Permit CI TY OF TIGARD SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2002 00018
LI " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/20/02
SITE ADDRESS: 13001 SW GALLIN CT PARCEL : 2S104DA 03500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING : R -4.5
BLOCK: LOT: 021 JURISDICTION : TIG
t.. CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: VALUE: $8,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Steel pipe retaining wall to stabilize rear slope.
•
Owner: •
FEES
- • RICHARD BROWN —
3001 SW GALLIN CT Type By Date Amount Receipt
TIGARD, OR 97223 PLCK CTR 7/15/02 $78.07 27200200000
PRMT CTR 8/20/02 $120.10 27200200000
Phone: 503-620-8860 5PCT CTR 8/20/02 $9.61 27200200000
Contractor:
Total $207.78
PRO LANDSCAPE INC
•
3045 SE 61ST CT
HILLSBORO, OR 97123
Phone: 503 - 642 -5696
• Reg #: LIC 140613
Required Inspections
• Fill Inspection
• Engineered grading final reprt
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 he 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- th�Oregon Utility Notification Center. Those pules are set forth in OAR
I 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: _ �_] � / ,
Iss ed By: n 4: %�
r .,'.. Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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Application : ,
Building Permit Appli, .,. , - . A .........
• — Date received 'l - 4 7 ' Permit no.: '1 aooa QJU tg i% ?:
Cit of Tigard
j y b ProjeciJappl no Expire date: 4
Address: 13125 SW Hall Blvd, Tigard. OR 97223 —
Ctry of7 Tigard Date issued. ay. Receipt no.
N. Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.. Payment type:
■
, Land use approval: _ I &z ramify. Simple Complex
C l tn:d ".J
U I
Oi ' Mult' Multi-family _ '-
,� ,. & 2 family dwelling or accessory U u mmcrcfalhndu l New construction �I Demo lition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler /alarm U Other: _— r -
. . • , • . . • i ,
• :: / Tit /, . ---4- / f ( tii Bldg. no.: Suite no_
Lot. I Block: 'Subdivision- m_ •
■ J a ddress: •„7 , ,G' � � � • .. 1.OB'. TE INfORMATIO "r Tax ma /tax o ac count no.
- -- IU - --
Protect name. — t .
Description and location of work on premises/special conditions: 1 1 ) / Al 1 L- cr• »4' ( - i C 1(,'(24 + :.% - -- C •
) 1tiNk:1K I OR SPF:c•IAL 1\I ' )R1'lATIO\ • I 'Sf (III (hi 1ST _
, r t (I lbudplern ,scptic.capacihsohr,ctc.)
Name: /c i[ L . ; Ai (.04
• - ' — I & 2 family dwelling: r -
Mailing address: ; �i / Su �,yL! /
City: % _ lr IState(' IZ1Pt/ 7 a 2 3 Valuat of work ............. $ o," �—
r •.
Phone :Q - f t to l :ax:(W - yk WiE -mail: No. of bedrofms/baths - --
Owner's representative. Total number of floors C
- Phone: Fax: , New dwelling area (sq •
ft.) _.— __—
• 4APPLIUAN . Garage /carport arca (sq. ft.) _____ -----
Covered porch area (sq. ft.)
Name: _
Deck area (sq. ft.) —
Mailing address: _
I State: I ZIP: Other structure area (sq. ft.)
City: Commercial/industrial/multi-family:
Phone: Fax: E-mail:
Valuation of work 5 — .
r Existing bldg. area (sq. ft.) .......................
Business name: /'t'✓ i 4- tA)•tLf k— New bldg. area (sq. ft.) —
Address: icy yf J f G /f,- ,/i Number of stories .-
City: f� /L fJt�. X1 State :/2�� ZIP: 9,7/ ? j
Type _-- —
I T of construction
Phott s (L(2 S i lL. I Fax: E -mail' Occupancy group(s): Existing: _-
CCBno.: L ck_... esc - =7 7 L - 'f - /410t1,01 New,
City /metro tic. no.: Notice: All contractors and subcontractors are required to he _
• • AR('lIl IECT /I)I SIGNI•.R . ' . : - licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may he required to be licensed in the
— jurisdiction where work is being performed. II the applicant is
Address: exempt from licensing. the following reason applies.
