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Permit C ITY OF T I G A R D SITE WORK PERMIT AIL DEVELOPMENT SERVICES PERMIT # : SIT2003 -00031 ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 5/21/2004 SITE ADDRESS: 07565 SW HERMOSO WAY PARCEL : 2S101AB 01502 SUBDIVISION: HERMOSO PARK ZONING : MUE BLOCK: LOT: 022 JURISDICTION : TIG CLASS OF WORK: OTR PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: 1,000.00 EXCV VOLUME: 0 cy LANDSCAPING ?: FILL VOLUME: 0 cy SITE PREP ?: ENG FILL ?: N STORM DRAINS ?: SOILS RPT REQD ?: N IMPERV SURFACE: 600 sf Remarks: Parking area for new law office. • Owner: FEES BERNT JACOBSEN 4248 GALEWOOD ST Description Date Amount LAKE OSWEGO, OR 97035 [BUILD] Prmt Fee - Valu 5/21/2004 $62.50 [TAX] Valu 8% State Sui 5/21/2004 $5.00 Phone: 503 - 892 -9301 [BUPPLN] Pln Ck - Valu 5/21/2004 $40.63 [FLS] FLS Pln Rv 5/21/2004 $25.00 Contractor: [ERPRMT] Erosion Cntl 5/21/2004 $80.00 EVERGREEN PACIFIC INC [ERPLN] Ersn Plck 5/21/2004 $26.00 5664 CARMAN DR [EROSN] Ersn Pick 5/21/2004 $26.00 LAKE OSWEGO, OR 97035 - 3358 [WQUAL] Wtr Qual % 5/21/2004 $225.00 [WQUANT] Wtr Quant ° 5/21/2004 $275.00 Phone: 636 - 5165 Total $765.13 Reg #: LIC 41521 Required Inspections Erosion Control Insp 846 -8444 Paving Insp 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 f more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notificati Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies o hese rules or direct questions to OUNC by calling (503) 246 -6699. Issued By: A' Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day it `` S Work . Building Permit Application Received 1/ FOR OFFICE USE ONLY , ved � Building . Date/By:A 3 a Permit No.S77 - ©/;9Z/ City Of Tigard Planning Approval Other Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Cigard, Oregon 97223 Date/By: IZ o)/5$5 Permit No.: , Phone: 503- 639 -4171 Fax: 503 -598 -1960 G a n �o''Ap�, v i ?, � I � ' Post- Review Land Use r -- Date/By: Case No. Internet: www.ci.tigard.or.us 6 Contact Juris.: ® See Page 2 for 4 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information W :... . a:a. ;; 114 if: 4 - ro'+4 «. r::t,F- �a-_.•;;I." 1-'- .:a:' '• :, :'LE' - l=s-�.:ir'_?",23� =? aitk.,a..- n' rA a:� ' ^•'` -`'� . �r�;� z �TYPEtOF`WORIC � M :s�?�? s� =.�.. , �,.- :.`; , .., fir,.. ` -, w w ^�;''�r`; f �" ;�•w� • �REQUIRED.�DATA�° :_s. �. f , f ❑ New construction Demolition 'Ir.. '% ' � . -. %t•.5_ `.f. � - '<a4'�'?'.a` a '. '''�,.;..a��:.e?'��:s:,E�4::_. -� �'a;� -mr te I gAddition/alteration/replacement ❑ Other: `° ii= r,CATEO:ORY OF CONSTRUCTION, y�' . Y.Vk'' `-' - - ` Note: Permit fees* are based on the total value of the work performed. Indicate ❑ I & 2- Family dwelling A, 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 1:1 Master Builder ❑ Other: Valuation $ ' ''' _ a :k. ';s — JOB :SITCINFORIVIATION,1 and =l OCATIONFqi. - - No of bedrooms: No of baths: Job site address: 75‘5 S 4) ` /eRno• $ WA Total number of floors / New dwelling area (sq. ft.) Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) o Project Name: ,7•ACo13SCN GAGt) ,1 /f /C-- Covered porch area (sq. ft.) Cross street/Directions to job Site: Deck area (sq. ft.) Other structure area (sq. ft.) KI :44 -a ,, w� ;� = RE UIltED DATA. � s• ,tr '3 .� � au,�,,. c., g ,� d °�-.- k.rt�a, sx �.n` . '�,d,��. t :1 ; i 9, -41 EItCIAL°' `tUSE4CHGI{LIST : " `, i i � - .;�Y„"•'.�;�a.,r sa5i�' ta ,x• >s:�ta� fur e'. A• �'�a�- � >2;�Y..���W;ai+�,_:,� Subdivision: . Lot #: Tax map /parcel #: 2 S /0/ 40- / O,re Z Note: Permit fees* are based on the total value of the work performed. Indicate . !AMME DESGRIP,�TIONS'OF WCQR2'C` i a „s= * MA the value (rounded to the nearest, dollar) of all equipment, materials, labor, C //Aiu E of Ufa A 9P PAie�A)F 4,2C-74 overhead and profit for the work indicated on this application. Valuation . $ / 1 Existing building area (sq. ft.) New building area (sq. ft.) Number of stories R P-.RORERTsT'r.;OWNER; ` 't;: �P, , a ENAlrJr .. 