Permit CITY TIGARD SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2003 - 00020
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 9!4(03
SITE ADDRESS: 15750 SW 98TH AVE ADM. BLDG. PARCEL : 2S111 CD - 00300
SUBDIVISION: ALDERBROOK FARM ZONING : R -
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 35,000.00
EXCV VOLUME: 250 cy LANDSCAPING ?:
FILL VOLUME: 60 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT READ ?: Y IMPERV SURFACE: 4,350 sf
Remarks: New 2,875 sf administration building.
Owner:
FEES
TIGARD CHURCH OF GOD
15670 SW 98TH AVENUE Description Date Amount
TIGARD, OR 97223 [BUPPLN] Pln Ck - Valu . 6/23/03 $232.90
[FLS] FLS Pln Rv 6/23/03 $142.32
Phone: [BUILD] Prmt Fee -Valu 9/4/03 $358.30
[TAX] 8% St Tax -Valu 9/4/03 $28.66
Contractor: [ERPRMT] Erosion Cntl 9/4/03 $80.00
SHADLE & OMUNDSON INC [ERPLN] Ersn Plck - USA 9/4/03 $26.00
16855 SW 129TH AVE [EROSN] Ersn Plck - 001 9/4/03 $26.00
KING CITY, OR 97224 [WQUANT] Wtr Quant 9 9/4/03 $550.00
Total $1,444.18
Phone: 503 - 804 -3903
Reg #: LIC 128509
Required Inspections
Erosion Control Insp 846 -8444
Retaining Wall /Footing
Paving Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA; • - 01 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6699.
Issued :y: 1 ,I , ,
Permittee Signature: 4i�i�.� /,
Call (503) 6 • , 175 by 7:00 P.M. for an inspection needed the next business day
: ite Work /3 �, %0 e) 3g
FOR OFFICE' USE ONLY .
BuiJ n Perm Ap plic ation Received Building . Date /By: &043 -o3 '� 7 Permit No.: 'D ; j 7 —0 0040
City f Tigard . -" %�ti ^ ! , . 1 Planning Approval Other
y g i -. L LI \ Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review A ., / � Other
Tigard, Oregon 97223 Date/By: ' J/ D S$ Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960] 4144MM Post- Review Land Use //''
Internet: www.ci.tigard.or.us ti tl� 22
e l i ! Date /By: Case No. � O�J 5
-•e
('� \ C� Qyi - ,ii 4 Contact Juris � ®See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 � , Name /Method: Supplemental Information
� �' .� 3�� . � 4 ' "'r "` �. A� $ .: s . „�,E. ._, s �^2:M, ': 'r € zF�' -�' ait�x is` s
� .:• a::.,.. t i a . , ,, , O ,,,W t : � 4s , s .: ,,, , . , i , 0 ;;,> �,
�ryg��s'r� � � �� � REQUIRED D � � 'x ; �.
XNew construction ❑ Demolition l "
° - :: ,1 & 2 FAM ILY DWEI LING
❑ Addition/alteration/replacement ❑ Other:
;,.�� s N `.„�` CATEGORY OF;C ONSTRUCTION, , .; '. _V ,. , Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ®' Other: GNUIe4}f Valuation $
,_ 1KTO<J;OWSITEIINIEORMATION a iidaL OCATI IN + No of bedrooms: No of baths:
Job site address: }.5(p 5W ?B1H 1kV4NVe_ Total number of floors
New dwelling area (sq. ft.)
Suite #: -- V-N le/3 Bldg. /Apt. #: — Garage /carport area (sq. ft.)
Project Name: ADM IN15 1eferl V - orrice. rore. Covered porch area (sq. ft.)
Cross street/Directions to job site: TIMID CWtxill DFbib Deck area (sq. ft.)
Other structure area (sq. ft.)
PUItilMvl 12.441D, AlNn 90 AileAlvf
� � ' i
'
s k r jiat DATA
2 1 " ? COMMERCIAL USE CHECKLIS t i-`
3
Subdivision: ��t Lot #: ..� , z . ...� . .�, -,:. ,.�� - n e
Tax map /parcel #: 25 III CD et, 304 Note: Permit fees* are based on the total value of the work performed. Indicate
t °" -X the value (rounded to the nearest dollar) of all equipment, materials, labor,
�a:. � T �„ >;::,,
A /4yW � I F-af }rA/�O a, 675 . overhead and profit for the work indicated on this application.