City: State: 'ZIP:
Contact person: , Plan no.: _ —
Phone: Fax: E -mail: —
Name: Contact person: Fees due upon application .. . .. ... .. 5 ___
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 aid examined this application and the r sine all runsdrarons acecp credit cants. { lease call fur Aaron for more tnfomunon 1
tt. attached checklist All pr visi)ns of laws and ordinances governing this U visa U MasterCard
t
—
Credit card number - - -
work will be complied itl;, tiv per specified herein or not. / / f xpnes
Authorized sig A / Jl -- Date: %/i J /L 4 — N of cardholder as shown on credit cad —
,,;' - Print name: e /-/.4i1.1) / ( Z.-144_1. /4 iJ Cardholder nanature Amount
Notice: This permit application expires if , permit is not obtained within 180 days after it has been accepted as complete a+o -aa rt'OMI
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SITE WORK PERMIT CHECK LIST
Commercial, Multi- Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted. .
Excavation Volume: _ _ _ _ cu. 1.ds
Grading Volume:
(Soils re ort required for >5,000 cu. ds. _ - cu. yds_
Fill Volume: - —
(Fill exceeding 12" in depth shall be compacted 10 90% of I -
maximum density) _ _ ___-- ____cu.yds. I
Retaining structure? (Check one) 0 Rock
i
U CMU
U Concrete
I ; D Other
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*Total new impervious area including all buildings,
sidewalks, and paving: — -- — L -- _ 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 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 1 and 2- family dwellings.
•
# of Plans
TXPE OF'SUBMITTAL Required at
(Includi3s NeW, Additions or Alterations) Submittal
Commercial 4 I
Multi- Family R -1 Occupancy 4 .
One- & Two- Family Dwelling 4
NOTE: Plan review is dependent upon submittal of a completed application 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). -_
r\rictc\fnrtns'Ladecheckiist.doc 09/24/01 '
Case Activity Listing 05/18/2010
8 4:51:13PM
C E �
Case #: SIT2002 -0001
_ -
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D'ate�._ �.� Date2 � ",� �51)ate.3�a» d <��rt " °.,.,.,�» A
Activity ��" esc'r`iptiou�- : �,Y;�z cs� °'� ,.. .m� �' .,M. � _
s..>ti -�,_ �; a,� - .a "�` �` bn�cz� �� - 1 a�� �� fp �_ °`
SITA005 Application received 07/1 5/2002 None DONE BB 07/15/2002
BLD
SITA008 Permit Created 07/15/2002 None DONE BB 07/15/2002
BLD
SITA012 Plans Routed to Plans 07/15/2002 07/15/2002 07/15/2002 None DONE BB 07/15/2002 Routed to Gary L. per request.
Examiner BLD
SITA026 Plans approved by 08/19/2002 08/19/2002 08/19/2002 None APPR GWL 08/19/2002
CPE GWL
SITA021 Plans 08/19/2002 08/19/2002 08/19/2002 None DONE GWL 08/19/2002
Approved /Routed to GWL
PT
SITA032 Post - review 08/19/2002 None DONE GWL 08/19/2002
completed GWL
SITA710 Fill Inspection None 08/19/2002
GWL
SITA775 Engineered grading None 08/19/2002 Geotech engineer to inspect piles &
final reprt Gm a, backfill & provide final report
SITA799 Final Inspection 08/30/2002 None FAIL KBS 08/30/2002 # - see inspection notes.
KBS
SITA070 (F) Ready to issue 08/19/2002 None DONE GWL 08/19/2002
GWL
SITA092 (F) Issue permit 08/20/2002 None DONE DEB 08/20/2002
BLD
Page 1 of 2 CaseActivity rpt
C ase Activity Listing os/18/2010
L. 4:51:13PM
''.- 6 C E
Case #: SIT2002 -00018
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�� „��, _ � „ � � ��. . -� �,Da e'2' ate,3 ��;Hold�, �..�Dis To ; -�� B "�< `� �� _ Notes 4 �� ;.
�Activif �,e� °Descri ton . � � E�.gUatel��� '��� t � = ��=D �a�:- p� Y �.� � ..m - Y � , � e� ,: �,..;,°
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SITA770 Misc. Inspection 10/02/2002 None RECD HAP 11/26/2002 Final acceptance of pipe pile
HAP retaining wall from Alder
Getotechnical Services
SITA799 Final Inspection 11/26/2002 None DONE HAP 11/26/2002
HAP
SITA800 Case Finaled 11/26/2002 None DONE HAP 11/26/2002
HAP
Page 2 of 2 CaseActivaty rpt