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Permit • �C it Y O F TIGARD SITE WORK PERMIT 11. COMMUNITY DEVELOPMENT PERMIT # : SIT2007 -00012 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 9/5/2007 PARCEL : 2S101AC - 01900 SITE ADDRESS: 12615 SW 72ND AVE ZONING : C - SUBDIVISION: LOWE'S HIW, INC LOT: JURISDICTION : TIG PROJECT: LOWE'S Project Description: New paving and parking relocation. CLASS OF WORK: UNK PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: 25,000.00 EXCV VOLUME: cy LANDSCAPING ?: Y FILL VOLUME: cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: N IMPERV SURFACE: sf Owner: FEES LOWE'S HIW, INC Description Date Amount HWY 268 EAST [BUPPLN] Pin Rv -Valu 3/27/2007 $184.15 NORTH WILKESBORO, NC 98055 [FLS] FLS Pin Rv 3/27/2007 $113.32 [BUILD] Prmt Fee -Valu 9/5/2007 $283.30 Phone: 336 - 658 - 7519 [TAX] Valu 8% State Surcha 9/5/2007 $22.66 Total $603.43 Contractor: ARRIS CONSTRUCTION 5155 BAINS GAP RD. ANNISTON, AL 36205 Contact #: PRI 256 - 237 - 1601 REQUIRED ITEMS AND REPORTS Reg #: LIC 172662 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 or 1.800.332.2344. Issued 40 li i i , / / Permittee Signature i Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Site. Work 4 eb , H H b odd b ( —r 000/ E Building Pe °r'mit Auplicatio 0 EC - VED - , rolz OFF I C E USE ONLY City of Tigard MAR 2 7 200 7 ReeBed , A -Die, Pemrit No r 7 -O6W / ° 13125 SW Hall Blvd., Tigard, OR 97 _ _ pl �„ P :h I N Phone: 503.639.4171 Fax: 503.5 tY GP 1 IijsgR© Date/B . /� �` / _ A d Other Permit: Inspection Line: 503.639.4175 DING DIVISION IO Date Ready :y: �� �71; ® See Page 2for i ` \ L) Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK j IRED TA: - AND 2- FAMILY DWELLING ❑ New consction Demolition Pe , .' 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 CATEGORY OF ONSTRUCTION work indicated on this application ./ El 1- and 2- family dwelling , Commercial /industrial Valuation: $ / /.LI r! . -y El Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: f01. S 1 l' om New w dwelling area: square feet City / State/ZIP: Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: kpil )6_ Covered porch area: square feet Cross street /directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees' are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. W INUCI` 1 IG. t l.. r•/ ti{L A Valuation: $ ` in ienid Existing building area: Square feet New building area: square feet • rROPERTY OWNER I ❑ TENANT Number of stories: Name: INdoCAA; 4 ° L/ Type of construction: Address: i Ze idE, 41 V ^. Occupancy groups: City / State/ZIP R.. Existing: Phone:( ) I Fax:( ) New: PLICANT ❑ CONTACT PERSON NOTICE Business name: / G . *eV), /6240,04 t 41144,1, All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: Q,®. - e (� ` jurisdiction in which work is being performed. If the • City /State/ZIP: -TC�AR„� %. n T applicant is exempt from licensing, the following reasons 1 L ,�,, ,� // �.± apply: Phone: ( &l e a Si i Z F ax: 6 • � 7( 1 E -mail: CONTRACTOR _ Business name ,[� 7 , � eo/✓sj vetv�� BUILDING PERMIT FEES* • A (Please refer to fee schedule) Address: / _ a� �'5 ZW/4 �' Structural plan review fee (or deposit): /g .is City/State/ZIP: 4^/A//,. //(/ * t% 2ilas FLS plan review fee (if applicable): / 5 79" Phone: (07sci .237, /`d/ (Fax: ( ) Total fees due upon application: CCB lic.: 72 �b Z / Authorized signature. ` � / Amount received: aci- I/7 M This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name' i_♦ ` fI Date: • ♦® • Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\SIT- PermitApp.doc 06/26/06 440- 4613T(l1 /02 /COM/WEB) City of Tigard: Site Work Permit Checklist Page 2 - Supplemental Information Commercial, Multi - Family and One- and Two - Family Dwellings: No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If fill is in a flood plain, drainage way, or wetland, the applicant must apply for a sensitive lands review (SLR). 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 ❑ 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" attached. 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 - El Erosion Control Plan and details ❑ Soils Report (if required) ❑ Retaining Structures *Does not apply to One- and Two - family. dwellings... - y • kof.Plans • TYPE OF SUBMITTAL Required at . ' - (Includes New, Additions or Alterations) Submittal • Commercial 2 Multi- Family R -1 Occupancy 2 One- & Two - Family Dwelling 2 1:1 Building \Permits\SIT- PermitApp.doc 06/26/06 2 ' CITY OF TIGARD BUILDING DIVISION PERMIT #: SIT2007 -00012 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/24/2007 TIME: 7:00AM PAGE: 59 SITE ADDRESS: 12615 SW 72ND AVE CLASS OF WORK: SUBDIVISION: LOWE'S HIW, INC LOT #: TYPE OF U PROJECT NAME: LOWE'S DESCRIPTION: New paving and parking relocation. OWNER: LOWE'S HIW, INC, PHONE #: 336 - 668.7519 CONTRACTOR: ARRIS CONSTRUCTION PHONE #: 256.237 -1601 Inspection Request Scheduled For: Date: 9/24 /2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 499 Final inspection 066138 -01 256 -343 -2294 N Corrections /Comments /Instructions: TS PAS IN PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL /A ALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED Inspector: Date: D Phone #: (503) 718-