/4I �15T D1 /-0. b P Valuation
l $ b uilding area (sq. ft.) 3 5/ O
5
"MAW CH0214/ op both, , i • . p� New building area (sq. ft.) Zi 875
/GJE /4041/ W V-5 I.lieHTIA(b IW P J 1iJb 4107" Number of stories ON 0-,,..
aN] PROPERTY'OWNER:° f , „ gii ;'.RM.N.-0-EIMANSZRiVaRZ Type of construction (a/dOQ
Name: T/(„¢(4.0 C/./ug t Op fop Occupancy group(s): Existing: 4 ,1
Address: 1%70 y W c e rH ANOMV - New:
City /State /Zip: 171i,kW ort q--azq
Phone: 563_6 .1_ Lf000 Fax: 3 -G39 -- / 835 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
r APPLICAN,Ti — .1 fl; lOcii ella SON a . provisions of ORS 701 and may be required to be licensed in the
Business Name: cirIM1L,!-0-/2 if:>14/ATis jurisdiction where work is being performed. If the applicant is exempt
Contact Name: JAGIC// Parr from licensing, the following reason applies:
Address: 2 3 0 NW 17-1V t4Ai) , 5O rm 20/
City /State /Zip: p002A/)0 , Al2 q 72/t
Phone: 3 - Y7, ..1J 8 Fax: 503- 22- -lsflo0 �. ,, rt, x, ,
� � BUILDINGsPERMIT EEES* i
t/CIEr 211.1b411//14% L�1 E g i
E -mail: .a
A � � � PI ase,refer to fee schedule � � � 3 ��
M:';.' :"2 CONTRAC�TO& .� M �.M
Business Name: 5HAt7l, - ( CMVNOSO/ � (NG Fees due upon application $
Address: f b6 55 5W I 2.9
City /State /Zip: J //t/k « n "R q 721171 Amount received $
Phone: 03• Bag - 3 943 Fax: Date received:
CCB Lic. #: 7576
Authorized
A n ature: Date: '"2.?"-703 Notice: This permit application expires if a permit is not obtained within
g 180 days after it has been accepted as complete.
11-1-4/e- Z0,07"
C Z *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms\BldgPermitApp.doc 01/03 (.31,u. q a` -5D- o
?dc- I * '3a-
� l
SITE WORK PERMIT CHECK LIST
Commercial, Multi- Family .(R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: 2 Cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) / �� Cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to 90% of /
maximum density) & " cu. yds.
Retaining structure? (Check one) 1:1 Rock
❑ CMU
Concrete
•
.5 Other
*Total new impervious area including all buildings, ,
sidewalks, and paving: • , `��
sq. ft
Site Utilities Plumbing Work: V
Complete the Plumbing Permit Application for site utilities plumb w ork. . •
Plans R equired `See' Si t e Wo k Permit Application Plan Subm ttal Requirements'
e`d Th f o llo win g ° mus ac company this a plicationm
'attach
Site Pl w h V cinity Map how ng *Parking (including ADAM) and
A Lighting, Plan ▪ :' :
Grading Plan a nd details *La ndscapgRlan ,
N
.,Eroslon,,�Cortr arid � � � � �Soils�Re �._� � -
Retaining S tructures . ,_ y . _ .. �_��.. �., .�.�� .� ,. .. . v ▪ .
•
' *Does not apply to 1 and 2- family dwellings. •• •
€ o f Plans .
6 1TYPEOP.4.$ BMITAL
UT
� � ��� � � ▪ �� Requ�reit at
In °eludes N ew, Ad Alterations)
Commercial 4 • • •
• Multi- Family R -1 Occupancy . 4 ' . •
•
4 .
One- & Two - Family Dwelling • 4 •
NOTE: Plan review is dependent upon submittal of a completed a pplication and, plans.
After plan review approval, the Plans Examiner will contact the applicant,to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard, ,
Washington County, and Tualatin Valley Fire & Rescue).
i:\dsts\forms\SIT-checklist.doc 01/29/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 / MST
f oL�f 1/ BUP % G�/` r � l
Received Date Requested AM PM BU
Location 57) / "� Suite MEC -20 b 3 — 60347
Contact Person Ph ( ) PLM
Contractor _ Ph ( )/ ) SWR
BUILDING Tenant/Owner Ci\ -tAA ` — ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain d O � j - 0 OOH 0
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler lgt , ` Fire Alarm , - - & , 6 -® I �j
Susp'd Ceiling —
Roof
Other: -
Final
PASS PART FAIL�� ) - -��
PLUMBING `�- j� egg-
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
mpers
PART FAIL
RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [I Please call '•r reins•-ction RE: Unable<o insect— no access
Fire Supply Line
ADA . { C
Approach/Sidewalk ' roach/Sidewalk Date Inspector �
Other:
DO N `, T REMOVE this inspection record from the job site.
A S PART FAIL