Permit CITY TIGARD SITE WORK PERMIT
th *- I� DEVELOPMENT SERVICES PERMIT # : SIT2003 -00022
" e 1 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 1/7/04
SITE ADDRESS: ;366 SW PACIFIC HWY PARCEL : 2S102CC -00600
SUBDIVISION: (35 ZONING : C -G
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 25,000.00
EXCV VOLUME: 500 cy LANDSCAPING ?: Y
FILL VOLUME: 50 cy SITE PREP ?:
ENG FILL ?: N STORM DRAINS ?:
SOILS RPT REQD ?: N IMPERV SURFACE: 9,590 sf
Remarks: Site work for new 3 -bay oil change facility.
Owner:
FEES
•
DDHK VENTURES, LLC
12604 SW 60TH CT Description Date Amount
PORTLAND, OR 97219 [BUPPLN] Pln Ck - Valu 7/18/03 $184.15
[FLS] FLS Pln Rv 7/18/03 $113.32
Phone: 503 - 977 -0578 [BUILD] Prmt Fee -Valu 1/7/04 $283.30
[TAX] 8% St Tax -Valu 1/7/04 $22.66
Contractor: - [ERPRMT] Erosion Cntl 1/7/04 $80.00
GRADY HARP OR + CARLSON [ERPLN] Ersn Pick -USA .' 1/7/04 $26.00
2945 NE ARGYLE ST [EROSN] Ersn Plck -COT 1/7/04 $26.00
PORTLAND, OR 97211 Total $735.43
Phone: 284 -9151
Reg #: LIC 63005
Required Inspections
Erosion Control Insp 846 -8444
Paving Insp
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 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6699.
Issued By: ,.„��1�yz,
Permittee Signature: � /� 44
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
I 3.�6.∎i - w PAC /f/ H w u ;
_,)J.l L8:3ii FAX 503598196U CITY OF TIGARD 21i0
.. to Work
FOR OFFI USE ONLY •
ail din Permit Application Received )wilding j
E Ep Date /B : , /. .)t �c )1) -00O j
iiy 0. Tigard G r I Planning : Approval � thCr �+ I
Tigard 1�� o>,tdav: • 'ermit No •errnit NoJT) R., 3 -coo op
: -': s Hai: Blvd. Plan Review I )ther
C rtgon T7223 � � a0o3 Date/13 _s 4.5 ermit tVe. ►
Oi o.9 -4L %l Fu: l 6 - ;; .�I � �t, lost- 2evi -and Use 0
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Contact ! s-: DateJB . I ;ue No. W
T T� OF ® See P ::ge Z r. 1—
. - .,,”lr :zpec,v)n actluest: I UI L 9 IVISION I Narne/Method: j 0 I Supplem•:ntal !lionisation --t,
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C,) ; CORY OP CONSTRUCTION • :vur:: ?-nuL le_,' are rrseu on tnt tot I value of the work: 'erforrled. rcica :e
' ' r dwelling C.mrnert.laL'Lndustria : the value !rounded to the nearest dollar: of all equipment. mn:tcrials. labor.
_ - - -- overhead and profit for the work indica• :d on this applicatiu ^.
_..:,:";:)r: Builain' ' I Multi- Family I
-7 :,1'37.::-I" Other: Valuation S
• ' Bu
_ - JOB SL'IIL NFORM .ION a ; _• ' ''O ••• .TIO�L; No. of bedroom.: No. of ba Ohs: _ r,
■'.- Total number of floors
)ddi - eSS.y �� i t I - I
r t New dwelling area (sq. .) _
ft.)
Al
6 ---
I Bldg. ` .t•r: Garage/carport area (sq. ft) _ ..
: I : � ac: AV/ I 0 n - Covered porch area (sq. ff..) _
v
- -- : to jCc s.. i •rc Deck area (sq. ti.) _ it.) --
Other structure area (sq.
