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Permit A CITY OF GI/I/DATE TIGARD SITE WORK PERMIT YIa DEVELOPMENT SERVICE PERMIT #: SIT1999 -00051 r�l �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) �38-I4 ISSUED : 9/14/99 SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST PARCEL . 2S110CD -00104 SUBDIVISION: KING CITY NO. 2 4 ( ZONING : BLOCK: LOT: JURISDICTION : KIN CLASS OF WORK: NEW PAVING ?: Y RESO. NO: • TYPE OF USE: COM GRADING ?: Y VALUE: 2hoo 0 EXCV VOLUME: 50 cy LANDSCAPING ?: Y FILL VOLUME: cy SITE PREP ?: Y ENG FILL ?: N STORM DRAINS ?: Y SOILS RPT REQD ?: Y IMPERV SURFACE: sf Remarks: Site work permit for new building Owner: FEES JACK MEDAK 4029 NE SANDY BLVD Type By Date Amount Receipt PORTLAND, OR 97212 PRMT DEB 9/14/99 $164.50 99- 318309 5PCT DEB 9/14/99 $11.52 99- 318309 PLCK BON 7/16/99 $106.93 99- 316925 Phone: • FIRE BON 7/16/99 $65.80 99- 316925 Contractor: Total $348.75 COLAMETTE CONSTRUCTION 8430 SW HUNZIKER #200 TIGARD, OR 97223 Phone: 620 -0106 Reg #: LIC 00032233 Required Inspections Erosion Control Insp 844 -8444 Excavation Grading Paving Insp Strm Drain Insp Culvert/Catch Basin San Sewer Insp Manhole /Cleanout - PVT 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 -00 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. • / Permittee Sign ure: 111b, `Ae„,_ 1/4F-Wi Iss ed By: !I Ark& rf i/ /// I� Call (5 -4175 by 7:00 P. . for an inspection needed the next business day Recd By'' 1 J - ` ' 1.0 CITY OF TIGARD Site Permit Application Date Recd ' / %' �� .:' 13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Date to P.E. ? -2 K -7c7 TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST c t 114 'IA le) (503) 639 -4171 x304 Permit # C pI1 l c; 'v -6) 0i ( Related SWR # Called 61-9-611 Print or Type Incomplete or illegible applications will not be accepted Project Name Utilities (Complete all that apply) Job iitr i�V- g4o6 dal ACC 'gLl%. Address Address Storm Sewer ��ii ( ( -7 =? CXIriE�/fv et�EAB Q Linear Ft. Nam Sanitary Sewer Name 146--a- 0 Linear Ft. Owner Maifng Address Fresh Water 4biJ I - G1 ?L1/6 / Linear Ft. rjty S ate Ae. Zip Phone Catch Basins + General Na we I # 1 �6AP- L4, ' �vn� Clean Outs Contractor # 5 Prior to permit Mailing Address Describe work to be done: ic of a f3 � s a�, r N -y1 e w ddition Alteration Re air copy of all Z�iyu101 � J.� � A ❑ ❑ P ❑ licenses are Cityp§ie Zip Phone el Additional Description of Work: required d S , 362 9 o La-c- /lots' expired in COT State Const. Cont. Board Lic. # Exp. D to database 3-2-2-5 1 O+ 60 Name 1 da Project V ff>> Valuation $ 0 V �J ° V Architect Mailing Address Plans Required: See Matrix on back The following, must accompany this application: City/State Zip Phone Site plan with Vicinity Map Parking (including Showing ADA compliance ADA) & Lighting Plan • Name, /� � p`‘ Grading Plan and details Landscaping Plan t xi Engineer Mailing Address /� Erosion Control Plan and Retaining Structures 7nlb L 3 ri. a s� I&j details including calculations City/State Zip Phone (c Site Utility Plan and details Soils Report (showing connection to (if required) �6N 6t. 91 ZZ3 1 / 1 /5 - 3 / 6 approved system) Excavation Volume I hereby acknowledge that I have read this application, that the (Soils report required for >5,000 cu. Yards) information given is correct, that I am the owner or authorized SO cu. yds. agent o he owner, and that plans submitted are in compliance with f : • on State s. Fill Volume S' of a /Agent Da (Soils report required for >5,000 cu. Yds.) cu. yds. / '7 14. Will the full support a structure Contact P rso amel tt Phone Os-3) (Engineer required if answer is yes) YESO NO1 VI\J t) I ,. iv / 672; -(42-‹ Retaining structure? (check one) ❑Rock FOR OFFICE USE ONLY ❑ CMU Notes: ❑Concrete ❑Other Total new impervious area including all Land Use Case # Map/TL# buildings, sidewalks, and paving litligErgq. Ft. Sr/ i �I L /O6.93 i:\dsts \forms\site- app.doc 10/30/98 f-L5 �_ .