Permit CITY T I G A R D SITE WORK PERMIT
I 1 DEVELOPMENT SERVICES PERMIT # : SIT2005 -00020
��' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED : 9/19/2005
PARCEL : 1S135AB -00900
SITE ADDRESS: 10200 SW GREENBURG RD V LINCOLN ZONING : C -P
SUBDIVISION: LINCOLN CENTER/FIVE LINCOLN LOT: JURISDICTION : TIG
Project Description: Relocate fire hydrant 18' at entrance in island.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 2,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
EQUITY OFFICE PROPERTIES TRUST Description Date Amount
ONE SW COLUMBIA ST #300 [BUILD] PrmtFee - Valu 9/19/2005 • $62.50
PORTLAND, OR 97258 [TAX] Valu 8% State Surcharg 9/19/2005 $5.00
Total $67.50
Phone:
Contractor:
B & J EXCAVATING
1848 NE 116 PL
PORTLAND, OR 97220
Phone: 503 - 255 -1487
REQUIRED ITEMS AND REPORTS
Reg #: LIC 58752
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 quest'Qns to OUNC calling 503 - 246 -6699
or 1 -800- 332 -2344. j
Issued By: Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Site Work ,.. .
Buildin Permit A lication roll orl t sE o Lv
City of Tigard
�, QED Received �` I
Date/B , " �/ 7 d - 'L Permit No.: w L - al a rm
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
� 2
Phone: 503.639.4171 Fax: 503.598.1 q /f A p �� f ` ) f (� t Date/B Other Permit:
Inspection Line: 503.639.4175 a 2005 _— . c Date Ready/By: ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: WI Supplemental Information
� OF TIGARD
. 6 "19t�P> LWiON . . 'REQUIRED DATA: 1- =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 ErOther: RE d„, . equipment, materials, labor, overhead, and the profit for the
.. CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2 -family dwelling Ifommercial /industrial Valuation: $
•
❑ Accessory building CI Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION , , . Total number of floors:
Job site address: / 0 .1--0 0 57 t,v , /f �.f®ll' /3¢k. iiii - New dwelling area: square feet
. City /State /ZIP: p i 4 it Garage /carport area: square feet
Suite/bldg. /apt. no.: rick
name: I/ A/6'Q� (:,fi � , Covered porch area: square feet
Cross street /directions to job site: AA / Wi A f'• f Deck area: square feet •
JW 4 ! v i AJ 9 A f s ' Other structure area: square feet
REQUIRED DATA: ,COMMERCIAL -USE CHECKLIST.
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
/� • DESCRIPTION OF WORK work indicated on this application.
/ l fi /n riL/itsii yeAltiv-/ i R f S 714/y4 Valuation: $ •
/9A Ciq f) /:-R0 , /n� Spit 1-6 t'44-74/7/., Existing building area: square feet
J New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
•
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: . Existing:
Phone: ( ) Fax: ( ) New: .
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: c�,„ ,, _,\ ot..) 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:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR. .
Business name: /3 - L1 * tJ it fig. BUILDING PERMIT FEES* .
Address: / 5'99 ,i‘ fI /' pb
Please refer to fee schedule.
/
City /State /ZIP: 7 /2179-,A0 (9 P, Y 6 /
Phone: L5 . 23 - 6 - - ) if F7 Fax: (.5773 ) ,75 S - 9,333 Fees due upon application
CCB lic.: 8 76 g e.` .f • 0 Amount received
'`' Date received:
Authorized signature: / • This permit application expires if a permit is not obtained
y� within 180 days after it has been accepted as complete.
Print name: G !- r b / l yr.- z, SAO\ w J r R Date: * Fee methodology set by Tri- County Building Industry
Service Board.
is \Building\Permits \SIT- PermitApp.doc 12/03 440- 4613T(11 /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.) 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
El Other:
*Total new impervious area including all
buildings, sidewalks, and paving: 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:
CI Site Plan with Vicinity Map showing ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
El 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.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi - Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
i: \Building \Forms \S1T - PermitApp.doc 1/13/04 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2005.00020
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005
Phone: (503) 639 -4171 I 4�u�p 1 ��l; 40H
Inspection Requests (24 Hrs.): (503) 639 -4175 .� __..
INSPECTION WORKSHEET FOR DATE: 116/2006 TIME: 7:02AM PAGE 72
SITE ADDRESS: 10200 SW GREENBURG RD V LINCOLN CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER /FIVE LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: LINCOLN TOWER
DESCRIPTION: Relocate fire hydrant 18' at entrance in island.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: B & J EXCAVATING PHONE #: 503 - 25&.1487
Inspection Request Scheduled For: Date: 10/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
495 Misc. inspection 017589 -01 503-310.4834 N
/o / e Cornts tr �
q
/1
M PM � i /(k
..I•A
(PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ C. LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: (O lU P- 19- Phone #: (503) 718-