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aviston: _ q� 1 Lot rr: -y
._1rL. 'Jf.; C:ti. #: C� LS4� if_041 7011162 :Vote: Permit fed' are baled on the tot J value of Inc work Jertbrr xo. indicate '
y .t�f�1 r:! :`r',t I!•' q: he .value (rounded n the neatest dollar of all aatri n'derialt :sew. 0
,.I.Iq �•�' _ +yi'7J.e:lt�+I�}LLYVJ���'��I� : :k... : I rJ: l r'.:. is •...:�1'. � Prnc ct,
overhead and profit for the work indices :d on this apolicLtic 1. ^^
-- _ ^ V (�(� !-�
-- - -• — - ------ — ' Existing building area (s q. r? )
. .. _ _- - - - - -• , f New building 37efi (sq. ft.) -
i Number of stories _
- --- �w: -: .:?" ' I ®'I'f1 l}al\'T:� : gro;_;' pap: 04 Type of construction i
. � Occupancy group(s): Existing:
�..-. 1/ (#043=1- j ! New. '
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- - I . NOTICE ; x111 u1:II172.Ctor ar:1 aL`b:L:r1IIact rs uru rec Sires! Co oe 1
c �i� --Id
. . • Y1T ra ;l) d under \
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.I . _. . ; �;� • ,• , , ;. - �r "• - - ....:. ,• licensed with the t • Construe; ion Lontr °e ar under
�.r`YLTCi:1'T::' •= "' ' ": " "' i provisions of ORS 701 and may be required to be iict use •n the
_ _:,:i:lezi:i Name: V jurisdiction where work is being pc rformed. lithe applicant is exempt
- f N ame: Anlirtear WI 1/1 j . I from licensing, the following reaso 1 applies: ..
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9� �� A mount received. S I
• • . RY -p!S/ Fax: Date received:
�3or __ _ y _ . , __i
/ IN , n1 3 •'.ocic this- permit ap ex virus ii i)cr:na is WL oo aineti within
130 days aster it has been accepter as compleit
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methodology set by Iri - Gaut Cy Building I ndustry Ser• I ce Boors.
(Please prInt name)
. _..'err :ut Forms \BidgPermitApp.doe 01/03
1 {
.21)0.3 L6:.76 FAX 5035961960 CITY OF TIGARD lj
SITE WORK PERMIT CHECK LIST
Commercial, M::i Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: I F 50Q cu. yds.,
Grading Volume: r �, / �
(Soils report required for >5,000 Cu. yds.) 5W) cu. Ids.
Fill Volume:
"Fit! exceeding 12" in depth shall be compacted to 90% of
der.sity; '�� cu. yds.
Re;air Iry s:ructure? (Check one) ❑ Rock
G CML
X Concrete
❑ Other
_ _ 0
'Total new impervious area including all buildings,
Sae Utilities Plumbing Work:
i Compete the Plumbing Permit Appiication for site utilities plumbing work.
Plans'R'e ul .eti : `S. "Si #e SNq' k:PecinitAp: cation ' - ;;P,lan'S,uf inittaf;:RE urrem eot4
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tarn ng Sett➢Fes k .
w Does not apply to 1 and 2- family dwellings.
'Y� �.•')>, :.' 1 - L;�':' 2 ' ar�)!r h-- `''1!'': �' l "r.': ':I'::. +'.l "` -,-�, ,'.:i �',, I ,I'•. -'r �' �JI "'•.'7
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• Commercial 4 • •
Multi- Family R -1 Occupancy 4
I -
One- & Two - Family Dwelling A.
i'40TE: Plan review is dependent upon submittal of a completed application and plans.
After plan r=-vie bproval, the Plans Examiner will contact the applicant to request
:;dditionai sass oT prans for di;atribution purposes (for Contractor, city of Tigard,
r' isningtori County, aiici Tualatin Valley Fire & Rescue).
iNists\fonns\SlT- cheesdlst.doe 0129/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Rece i d r � a equeste AM PM BUP
Location 3 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT �"
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing /III
Firewall
Fire Sprinkler r ` f -
Fire Alarm
Susp'd Ceiling ' �•
Roof
final . �,
- PASS , PART FAIL '�'�
- - NG
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.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL