Permit � , CITY OF T I G A R D SITE WORK PERMIT
A DEVELOPMENT SERVICES PERMIT : SIT2005 -00011
r�I j! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED : 6/8/2005
PARCEL : 2S102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING : CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION : TIG
Project Description: Vault & fire lines.
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 8,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
INTEGRITY INVESTMENTS INC Description Date Amount
2229 NE BURNSIDE SUITE 86 [BUPPLN] Pln Ck -Valu 5/6/2005 $78.07
GRESHAM, OR 97030 [BUILD] PrmtFee -Valu 6/8/2005 $120.10
[TAX] Valu 8% State Surcharg 6/8/2005 $9.61
Phone: [FLS] FLS Pln Rv 5/6/2005 $48.04
Total $255.82
Contractor:
KONELL CONSTRUCTION CO.
36000 SE INDUSTRIAL WAY
SANDY, OR 97055
Phone: 668 -3516
REQUIRED ITEMS AND REPORTS
Reg #: LIC 122459
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 f- ow ru - - dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
throu f, OAR 952 -00 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- :00- 33;2344.
Issue • = y: /A A i ! Permittee SignatureY>4
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.
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Building Permit AD ti�k�- E IVE FOR Or1 IC.1: till: r)�1
City of Tigard D e/B J' . a � Permit No.: S "S�� aU01 /
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.639.4171 F 8 60
Inspection Line: 503.63 5
Plan Review �'
ax: 503.59.19. ir - y /�' Other Permit:
P1 AY 0 6 2005 Date/B .
9.417 % Date Ready/B Supplemental See page l for
Internet: www.ci.tigar d.or.us CITY OF TIGAItD y Notified/Method Supplemental Information
B UI,d &VISION 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 XOther: Von.T r pile 6./0/4 equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this application.
Valuation:
❑ I- and 2- family dwelling b( mm $
Coercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /Z�.3 0 s Gli /7A /At) Sr New dwelling area: square feet
City /State/ZIP: T " / GAt.') OR- ?9 X 23 Garage /carport area: square feet
Suite/bldg. /apt. no.: / Project name: C/Z 040i1 CARPer Covered porch area: square feet
Cross street /directions to job site: Deck area: square feet
• Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
F ig c OD/Pile/Jr 1M4vt.T 4- UNDlyz Pow Valuation: S re* 0 o
r//e5 f - / 4 e f' Existing building area: square feet
New building area: square feet
y r PROPERTY OWNER ❑ TENANT Number of stories:
Name: DIY MG- R t Zy V l rifir It/r-S-1 P / c. Type of constru rm R r ction:/ : if .
Address: 1 , f3 r- Aorr /, � J c.. r n IC 6 Occupancy groups:
City / State/ZIP: G Qig,p 4„..., 0 (Z - q 70.3 C) Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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
applicant is exempt from licensing, the following reasons
City / State/ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: KGTizr 61,AtSTC/c_77a •-- -- BUILDING PERMIT FEES*
Address: ?ea O 0 r. //KA v �4-s/
�'p� Please refer to fee schedule.
City / State/ZIP: re y f (r// � J 9 7C,S Fees due upon application
Phone:( ) J I Fax:( )
CCB lic.: cf C 9., 2 LIS•q Amount received
Date received:
Authorized signature: ^/e / - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I Print name: ` it , .0. Date: 5:6 /4� • Fee methodology set by Tri -County Building Industry
f� Service Board.
i:\Building\Pennits \SIT- PennitApp.doc 12/03 4404613T(I1 /02KOM/WEB)
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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
❑ 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 ap lication:
❑ 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 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
is\ Building \Forms\SIT- PennitApp.doc 1/13/04 2
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4i
Site Work Permit Application
Plan Submittal Requirements
Commercial, Multi- Family and One- and Two - Family Dwellings
City of Tigard
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi - family R -1
occupancies. A site work permit is required for excavation, fill, grading, paving, retaining walls ,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the
accessible route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing:
1) Silt fence locations.
i :\Building\Forms\SIT- PlanSubReq.doc 12/29/03
1
. a ,
2) Bio -filter bags /other approved barrier material surrounding catch basins.
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and
additions to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb. /sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
i:\Building\Porms\SIT- PlanSubReq.doc 12/29/03
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CITY_ OF TIGARD
BUILDING DIVISION PERMIT #: SIT2005.00011
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639 -4171 Apip l l �
Inspection Requests (24 Hrs.): (503) 639 -4175 .,
INSPECTION WORKSHEET FOR DATE: 6/22/2005 TIME: 7:28AM PAGE: 89
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Vault & fire lines.
OWNER: INTEGRITY INVESTMENTS INC, • PHONE #:
CONTRACTOR: KONELL CONSTRUCTION CO. PHONE #: 668 -3516
Inspection Request Scheduled For: Date: 6/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 009810-01 971- 404 -4501 N
Corrections/Comments/Instructions:
Ihii,
IMMIIININIIIML IN
•
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR NSPECTION ❑ ADDITIONAL FEES ASSESSED -- Inspector: Date: (35 Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: S1T2005-00011
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639- 4171 mme`�'f +hid
Inspection Requests (24 Hrs.): (503) 639 -4175 —NI-
WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 78
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Vault & fire lines.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: KONELL CONSTRUCTION CO. PHONE #: 668-3516
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
420 Sprinkler supply lines 009954 -01 971 -404 -4501 N
Corrections /Comments /Instructions:
• .� ill
SI I.I ;�aT : la I
27 .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITI NAL F ES ASSESSED
Inspector: Date: v ✓ Phone #: (503) 718-