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Permit 4 CITY OF TIGARD SITE WORK PERMIT ,111 DEVELOPMENT SERVICES PERMIT # : SIT2003 -00021 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 7/15/03 SITE ADDRESS: 13855 SW PACIFIC HWY PARCEL : 2S103DD -00900 SUBDIVISION: ZONING : C -G BLOCK: LOT: JURISDICTION : TIG • CLASS OF WORK: ADD PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: 2,000.00 EXCV VOLUME: cy LANDSCAPING ?: FILL VOLUME: cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: Site work for 2,066 Sanctuary addition to existing church Owner: FEES COMMUNITY OF CHRIST PO BOX 23462 Description Date Amount TIGARD, OR 97281 [BUPPLN] Pln Ck - Valu 6/24/03 $40.63 [FLS] FLS Pln Rv 6/24/03 $25.00 Phone: 503 - 684 - 6620 [BUILD] Prmt Fee -Valu 7/15/03 $62.50 [TAX] 8% St Tax -Valu 7/15/03 $5.00 Contractor: [ERPRMT] Erosion Cntl 7/15/03 $80.00 MORELAND COMMUNITY BUILDERS [ERPLN] Ersn Plck USA 7/15/03 $26.00 4600 NE 24TH AVE [EROSN] Ersn Pick - COT 7/15/03 $26.00 VANCOUVER, WA 98663 Total $265.13 Phone: Reg #: LIC 153225 Required Inspections Erosion Control lnsp 846 -8444 Grading Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules : 6 the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through R 952 -001 -0 40. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699 / Issue By: Permittee Signature: )(� �_ :•' i' Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • Site Work Building Permit Application FOR OFFICE USE ONLY Received �. i Building • Date/By: ��� _ Permit Nom/ 77,9-00 3 - ODaa -/ CI of Ti and �, Planning Approval 1 Other ty g �� Date/By: Other No.: 13125 SW Hall Blvd. ,, Plan Review 1— i S -DJ Other Tigard, Oregon 97223 Date/By: 6 v Permit No.: Phone: 503- 639 -4171 Fax: '503 =5 -08 -1960 '" 4/ *P$ ,Ili' � . Post Review . _ S _ o 3 Land Use Internet: www.ci.tigard.or.us 'D y: Contac to / Case No. g Contact Juris.: El See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name /Method: Supplemental Information TYPE OF WORK REQUIRED DATA: ❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING ® Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION 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 $ JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: Job site address: /3 S'$ Sal 1paG Alloy Total number a e a (sq New dwelling area (sq. ft.) Suite #: Bldg. /Apt. #: Garage/carport area (sq. ft.) Project Name: (o /y 4f 6j/ys f eAiereh . Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) ...cc✓✓ 11 at �QQ � �� g9 • Other structure area (sq. ft.) di REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: ' Lot #: ao' '6 Tax map /parcel #: oZ c5' /63 D I) Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Re/nova" ©I a s /f, sib t brk Ar, „ZnG G 4'Z san c, Ca ry Valuation $ 't t 000. 00 Existing building area (sq. ft.) G, 2 New building area (sq. ft.) _a p G. G Number of stories D NL 17 PROPERTY OWNER /� I I:=1 TENANT Type of construction 4 m Name: Cbmun ii-y o T CPIricf Ck Occupancy group(s): Existing: A New: Address: `P.0. cx a3g42. City /State /Zip: "T, els n 1Q 1124 1 Phone: (� $N 1,6,2_0 Fax: NOTICE: All contractors and subcontractors are required to be Phone: ❑ CONTACT PERSON licensed with the Oregon Construction Contractors Board under R. 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 n lh S I blrt from licensing, the following reason applies: Address: S 3 L 1 Ot n dsbr R°.rY17Le...e. City /State /Zip: ,' j 4. i_ l h n OR, ot'1 b , g Phone: 6s - 41474 , Fax: 6s-p. 6 , 2 I S" E -mail: ,4h bv»'S a crit loi . Cb1Vt BUILDING PERMIT FEES* Please refer to fee schedule. CONTRACTOR J Business Name: If'I/lar�lanr CDYYIWI lih tty ?,,.1(dtrs Fees due upon application $ Address: 4 1606 kiE aqtk, A City /State /Zip: Votv1 couv{,r -(v.A q $le 63 Amount received $ Phone: 3( j of iVt 7 I Fax: Date received: CCB Lic. # , ' , d `/ D'22 f Authorized /�_ Notice: This permit application expires if a permit is not obtained within Signature: / / /�//�///, / %//I/L`f % - - :b.3 180 days after it has been accepted as complete. ' yt,LCI tL2 !/l T ., 1 I' Lb re . I CI F\ Cpl *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms \B '`" ldgPermitApp.doc 01/03 �^ " / . 40,103 /p s ,(0 PL � 06 ob 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 Plumbing Permit Application for site utilities plumbing work. Plans Required: See "Site Work Permit Application - Plan Submittal Requirements" attached. The following must accompany this application: 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 1 and 2- family dwellings. # of Plans ' TYPE OF SUBMITTAL Required at (Includes New, Additions or Alterations)' Submittal 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 \SIT- checklist.doc 01/29/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST ''// Z�. BUP Received YZD 2 Z' Date equested I / 4 / AM PM BUP Location /3 3 --s ' Suite MEC Contact Person ��.C� � 7 Ph ( 6 5 ?- </97c/ PLM Contractor Ph (sue 3) 9 ' 7 — SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain r - ,�)G� ELR Crawl Drain T O Slab Inspection Not _ Post & Beam (-1J+7,..4.4 0 `F,// 9 od1' Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing e � �� Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL / r � r PLUMBING ,14.(1,0/ CCi /7 /C 61- /27 v /aFS / LA Y.) ; j Post & Beam �1 . Under Slab ��J S/b - Rough -In Water Service Sanitary Sewer d, /� /J hers - 4 � y.b/ �j Rain Drains / Catch Basin / Manhole Storm Drain Shower Pan Other: �/ Final 7 A/ < </ c/ a 6-f 7 3 � E (Y PASS PART FAI 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. V PART FAIL SITE Please call for reinspection RE: Unable to inspect - no access aapigitine ADA /—,2 _ � Approach/Sidewalk Date / Insp ector 6l - Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL