Permit t yc —
CITY TIGARD SITE WORK PERMIT
A I
DEVELOPMENT SERVICES PERMIT # : SIT2002 -00015
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— r>r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 7/16/02
PARCEL : 1S133AD -02200
SITE ADDRESS: FtKKrRID — .
SUBDIVISION: / 0 73 0 /30 ZONING : R-7
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $228,001.00
EXCV VOLUME: 3,000 cy LANDSCAPING ?: Y
FILL VOLUME: 2,500 cy SITE PREP ?: Y
ENG FILL ?: Y STORM DRAINS ?: Y
SOILS RPT READ ?: Y IMPERV SURFACE: 107,158 sf
Remarks: Site work for new multi - purpose Church and School.
Owner:
FEES
WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD Type By Date Amount Receipt
TIGARD, OR 97223 PRMT CTR 6/13/02 $1,247.40 27200200000
5PCT CTR 6/13/02 $99.79 27200200000
PLCK CTR 6/13/02 $810.81 27200200000
Phone: FIRE CTR 6/13/02 $498.96 27200200000
Contractor: EROS CTR 7/16/02 $150.00 27200200000
GRACE CONSTRUCTION. INC. ERPU CTR 7/16/02 $48.75 27200200000
ERPC CTR 7/16/02 $48.75 27200200000
5070 NW 235TH AVE.
STE 101 Total $2,904.46
HILLSBORO, OR 97124
Phone: 503 - 648 -2388
Reg #: LIC 00080572
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Required Inspections
Erosion Control Insp 846 -8444
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Excavation
Fill
Grading
Paving Insp
Fire system test
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 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 4, 9_, 4...„14„___/
Issued By: ISA 7-1GtiZ4
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ur) /lv /LUUL 14:17 rAA .7vJ.72folifov r G � 1 ^ .1 �j j / ' I yyr i1��arisw _ ) / / ' ,yam .2vv
Building Permit Application 11 ` •
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�-;� �i ° City of Tigard r , Date t ceiv 4" P r '2 Pe no.:7 /f �' pp0C 5°
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Address: 13125 SW Hall Blvd. Tigard, OR 97223 f = Riijecdap Expire date:
City ofTigard `" Date issued: B
Phone: (503) 639 -4171. .9 00, � ;-- . , e o c : � � y:/J Rcccipt no.: \
Fax: (503) 598 -1960 0225 Payment type:
1
G l,t 2 00 1- OOOD : = P &2 f = Complex:
Land use approval: , �., .. v,., ,,, J=~•• ,
-1 ;4U ,nn.t)ll.Nv 1v:1 V ::J.::._ 4
TYPE OF PERMIT
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41 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Now construction 0 Demolition
Addition/altcration/replacement O Tenant improvement 0 Fire sprinkler/alarm 0 Other. n
JOB SITE INFORMATION
Job address: 12.S 30 5 t.1 SC-HO t,—S F--e-P--2.`P 20 - Bldg. no.: Suite no.:
Lot: ' Block: 'Subdivision: I Tax map/tax lot/account no.:
Project name: V.1 i✓ST A. , PTtST G4-h- .kt2�. -1-i
Description and location of work on premises/special conditions: I t• S .1 k-- 4 "‘`P .(51 -- ,T / •
C► -D lt_i, Ea , UT1I_1 -- '1"" v.1 it l
OWNER bit SPECIAL INFORMATION. USE, CHECKLIST
Name: i A 1 ' T E l t . ` 1 - 6,4 S T c--1 _k - t - (Tloodplain, septic capacity: solar, etc.)
Mailing address: 1 293 CD SW SC# - LS - e" I & 2 family dwelling:
City: Tl la?r�D 'State: 0IZ'ZIP: 9 7223 Valuation of work $
Phone:5o3 'E -mail: No. of bedrobms/baths
Owner's representative: t..r p ( p.G ( I--i Total number of floors
Phone:50 858.4 Fax: 503 6 45 +• di" ail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: `- D G �lU 1---.1 &l e-C t_ .tP Covered porch area (sq. ft.)
Mailing address: 3302 ►.1 vJ 2 t 1 Deck area (sq" f .)
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City: H - t LA ei2L0 ' State: ZIP: 37 (2_4. Other structure area (sq. ft.)
Phone•973 8 8 4424. ax:503 . • • mail: CommerclalllndusMallmulti- family: - . '
CONTRACTOR ation of work $ ` , 22_8, f _
Business name: G- riz,1S, -CAE c.��STA.IG"RO..t l sting bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: v070 N 235 1.1-1 I tnl 23S '-e ,. r r 10 I Number of stories
City: } }-t ■.l -C I State:012_1 ZIP: 97 12,A Type of construction
Phone:503 048 238B Fax: I E -mail:
Occupancy group(s): Existing:
CCB no.: c• os 3 / /li° New:
City /metro lie. no.: Notice: All contractors and subcontractors are required to be
AIt(:1IITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
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City: I Stain ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: t.-DG C> 4e:fitJ Contact person: ' Fl. ` i . •, Gee upon application $ , 2, OS0• 96o
Address: 33 0c) .s W at 1 - r - Date received:
City,A -1 e_5 a0( =o ,State :• Otz ZIP: 97 ( 24 Amount received $
Phone: 858 42421Fax:0 645 55:4B-mail: Please refer to fee schedule,
I hereby certify I have read and examined this application and the Not all jutisdictiom accept credit cards, please call jurisdiction for more infom ntioa
attached checklist. All provisions of 1. : d ordinances governing this O visa 0 MasterCard
work will be complied / w" , whe j r . 4 ified herein or not. Credit card number: E:pt
Authorized signature: / (/ 7 1 Date: r'/ I I / Name or cardholder as shown on credit card
tic ell-- 44—A1:).° $
Punt name. Cdr aigoattac Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 446461:+ (mtmrCOM)
/ Fl
L ,77
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location Suite MEC
Contact Person Ph ( ) 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner .c ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT c —000
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall E L r, •
Fire Sprinkler EritiTLAPP.
Fire Alarm
Susp'd Ceiling -
Roof
Other:
Final
P ASS PART FAIL �
PLUMBING
Post & Beam �+�
Under Slab _
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL ` j
Service
Rough -In 4g W! 1��AMIWw' /
UG /Slab A . `�e'/ -'
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Oth - •
0 DO NOT REMOVE this inspection record from the job site.
PAS PART FAIL