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Permit C ITY O F TIGARD SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT # : SIT2004 -00013 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 5/5/2004 SITE ADDRESS: 09725 SW DURHAM RD PARCEL : 2S111CD 00400 SUBDIVISION: ALDERBROOK FARM ZONING : R -7 BLOCK: LOT: JURISDICTION : TIG CLASS OF WORK: ADD PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: 126,000.00 EXCV VOLUME: 2,527 cy LANDSCAPING ?: FILL VOLUME: cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: Y IMPERV SURFACE: 9,952 sf Remarks: Site work for church addition Owner: FEES SOUTHWEST CHURCH OF CHRIST Description Date Amount 9725 SW DURHAM ROAD [BUPPLN] Pin Ck-Valu 4/13/2004 $549.71 TIGARD, OR 97223 [FLS] FLS PlnRv 4/13/2004 $338.28 Phone: [BUILD] Prmt Fee -Valu 5/5/2004 $845.70 [TAX] Valu 8% State Sui 5/5/2004 $67.66 Contractor: [ERPRMT] Erosion Cntl 5/5/2004 $80.00 H + A CONSTRUCTION COMPANY [ERPLN] Ersn Plck - USA 5/5/2004 $26.00 14945 SW 72ND AVE [EROSN] Ersn Pick 5/5/2004 $26.00 PO BOX 23755 Total $1,933.35 TIGARD, OR 97223 Phone: 639 -6148 Reg #: LIC 00001341 Required Inspections Ersn Cntrl 681 -4444 Paving Insp Sprinkler supply lines 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 • .- ° : -goon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0 60. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. Iss ed By: , 4 ' ; 7 -- 0 -P/41-12-?# Permittee Signature: . '� Eb9140.54fri/TA Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day f7 - SW Du et Nfr, II Site Work (0/ Gli�RGrrof pp J' , --OOP. . Building Permit Applicati FOR OFFICE USE ONLY City of Tigard `� :iew � Permit No. 1 31SW Hall Blvd, Tigard, OR 97223 1 3 2 y Dat R Phone: 503.639.4171 Fax: 503.598.1960 , Q4' y / \ Date(B „� Other Permit. s ' i t ° I ga DateB : , j Inspection Line: 503.639.4175 1 - 1 Date Ready /By: Et See Page 2 for Y OF T1r = = Internet: www.ci.tigard.or.us BUILDI .Gcolvf6oN Notified/Method: Supplemental Information t r rp \\ , , �. ,rt .� �,vi-::� 4' ..l- ^�., °,,?rep,. k?. A'tt .».. fix . x "° t '.;'£: a ;,zl's5 ; .t , i;E .':s.s�f .rg €:` ::�:.F; . ;sa:„....,- �`e: e:.2s z rr.;tr i a ( 'gi ' .4 . ' '- . a t s.� r f ' , + .I , a ° ''. I , r l l TYPE d , vI ' " ,, , : • t :414,1` �i° 1 f`'~REQT DATA: 1 - 2 FAMIL 4 46. 0, ING :�.�1.�.;�. `�..: SFr. °.��'L� ''� ` �. a .: cwx' �: irl , �;?'? >?at;.:§s..;...,,.w+ai ,,.:.:�- isM'�•��;. fir?. a�f' i�»' ��I�.: �.a�.:3a�:;�r:2= '[�xfs:; -e .: �5.ar�:�1 :, ., v�. �.,�- .:�.�.:�CC.��'�`` ' +%�aG R..t3^3�x;�; .: a:.&` -, � .. ❑ New construction ❑Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the is 1 ,,,,: ;. 1 .;:,: : k, =a, ,.�; r �...,a f- a m ,:a. � >R work indicated on this application. ; „ le ,` , g �� CATEGORY„ °OF CONSTRUCTION l t 4' * 4 ` ,,A pp � r '�. . �r -� S� a �.. �"..� ,.c �: �r - a. � �� :;°as � fir.,, ���^.,,�rn' x 7 � ;r � t . � ; �"�.. Valuation: $ ❑ 1— and 2- family dwelling . • ❑ Commercial /industrial Cam= ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: x„+ i , 5 $4. s iJOB SITE INFORMATION: AND LOCATION' s , " £s.5 °' Total number of floors: Job site address: --i . w oV R4 ift.VtA vzic) New dwelling area: square feet C City/State/ZIP: - j - lC., PrR Lo O2 41 2'1 )4-- Garage /carport area: square feet t� Suite/bldg. /apt. no.: Project name: 5 Vv C W 1JCc (i-t O F GK f1.15 Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet mac .. .. - :.x e .. _, ,,..- 3 •x:" }r > ...:cli, a's't,_,;,#+2 MRE CO USEICHECK Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the �,�� ^n`. - �. „” �::.�'.;" -.:�x �,.�;r, .r� - �;:;�.:s����a ,tom` �`'.��?� =.K ,r,,;4: >e.�x,;;2 r DESCRIPTION (QF'WORK rJ work indicated on this application. Valuation: $ I "2e.tv i o an A I010 t -r-te te, e r l-N A' 'V) C2-4 t I w, )A-►., v) t2C v.iOpvc Existing building area: square feet /1 A- p -z � c� Z T1—t -. W 2c.t. s -- G t—t Li c t-t New building area: square feet • r ®lPROPERTX A©WNER -' '„ oirl 1 ' TENANT w 1 Number of stories: / Name: w.T.;...I wg 5"1• Ct u iZC k^t cal e• kit 12.\ ST Type of construction: V•• /J/2 Address: Gi-1 ZF ,5 t . i t, r2 tt err4 - RIO Occupancy groups: 4 2. . City/State/ZIP: Tt'- F- L 1 cyr-z_ q - r - 2 _. Z 1 - Existing: / Phone: (inO' �Z� ., O.2-,-Z - I Fax: ( ) New: =tea :. -x� F.,,�^..�s.�� = .3?' ":'�?:a � , >.�t�� =...�..� y„a.:�,. ': €� ..� � - �x..� �•``�� <. ';'' _�- s�'�� �.. CONt'TAGT; . �. :� ��,.,t': =i r� , � . �. . .t. 'AP?I;ICANT��. :�w. ��� �;K. �,.,.;'� - .,..� ., �.�:a .`.., .,�. .;z�• ��;_� s. "4 . , :,w.. .s `- 4 r„ a- yt: ,,. ,:a a �,z— _ NO , TICE . , e' P �ti". � : a a. ,.,_s- H<.,„a4sES`"��tp. _� _ .,. �'��. _.- �.a� S. .. t� � �� :.k �r �-�. �t . fi aa: , s m Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: y Phone: ( ) Fax:: ( ) E -mail: ' W 3 R 66 x4 '. b 4 fi ' S yry S JI • x" ..5 3 ,( ep i ' ) , s„� . Laaak �5: �R�. At ei t , - , ` CONTRACTOR Agiw s - V i �,� . ,��.�. ;.�r,�r.. �,�r�s.� .. , t �� , . �. � t� � ,us�fi7,��ars fifi �r�-�,a� ,.��r`� .'�' ��. rox, ,�„a: ,,:.k., i14.0 Business name: 4 i Ot �' °� �:. .,,...- :_,::r< - � >� <: _ _�:: ,.;,..,; < .,r•-:�:; . K C1s1uST- A.i' : = {B UITDINGk i . PER1VIIT.tt ..0 r 4 Address: • Po ("? K 2 ' to 5 Please refer to fee schedule. City/State /ZIP: - TA v PI - 1 ) C C)— g -1 Fees due upon application Phone: (9 2)3) ( 0 9 _ Fax: ( ) Amount received CCB lic.: L 4• ( C 1( 11 7 0 Date received: Authorized signature: ( Li_ \` _ • ..- This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: W LA *, ( t--- 4...t.. Date: 4.( 13 / ej 4.__ * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits\.S1T- PermitApp.doc 12/03 440- 4613T(I1/02 /COM/WEB) City of Tigard: Site Work Permit Checklist .. , Page 2 - Supplemental Information Commercial, Multi-Family and•One- and Two - Family Dwellings: No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill, it. must be engineered fill. If fill is in a flood plain, drainage way, or wetland, the applicant must apply for a sensitive lands review (SLR). Please complete all items below, unless otherwise noted. Excavation Volume: cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) J 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: 2 " sq. ft. Site Utilities Plumbing Work: • Complete the 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 showing ❑ *Parking (including ADA) and ADA compliance Lighting Plan ❑ Grading Plan and details • ❑ *Landscaping Plan • • ❑ ` Erosion Control Plan and details ❑ Soils Report (if required) ' ❑ Retaining Structures *Does not apply to One- and Two - family dwellings. t aik w r - # of Plans st4 TYP E`OFS ` ' 1VIITTAL �� /Required at 1 -1 ,, f yc T '' ` ; � k ' ., " h i i ° } y �(Ine1udes Ney Additions orlAlterations) ,,. t, Submittal Commercial 2 Multi- Family R -1 Occupancy • 2 One- & Two - Family Dwelling 2 • • i:\Building\Forms \SIT - Checklist.doc 12/29/03 • • . • 'CITY QE TIGARD ' BUILDING DIVISION PERMIT #: SIT2004 -00013 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/5/2004 • Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/612005 TIME: 7:10AM PAGE: 1 1 SITE ADDRESS: 09725 SW DURHAM RD CLASS OF WORK: SUBDIVISION: ALDERBROOK FARM LOT #: TYPE OF USE: PROJECT NAME: SOUTHWEST CHURCH OF CHRIST DESCRIPTION: Site work for church addition OWNER: SOUTHWEST CHURCH OF, PHONE #: CONTRACTOR: H + A CONSTRUCTION COMPANY PHONE #: 639 -6148 Inspection Request Scheduled For: Date: 4/6/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 499 Final inspection 003867 -01 503 -522 -5163 N Corrections /Comments /Instructions: 4tati '1111 a,'1 W 744k •11.111P"111/ • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAI ❑ CALL FOR INSPECTION ❑ ADDITIONAL F ES ASSESSED Inspector: ector: `�` Date: (!J v Phone #: (503) 718- CITY OF TIGARD 24 -Hour "BUit Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP 1 — Received Date Requested 7 AM �PM� BUP Location 7 Suite MEC Contact Person Ph ( 4) 3-1. �� PLM Contractor • Ph ( ) SWR BUILDING Tenant/Owner ■ ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT (20 y Od of 3 Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear • Framing Insulation • Drywall Nailing Firewall Fire Sprinkler : ' � ► Fire Alarm �• , f� 11/ t,�� Susp'd Ceiling Roof Other: Final l I ► FINI111141W (� PASS PART FAIL V 'IP PLUMBING Post & Beam Under Slab Rough -In I1& � si Water Service S j J 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 .°t c .1� /) I =� i Low Voltage �-.� /� .��� ���•�.; Fire Alarm Final 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 i re S upply Liae> ADA Approach /Sidewalk Date Inspector Ext inal DO NOT REMOVE this inspection record from the job site. P.. S - PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Reqi.tAted 7 -" ( AM PM BUP Location T7 9 Suite MEC Contact Person 9 , fif e Ph ( 9 7( ) 6 - /36 2 O PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: / / it F D SIT occ 0 /3 Post & Beam `� Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation 00 070 f� r HELD y �� Drywall Nailing ( t lJ ! t " v l �1 Firewall i Fire Sprinkler Fire Alarm J lJ l - C I Susp'd Ceiling Roof Other: Final PASS 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 Service Rough -In 4 d \ � a _ UG /Slab AM*7 �� 44 � ' 1 Low Voltage / Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL 111 Please call for reinspection RE: Unable to inspect - no access ire Supply Line Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. , PASS AR FAIL CITY OF TIGARD 24 -Hour r "UIL,>iIG, Inspection Line: (503 . 