Permit CITY TIGARD SITE WORK PERMIT
i � DEVELOPMENT SERVICES PERMIT # : SIT99 -00006
V 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 4/29/99
SITE ADDRESS: 16135 SW 74TH AVE PARCEL : 2S1 13AB 00800
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING : I -P
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?:.Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $76,016.00
EXCV VOLUME: 0 cy LANDSCAPING ?: Y
FILL VOLUME: 884 cy SITE PREP ?: Y
ENG FILL ?: Y STORM DRAINS ?: Y
SOILS RPT READ ?: Y IMPERV SURFACE: 12,782 sf ORIGINAL
Remarks: Paving, curb and sidewalk work for a new 10,097 square foot warehouse /office building.
Owner: FEES
JOHN DUNCAN
7060 SW PALMER WAY Type By Date Amount Receipt
BEAVERTON, OR 97007 5PCT GEO 2/11/99 $18.20 99- 312741
FIRE GEO 2/11/99 $145.60 99- 312741
PRMT DST 4/29/99 $364.00 99- 317948
Phone: 807 -1735 EROS DST 4/29/99 $80.00 99- 317948
Contractor: WQUN DST 4/29/99 $1,404.08 99- 317948
ERPU DST 4/29/99 $26.00 99- 317948
OWNER ERPC DST 4/29/99 $26.00 99- 317948
SIGNED RESPONSIBILITY FORM PLCK BON 2/11/99 $236.60 99- 312741
IN FILE
Total $2,300.48
Phone:
Reg #:
Required Inspections
Erosion Control Insp 844 -8444
Fill
Grading
est,4„--- Strm Drain Insp
�- Culvert/Catch Basin
(K,r(. 0 o bi- San Sewer Insp
Manhole /Cleanout - PVT
Ott,. Domestic water line inspect.
Landscaping Insp
Final Report Eng'd Grading
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 taw
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 -0' 6080. You ma obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signature: ���t" P �,
a/
Issued By: 4 � r F / //
Call (503) .39 -4175 by 7:00 P.M. for an inspection needed the next business day
/ '''°'L
d 2.-- G
Rec'd By f CITY OF TIGARD Site Permit Arlrllication
~~ Date Rec'd 2- S
13125 SW HALL BLVD. Commerc and Multi - Family: C omplete ENTIRE form Date to P.E - -
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST Fes; '
(503) 639 -4171 x304 Permit # v/ jT' 000
• Print or Type
Related SWR #
C all e d q- 0 9 I , 2 r?P
l
Incomplete or illegible applications w not be accepted
Project Name Utilities (Complete all that apply)
Job
t� r l
.,ar $ 11.t? k t !1
Address Add re ,, Storm Sewer
S
5-: 5 u -74W 3 48 Linear Ft.
N a m e: Sanitary Sewer
t JO B+ b� ►� ► �a►� 20b Linear Ft.
Owner M ailing' Addr ess Fresh Water
� o r o W P P� L+ ! n F 4j r t
Ci /State Zi 20 Linear Ft.
ty p Phone Catch Basins
' 13t;PV6�t`of Oe ° . " . 0a ' 1 '° 80'1 :1'13 y` # 1
General Name
Clean Outs
Contractor' D. 4 $ EIZ
Pnor to permit'' Mailing Address work to ne:
Issuan a " °� .; Ne w do Addition Alteration Re air
copy!o fall '' � ❑ ❑ p ❑
licenses are City /St Zip Phone Additio nal Description of Work
re q uired rf t Gy rte s► I1a�1,.1/�. •
e C O T State C Cont. "Board Lic Exp Date pa -
databa
-
Name Protect
Valuation
$ ` Z —
Architect Mailing Address Plans Re cared See Matrix n back
4
The.following must'accomp this application:,
City /State Zip Phone Site pla with Vicin Map ;Parki ( p includin l g
` F owing 'ADA complia nce ,, . ,, ' Lighting Plan n
• Name G rad i ng P I n • and<d eta ils "` 'Landcaing Pa
N1(4A 1 W
Engineer Mailing AAd Erosion Con trol PIan and Reaning Structures
P O . zt7ri 23'18 details ' I J includint i g calcu
City /State Zip Phone Site Utilit a nd detail's Soils Report
'1 b 20 • 2 o P ��0 "( connecti t o ✓ (if require
It 4At2d� q 2$) „ap s
Excavation Volume I hereby acknowledge that I have read t his application at th • (Soils report required for >5,000 cu. Yards) i n f o r mation given is cor that 1 ' am the -owner or authori
the
cu. yds. a of the owner an d that pl su are in com
with Oregon , State la
Fill Volume Sign o Owne / Date
(Soils report required for >5,000 cu. Yds.) (b84•6
cu. yds.
Will the fill support a structure Contact Person Nam e ' Phone
(Engineer required if answer is yes) YES�/J NO
J tNt Aµ oR �wS ` t�2o Z oB
Retaining structure? (check one) 14 ❑Rock FOR OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
❑Other
Total new impervious area including all Land Use � Case # Map/TL#
buildings, sidewalks, and paving (2 Sq. Ft. , bRci% -7()92-I ,2S / /3/f�/S �
is \dsts \forms\site - app.doc 10/30/98 3‘ Y
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2.zi /. o //. 2-1 i
.. • COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plait ttr
:....... .
R ow s dependent upon submittal of BOTH ptans AND a MP E € ;>
o ica. ion > :For an eaeccal s bmitta , th .ca..on >...,:..;: is ain . >:. o. _ >:::
pp .:...::.::::::::::::::: ::::.:.:::::: >::.:::�3:.;�h�.:a .:.Iicattc�� � rtt�tr� . #h�.:::::::::::::::::::::::
of the supery si electr�er n before ptan review will be conductet 0 <: <:: >::: >::
Afte plan revru e appror l,, flans Examiner wilt ta
conct the applicant to request
::: : ti:80 lait.6ts faratisttt loan. yt e.:
s. Oa :: >: <> e .: :, :.. : ::.!.::.;:.;:.;;:.::.;:.::;:
�F �U�MITTAI:� Plans ;::. KEY:
S (Private) ::::..................... ...............................
tted
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:
:�...aded:::ateas::::desr < o te: ALT.. ubrrrrttals: >::>::> :::::::.:.::............................:.......:. :..............................
I: \dsts \forms\matrxcom.doc 12/17/98