- f/7 7 3 t 1 COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX 011 Oppl!goygogitg5#0101*1900140.. *tort plan revew approval, Plans Exammer will contact the applicant to request addthonal plan sets for distnbution purposs (Copy fer Contractor. City. TothIf TYPE OF SUBMLI JAL Pans KEY: Submitted S (Private) 1 S = Site Work B (New or Add) 1 B = Building F (New or Add or Alt) 3 F = Fire Protection System M (New or Add or Alt) 1 M = Mechanical B & M (New or Add) 1 P = Plumbing P (New, Add, or Alt) 2 E = Electrical B & M & P (New or Add) 2 New = New Building E (New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to Existing (New , Add) Building • •••••••••• NOTES: 1:\dsts\forms\rnatrxcom.doc 12/17/98 • 01/05/2000 Activities for Case #: SIT1999 -00051 , 11:14:48 AM - Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes SITC700 Erosion Control lnsp 844 -8444 10/01/1999 . • PART No Hold RB 12/07 /1999 Approved by CPB. SITC005 Application received 07/16/1999 DRA RECD ' No Hold BON 07/28/1999 SITC008 Permit Created 07/28/1999 BON DONE No Hold BON 07/28/1999 SITC013 Plans Routed to Plans Examiner 07/28/1999 07/28/1999 07/28/1999 BON DONE No Hold BON 07/28/1999 SITC015 Plan Rev. Ltr Sent to Ofc Svcs 07/30/1999 07/30/1999 No Hold RDP 07/30/1999 SITCO30 Reviewed plans routed to DSTS 09/02/1999 RDP DONE No Hold RDP 09/02/1999 . SITCO26 Plans approved by CPE 09/02/1999 09/02/1999 09/02/1999 RDP DONE No Hold RDP 09/02/1999 SITC700 Erosion Control Insp 844 -8444 09/02/1999 09/02/1999 10/01/1999 TLP PASS No Hold . AKJ 10/03/1999 SITC702 Excavation 09/02/1999 09/02/1999 09/28/1999 RB PART No Hold AKJ 09/28/1999 usa erosion approval req (none), earth moved ok - contingent to usa erosion approval • SITC720 Grading 09/02/1999 09/02/1999 12/07/1999 RB CONF No Hold RB 12/07/1999 Conference- Questions: 1. Slope towards building- question. NE end drainage . • system will empty into rain drain by way of area drain - OK, 2. Walkway grade- question. Plan to put steps at NE end to take care of slope of a non- ADA ramp- OK. • SITC730 Paving lnsp 09/02/1999 09/02/1999 .12/30/1999 RB PASS No Hold RB 01/03/2000 ADA & striping completed. SITC740 Strm Drain lnsp 09/02/1999 09/02/1999 12/30/1999 MRS PASS No Hold AKJ 01/02/2000 SITC750 San Sewer Insp 09/02/1999 09/02/1999 12/30/1999 MRS PASS No Hold AKJ 01/02/2000 SITC744 Culvert/Catch Basin 12/30/1999 MRS PASS No Hold AKJ 01/02/2000 SITCO32 DST Post - Review Completed 09/09/1999 BON DONE No Hold BON 09/09/1999 SITC080 (F) Ready to issue 09/09/1999 BON DONE No Hold BON 09/09/1999 Do not issue permit until USA sewer permit is issued. ' Require green copy of USA . sewer permit. SITC092 (F) Issue permit 09/14/1999 DEB DONE No Hold DEB 09/14/1999 SITC799 Final Inspection 09/02/1999 09/02/1999 12/29/1999 RB FAIL No Hold AKJ 12/29/1999 1) no USA erosion control final found on site 2) eng soils report req • 3) install bike rack 4 stalls 4) storm, sanitary, catch basin . and manhole cleanout insp done by other than the bldg insp no other issues noted SITC799 Final Inspection 01/02/2000 01/02/2000 12/30/1999 MRS PASS No Hold AKJ 01/02/2000 ' Page 1 of 2 • 01/05/2000 Activities for Case #: SIT1999 -00051 11:14:48 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes SITC800 Case Fineled • 01/02/2000 AKJ DONE No Hold AKJ 01/02/2000 • • • • Page2of2 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /0/ f[ /R l q AM PM BLD Location / C 73S - ekU/A4-1 6t// / // ? Suite MEC Contact Person /�GC)l� U/C-6( 1Z7 (:¢'yt. Ph 3q/ -gOl/ PLM Contractor Ph SWR BUILDING Tenant/Owner U %"/ ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: / Slab SIT l -6- 5 I Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Fire wall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL EXPIRED PLUMBING e Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service G /Sla Zow oltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay'at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ) Please call for reinspection RE: [ ] Unable to inspect - no access ADA KG-c-e) Approach/Sidewalk Other Date /C / - 9. /F Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.