with Grading Insp
approved plans. This permit will expire if. work is not started . Strm Drain Insp
within 180 days of issuance, or if work is suspended 'for more Structural mason
than 180 days. Final Inspection
Permittee Si ature: ��@m ~
Issued By: A ` � �� ��y� 1
'--Call for inspection — 639-4175
Ilk ''''\'
• q6 -2,Y 59/(„6 .
CITY OF TIGARD Site Permit Application RIB Beck # I -,
13125 SW HALL BLVD. Private Grading, Paving, Site Accessibility Date Redd ,-
d 0 - 3 , - b
TIGARD, OR 97223 Retaining Structures, Utilities and Related Work Date to P.E. - -
(503) 639 -4171 x304 Date to DST `a - /!�
Permit # r 1(c- cce
Called ./. .- vq� V/ c-P..=...
Print or Type CJL -3
Incomplete or illegible applications will not be accepted
SD. 9% -0009
Project Nam ', / ,,/� s Utilities (Complete all that apply)
Job the. .bat y rK //c 6 2 A S/, RA -�•.• eze...�...s 35 L. F
Address Address b te_ Storm Sewer
/.35 70 sw 69 — 4 Aed G>i2,
75 Linear Ft.
Name Sanitary Sewer
.7 2 O , , R. 5 Linear Ft.
Owner Mailin Address ,2 Fresh Water
12.440 SW 481 46 - f 0 Linear Ft.
• City/State Zip Phone Catch Basins
T,acd Ca 97ZZ3 X39 2.:39 #
Name
Clean Outs
V- A/ ; KeA-(/ /:4. � - . - - # 3
+� Mailing Address _ Describe work to be done:
General //565 --5-‘;') ; :f. ' : Newer Additionp Alteration❑ Repair
Contractor City/State Zip Phone _ . Additional Description of Work: •
` r- E C,� (/ � !�l/ -7 = / OGf l7 /�
Attach State Cont. Board Lic. # Exp. Date
copy 'lid77`15 /- / 2 97 L /(/1 7 pf c, /AI Sir EP lti , yS
e
of current COT Business Tax tro # Exp. Date f'/ LJ €- (S7 1 L". iA- eFhuer, am-0,06.
licenses / 70 / - / ' 9 7 /vQ !N /1"� �j .�./7 r f {' .
Project
$ ' , �rq�
Nam " D l.4 cam_ e S 19 Valuation
Architect Mailing Address ir Plan Submittal: (3) sets containing each of the
•• A following, must accompany this application:
Ci /State Zip I Phone Site plan with Vicinity Map Parking (including l�.� C 97L33 5� I S Showing ADA compliance Q ADA) & Lighting Plan
Name /` ti Grading Plan and details k Landscaping Plan
on tcx. Engineer Mailing Address 1 Erosion Control Plan and .. j, Ret Structures
I / 7355 37,J taj �Llr �� y details including calculations
C.ty/State Zip Phone Site Utility Plan and details Soils Report / ,,
LAAt Gswe O„ 9p35 66 5 36 �8 (showing connection to (if required) Q cyt�
�L!!�� N v.7-�� approved system)
Excavation Volume 1 hereby acknowledge that 1 have read this application, that the '�
(Soils report required for >5,000 cu. Yards T •information given is correct. that I am the owner or authorized
U cu. y agent of the owner, and that plans submitted are in compliance r h,
with 0 - • on State laws. V 1
Fill Volume j Sig r ture . er /Agent Date
(
CI
Soils report required for >5.000 cu. Yds.) r
AocK oNt V 6 le er cu. yds. / 1 /0 • L9 96 c n
NII the fill support a structure o n - ct P - on Name Phone v ,
(Engineer required if answer is yes) t) !/- YESD NOD - • / x 3
Retaining structure? (check one) �`� ` DRock • FOR OFFICE USE ONLY ! oi
' / U e 0 CMU Notes: '*-0 �! A ✓� N ❑Concrete
ile I ) pother . -
Total new impervious area including all Land Use Cape # Map/TL#
buildings, sidewalks. and paving 70 Sq. Ft. 6. 7b2 )j- firr i -
i:lds
8/96 zr _
• - o t t ✓ -ey V 1 0 ill _/ L/ m 0(I 0
- _ _\
Permit # Account Description Amount Amt. Pd. dal Due
51771 '°05 Build. Permit' ` - _ - -- (BUILD) - . - 3 v i -- V o
-- - Plumb. Permit • . • - -- (PLUMB) - - -
Mech. Permit (MECH)
. ELC /ELR Permit _ MA � (ELPRMT)
State Tax (TAX) l S-'�i V X5.20
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check _ _
. Build: (BUPPLN) /q7.60 ✓ /97. 60 --8-
Plumb: (PLMPLN)
•
Mech: _ .._ - (MECPLN) - - -
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection - (SWINSP) f
Parks Dev Charge - (PKSDC)
Commercial TIF (TIF -C) _
Industrial TIF___. _ _ . _ (TIF -I)
Institutional TIF - _ (TIF -IS)
Office TIF (TIF -O)
Mass Transit TIF (TIF -MT) ..
Water Quality . - -- (WQUAL) 93 . 955 O
Water Quantity (WQUANT) 5 6-1- V C 3v lv 1
Erosion Control Permit (ERPRMT) J'v ✓ ?0•0-0
Erosion Planck/USA (ERPLAN) ,2b ✓ V7•CV. •
Erosion Planck/COT (EROSN) 4 V 26a)
Fire Life Safety - _ . . (FLS) .. -8 _ .
TOTALS: 213,1, 5 lq7 636.9 -
A