Permit CITY OF TIGARD
� SITE WORK PERMIT
I, DEVELOPMENT SERVICES PERMIT # : SIT2002 - 00001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 9/18/02
SITE ADDRESS: 11515 SW HALL BLVD PARCEL : 1 S135DA 01400
SUBDIVISION: ZONING : C -
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: $80,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: Y IMPERV SURFACE: 5,000 sf
Remarks: Site work for construction of new temple and addition to existing SF residence and change of use as a
congregate residence.
Owner:
FEES
BRAHMAPREMANANDA ASHRAM/TEMPLE
11515 SW HALL BLVD Type By Date Amount Receipt
TIGARD, OR 97223 PLCK CTR 1/9/02 $419.80 27200200000
FIRE CTR 1/9/02 $258.34 27200200000
PRMT CTR 9/18/02 $645.84 27200200000
Phone: 5PCT CTR 9/18/02 $51.67 27200200000
Contractor: WQUN CTR 9/18/02 $1,650.00 27200200000
EROS CTR 9/18/02 $120.00 27200200000
D & A GENERAL CONTRACTORS ERPC CTR 9/18/02 $39.00 27200200000
3100 TURNER RD SE #204 ERPU CTR 9/18/02 $39.00 27200200000
SALEM, OR 97302
Total $3,223.65
Phone: 503 - 581 -8036
Reg #: LIC 145089
Required Inspections
Erosion Control Insp 846 -8444
Paving lnsp
Strm Drain Insp
Culvert/Catch Basin
Manhole /Cleanout - PVT
Sprinkler supply lines
Domestic water line inspect.
Landscaping lnsp
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 by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -00 -0081 z. obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signature , iW
Issued y_ li 9 lX,lk .4114
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
-- � r r - i 6 1 _ ,�''
i f G O
, -, ' Huddling Permit Application s', ,
Date received: //9 /a A Permit no. :5 ∎p ,?ca;i.Neu/e/
" 1 al' City of Tigard
Projectiappl. no.: Expire date:
City q(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: t P D R) 2001-0000 I &2 family: Simple Complex:
M I II/ i1ililli
=TYPE OF 'PERMIT "
0 I & 2 family dwelling or accessory a Commercial /industrial 0 Multi- family III New construction ❑ Demolition
0 Addition/alteration /replacement 0 Tenant improvement • O'Fire sprinkler /alarm 0 Other:
N'',' .__ ,. �,. JOB SITE INFORMATION tea :'i • ' ''k - r ;i,,. , q;.,: 9,.`
Job address: 11515 S.W. HALL BLVD. T I GARD , 0k 97223 Bldg. no.: Suite no.:
Lot: Block: Subdivision: u r r t Tax map /tax lot/account no.: 1.1 35 DA
Project name: BRAHMA PR_M`NAND . d HR: ■ u' $ : Ail I 0500
Description and location of work on premises /special conditions: SEE SITE PLAN.
;`,, OWNER_, . .. • 'r> ' FOIL SPECIAL ° INFORMATION, USE CHECKLIST
Name: BRAHMA P R E M A N A N D A ASHRAM (Floodplain; septic capacity, solar, etc) t
Mailing address: r • d I : I I & 2 family dwelling: -"''--
Eta 1 ,. 1 1EMMEM ZIP: I Valuation o.f work ,�$•-
Phone: 10185111511 Fax: E -mail: No. of bedrob s /baths
Owner's representative: SAM ADD I T I WAR Total number of l rQ
Fax: E -mail: New dwelling area 'f '�
Phone: � � g s (q• —
r APPLICANT Garage /carport area‘. ft.)
Name: VICTOR M NOBLEZA Covered porharea(sq.ft.)
Mailing address: S . W .HALL BLVD. Deck area (sq. ft.)
zIP9 7 2 2 3 Other structure area (sq. ft.)
Phone: - 1 Fax: E - mail: C family: •
CONTRACTOR Valuation of work $ 132 000.00
' a • l i, ) }sting bldg. area (sq. ft.) _
Business name: V-- N 1 a kii-c , /1/4 3-7-k i te ! ``cam'
New bldg. area (sq. ft.)
Address: Number of stories ./
City: State: ZIP:
Type of construction
Phone: Fax: E-mail: Occupancy group(s): Existing:
CCB no.: 400 " 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: AV I N A S H G. P R A D H A N provisions of ORS 701 and may be required to be licensed in the
Address: , u • i 'A jurisdiction where work is being performed. If the applicant is
exempt from licensing, the following reason applies:
IlEn . i, ► i MI ZIP: • i
Contact person: , • - All _ Plan no.:
Phone: _ E -mail:
. ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: 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: Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete , • 44 -4613 (6 /OOICOM)
• as% • V/ } &it' ..,
•
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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: tell V. 0 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) LE e"1"aT-030Ocu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to 90% of
maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
VL Concrete
❑ Other
•
*Total new impervious area including all buildings, -
sidewalks, and paving: 1,4 r 7, 41 ›-n 0 sq. ft.
Site Utilities Plumbing Work:
Complete the "TAN" Plumbing Permit Application for site utilities plumbing work.
. ttac uired` `Seep" Site`V1 /ork Perinit,Apphcation, Plan Sub` m ltfal Requirem=ents"
ahed The following must appllcation a
Site flan with Vicinity Map liowin`g 'Pa ng(Includin g ADA ands
ADAcomplianee °,,, Ligting Plan'
`' } G "raging Plan and °details '✓' *Lan ° dscaping 4PIan
V r osi o n C on t ro l Pl a detail z * Soils Report (if r
Retaining Strucfuies , , , °. ._ ' :..
*Does not apply to 1 and 2- family dwellings.
•
Pitt 04,1244M4111#4,7,
� ` Required�at `
(Includes New, A dditions tf i eV Alterations) Submittal A
Commercial 4
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).
is \dsts \forms\sitecheckiist.doc 09/24/01
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2002 -00001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/18/2002
Phone: (503) 639 -4171 / µ? f
Inspection Requests (24 Hrs.): (503) 639 -4175 _:_..
INSPECTION WORKSHEET FOR DATE: 9/7/2005 TIME: 7:08AM PAGE: 139
SITE ADDRESS: 11515 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BRAHMAPREMANANDA
DESCRIPTION: Permit reinstated (for a period of 30 days) for FINAL INSPECTION. Site work for construction of new
temple and addition to existing SF residence and change of use as a congregate residence.
OWNER: BRAHMAPREMANANDA ASHRAM/TEMPLE, PHONE #:
CONTRACTOR: D & A GENERAL CONTRACTORS PHONE #: 503 -581 -8036
Inspection Request Scheduled For: Date: 9/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 014833 -01 503 -598 -3073 Y
Corrections /Comments/ Instructions:
• f � Th / /
6ci -
...,
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL I/ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED ...„...
Inspector: D ate: , • (J C Phone #: (503) 718-