Permit CITY TIGARD SITE WORK PERMIT
r� DEVELOPMENT SERVICES PERMIT # : SIT2003 -00019
� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/29/03
SITE ADDRESS: 12665 SW 69TH AVE PARCEL : 2S101AD -02800
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : MUE
BLOCK: LOT: 031 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 95,000.00
EXCV VOLUME: 0 cy LANDSCAPING ?:
FILL VOLUME: 2,222 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 6,691 sf
Remarks: Site work for new 6,340 sq ft, 2 -story office building.
Owner: FEES
CEDAR ENTERPRISES Description Date Amount
MARTY GOLDSMITH & RON ENYEART
4004 KRUSE PLACE [BUPPLN] Pln Ck -Valu 6/20/03 $466.02
LAKE OSWEGO, OR 97035 [FLS] FLS Pln Rv 6/20/03 $286.78
[BUILD] Prmt Fee -Valu 8/29/03 $716.95
Phone: [TAX] 8% St Tax -Valu 8/29/03 $57.36
Contractor: [ERPRMT] Erosion Cntl 8/29/03 $80.00
JOSEPH HUGHES CONSTRUCTION,INC [ERPLN] Ersn Plck-USA 8/29/03 $26.00
7035 SW HAMPTON [EROSN] Ersn Plck -COT 8/29/03 $26.00
TIGARD, OR 97223 Total $1,659.11
Phone: 624 -7100
Reg #: LIC 45645
Required Inspections
Erosion Control Insp 846 -8444
Retaining Wall /Footing
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 181 _ - vs • i • .ace, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to f• ow rules adopted b e Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 rough OAR 952 - 001 -0111. You , obt copies of these rules or direct questions to OUNC by
calling (503) •46 -6699.
.4 Issued By: 1 .1 •I e
Permittee Signature: i Alf( fet •
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/ZGG. sw b 77-w `cNYeAg -C
e Site Work
FOR OFFICE USE ONLY.
Building Permit Application Re ee/ve A 05. C0 Buil Permit No.: o�! >�oa
City of Tiand Planning Approval Other
>ly g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Revie 45.0 Other
Tigard, Oregon 97223 Date/By: / 4 - 9 Permit No.:
Phone: 503 639 - 4171 Fax: 503. - 598 - 1960 - ^ ^ G d i di Post Review Land Use
jai e _ Date /By: Case No. 3 '5 1
w
Inte ww.ci.tigard.or.us Contact Ju s.: ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name/Method: 'I i4 Supplemental Information
TYPE OF WORK REQUIRED DATA:
® New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building [� Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 2.( E ,k rog Total number of floors
New dwelling area (sq. ft.)
Suite #: 1 Bldg./M.#: Garage/carport area (sq. ft.)
Project Name: \ l 0 Cc. w_ Covered porch area (sq. ft.)
Cross street/Directions job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: 1 Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
^� ��� Q
overhead and profit for the work indicated on this application.
nua tat r n9 1 Valuation $. C 15 000
Existing building area (sq. ft.) O
New building area (sq. ft.) to SA-
Number of stories 2.
'PROPERTY OWNER 1 ❑ TENANT Type of construction N t
Name: 0
Occupancy group(s): Existing: 8
C;Q ,Y (� ,. ,pp� 1 S eS New:
Address: ��' , SIA) Kr LA,SC. Wei y 1.11
City /State /Zip: L.ct c 0 S we AD d ci
1, i g NOTICE: All contractors and subcontractors are required to be
Phone6D3 • ;13(p • b5 ' Fax: 3a licensed with the Oregon Construction Contractors Board under
11 APPLICANT • CONTACT PERSO ovi of ORS 701 and may be required to be licensed in the
: siness Name: • a; . S ►�C!lt . NW AS_ � It t ion where work is being performed. If the applicant is exempt
■
Contact Name: Male' • i
from licensing, the following reason applies:
Address: is Ap e lk .v JDD
Cit /State /Zi.: IR; r •c
Phont ., • . r • ► LV j
BUILDING PERMIT FEES*
. �
E -mail: • . 4 a.' _• rY- Please refer to fee schedule.
_
CO T' CTOR
���vireas e
Business Name: ""`,9 C-'�" �0
11 ue upon application $
dress: 8
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #: 451
Authorized / ,, (� Notice: This permit application expires if a permit is not obtained within
Signature: � I� Date: b ( "L • Q� 180 days after it has been accepted as complete.
j(M / (1' f / L � 1 c, *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
iMsts\Permit Forms\BldgPermitApp.doc 01/03
pelt 1'L n AGAft d S-? 9 l L/1 1
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SITE WORK PERMIT CHECK LIST
Commercial, Multi- Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
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.
1 Concrete
❑ Other
❑
*Total new impervious area including all buildings, '
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attach ed. The following must accompany this application:
Site Plan with Vicinity Map showing *Parking (including ADA) and
ADA compliance Lighting Plan
Grading Plan and details *Landscaping Plan.
. Erosion Control Plan and details Soils Report (if required)
Retaining Structures
*Does not apply to 1 and 2- family dwellings.
# of Plans. •
TYPE OF SUBMITTAL , Required at
(Includes New, Additions or Alterations) Submittal •
Commercial , 4
•
Multi - Family R -1 Occupancy 4
One- & Two - Family Dwelling 4'
NOTE: Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
is \dsts \forms \SIT- cheddist.doc 01/29/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 2 - 7 A BUP
Location / Z 46,c Cn T 11-(e— Suite MEC
Contact Person 90,41./Nt_J Ph ( ) c;- v I ' s 7/676 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain SIT 3 -'D d v � r
Slab Inspection Notes: A
Post & Beam ATI
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final I /
i� 1`.�/ .l� L i % /F �/ _
PASS PART FAIL a'"'
O g U rsil
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basi Manhole
o ...
ower Pan
1111 201/ PART FAIL
ANICAL
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 PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector r Ti , " Ext
ottilk O NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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