Permit A CITY'OF TIGARD SITE WORK
� DEVELOPMENT SERVICES PERMIT
...... PERMIT #.: SIT98 -0041
e= 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 10 / 0 , / 98
PARCEL: 2S112DC -01400
SITE ADDRESS...: 15860 SW 74TH AVE
SUBDIVISION : CREEKSIDE INDUSTRIAL.PARK ZONING: I -P
BLOCK..........: LOT .............:004 JURISDICTION: TIG
CLASS OF WORK..:? : PAVING ?.........: RESO. NO.:
TYPE OF USE °COM : GRADING ? ...... °.: VALUE... $: 0
EXCV VOLUME: 0 cy LANDSCAPING ?....:
FILL VOLUME: 0 cy SITE PREP? •
ENG FILL? STORM DRAINS ?...:
SOILS RPT READ ?: IMPERV SURFACE: 0 sf
Remarks: Erosion control only.
Owner: -- -. -. -- FEES - - - -•
PACIFIC REALTY VENTURES type amount by date recpt
17700 SW UPPER BOONES FERRY RD EROS $ 80.00 B 10/02/98 98- 309671
STE 100 ERPU $ 26.00 B 10/02/98 98- 309671
PORTLAND OR 97224 ERPC $ 26.00 B 10/02/98 98- 309671
Phone #:
Contract or: --
GRIGSBY CONSTRUCTION INC
8114 SW NIMBUS AVE
BEAVERTON OR 97008
Phone #: 641- 7343 $ 132.00 TOTAL
Reg #..: 45073
REG!U I RED I NSF' CT I ONS , --
This permit is issued subject to the regulations contained in the Erosion Control — C0.W- S�q - SW 4 7
Tigard Municipal Code, State of Ore. 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 DAR 952 -001 -0010 through OAR 952 -001 -0080. Your may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
.Issued by: pv' _I,4/_ / ` Permittee Signature:
CITY OF TIGARD Site P Ar�11rrl�lication Rec'd By rid ,z,/
�
M I Date Recd 0 Z_ / v •
13125 SW HALL BLVD. Commercial: Comp lete ENTIRE form Date to P.E. r�
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST % O / - 4 ./ � r
(503) 639 -4171 x304
Permit # IT - /7t�)/t1
Related SWR # V
Called
Print or Type
Incomplete or illegible applications will not be accepted
Prote N a m e" : , n Utilities (Complete all that apply)
Job i .P l t": 'c
A l ddress Addres� -�* is 0� n x Storm Sewer
. g 1� s Gar 7 , ! 9._ x 'x Linear Ft.
IliMeligkillifigi Na e 3
r Sanitary Sewer
`tt �c� c�� Linear Ft.
'Owne Mall mg Address « - Fresh Water
' ra! ��:'rr Linear Ft.
'` City/ Z ip, Phone' Catch Basins
_� . {� �{ �y .� /y pry
General Name Ys r f, p,Ga 4 3 y 3 Clean Outs
Contractor rrsb �ar $ < #
Pnorto p erm it n Mailing A i _ 3 Describe work to be done:
issuance a
copy of all i�' New❑ dition❑ Alteration❑ Repair❑
#. Iicenses Ci /Sate �' Zi Phone s Additional D of W
3 r uire if c'
,, ;e xpi red in COT State Const Co.nt Board Lic �# ° Ezp Date 0 " ' -
database l: P - P , •
Name ;Protect, ; f s
Valuation ; $ '
Architect Mailing Address plans R equir ed See Matrix on bac +
The f must ac c o mpany t his a :
City /State Zip Phone Si te p lan with Vici Ma Parking :( includi ng
Showing ADA compliance. ADA) &. P lan ;; 4
Name Grading' Pla an tl Landscaping P ,
Engineer Mailing Address E rosion Co P l a n and Retaining Struc
d ; K `t " °�.:� including calculations
City/State Zip Phone Site :Utility Plan an details; Soils Repo
(showing connection t � � ; (if re quired)
_I approved system) , ,,.� ,,, , . _
Excavation Volume I hereby acknowledge that I hav this application that t he
Soils report required for >5,000 cu. Yards informa given is correct that I am t owner or authorized
( p q cu. yds. iagent of owner an t hat plans* are in comp ;
y with =.,Oregon -State laws „„ ; :_. ... . ' . :`.._ w.... " . r
Fill Volume Sign o f Ovvner /Agent y Date '
(Soils report required for >5,000 cu. Yds.)
cu. yds. .�'+ � � R'�S g °� � : fi
Will the fill support a structure Contact Person Name Phone g
(Engineer required if answer is yes) YES❑ NOD
Retaining structure? (check one) ❑Rock F OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
❑ Other
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving Sq. Ft.
0 St* �
siteapp.doc 3/98
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COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
an Review is dependent upon subm al of BOTH plans AND a COMP ETED > ::
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. Mobiogtot Oo €nty, Ttioiotl.rr
...... J 3 lTiA ..... .. KEY:
d.
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
S
NOTES:
areas..d
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I: \dsts\maxtrixl .doc 07/06/98