Permit C 1 441141/1 - 6 '0-6 tO aCteLe
CITY F TIGARD SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2003 -00032
Alj 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 1/23/04
SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL : 2S101AB 01501
SUBDIVISION: HERMOSO PARK ZONING : MUE
BLOCK: LOT: 021 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 13,000.00
EXCV VOLUME: 600 cy LANDSCAPING ?:
FILL VOLUME: 250 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT REQD ?: Y IMPERV SURFACE: 12,265 sf
Remarks: Site work for new 7,250 sq. ft. office building.
Owner:
FEES
LIONEL LLC
BOB DAVIDSON Description Date Amount
14285 SW PACIFIC HWY [BUPPLN] Pln Ck - Valu 12/10/03 $109.27
TIGARD, OR 97224 [FLS] FLS Pln Rv 12/10/03 $67.24
Phone: 503 620 - 5203 [BUILD] PrmtFee -Valu 1/22/04 $168.10
[TAX] Valu 8% State Sui 1/22/04 $13.45
Contractor: [ERPRMT] Erosion Cntl 1/22/04 $80:00
GRAY PU RCE LL INC. [ERPLN] Ersn Plck - USA 1/22/04 $26.00
PO BOX 23516 [EROSN] Ersn Plck - COT 1/22/04 $26.00
TIGARD, OR 97281 -3516 Total $490.06
Phone: 503 - 639 -6127
Reg #: LIC 79018
Required Inspections
Erosion Control Insp 846 -8444 (P$ / -1/4Jq
Paving Insp
Final Report Eng'd Grading
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 o A '01 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6 %•9.
I sued By:
Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
7S'' s se /-t a.so ■
*- Site. Work rla�►urerA„ .
4 t �~ FOR OFFICE USE ONLY . _ .0
( ,' ulllding Perm i :trA.piphca -tion Received r j � Building
/ l u � I U U 1Q Date /By: / /7 /e � � Permit No.:�A/ o 0
City of Tigard Planning Approval Other
y g DE 2003
a Date /By: Permit No.:
13125 SW Hall Blvd. 9 J Plan Review Other
Tigard, Oregon 97223 D ate/By: /2 - Q Permit No.:
Phone: 503- 639 -4171 FaxTY503=59$-i1�960 A.A mg� ( P - Review Land Uset••
^ " DING DIVISION A.. � � � Date /By: Case No 7r .6 G79�bg
Internet: www.Ci.tigard.or:u ARM. 2 �" Contact / Juris.: ' ■ ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: ( Tl6/ Supplemental Information i,,
.
V !^?". _ A ?. i_' �
y ... : ,., .. ,.. �:� >.:-.::., .�TYPE OE =WORK' ..�•. -: .. . - ;?': �': • +RE .�'a'� nr '.'t`FC "`
N y a$ QUIRED`DAT A:' 7,:•.-..A..:,.-‘.:'!,
` '
N ❑ Demolition er ` ,, .
New construction
w;rw ��. � 1�`8c 2 <EA'MILY,DWELLING �� rk ` ,
" ����
Addition/alteration /replacement ❑ Other: ,
` - r a l : ' °; CATEGORY.OF CONSTRUCTION T : =, :t` '' -i Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ® Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
�;n k:fiJOBnSITE INFO ION4nd.LL- OCVTION, ,
° No. of bedrooms: No. of baths:
Job site address: 1 SIJ I4eryiir J Pa Total number of floors
Y New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: /'hi- r f A A., Pr, ii of T , r a Covered porch area (sq..ft.) I'
Cross street/Directions to job site: , Deck area (sq. ft.) �. 41A i ` .
Other structure area (sq. ft.) 0 ii
J Qeve I d Sfree,+ ) ®
S o,
;x ' ` ; -�." t. 7:5 a REQU�IREDDATA::;a� , t',a ',:a
COMMERCIAL- - USE CH fi 1
Subdivision: A -r RA r`IC Lot #: a . .