1'0M.* Type of construction Name: /3gevT 714 c o,t3 SEA) Occupancy group(s): Existing: New: Address: Z SG,S .sGv NERr7oso will . City /State /Zip: T /6ARA OA • Phone: So3 `892 ' 9,30 / Fax: /41, NOTICE: All contractors and subcontractors are required to be ur.,F ti , ., licensed with the Oregon Construction Contractors Board under s. M; ICANTi,,4 "�„ •h ® r CONTACT' PERSON :4 -, provisions of ORS 701 and may be required to be licensed in the Business Name: /' CA)7Rc/'l ARCM /rt ruRE jurisdiction where work is being performed. If the applicant is exempt Contact Name: QAyARD / 7 - AiTRQ/'► from licensing, the following reason applies: Address: 10.5 N W f4N7A,v/ Z A 7C-All. City /State /Zip: PORTLAND 0 ? Z/O . Phone: w., „ �3, �.:_ , f Fax: ' = > t'. ) DING ERVhTFEES* *n..3 :;. •;, E -mail: , ;�:, �' w F , . i b 7� :' ,� •�: , 4 �>� -,n�n � bPlease to:feersched �, .aZ : :: :. r- ssie:'t?,:,Y.t.�;xw {` - , $.",. - "s r ;._1'h -':S ?L` x . ; 5i' ° ,'Jc'..,•;4'411 � -Ift * " ' ' ' ' : '', y ', "s?fi4Y°ls£1.1' ••Pvd. 41';�S'£',v`,: 2'.`�`"a°�.r ;'' >3:,'-°-"' Business Name: L Vtf2G -R `uf' Pi4c /F/C Fees due upon application $ Address: $ 6't SGv CAarMA) .01Z11/6 City /State /Zip: LA kE OSt0 -6-0 f 0 A 17035" Amount received $ Phone:5 o3 /6S Fax: . Date received: CCB Lic. #: y- / 5)-_ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) - i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 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) cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the "TAN" Plumbing Permit Application for site utilities plumbing work. n � a.•n .w, °.:� °' :x- � -}" � �._ .�a:x-�.�i. t a' "a,z-`�„ - �.xa..:.�; �u =�:a'.. �,. sr,.r - „�.�r .- .,.. - .. ��.. - = Seeb Site�WNork A ' Iication �3Pian Submiftal Ren uirements': Plans. Required -L q sa�.,�.�a sir4 "&�;� "� "�Z� ^"r''` �, '$��:F"f�.�;��*'�' "`�'$ ��. - �� � I attap ed ,The fgllowingrrnust accornpany;Ois; appli * 4 r :# `4" ' u ; & ' A SA Site lang J i iity =Nlap s howin g ` iv* Park (i nclu d n ADA) a nd K Q r M �•, .` . 5 „�e. 'E"'+1"'; .. ,�»., , ",. ; r ? 3 ° t' s ^w., kit oP -x a .' .5+ .,,.� " , €- i'�i,� a as 7w e< ' L� htln �Plar z�a � . 9.: 9 �r.� �� r �, rk Y :ig ing Plan arid�'defails A �V —N *Landscapin Pir , � , ,, r��,w.�,�.s ° .,.m e a.. , s�• s,�, v - ^�.�r�f -� �, ^` "s"r ' r{ " a ,. ErosioinfContra laPlan ;andYdetails 9 - fi� Soils�Repo } rt (if r`equi_rao ` ;a .# ^2t %.YIAS.� mr. St "r0` % ,y; .. mk "�' Y''S � '�� '� - Retainin Structures.:. $ >m � �.��;. *Does not apply to 1 and 2- family dwellings. s "C' � k 4 t a ,,.o- . e, V � �� yy '�" e _ EBwuel .. PE 'OF SU BMITTioL . F Requirec! �atrt , A (Includes New, Addition er i gar e'rations) , ital�. � s� WFw,.. � 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\sitechecklist.doc 09/24/01 CITY OF TIGARD 24 -Hour BUILRING Inspection Line: (503) 639 - 4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 . BUP X36 Received Date Requested /G' °"/ 3 AM PM BUP Location 7 � .��� Suite MEC Contact Person 1, t Ph ( ) 57 9 -- F r? p ? PLM Contractor Ph ( ) SWR BU IN Tenant/Owner -4—em 4 6 r. ELC Foundation ELC Ftg Drain Access: 1 - , ,,,/ ELR Crawl Drain Slab Inspection Notes: SIT _960 3 —DO 3� Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation „f,� /� r 1 /kti( ' -T Drywall Nailing �N \v T /� V l Firewall Fire Sprinkler Fire Alarm FP_Crke( _ � C Susp'd Ceiling ', 1 l �� Roof (A� IU'r Rt , �"'�- F-� o.. o Other: �-; imp / a(�1 4 L P •ASS PART PLUMBING 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 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. PART FAIL Please call f r reinspection RE: Unable to inspect — no access ire Supply Line IF A ADA P � 0 Approach/Sidewalk Date t V - Inspector A� �( Ext Other• 0 . DO NOT REMOVE this Inspection record from the Job site. r :;; PART FAIL