Permit g/3044,
CITY OF TIGARD SITE WORK PERMIT
P ERMIT # : SIT2005 -00016
jll DEVELOPMENT H Blvd., MEN9 SERVICES 9 3 639 -4171 DATE ISSUED : 9/26/2005
PARCEL : 1S136DD -03400
SITE ADDRESS: 11740 SW 68TH PKWY ZONING : MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT: 008 JURISDICTION : TIG
Project Description: Tree removal, site grading & erosion control work only. No site development at this time.
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 200,000.00
EXCV VOLUME: 15,000 cy LANDSCAPING ?:
FILL VOLUME: 15,000 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
PACIFIC NW PROPERTIES Description Date Amount
ATTN: PAUL GRAM [BUPPLN] Pln Rv -Valu 7/25/2005 $737.30
P.O. BOX 2206 [ERPRMT] Erosion Control 9/26/2005 $260.00
BEAVERTON, OR 97075 [ERPLN] Erosn Pln Rv CWS 9/26/2005 $84.50
Phone: [EROSN] Erosn Pln Rv COT 9/26/2005 $84.50 •
[BUILD] Prmt Fee -Valu 8/11/2005 $737.30
Contractor: [TAX] Valu 8% State Surcharg 9/26/2005 $90.74
Refund - [ BUPPLN] Pln Rv -Va 8/11/2005 - $737.30
COFFMAN EXCAVATION LLC
PO BOX 687 Total $1,257.04
OREGON CITY, OR 97045
Contact #: PRI 503 - 656 -7000
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Reg #: LIC 146689 Engineered soils
Special inspection (see plans)
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 questions to OUNC by calling 503 - 246 -6699
or 1 -800- - - 44.
Issue s By: /,� /L ice . Permittee Signatu -
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.
ill w o rk 4s et ClrivL°••- It t • vi. Ca(' fi`� r `S
Building Permit Application / 49/ FOR OFFICE USE ONLY
City of Tigard EC E I V ® Received �/ / u
` f DateB : � , I ` `. Permit No. j'oo J � 0
13125 SW Hall Blvd., Tigard, OR 9,22... Plan Re v
Phone: 503.639.4171 Fax: 503.598.1960 4 ` :i li
2U05 ` DatrJB : ' i f Other Permit
Ins Line: 503.639.4175 JUL 2 5 7 ^ P L� Date Ready :y: Ju�* Fa See Page 2 for
Internet: www.ci.tigard.or.us -- - Notified/Method: ) ) If Supplemental Information
CITY OF TIGARD
- . . 10 03ION - 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
• CATEGORY. OF CONSTRUCTION ; ` :; :_..: _� •a - work indicated on this application-
❑ l- and 2- family dwelling ® Commercial/industrial Valuation: $200,000
❑ 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: W€4144464-3609--T-1,--3409 / /gs6 6 7�p •/ New dwelling area: square feet
Ciry /State/ZIP: Tigard, Oregon � Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Tigard Triangle Commons Covered porch area: square feet
Cross street/directions to job sie: 68 and Clinton Deck area: square feet
Other structure area: square feet
• CHECKLIST'
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: WCTM 1S136DD TL 3400, 4100, 5300 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
.. ;!'` *,t;-N. x- �:DESCRIPTION_OF. WORK.. " N = ;l . v..Ki — - work indicated on this application.
Tree removal, site grading, and erosion control Valuation: $$200,000.00
Existing building area: square feet
New building area: square feet
• ®s PROPERTY'OWNER: ';a I2 -1 ;.i _ _ -E TENANT . 1-- - - ; : Number of stories:
Name: Pacific NW Properties Type of construction:
Address: 6600 S. W. 105 Suite 175 Occupancy groups:
City/State/ZIP: Beaverton, Oregon 97005 ._ Existing:
Phone: (503)626 -3500 Fax: (503)671 -0211 New:
. ''.- .• .'. - ® •e1PPLFCAism?-' - s •' , 4x ' ; r : r F 12 CONTACT'PERSUN 3 40 t ' 1 ,+,:- ..�. =-,
: ": .. _ ,_ .. t -.:, .. , ,,� . . c r. > .. x Ly:,a., ;X N�'�' =r�� 1!IOTICEf n, .'�„ , , �:,.; :-
Business name: TM Rippey Consulting Engineers • All contractors and subcontractors are required to be
Contact name: Karl Koroch, P. E. licensed with the Oregon (Instruction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7650 S. W. Beveland Suite 100 jurisdiction in which work is being performed. If the
City/State/ZIP: Tigard, Oregon 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 443 -3900 Fax: : (503) 443 -3700
E -mail: kkoroch @tmrippey.com
- b.ft., .r .N.'Ya,N. ;*^., ., .i tTK-.,it.1:, 4?2-40:`x. k���;..
Business name: Taff �n ,. - -. .
I ' tlil: LDINGyEE*.i "F ES *'
Address: z .a.� a�...v
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application .
Phone: ( ) Fax: ( )
CCB lic.:
Amount received
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Karl Koroch Date: 7J7,,, faj • Fee methodology set by Tri-County Building Industry
Service Board.
i:\ Building \Pernits\SiT- PemutApp.doc 12/03 440- 1613T(11 /02/COM/WEB)
• CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2005-00016
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2005
Phone: (503) 639 -4171 '" l°�' �
Inspection Requests (24 Hrs.): (503) 639 -4175 x'11- -
INSPECTION WORKSHEET FOR DATE: 9/1/2006 TIME 7:01AM PAGE: 72
SITE ADDRESS: 11740 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Tree removal, site grading & erosion control work only. No site development at this time.
OWNER: PACIFIC NW PROPERTIES, PHONE #:
CONTRACTOR: COFFMAN EXCAVATION LLC PHONE #: 503-66&.70Q0
Inspection Request Scheduled For: Date: 9/1 /2006 Pour Time:
Code # Inspection Description Confirm # essage
499 Final inspection 035897-01 503 - 710 -0922 Y
Corrections /Comments/ Instructions: Tiiiii
fl zz.
U" 0104:
F1kL- 617-- S R(kp
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL U CALL FOR INSPECTION ❑ ADDITI NA FEES ASSESSED
Inspector: 1 11! 4 _ Date: q Z Phone #: (503) 718 - 2 4z-
Iv