Permit CITY OI TIGARD SITE WORK PERMIT
i . DEVELOPMENT SERVICES PERMIT # : SIT2004 - 00005
e �� DATE ISSUED 4/8/04
• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09000 SW DURHAM RD PARCEL : 2S114AA
SUBDIVISION: ZONING : R - 4.5
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 80,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 18,800 sf
Remarks: Temporary contractor access road.
Owner:
FEES
SCHOOL DISTRICT 23J
13137 SW PACIFIC HWY Description Date Amount
TIGARD, OR 97223 [FLS] FLS Pln Rv 2/25/04 $253.96
[BUPPLN] Pin Ck -Valu 2/25/04 $412.69
[ERPRMT] Erosion Cntl 4/8/04 $80.00
Phone: [ERPLN] Ersn Plck -USA 4/8/04 $26.00
Contractor: [EROSN] Ersn Plck -001 4/8/04 $26.00
ROBINSON CONSTRUCTION [BUILD] Prmt Fee 4/8/04 $62.50
21360 NW AMBERWOOD DR [TAX] Valu 8% State Sui 4/8/04 $5.00
HILLSBORO, OR 97124-9321 [BUPPLN] Pln Ck - Valu 4/8/04 $40.63
Refund - [FLS] FLS Pln 1 3/17/04 - $253.96
Phone: 503-645-8531 Refund - [BUPPLN] Pln I 3/17/04 - $412.69
Reg #: LIC 63147 Total $240.13
Required Inspections
Ersn Cntrl 681 -4444 .-
Driveway surfacing
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 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6699.
Issued By:
/
Permittee Signature: ' • . CG K. iilg /O
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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Site Work RD l�
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Received `/ 3 c (r -- I 4 _ 5 i
City of Tigard Date/13 • °� �'7 ° f Permit No J
13125 SW Hall Blvd , Tigard, 1 ', $122, 044 Plan Review
Phone 503 639 4171 Fax. 513. n on !Nog "g i'� Date /B . ^ I 41' All 13 Other Pernur �L.i�SY j/I14+
Inspection Line 503.639,41 t- T (tAKD ` I ' I ` I Date Read /B ' �' ' S P a e 2 for
�lTY O - -. _;_ -.. y y o
Internet www,ci ttgard or us tut4G Dtv*ION . - Me� L thod_� l- i'`yyy`— ...yam +++ / , Supplemental Information
TYPE -OF WORic , :.:,:.„,,-,,.-%, E ` , . =:REQUIRED DATA: 'I AND ' .2- FAMILY' DWELLING
❑ 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: (WTttGbWL e - tb10p(, equipment, materials, labor, overhead, and the profit for the
"_ Y. OF ,- work indicated on this application.
i `-
CATEGORY 4
, , CONSTRUG T
� I , , C , ,. ",
❑ 1- and 2- family dwelling Is, Valuation $
❑ Accessory building ❑ Multi -family Number *\ bedrooms"
❑ Master builder ❑ Other Number of bathrooms
L OCATION Total number of floors.
u =- ?, ? JOB SITE " IN FORMATION YAND = - L% - -
Job site address: .=:, boo 6 L) to kem. b.M 12.0 . New dwelling area: square feet
City/State /ZiP -- j6.4 y- p.e. 9 - 1 ZZe4- Garage /carport area square feet
Suite/bldg /apt. no.• up Project name. T &men p epd6,$C'S„ Covered porch area square feet
Cross street/directions to job site. S(,J - .14.Ll. yl b uv0 To Deck area: square feet
190e-}k144 12 D . Other structure area: square feet
REQUIRED DATA: COMMERCIALAJSE CHECKLIST
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.: 2. 5 I4 .4- AA 00 (OD equipment, materials, labor, overhead, and the profit for the
-:; - " - .. - work n aced on this a
�DESCRIP'TION ; , OF WORK =f ' � � application
C. o -1911e or TE► h eoP�-( C-491.-)1 I E.�s •0-0, .
( Valuation: $ 4 60 i D b0
- mg ui ing ar . l 95g 8 square feet vfj110#
Va7L1oC¢ -F-o12,-- -1u6InJ—.S�GC>C7oce,
New building area: N/A square feet
ROPERTY'" OWNER• ' ® " aTE =>:', - -'s :,- '' ; : Number of stories: 2
1�
PROPERTY
�.Fn. 2 +;,E
Name. 6,A - To 41. p( SG OLSTACT Type of construcnon. N
Address: 6I 60 $W S A).ty tsovz..Cs. Occupancy groups:
'City/State/ZIP 6 I 04. . 9.1 2.23 Existing e- 1
Phone: (co 3) 4 Fax. (6b5 43 i - 4047 New e- 1
, 11 APPLICANT ._ CONTACT.. PERSON • , "
Business name ouu j o Lse ki w ix ets A►2c1 - j t All contractors and subcontractors are required to be
Contact name 1�� ��iJ licensed with the Oregon Construction Contractors Board
4 under ORS 701 and may be required to be licensed in the
Address: 3 4C1 5(A) I JpcW.ING.Tpi,1 Sl . A eop jurisdiction in which work is being performed If the
City /State /ZIP 7D1�2, t b 12 cri2 0 4„ a ap y ant is exempt from licensing, the following reasons
Phone: (S6-22) V2 b - 6950 Fax:: (SD-3) 213 - c J IQ 2
E -mail Vt A j e dvW(i.. Gay
. -:,
4COIVTRACT;OR4..; % - „-.R 1:
Business name: .O\DI". cp„N d..04.-Si ,- 94 = 13UILDING;PERMITFEES*
Address 21 3 ( a.G lAW 14.4,..te.arwoo) 0 e.
Please refer to fee schedule.
City /State /ZIP: .', 1 1 ? 6 YZ q 7(2 y
r Fees due upon application
lo
Phone (503) t{ S - 2:;,5 3 1 Fax: (go) ) (L.(S - .53 5 7
Amount received
CCB hc.• 6 3 I 47
�(� Date received'
Authorized signature. ` \ _ 1 CC (x rX a s In This permit application expires if a permit is not obtained
1� vV" � within 180 days after it has been accepted as complete.
Print name- V Clik to S Date Z'2S /0 W * Fee methodology set by Tn- County Building Industry
/ � Service Board
i \Bmldmg�Permns\.SIT- YermriApp dec 12/03 ■ 440- 4613T(I I /02 /COM/WEB) f t:' 4-1 1 ��/ 1, ./ , ley
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.) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CM U
(l Concrete
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: sq. ft.
'o'x',i_ '',.z_„ - - :>;r '�.: a .�. :a .,•..}, ; >r;s •; •r,:,i` : }',.
Sa :'� -i3. x'. j ..
x "'N
.,�....... i.Ay': x.,,Yi' "'- ,.�:�J �'3 a:�('i. � -- .e.r'.'- '.";S'�'.v� _ -t }� : v'i+.'.'.Y>.;.t" �'S i'.d � .. - ...,.. � � z �w%,., u ' .Si�'�.�i i � u t �i :i � ..., u " -:rt w _ . .s
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 (I Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
, # of Plans
:FFa TYP "EOF SIJBIVIITTAL ':Re aired at
"eludes New= Additi`orisWorAlteratioris Suliiniftal:
Commercial 2
Multi- Family R -1 Occupancy . 2 .
•
One- & Two - Family Dwelling 2
•
i \Building \Forms \SIT- Checklist.doc 12/29/03 . ••
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTIONDIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — ° Z AM PM BUP _
Location 69 d /LtUI L� Suite MEC
Contact Person Ph ( )
Contractor Ph ( )
SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT c7Ze I
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm id )1.
Susp'd Ceiling
Roof
Other: IW����`� -
Final
iii
PASS PART FAIL
PLUMBING r� i
Post & Beam
Under Slab
Rough -In NIWAMINEWMir
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
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 Ei Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
O
DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL