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Permit CITY TIGARD SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT # : SIT2001 -00013 ' I— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/7/01 SITE ADDRESS: 06855 SW BAYLOR ST PARCEL : 1S136DD 01300 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : ? BLOCK: LOT: 002 JURISDICTION : TIG CLASS OF WORK: NEW PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: $47,000.00 EXCV VOLUME: cy LANDSCAPING ?: Y FILL VOLUME: cy SITE PREP ?: Y ENG FILL ?: Y STORM DRAINS ?: Y SOILS RPT READ ?: Y IMPERV SURFACE: sf Remarks: Site work permit for new office building. Owner: • FEES ESLINGER BUILDERS 11575 SW PACIFIC HWY Type By Date Amount Receipt TIGARD, OR 97223 PLCK CTR 6/7/01 $291.40 27200100000 FIRE CTR 6/7/01 $179.32 27200100000 PRMT CTR 8/7/01 $448.30 27200100000 Phone: 503 - 245 -9773 5PCT CTR 8/7/01 $35.86 27200100000 Contractor: EROS CTR 8/7/01 $80.00 27200100000 ESLINGER BUILDERS INC ERPU CTR 8/7/01 $26.00 27200100000 11575 SW PACIFIC HWY ERPC CTR 8/7/01 $26.00 27200100000 TIGARD, OR 97223 Total $1,086.88 Phone: 503 - 849 -4653 Reg #: LIC 62363 Required Inspections Grading Paving lnsp 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. /AA Permittee Sig• . ure: .a Is ed By: � 1 f�a► �� . Call (503) 639 -4175 by 7:00 P.M. fo an inspection needed the next business day ' i 1 I .-col B uilding Permit Application Date received: 4 ? /d 1 Permit no.: t} P ( 3 ' _ ., j City of Tigard ° __. Project/appl.no.: Expire date: o City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639 -4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: _ 1 &2 family: Simple Complex: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION r Job address: (7 6 6 A K . CO Bldg. no.: Suite no.: ,... Lot: I Block: ISubdivision: I Tax map /tax lot/account no.: Project name: '' 1 Description and location of work on premises/special conditions: 494 arl� '6 itee- OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: EseltA,(. $ A (Floodplain, septic capacity, solar, etc.) // S W Mailing address: 7 S S fat. I & 2 family dwelling: City: T (/) (State: 9 ZI P:Gf 72 Z Valuation of work $ Phone: IFax: E-mail: I No. of bedrooms/baths Owner's repres- . °te• 44) 6,A/ja eel Total number of floors • Phone: *Cci0'1f 3 Fax: E -mail: New dwelling area (sq. ft.) APPLICANT Garagekarport area (sq. ft.) Name: mwiJe.g. Covered porch area (sq. ft.) Mailing address: /Lj Deck area (sq. ft.) g 1 City: i r I Other structure area (sq. ft.) fate: ZIP: Phone: ' Fax: E -mail: Commercial /industrial /multi - family: `F l 1)0 CONTRACTOR Valuation of work $ Business name: mWn/g� Existing bldg. area (sq. ft.) New bldg. area (sq. ft.) Address: Number of stories City: I State: I ZIP: Type of construction Phone: I Fax: I E -mail: CCB no.: Occupancy group(s): Existing: New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be ARCHITECT /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 City: I State: I ZIP: exempt from licensing, the following reason applies: Contact person: Plan no.: Phone: Fax: E -mail: Name: Contact person: Fees due upon application $ Address: Date received: City: (State: IZIP: Amount received $ Phone: I Fax: I E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. - attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard work will be complied with, whether specified herein or not. Credit card number: Expires Authorized signature: ` Date: // Name of cardholder as shown on credit card $ Print name: L Hit1r'� ,l��o(�/ !/lJ6s �; ' - 7(�S� Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (Moo/COM) fri 7)1) 0 1114#1 1 14446ij1;41j . 1 1 9 4)4 1 . : / SITE WORK PERMIT CHECK LIST Commercial, Multi - Family (R -1 occupancy) and Residential: Please complete all items below, unless otherwise noted. Excavation Volume: 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) ❑ Rock ❑ CMU ❑ Concrete ❑ Other *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the "TAN" Plumbing Permit Application for site utilities plumbing work. Plans Required: See "Site Work Permit Application - Plan Submittal Requirements" attached. The following must accompany this application: Site Plan with Vicinity Map *Parking (including ADA) and showing ADA compliance Lighting Plan Grading Plan and details *Landscaping Plan Erosion Control Plan and details Retaining Structures Site Utility Plan and details Soils Report (if required) (showing connection to approved system) * Does not apply to 1 and 2- family dwellings. is \dsts \forms\sitechecklist.doc 05/31/01 • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 / BUP Received _ Date Requested 7 f/�, AM PM BUP Location 5 S ( r 9 E-C? Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT 4 2C/ - Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: - Final PASS PART FAIL PLUMBING �' 111 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 Service Rough -In �� ( i _ Low Voltage ,11171 � Fire Alarm wi �� 1111111/ Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date Inspector Ext Othe 15 - - DO NOT REMOVE this inspection record from the Job site. PART FAIL