Permit !'
• CITY OF TIGARD SITE WORK
„w,gyp 1 A, DEVELOPMENT SERVICES PERMIT
6 ' • I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # .......: S I T 99 - 0007
DATE ISSUED: 03/11/99
PARCEL: 26101BD -00105
SITE ADDRESS...: 12805 SW 77TH PL
SUBDIVISION - ZONING: I -L
BLOCK LOT ° JURISDICTION: TIG
CLASS OF WORK..: ADD PAVING? Y RESO. NO.:
TYPE OF USE :COM GRADING? N VALUE...$: 9500
EXCV VOLUME: 237 cy LANDSCAPING ?:`...: Y
FILL VOLUME: 0 cy SITE PREP? Y
ENG FILL? . • N STORM DRAINS ?...: Y
SOILS RPT RECD ?: N IMPERV SURFACE: 6400 sf
Remarks: Expansion of parking lot
Owner: FEES
ROY GEOCKS type amount by date recpt
12805 SW 77TH PL PLCK $ 40.63 B 02/09/99 99- 312799
TIGARD OR 97223 FIRE $ 25.00 B 02/09/99 99- 312799
PRMT $ 80.50 DEB 03/11/99 99- 313623
Phone #: PLCK $ 11.70 DEB 03/11/99 99- 313623
SPCT $ 4.03 DEB 03/11/99 99- 313623
Contractor: FIRE $ 7.20 DEB 03/11/99 99- 313623
GFC CONSTRUCTION INC EROS $ 80.00 DEB 03/11/99 99- 313623
17017 CANAL CIRCLE ERPU $ 26.00 DEB 03/11/99 99- 313623
LAKE OSWEGO OR 97035 Additional fees not shown here
Phone #: 685 -9702 $ 1513.18 TOTAL
Reg #.. 000884
REQUIRED INSPECT
This permit is issued subject to the regulations contained in the St r m Drain Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Culvert /Catch Ba
applicable laws. All work will be done in accordance with Landscaping Insp
approved plans. This permit will expire if work is not started Final Inspection _
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- 001-0080. Your may
obtain copies of these rules or direct questions to OUNC by calling
1503)246 -9187.
(
Iss'_ed by: L� �� Permittee Signature: r
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + ++ + + ++ + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Site Permit Application �
Recd ey'rJbV� v�
Date Recd 2.- 11
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Date to P.E. 2- (l 11
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST ) Z v
7
(503) 639 -4171 x304 Permit# 1 t — OQDY
Related SWR #
Called A -2)22 q (L)p
• - -
j Print or Type
J Incomplete -o ill applications will not be accepted
7 )
Project Name= _ Utilities (Complete all that apply)
Job G� �'l�.� lLll1 s
Address Addre Storm Sewer
2
_;�U a' -'�.J. .�— q �Linear Ft.
, Na e "'. w - Sanitary Sewer
Owner Mailin dress X ` Linear Ft.
9 ° .. ..- ._, -: T Fresh Water
4 ` %0 �a� t ` tcL Linear Ft.
City /State , Zip,. Phone Catch Basins
' Z223 .G.'L,C 'b(n1,�. # t
General Nam
a n : := � Clean Outs
Contractor - � ��` #
Prior to permit Mailing Address Describe work to be done:
issuance a '',:] /"` /� New Additio Alteration Re air
copy:of all ' � � l �J• r . ❑ � ❑ P ❑
license are . City /St Zip,, Phone Additional Des o W equ ir ed if f ork ,
r
t i l - G `ions' 9c l EyCf?O� .Cp g ' n a ` Z ot`
expired in COT State°.Const.. Cont rd Lic;# Ex Date
database f ' �� ';;:. , . " "_.
Nam �"'% .,` Protect
l ��Y �� Va l ua $ t .:
Architect Main Address Plans _Required See Matrix on back
( 3 N� � The following, must; accompan this application,
Cit /State Zip Phone Site plan :with Vicinity Ma:p • Parking (including
le Q"'(Zpl, 20 � - Showing ADA compliance :ADA) & Lighting n Pla
. Name '''Grading: Han and ils 'deta ' 'Land s caping'Plan
Engineer Mailing Address 1 E rosion Control Plan and' ; Retaining Stru es ctur -
.'- d ncluding calculation
City /State Zip PhoneSite Utility PIan and details :Soils Report . .