175 �' MST INSPECTION_DIV1SION Business Line: (50 , « -41 1 -- —1 j c__ --j �� 6 (�. O O I (o Received Date Requested /o ` AM PM CBlZ� �7 `� e " 5 s Location � l oZ� 7) MEC Contact Person Ph (_21L) • 5 - (3$,-_ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner SL-C.) ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: 0Q /'„ �� 0' l _ 000 2, Omq-00/),3 o Post & Beam 1.1 "I Shear Anchors \.'\ ga-C l' / 1- Ext Sheath/Shear `� 4 Int Sheath/Shear Framing Insulation C ` • Q Le \I .-G'N. i/\ ,2 - -- Drywall Nailing _ Firewall w . pri ri - . 6 Fir- ' . Susp'd Ceiling Roof l KY G P9_,, LA nn, a "e-CJ O.1 ,v Other: 1 f l 7 k S a_,/1 COQ /(_ PASS 0 �f FAIL 0 PLUMB! e7A VAS / a- V\ d s :` k O v`� Post & Beam ¢_ , l '9 Under Slab 1N1 e--( �` t---t7-‘,--\ 5 v� '� • Rough -In Water Service Sanitary Sewer 0i S / ;-36 — -3 Rain Drains Catch Basin / Manhole Storm Drain ( 9 5- O / Shower Pan Q < Other: Final - -_ - _ -1� PASS PART FAIL �� - MECHANICAL �°) RQ___C Post & Beam 1 �( �� ~ � , ^ Rough -In \ v T v Gas Line t - .Q// �- \/7 4 Smoke Dampers ii ��,, ,,,� c " / Final t 2--e- ` J &i.- V___)■_ r " / i S L ),:_ s PASS PART FAIL ELECTRICAL. ■V__, ./v\ Ze__._A cQ, \ 3.,5 1 S ,: 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 _ 0 Please call for reinspec on R : ❑ Unable to inspect - no access FI Supply Line (� 6 ADA `-� ol- Approach /Sidewalk Date Inspector Est Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour ',BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested t'`' 1 AM � PM BUP J/ Location C7 7 � ,� Suite MEC Contact Person Ph (_71) — /3 (� O PLM Contractor ( Co �� Ph SWR ] ) BUILDING Tenant/Owner Sum 1 A ELC Footing or Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT dc 65/-000 /_3 Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation ' Drywall Nailing tt Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling pp / r Roof Other: .. L./t �. Final PASS PART FAIL PLUMBING I. OP 40 - Post & Beam 1 e ? � 1 Under Slab UMW • +► '�— i� J� 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 r UG /Slab 11101E MIN '`�� '- Low Voltage �� Fire Alarm it Final ❑ 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 Supply Line AD Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PA PART 1 FAIL CITY OF TIGARD 24 -Hour i3'IJII�DING , Inspection Line: (503) 639 -4175 MST INSP DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested - 1 7 AM V BUP Location �� o - S t JJ� - at.■rh Suite MEC Contact Person . Ph ( 1L) * - 1 3 Ed PLM Contractor /? Ph ( ) SWR BUILDING Tenant/Owner .< (4) C _i mot -i ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT RD,O V de0 /3 Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall I - /��_�� Fire Sprinkler Fire Alarm Susp'd Ceiling Roof • _�.. viaeir Other: Final PASS PART FAIL �{ PLUMBING Post & Beam Under Slab '7 Rough -In (LL- Or/A 1/ 1 Water Service r Sanitary Sewer 9 ., �jl �- L I x- /O� g2 Cyc-e s Rain Drains �� c � h t T�-� w°-� ~-mi l ��" 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 4I!rr�'O UG /Slab Low Voltage Fire Alarm Final ii Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: D Unable to inspect - no access e upply Line •; • Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS P RT FAIL