Tax map /parcel #: ...,S 0 1 A Q - /.SO/ Note: Permit fees* are based on the total value of the work performed. Indicate
;,7;4iIt°, 5aa;;( 3DESCRIPTIQN ; QC , WORI{;il'kfiV'':.;;t,: _".;° '.`.' .:' '`�: the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this applicatio
con +rue+ n'z,I of-co ce (31dJ v r !q, co d
RS) /NIo , e e-X rsi r` Rf fr deice, Valuation $
Existing building area (sq. ft.) J.2.00
New building area (sq. ft.) 2200
• Number of stories
' _ ; ` : Type of construction Viv
Y.[a+] ;PROP ERT,Y„- OWN'E'R; .�� r ' ®. ; TENAN"T''i :"- . - {'�a`=' � >: • YP
Name: L l D,q C I LL C % 0g Drn' sor/ Occupancy group(s): Existing: R
Address: /co.$5 $tri eAct ti . y New:
City /State /Zip: fl c ,,,l , 2 9 - 722_9 •
Phone: SDI 6Zo Si,o3 Fax: 5o3 910 NOT NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
''' ®AP<k PLICANT "/ 4,;. I_ .;_.` ,.:' ::';, ;, ®: COIVTACT4',ERSON ':.. '4:
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: a Ark; S from licensing, the following reason applies:
Address: a NC Hvy alio
City /State /Zip: Ne , of 97/3.2_
Phone: 5 3 537 30o2.` ' Fax: 503 .53P O ).Z - •.,, .,. t f - r'r - -t . ,- .° .i -T :_ 4-- 4
r ,1 BUILDING'PERMIT F EES* ter c A
E-mail: r v P I h S� vet 1 o) r NQ � „k: ' 'Plea t o fe s c h edu le `. � h.Y 0 e r
ONTRAC.;OR . , . " F " '' . _ . < z. . " . 2._ .. , K:_ =.,
Business Name: (l^„ p (`L¢ (I , rq c Fees due upon application $
Address: Po 13r,,X • .3S I(
City /State /Zip: pd rzo „4 oR . 97.1.$1-3 - 4 Amount received $
Phone: 503 63') - 607 I Fax: S03 - 639. 6l3N Date received:
CCB Lic. #: '7 9b 1 3
Authorized I n Notice: This permit application expires if a permit is not obtained within
Signature: . Date: 4-4 01 180 days after it has been accepted as complete.
fh 'lie ke zc(r *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) ..&&(. C A/ /O Q? 7
is \Dsts\Permit Forms \BldgPermitApp.doc 01/03 I S t o 7, ,2 V
r9e7° d £ t/f4 VAe4 y 7 /. Su c i /7 .57
•
•
SITE WORK PERMIT CHECK LIST
Commercial, Multi - Family (R -1 occupancy) and Residential:
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) 2-CO
cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other
*Total new impervious area including all buildings,
sidewalks, and paving: 71) Z-6 sq. ft.
Site Utilities Plumbing Work:
Complete the "TAN" Plumbing Permit Application for site utilities plumbing work.
PlansRequi See "S Work Pe A Plan Submittal Requirements"
attached The following mustiaccomp this application
k . Site Planwith Vicinity Mapshowing f. *Rarkmg ADA)and
ADA compliance k . Lightingr Plan''
G rading Pla and details " . * Landscapi'ng °PTan
Erosion':Control Plan and` "details Soils Reporf`(if equired) � 1-1
E etairii Struct005,
• *Does not apply to 1 and 2- family dwellings.
k rfetr f is
�` �� � � f WN"w � ` rvof Plans :q
SUBMI Requ' reefat
nclud`esNew o AIterations) Submittal
�I � We i
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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested g — 15 AM PM BUP
Location Suite MEC
Contact Person .C1—P i Ph ( ) 5 7 7 -5 3d PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT d(' ) ' e00, 3�
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: \ 4!
Anal A
PASS ; PART FAIL IrAtard •
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 r `
ELECTRICAL LIN, A
Service ,1111111MNia■ r.'I�
Rough -In
UG /Slab - ■ Taw w
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
-j fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Ot r:
in DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL