Permit , • ' CITY OF TIGARD SITE WORK
DEVELOPMENT SERVICES PERMIT
„a s0/ 11 PE RM I T # • S I T98 -0030
1 3125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08 / 24 / 98
PARCEL: 2S114AD -00100
SITE ADDRESS...: 16575 SW 85TH AVE
SUBDIVISION • ZONING: R -4.5
BLOCK • LOT • JURISDICTION: URB
CLASS OF WORK..: NEW : PAVING? • N RESO. NO.:
TYPE OF USE :COM GRADING? • Y VALUE...$: 3300�r"�
EXCV VOLUME: 0 cy LANDSCAPING? • N
FILL VOLUME: 2E00 cy SITE PREP? • N
ENG FILL? • N STORM DRAINS ?...: N
SOILS RPT REOD ?: N IMPERV SURFACE: 0 sf
Remarks : Landscaping bens for litigation.
Owner: FEES
UNIFIED SEWERAGE AGENCY type amount by date recpt
2132 SE RIVER RD PRMT $ 206.50 B 07/16/98 98- 307255
HILLSBORO OR 97123 5PCT $ 10.33 B 07/16/98 98- 307255
PLCK $ 134.23 B 07/16/98 98- 307255
Phone #: FIRE $ 82.60 B 07/16/98 98-307255
Contractor -- -- --
KEN LEAHY CONSTRUCTION INC
PO BOX 489
CORNELIUS OR 97113
Phone #: 357- 2193 $ 433.66 TOTAL
Reg #..: 000004
REQUIRED INSPECTIONS
This persit is issued subject to the regulations contained in the E x c a v a t i on
Tigard Municipal Code, State of Ore. Specialty Codes and all other Fill
applicable laws. All work will be done in accordance with Grading
approved plans. This permit will expire if work is not started Final I n s p e ct i o n
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-Y,14%110 through OAR 952-001 -0080. Your say
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187. •
Issued by: - Permittee Signature• r �L ; z 9
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
1 - I 1- 1 i 5-1 7_ yJ G
1 j
orTY OF TIGARD Site Permit Application Recd By I ��
Date Recd i ! ,
13125 SW HALL BLVD. Commercial: Complete ENTIRE form D ate to P.E. 1
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST ' 'u
(503) 639 -4171 x304 Permit # fr
Related SWR #
Called 1
.
Print or Type
Incomplete or illegible applications will not be accepted
Project Name Utilities (Complete all that apply)
Job T1-}on As Pu oPt t Quoi -D, rv(, .
Address Address Storm Sewer
1 ( 9 5 ' ) S &u `86D" Ave Linear Ft.
Name Sanitary Sewer
Vtv t F t r p "SE (Ai r =n.f r AC* r�1VC,`r Linear Ft.
Owner Mailing Address Fresh Water
3I2, 5 5r et ut�rt, (LO .) f Linear Ft.
City /State Zip Phone Catch Basins
14tLt.s g0(1.O oil. 91143 (41.1 -SZA9 #
General Name Clean Outs
Contractor #
Prior to permit Mailing Address Describe work to be done:
issuance, a New A Q Q p Q
copy of all Q ddition Alteration Repair
licenses are City/State Zip Phone Additional Description of Work:
required if
L tzo\J 0 S c. rat P I iV t:. C 'S Q. l ` 2
expired in COT State Const. Cont. Board Lic. # Exp. Date
database (\ 1 .(.%, G.A•71 cm.,
Name Project oc ,
Valuation $ 33, d00
Architect Mailing Address Plans Required: See Matrix on back
The following, must accompany this application:
City /State Zip Phone Site plan with Vicinity Map Parking (including
Showing ADA compliance ADA) & Lighting Plan
Name ,,/Grading Plan and details Landscaping Plan
V
NcR Ero(- ,\i.)1= r1 . ►f•C,
Engineer Mailing Address /Erosion Control Plan and Retaining Structures
t o S op Sw Co(Li'-, ejuau ;i QJ S..,'1'' 500 V details including calculations
City/State Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
QEYttlSVA)b Op c( 74;3 7623 - 3 70 0 approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
(Soils report required for >5,000 cu. Yards information given is correct, that I am the owner or authorized
cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill Volume Srlure of Owner /Agent Date
(Soils report required for >5,000 cu. Yds.)
C� f31: cu. yds. a� 7 • / ®
Will the fill suppon a structure Contact E rson Name Phone
(Engineer required if answer is yes) YESQ NOR'''
Retaining structure? (check one) QRock FOR OFFICE USE ONLY
Q CMU Notes:
QConcrete
❑Other /
julkik. WtS \IAA n� OKIA/ - i) 1 ' '
Total new impervious area including all Lan Use Case # Map/TUt
buildings, sidewalks, and paving 0 Sq. Ft. N.rt 2_1 l -
100
siteapp.doc 3/98
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
DISTRIBUTION TO PLANS OUT TO DST
EXAMINERS (Note a.)
TYPE OF SUBMITTAL TOTAL CPE PPE EPE CPE PPE EPE
SITE 1 1 -- -- 3 (j,o,u) -- --
B (New or Add) 1 1 -- -- 3 (j,o,w) -- --
F (New or Add or Alt.) 3 3 -- -- 3 (j,o,f)
M (New or Add. or Alt) 1 1 -- -- 2 (j,o) -- --
B & M (New or Add) 1 1 -- -- 3 (j,o,w) -- --
P (New, Add. or Alt) 2 -- 2 -- -- 2(j,o) --
B & M & i (New or Add.) 2 1 1 -- 3 (j,o,w) 2(j,o) --
E (New, Add, or Alt) 2 -- -- 2 -- -- 2(j,o)
3 1 1 1 3 (j,o,w) 2(j,o) 2 (j,o)
B & M & P & E (New, Add)
..: :i': Sir: i:.::':.:: i`> i' i:` i i<::'. Si :;:::::ip;.;:5>i:::' :i <: :: - ..
B or B . : ;: :.:
J�yy�yylI�`. ::i ':.i .: ::?: ! }:. . ;:v :: ^;.i;:. : :;: »:: i. :::• i'.:: : :. :i• i::::: ; .i'f.. :;! . is . •;ii;!.: :. {'.::: '.;i . 4: :::::::::::::::::::::!::::::::::::::::..m.
.. &P. It . ;;:: :'<::::<:i;.7}'';iii::;::.:i:. } :iii:// :i ........ ............
B &M+
I' . E . ,,lt
NOTES: KEY:
a. Before returning to DST, Plans examiner gets appropriate j = Job B = BUP
number of- revised plans from applicant, stamps and completes, o = Office M = MEC
updates and adds actions. f = Fire P = PLM
u =USA E =ELC
?:':: b ed:a, :. :.ALTS" ; tt 'o ; <: » »: >< : : : ::: >:::: > w Wash.Coun F=
............. ...............................
::::: :: : .: ;;;;.>;:.;;; :; .::;.;::.;;�:::.;;;:.::.::::: ;;:.>:;;:.::.;:; :.:i::;. >::.:: >: >:: >: h' FPS
c. FPS is a new permit category set aside for fire sprinklers and fire alarms.
d. Effective August 15, 1997, Tualatin Valley Fire and Rescue no longer requires a set of
approved plans to be forwarded to their office.
Exception, continue to forward a copy of approved fire sprinkler and fire alarm plans with
calculations.
h:lmatric.Doc
siteapp.doc 3/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
•
Location 1 CDS S g S`P '(i Suite MEC
Contact Person I Ph G PLM
Contractor f)2't (SJ2Jv'� - 0 _ Ph 'S 7 _2 r< 7 SWR
BUILDING Tenant/Owner (,C k ELC
Retaining Wall ELR
Footing Access:
Foundation 4wtvjfrL__ FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: / l
Slab SIT 6 N'000.30
Post & Beam
Ext Sheath /Shear • / L. r ,
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
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
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA i7( /) // (J � Approach /Sidewalk Date V Inspector Ext
Ot er
ice
ART FAIL DO NOT REMOVE this inspection record from the job site.