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Permit CITY OF TIGARD SITE WORK PERMIT 1� '' DEVELOPMENT SERVICES PERMIT # : 06/16/ 2000 0 -00020 " '�I� DATE ISSUED : 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 06/16/ SITE ADDRESS: 15450 SW 116TH AVE PARCEL : 2S110CD 07600 SUBDIVISION: KING CITY NO. 2 ZONING : BLOCK: LOT: JURISDICTION : KIN CLASS OF WORK: UNK PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: $12,000.00 EXCV VOLUME: cy LANDSCAPING ?: • FILL VOLUME: 560 cy SITE PREP ?: ENG FILL ?: Y STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: site work to fill existing basement. Owner: FEES TOBIAS INVESTMENT CO 300 SE SPOKANE ST Type By Date Amount Receipt PORTLAND, OR 97202 PRMT KJP 06/16/2000 $142.50 0003069 5PCT KJP 06/16/2000 $11.40 0003069 PLCK GEO 05/17/2000 $92.63 0002262 Phone: FIRE GEO 05/17/2000 $57.00 0002262 Contractor: Total $303.53 ROBERT WESTLUND GENERAL CONTRACTOR PORTLAND RD STE D NEWBERG, OR 97132 Phone: 628 -1344 Reg #: LIC 00042503 Required Inspections Fill Final Report Eng'd Grading • Final Inspection OR/G/NAL 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Permittee Signature: ,1' i we 0 i‘ 1,Z07 V Issued By: /* # 1 • Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • CITY OF TIGARD Site Permit Application Plan Check — 5 13125 SW HALL BLVD. Commercial, Residential Rec'd By Date Rec'd .- i9 E0 TIGARD, OR 97223:: and Multi - Family Cf Date to P.E. 6---2I -od (503) 639 -4171 x304 Date to DST dSf 3i? i 1a i Permit # 9/ r pew -avow Print or Type Related SWR # Incomplete or illegible applications will not be accepted Called ( i3-0 . GE r Vii' ffitf-05, Project Name Utilities (Complete all that apply) Job \4 Cft"L \. Address Address Storm Sewer - J u) ' 5 I) I � Linear Ft. Name, > F r Sanitary Sewer Aa+ C A L \, Linear Ft. Owner Mailing Addre 1 Fresh Water q -bb Ss UJ -arb �\v A .. Linear Ft. .—CA//State , ,,, Zip Phone Catch Basins Yeti l' .0 9-Al. 1 35 # General Nip, e Clean Outs Contractor \ock . \\\Vok-Vla CpQ+.1 jj # Prior to permit Mailing Address Describe work to be done: issuance, a _ w Q New❑ AdditionAddition!: Alteration❑ Repair copy of all \t % S I \+ �` \1� 1:1 licenses are City/State W Zip 1' Phh Additional Description of Work: required if ` I b a ( 1h'L'L'l 5q1 -8bt � •� � T 1 expired in COT database State Const. Cont. Board Lic. # Exp. Date b c 1`� S�� S X c 3 o4�eq � e Name Project Wvk Valuation $ 10..Voo Architect Mailing Address Plans Required: See Matrix oft back page 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 Engineer Mailin ddr Erosion Control Plan and Retaining Structures VIL f 23814 details including calculations City/State Zip Phone Site Utility Plan and details Soils Report (showing connection to (if required) , im, Ci q\ y, epTi-vAlp6 approved system) Excavation Volun I hereby acknowledge that I have read this application, that the 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. Grading Volume t re of Owner /A gL gent Date � (Soils report required for >5,000 cu. Yds,) \ 11 cu. yds. 1 tX\ tl 0 0 Fill Volume Contact erson Name Phone (Fill exceeding 12" in depth shall be compacted "� To 90% of Maximum Density) G�ODcu. yds. \�4 l / FR` U� L , \ 4614 6C1g_Ob b p Retaining structure? (check one) • ❑Rock FOR OFFICE ONLY ❑ CMU Notes: ❑Concrete ❑Other Total new impervious area including all Land Use Case # Map/TL# buildings, sidewalks, and paving — Sq. Ft. CITY OF TIGARD % 2 '3 COMMERCIAL SITE WORK PERMIT 6 6 is \dsts \forms\site - app.doc 3/17/00 / ` , 2 • ,, . . VI iir KING CITY 15300 S.W. 116th Avenue, King City, Oregon 972= -2693 Phone: (503) 639-4082 • FAX (503) 639 -3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: CA I . it. MLA' v.. ir-LL located at: /5 //50 SW /// La— e. King City Representative 6 1 DSTSKCNST DOC BUP - Building Permit ELC - Electrical Permit Inspection Description Date Passed By 4 Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing I Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry /Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation Drywall nailing � Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line • Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final Structural observation Final inspection PLM - Plumbing Permit 4 Inspection Description Date Passed By BUP - Fire Protection System Permit Plumbing underslab Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm final Rain drain Storm drain * ZOOCJ 60 0 Water service ITS Site Permit Sanitary sewer J Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final Sprinkler supply lines EXPIRED Sprinkler underfloor /slab tl / (3/ 6 2— Catch basin /Manhole 7 ,, ® SWR - Sewer Permit A Engineered soils v 11 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS • CITY TIGARD ale SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT #: SIT2000 -00020 -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 6/16/00 SITE ADDRESS: 15450 SW 116TH AVE PARCEL : 2S110CD -07600 SUBDIVISION: KING CITY NO. 2 ZONING : BLOCK: LOT: JURISDICTION : KIN CLASS OF WORK: UNK PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: $12,000.00 EXCV VOLUME: cy LANDSCAPING ?: FILL VOLUME: 560 cy SITE PREP ?: ENG FILL ?: Y STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: site work to fill existing basement. Owner: FEES TOBIAS INVESTMENT CO 300 SE SPOKANE ST Type By Date Amount Receipt PORTLAND, OR 97202 PRMT KJP 6/16/00 $142.50 0003069 5PCT KJP 6/16/00 $11.40 0003069 PLCK GEO 5/17/00 $92.63 0002262 Phone: FIRE GEO 5/17/00 $57.00 0002262 Contractor: Total $303.53 ROBERT WESTLUND GENERAL CONTRACTOR PORTLAND RD STE D NEWBERG, OR 97132 Phone: 628 -1344 Reg #: LIC 00042503 Required Inspections Fill Final Report Eng'd Grading Final Inspection EXPIRED 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 O OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Permittee Signature: Issued By: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 8/22/00 Activities for Case #: SIT2000 -00020 12:56:08 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes SITC005 Application received 5/17/00 GEO RECD No Hold GEO 5/27/00 SITC008 Permit Created 5/27/00 GEO DONE No Hold GEO 5/27/00 r SITC013 Plans Routed to Plans Examiner 5/27/00 GEO SENT No Hold GEO 5/27/00 SITCO26 Plans approved by CPE 5/31/00 5/31/00 5/31/00 RDP DONE No Hold RDP 5/31/00 ■ SITCO30 Reviewed plans routed to DSTS 5/31/00 RDP DONE No Hold RDP 5/31/00 SITC710 Fill No Hold RDP 5/31/00 SITC775 Final Report Eng'd Grading No Hold RDP 5/31/00 SITC799 Final Inspection No Hold RDP 5/31/00 SITCO32 DST Post - Review Completed 6/13/00 GEO DONE No Hold GEO 6/13/00 SITC080 (F) Ready to issue 6/13/00 GEO DONE No Hold GEO 6/13/00 SITC092 (F) Issue permit 6/16/00 KJP DONE No Hold KJP 6/16/00 SITA093 (F) Reprint Permit 8/15/00 ZZZ DONE No Hold ZZZ 8/15/00 6 Page 1 of 1