(showing" connection to (lf required)
approved: system); a:
Excavation Volume 1 hereby that 1 hav this application that the
(Soils report required for >5,000 cu. Yards) information given is correct that,, am the: owner orauthorized
231 cu. yds. . agent of the owner a plans submitted are in compliance
with. State•laws.;
Fill Volume Signature of.0 e/r Agent D at e
(Soils report required for >5,000 cu. Yds.) '�
cu. yds. '.: Im,
Will the fill support a structure Con c e � _ `�"' P 22hon 3 e 1
3 5'
(Engineer required if answer is yes) YES❑ NO
Retaining structure? (check one) ❑Rock FOR OFFICE USE ONLY
❑ CMU Notes:
['Concrete l ` dtc e DOther
�_ �n�
Total new impervious area including all Land Use Case # � Map/TL#
buildings, sidewalks, and paving (,4 Sq. Ft. (v1 Ab - tc k, . (eth ` r f
c& k&, a $e si,t,r e -Fo ct'.eJe v i
i.ldsts\forms\site- app.doc 10/30/98 MO ,/
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Ian Review is dependent upon subr tttal a BOTH plans AND a COMPLETET ;: :::
o g ».;.»:.... :.. » f tl supervising eleotrrotan befiore plan review 4#111 k e contlucte
Afte plan revie approval, .Plans Examiner will c onct t
t ahe applicant to request
additional :: lan<:sets:for::distribution:< > ur .:
Washington �:f {:t.,,. :, o n : : To :. a . i :':' :.`
' n .>:.;> > :; :. e ' > <>
.;> ; P g::.111 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
NOTES:
I: \dsts \forms\matrxcom.doc 12/17/98
CITY OF TIGARD
COMMERCIAL SITE WORK PERMIT
APPLICATION /PLANS SUBMITTAL REQUIREMENTS
Applicants: Please complete
APPLICANT
1. APPLICANT NAME: - .E_ PHONE #: 22.3
2. SITE ADDRESS: 1 2-f 1 FAX # 22-3 2 (3 0
NOTE: A Site Work Permit is required on all additions, accessory buildings larger than 120 square feet,
modular structures and new buildings.
1. SITE PLAN and vicinity map (Fully dimensional, drawn to scale) showing the geographic location labeled with:
❑ map & tax lot #, ❑ project name, ❑ site address ❑ suite number
•
❑ zoning, ❑ applicant name, ❑ phone number, and identifying:
A. North Arrow.
B. Scale (Any standard, architectural or engineering only).
C. Street Names.
D. Building pads (drawn to scale) with project location.
2. BUILDING PLANS (no red line revisions or tapeons). Number of plans based on type of
submittal. See Matrix on back of application.
ALL DETAILS LISTED BELOW SHALL BE INCORPORATED INTO THE PLANS
A. Site Plan showing:
1) Required parking spaces and driveways
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance -
3) Accessible parking spaces and adjacent access aisle connecting with the
accessible route
4) Curb ramps along the accessible route, curb, sidewalk and gutter
5) Finish grade elevations along the accessible route
B. Site Detail sheet showing a detail and specifications for each of the following:
1) Accessible parking and adjacent access aisle
2) Pavement markings showing the international symbol of accessibility and;
3) Accessible parking stall signage
4) Stairway, ramp and handrail within an accessible route
C. Topographic survey plan showing grade elevations crossing the entire site
D. Overall grading plan
is \dsts \forms\site- app.doc 10/30/98
•
E. Storm drainage plan showing:
1) Finish elevations throughout the developed site
2) Grade breaks determining area serving each catch basin
3) Location of catch basins
4) Pipe size
5) Type of material
6) Slope of piping
7) Manholes and field drains
8) Cleanouts provided for each 100 feet or fraction
9) Roof drain laterals specifying cleanouts at each upper terminal
F. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm
2) Size and location of domestic water piping and drainage
3) Fire hydrant location and pipe size if on private property
4) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant
5) Size of underground water service for the sprinkler system
G. Erosion control plan complying with the requirements of the Unified Sewerage Agency showing:
1) Silt fence locations
2) Bio- filter bags /other approved barrier material surrounding catch basins
3) Illustrations detailing the correct installation of the silt fencing and catch basin protection
H. Landscaping plans
3. Additional Requirements:
A. Soils (qeotechnical) report:
A soils report is required for new building and additions.
1) The report shall address the potential of soil liquefaction and instability (OSSC Sec. 1804.2) and:
• 2) Fills to be used to support foundation of buildings (OSSC.Sec.3301.1) and:
3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft (OSSC.Sec. 1805)
B. Plan review deposit
is \dsts \forms\site - app.doc 10/30/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 API/ BUP
1 13 Date Requested AM PM BLD
Location -77 Suite MEC
Contact Person Ph 53 5-6 PLM
Contractor Ph SWR
BUILDING Tenant/Owner _ _ 1 ELC
Retaining Wall ELR
Footing Access: r —
Foundation
� Y CA FPS
Ftg Drain 4 – SGN
Crawl Drain Inspec i n Notes, ,�¢.
Slab 7 � c,� ' i FLAL) SIT ��� 7
Post & Beam /
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall 4 " 'e (3, .5 /i S ` /
Fire Sprinkler
Fire Alarm ✓ 0 n cam- ) /1.1 ` 4
Susp'd Ceiling / 'T •
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer • `
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PA PART FAIL
ackfill /Grading
Sanita Sewer
*no .5_ - -: [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
[ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire upply Line
ADA l�1I
Approach /Sidewalk "5/4/? Other Date "I Inspect° Ext
f
Fi
PART FAIL DO NOT REMOVE this inspection record from the job site.